Inventory Management and Convalescent Plasma Utilization during the COVID-19 Pandemic: Results of AABB Weekly Survey

Background/Case Studies: The COVID-19 pandemic has had a major impact upon transfusion services and blood collectors' operations Study Design/Methods: The AABB submitted a weekly survey to 887 AABB institutional hospital members to capture information regarding blood and convalescent plasma (CCP) availability from the beginning of March through July 2020 Results/Findings: An average of 138 institutions from 39 states completed the survey By March 31, 2020, 57% of institutions were alerted by their blood supplier about challenges in meeting inventory needs, in particular red blood cell (RBC) units By mid-July, the number of institutions reporting inventory challenges decreased to 25% Forty five percent of institutions implemented prospective audits of RBC and platelet orders A minority of institutions limited the number of units in a massive transfusion protocol Only 10% of institutions continued to perform elective surgeries through March and April, and 43% reported having increased wastage during this period secondary to cancelled procedures Elective procedures were resumed in 75% of respondents by early June, and the number of institutions having increased wastage decreased to 18% The top 3 considerations for cancelling surgeries included: intensive care unit beds availability (26%), COVID-19 case load (24%) and blood availability (18%) By the end of April, approximately 84% of respondents indicated the intention to participate in a protocol to obtain CCP, and the vast majority was using theexpanded access protocol to obtain the units, with a minority of institutions using an emergency investigational new drug (eIND) protocol Approximately 65% of the institutions obtained CCP units through their usual blood supply, 35% from an alternate blood supply and 10% were collecting units Approximately 46% of the institutions reported at least a 24-hour delay in obtaining CCP units by the end of April, which decreased to 19% by the end of July Fifty percent of the institutions were testing for COVID-19 antibodies, approximately 75% did not know the antigen target of the antibody testing, and 7% reported using a test that includes neutralizing antibodies The vast majority (90%) of the institutions were transfusing 1 unit of CCP, and less than 10% were transfusing 2 units over 2 days The indication for transfusion of CCP units shifted from severely ill patients (48%) during the early period of the pandemic to mildly ill by mid- July (40%), with approximately 20% of the institutions indicating CCP transfusion as a final option Conclusions: The COVID-10 pandemic resulted in a dynamic balance of blood supply and demand that required strategies to mitigate the risk of shortages and wastage Although the therapeutic efficacy of CCP is still unknown there is ample use and a continued demand for these units across the country