During her more than 20-year career, Dr. Sally Campbell-Lee, director of transfusion medicine for the University of Illinois Hospital in Chicago, said she has never witnessed such scarcity in the blood supply inventory as what was seen during the COVID-19 pandemic
Blood centers nationally declared that drop-offs in donations had reached a crisis point.
Campbell-Lee said things have improved since January and February.
“Things have started to return to what I guess we’re going to have to call our new normal,” Campbell-Lee said. “But we are still short of what we need. The difference being, most blood collectors like to have a goal of four to five days inventory on hand and we’re generally at one or two days.”
She and other doctors point to a variety of factors.
Earlier in the pandemic, regular donations sites like high school and universities had moved to virtual platforms. With schools back open, things improved though they aren’t back to what they were pre-COVID.
Offices, a prime place for blood drives, aren’t fully back. Health care staff shortages were, and continue to be, a challenge.
But also donations perennially dip in the summer when people’s routines are off and they’re taking vacations, said Dr. Dan Waxman, vice president of transfusion medicine for Versiti blood center.
He monitors daily inventories of every blood type, and is looking toward the Fourth of July long weekend. The holiday means people are unlikely to donate, even as the demand for blood holds steady.
“We really want to be able to go into that Fourth of July time period with more blood. Once we start getting under a two-day supply of red blood cells, especially O-negative, then it’s like, ‘OK we’ve really got to encourage people to start coming in,’” Waxman said.
Blood has a limited shelf-life of 42 days; platelets only five to seven days.
“You could give me billions of dollars — billions. The best laboratories. The absolute best laboratory you can imagine. Smartest scientists — top of the line people. And they still cannot invent in a lab, with all that equipment, money, brain power behind it — they can’t invent in a lab what someone can do in a donor share in 15 minutes,” Waxman said. “We cannot manufacture blood products. They’ve tried.”
Blood is needed for patients across the spectrum.
“There are people obviously who need blood transfusions regularly, like cancer patients or patients who have anemia or low blood counts, or people who are getting medications that result in their blood counts dropping,” said Dr. Shihka Jain, a hematology and oncology physician at the University of Illinois Cancer Center in Chicago. “But we also need blood transfusions if somebody for example gets into a car accident and they lose a lot of blood. If somebody is pregnant and they go into labor you can lose a lot of blood during delivery. So everybody at some point in their life may need a blood transfusion.”
If there’s not enough supply, Jain said scheduled surgeries could be delayed, a problem particularly experienced by critical care hospitals in rural areas where supplies may be especially tight.
“We have a blood shortage. It’s continued, and it’s going to continue to be a problem. We have a health care worker shortage. We have a contrast dye shortage. So the healthcare system is at its breaking point as so many levels, so even those tools that we had in place pre-pandemic are at their breaking point,” Jain said. “In the past, we could have patched up these holes with quick fixes but we don’t have those quick fixes right now … it’s a real concern, especially for patients who need either chronic transfusions or patients who might need an emergency transfusion.
Waxman said for those who aren’t first responders, volunteering to give blood is a short and easy way to literally save a life.
Donating takes about an hour.
“The actual donation itself, 10-15 minutes. And this is really something that is a voluntary act and it saves lives,” he said. “It absolutely saves lives. If you donate today, by tomorrow or the next day, up to three products will be made of that whole blood donation that can help up to three different patients.”
But not everybody that wants to can donate.
The U.S. Food and Drug Administration sets regulations that all blood collection agencies must follow.
Getting a tattoo could temporarily disqualify a donor, and traveling to places were malaria is endemic would make someone ineligible.
The FDA also lists as a reason for deferral “being a male who has had sexual contact with another male in the past 3 months.”
University of Chicago med student Christian Carrier, who just completed his first year, said the restriction is a sweeping generalization.
“It doesn’t allow for potentially men that are in monogamous relationships, it bars men that are engaging in safe practices from donating blood despite how much they would want to help,” Carrier said. “And I think that by not allowing these people to donate, I think it also puts a little bit of social stigma on the community as well. By having this rule it looks at the queer community and says, ‘We don’t’ trust you enough to be able to donate blood.’ Although there are so many queer health care providers that are trusted to do all this amazing work for patients, they can’t do something as simple as donating blood.”
The three-month period is significantly shorter than it used to be.
“Prior to 2008, men who had sex with men even once since 1977 were essentially permanently deferred. In 2018, it became a 12-month deferral. And in 2020 it was reduced to a three month deferral,” Campbell-Lee said.
Despite the changes, Jain said the rule is outdated.
She says it was made early in the AIDS pandemic when HIV was an epidemic in the gay community, but she says today the medical community knows a lot more about HIV and other blood borne and sexually transmitted illnesses.
The ban “seems like it’s actually going to result in more prejudice as opposed to protection of people who are receiving the blood,” Jain said. “The real issue is whether you’re having unprotected sexual intercourse, if you’re having sexual intercourse with multiple partners. And that can happen whether you’re a man having sex with men or whether you’re just having sexual intercourse in general. So there’s a lot of other things that I think weed to be looked at and need to be advised as to who can and cannot give blood.”
Jain said while there’s never a 100% guarantee, all blood is carefully screened before it’s used in a transfusion.
There is a chance the ban will be lifted in the future.
The FDA is funding a study to determine whether a different donor deferral policy can be used at blood centers nationwide while maintaining the safety of the blood supply.
Campbell-Lee is waiting for its results.
“What we need to focus on is making sure that we have an adequate supply of blood that is safe for our recipients,” she said.
While she encourages anyone to give blood, African American donors are in particular demand.
UI Health’s Sickle Cell program cares for some 700 patients with sickle cell disease, which Campbell-Lee described as a genetic disease in which a mutation causes red blood cells to be crescent-shaped rather than round and pliable.
The sickle-shaped cells are more rigid and have a difficult passing through blood vessels; that can lead to “painful crisis” and organ damage.
Blood transfusions can help to mitigate these complications, which is why Black blood donors are needed.
“These patients require specially matched red blood cells, generally from mostly African American donors because it is mostly through not exclusively African American patient population,” Campbell-Lee said. “The donors that re going to match these patients are going to be generally found from their ethic group just like if you’re matching for say a bone marrow transplant.”
Versiti is hosting a mobile blood drive Wednesday at Northwestern.
The Association for the Advancement of Blood and Biotherapies lists locations for any blood drive, searchable by ZIP code.
You need to be at least 16 to give blood in Illinois, and there’s no age maximum. Waxman advises donors to hydrated, and not to donate on an empty stomach.
Follow Amanda Vinicky on Twitter: @AmandaVinicky