Some hospitals have had to cancel surgeries and redirect emergency care as the national blood supply drops.
Only about half of hospitals' blood orders are being filled, according to the group purchasing organization Vizient. Some rural facilities have been forced to triage care by prioritizing who gets treatment and who doesn't.
"Some of my colleagues in rural areas are doing that on a daily basis," said Dr. Claudia Cohn, medical director of the M Health Fairview University of Minnesota Medical Center's blood bank. M Health, 15-hospital system based in Minneapolis, had to slightly reduce its standard inventory levels and avoided delaying or canceling care.
"Lowering your standard inventory in rural areas is a much scarier thing. If there's a car crash or someone has a gastrointestinal bleed in the middle of the night, that can be a life-or-death situation," Cohn said.
More than a third of community blood centers report having a one-day supply or less, according to America's Blood Centers' daily update from 59 banks. Centers with three or more days have worth enough supply to meet normal operating demands, but more than two-thirds have two days of blood or less on hand.
One hospital in Raleigh, North Carolina, recently went through 10 units of Type O blood after a multiple-patient trauma event, said Akiva Faerber, Vizient's senior principal of laboratory and blood consulting. The hospitals supply of O blood, typically at 20 units, fell to seven, he said.
"Many of our Vizient members have called me over the last three weeks in desperation to try to get additional product," said Faerber, who described the present shortfall as the worst during his 47 years in the industry. "Many hospitals are asking for Os, but the Red Cross is metering out regularly scheduled orders. Some have been cut back as much as 60%," he said.
Harbor-UCLA Medical Center, which is owned and operated by Los Angeles County, temporarily closed its trauma center to new patients for hours this week.
"It's already having a profoundly negative impact on patient care, ranging from the cancellation of elective procedures in an attempt to preserve scarce resources, to [emergency departments] on diversion," said Christopher Godfrey, CEO of Bloodbuy, which sells software to facilitate blood distribution. "We're currently in the midst of an unprecedented blood supply crisis that has been building for several months, as a result of COVID-19 and the negative impact it's had on blood donation nationwide. It's truly a public health crisis and all indications are that it is likely to get worse before it gets better."
The COVID-19 pandemic has depressed blood donations for several reasons. Among them is that vacant offices and schools mean fewer donation drives. Blood suppliers, like the rest of the healthcare industry, are also having staffing issues.
Blood donation has declined 10% since March 2020, Red Cross data show. There's been a 62% drop in college and high school blood drives due to the pandemic, illness, weather and staffing, according to the organization.
Many hospitals have had to postpone non-urgent surgeries once again as they struggle to keep up with the latest COVID-19 surge. That has helped conserve blood, but many facilities have adjusted or are considering adjusting their blood allocation protocols.
"It's the worst blood shortage in over a decade, posing a concerning risk to patient care," the Red Cross website says. "Doctors have been forced to make difficult decisions about who receives blood transfusions and who will need to wait until more products become available. Blood and platelet donations are critically needed to help prevent further delays in vital medical treatments."
Traditionally, clinicians default to blood transfusions when patient's hemoglobin counts are below 10 grams per deciliter. But many patients with levels between 7 and 10 grams per deciliter may not need blood transfusions according to recent research that suggests one unit of blood rather than two may be safer.
Now, hospitals are telling patients to eat more leafy greens, nuts and other food to boost their iron levels and giving them intravenous iron or red cell stimulators before surgery to reduce blood loss. Some are using cell-saver devices, which recycle blood during surgery.
"Those measures are really important and need to be a part of hospitals' pre-surgery assessments," Cohn said.
Clinicians are taking more time than previously to determine whether patients are stable enough or if they need transfusions, and they're developing alternatives, Faerber said. "We are still behind the times in evaluating our blood use more carefully," he said.
In the meantime, larger health systems have fared better because they can transfer blood between hospitals, which is the case at Roseville, California-based Adventist Health and its West Coast facilities, a spokesperson said.
University of Utah Health of Salt Lake City has maintained adequate blood supplies and has not had to delay care, similar to Memorial Hermann Health System in Houston and Froedtert Health of Milwaukee, according to the companies.
Edward-Elmhurst Health of Naperville, Illinois, has expanded its blood supplier network and has received shipments from Florida and New York, said Guy Diehl, blood bank supervisor at Edward Hospital.
"It's a testament to how hard the system is working," Diehl said. "We would love it if folks could donate."