COVID-19 and blood needs: the impact of the pandemic on transfusion therapies

An update of “Blood and Beyond” highlights the need to optimize and make more sustainable the blood supply in Europe

“The COVID-19 pandemic has made evident the vulnerability and instability of the blood supply system in Europe”, explains the Esther Natalie Oliva, medical director at the hematology division of the Great Metropolitan Bianchi Melacrino Morelli Hospital in Reggio Calabria. “For this reason, it was necessary to review, expand and update the policy recommendations already provided in 2020 for better management of blood and transfusion services.” In fact, on March 26, 2020, the multi-stakeholder report was presented “Blood and Beyond – Rethinking Blood Use”, Containing a series of useful tips to safeguard the collection and optimize the use of blood in Europe. The new version of the document, updated taking into account the strong impact that the COVID-19 emergency has had on transfusion services, was discussed in an ad hoc symposium on June 14th., on the occasion of World Blood Donor Day promoted by the World Health Organization.

In the new draft of the report they are put highlights the critical issues, partly due to the pandemic, in the management of the blood supply in the various countries of the European Union, with the aim of raising awareness among public authorities about the impact of transfusions on patients, health systems and society in general.

Despite the proven benefits, long-term transfusions also carry risks and complications, such as adverse reactions and iron overload, as well as considerable costs for the health system. “There are many patients who cannot do without it, especially in Italy, where the incidence of beta thalassemia is very high”, emphasizes Dr. Oliva. “Transfusion-dependent patients are people with hereditary hemoglobinopathies, such as thalassemia in its homozygous form (thalassemia major or Cooley’s disease), or from chronic renal failure or from haematological diseases such as myelodysplastic syndromes. Often, these people have received therapy with erythropoietic drugs in the past, but they no longer respond to treatment or are resistant ”.

“Precisely to meet the needs of these patients, transfusions in Europe must be organized in such a way that there is always a good supply of blood and that blood products are used correctly: this is the goal of Blood and Beyond ”, says Dr. Oliva, a member of the scientific committee that drafted the new document. “Unfortunately, with the COVID-19 emergency, the already fragile system entered into crisis. Blood transfusion services have been deeply affected by the pandemic and the pre-existing problems have been amplified: the number of donations has dropped drastically and many patients have had to deal with the shortage of blood products ”.

The causes are many “, continues the hematologist. “First of all the fear of contagion: donors do not show up and patients themselves are afraid to go to transfusion centers. Furthermore, although transmission of SARS-CoV-2 through blood is currently considered unlikely, it is a possibility that cannot be completely ruled out. For this reason, a swab for the verification of SARS-CoV-2 infection had to be added to the classic controls for the protection of the patient (HIV, HBV, HCV, etc.). Then there was the cancellation of some information campaigns and the classic ‘donor gatherings’, the diversion of health personnel to COVID centers and the use of a lot of blood for the production of the so-called hyperimmune plasma. In the end, the restrictions dictated by the pandemic they interrupted the blood supply chain, thanks to which the countries of the European Union imported and exported blood products. If the system has not gone completely into crisis, it is only because, during the pandemic, the demand for blood also decreased: fewer surgeries, fewer chemotherapy cycles and fewer road accidents ”.

In general, the COVID-19 emergency underlined the need to think about the good use of blood as a priority and to increase innovative approaches throughout Europe. “This challenge has a specific name”, explains Dr. Oliva. “Is called Patient Blood Management (PBM)“. This term, used since 2012, is used to indicate the multidisciplinary and multimodal strategy that has as its purpose the correct management of the patient’s blood. Patient Blood Management it translates into the sustainability of blood supplies, greater patient involvement, better organization of transfusion services. To these needs, already very important, are added those highlighted by the pandemic: the facilitation of access to therapies (for example through home assistance or mobile units), the enhancement of IT tools such as telemedicine or remote monitoring, as well as development of new models aimed at predicting the impact of pandemic threats on the balance between supply and demand of blood.

A last aspect to consider, no less important, is therapeutic innovation”, Concludes Dr. Oliva. “In recent years, drugs have been developed that can increase the autologous production of blood products. Just this year, the European Commission approved luspatercept, an erythroid maturing agent, and there are other drugs under investigation, such as imetelstat, a telomerase inhibitor that is expected to reduce the need for red blood cell transfusions in patients. with myelodysplastic syndromes “.

“Blood and Beyond” is a multi-stakeholder initiative involving experts from different fields, from hematology to health economics, from patient associations to hospital management, and was promoted by the pharmaceutical company Celgene, now part of Bristol Myers Squibb .

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