SARS-CoV-2 pandemic and its impact in a Portuguese Transfusion Medicine Department

Background. The first case of SARS-CoV-2 diagnosed in Portugal was on March 2nd 2020. Due to its high rate of transmission and globalization as a vehicle, the safety and supply of the blood banks worldwide has been a concern. In order to limit the impact of the pandemic on the number and quality of blood donations, our transfusion department changed the work routine and created new protocols. The present study aims to overview the implementation of these protocols and access its success rate on limiting the impact of Coronavirus Disease 2019 (COVID-19) pandemic in our blood centre. Methods. Changes in standard operational procedures were performed from March 16th 2020 to March 15th 2021. The use of mask and hand sanitizer became obligatory and waiting and donations rooms were rearranged to allow security distance between donors. Blood donations started to be made by appointment. The initial questionnaire to the donors was adapted and temperature measure before donation was performed. Donors that were in close contact with someone infected with SARS-CoV-2 or travelled from countries with active transmission in the community were initially suspended during 28 days. Later blood donations from donors that travelled from risk areas were kept on quarantine (initially for 28 days and then for 14 days). We evaluated the impact of these changes comparing the numbers of blood donations and transfusions between the pandemic period and the previous year. Results. During the first wave (from March 16th 2020 to May 3rd 2020) there was a reduction of 0.4% on blood donations, with no significant impact in our blood reserves because there was a decrease of 28% in overall transfusions, especially in emergency department (40%). However, public appeals to blood donation were performed. Since May 2020 until March 2021, there was an average increase of 4.2% in donations. During the pandemic period in study, 545 red blood cells units (RBC) out of 9554 collections were kept on quarantine. This process implied the waste of plasma and platelets from those donations. Seven RBC and 1 plasma unit were rejected because of confirmed COVID-19 after donation. Two RBC and 1 buffy-coat platelets from two donors with COVID-19 diagnosed after donation were transfused, with no reported SARS-CoV-2 infection in the receptors. The department was always able to maintain its blood supply (9402 RBC and 1033 platelets concentrates transfused in the studied period), but blood use also decreased in a range between 4-9% from May 2020 to March 2021, comparing with the same period in the previous year. Conclusion. In the last year many standard operating procedures had to be adapted due to SARS-CoV-2 pandemic. We observed a reduced use of blood components that was associated to the cancellation of elective procedures, decrease in emergency department' patients and use of restrictive transfusion criteria according to actual patient blood management guidelines. Measures to ensure the safety of blood donors and donations were implemented, with a positive balance throughout the pandemic, being able to maintain sufficiency in blood supply and patients safety.