SPOTLIGHT programs , Junping Yu , a technical officer on the WHO Blood and Other Products of Human Origin team , explained to ASH Clinical News .
“ They rely on regular blood donors and are more likely to be successful when they ‘ call on ’ the public and blood donors ,” Mr . Yu said . “ For example , many of these countries had also introduced the use of social media to [ contact ] donors individually for a personal appointment .”
Meanwhile , many lower-income countries have reported a severe interruption in the frequency and quantity of blood collected . The main source of blood in these countries is often so-called family / replacement donors who donate blood to meet the needs of family and friends who require transfusion . The lack of a voluntary donor culture and infrastructure in these countries makes it more difficult to collect donations in times of crisis , Mr . Yu said .
Another hurdle for low-resource settings during the pandemic has been a lack of consumables , equipment , and personal protective equipment ( PPE ), due to closed borders and interruptions in air travel .
In Latin America , the impact of COVID-19 on blood supply has been mixed . So far , declines in blood collection have not resulted in critical shortages , according to Mauricio Beltrán Durán , regional advisor for Blood Services and Organ Transplants for the Pan American Health Organization ( PAHO ).
In May 2020 , PAHO asked its member countries if they had seen a decrease in blood availability and whether it affected clinical care . Seven countries responded , representing about 70 % of Latin American and Caribbean countries . Two countries reported a decrease in blood availability of more than 40 %, two reported decreases between 20 % and 40 %, and three had reductions of less than 20 % in availability , compared with 2019 levels .
“ The challenge was common to all countries as the pandemic spread , but the impact differed according to the capacities and measures taken by the countries for containment ,” Mr . Beltrán Durán told ASH Clinical News . “ Countries that reported an impact of less than 20 % of the decrease in blood availability were those with voluntary donations greater than 60 % and with a processing capacity greater than 8,000 units per year , per bank , meaning greater capacity .”
There have been some positive developments in Latin America during COVID-19 , said Jose Ramiro Cruz , DSc , an independent consultant on blood safety issues who has worked extensively in Latin America . For example , the pandemic has forced countries to make changes that were beneficial overall , such as increasing mobile collection and building up communication efforts with donors .
“ The relationship between the blood services and the donors is very , very weak in the Ibero-American region , but [ measures taken during the pandemic ] have strengthened it ,” Dr . Cruz said .
In Africa , where blood availability was stretched thin even before COVID-19 , Dr . Odame said the pandemic in 2020 had not had the devastating consequences he had feared . However , since the beginning of 2021 , African countries have experienced a surge in COVID-19 cases , putting further stress on blood availability on the continent .
Conflicting Messages Blood availability during the COVID-19 pandemic has not only been a problem for the developing world . Konstantinos Stamoulis , MD , scientific director of the Hellenic National Blood Transfusion Centre in Athens , said he has also seen these problems play out in Greece .
Part of the problem is the contradictory public health message that officials have wrestled with during COVID-19 . “ We say to the people if you want to be safe , stay home ,” Dr . Stamoulis said , “ and then the transfusion service says , ‘ If you care about your fellow citizens , get out and donate blood .’”
“ The impact [ of the COVID-19 pandemic ] differed according to the capacities and measures taken by the countries for containment .”
— Mauricio Beltrán Durán
He has seen reluctance among health care providers to initiate blood collection and among donors to give blood . The result is a significant drop in donations across Greece . Every time the country had a lockdown order , it saw a decline in blood donations , with lows of 18 % in April 2020 and 15 % in November 2020 . This has delayed care for many patients with thalassemia , a condition that affects roughly 8 % of the Greek population .
Greece needs a significant amount of blood each month just to meet the transfusion needs of patients with thalassemia , who typically need transfusion with two units of blood every 15 days . This requires donations from about four donors per patient each month , which is primarily handled through donations from family members and friends of patients . The Greek government also imports a small amount blood each month from Switzerland , Dr . Stamoulis said .
Since COVID-19 has cut into blood donations , including family / replacement donation , there is not always enough blood to transfuse patients with thalassemia in a single session , he explained . Instead , physicians transfuse a single unit of blood at a time and bring the patient back in four to five days , with the hope that the hospital will have a greater supply by that point . “ It ’ s not just that we are delaying transfusion , we are also bringing them into the hospital environment to be transfused much more often ,” he said .
At the beginning of the pandemic , the Greek Ministry of Health postponed elective surgeries , which was effective in lowering the demand for blood . But , because the Greek blood system comprises roughly 30 % family / replacement donations , the delay in scheduled surgeries also resulted in family / replacement donors staying home , lowering the overall supply of blood . “ The lesson is that you have to be careful what you ask people to do ,” he said .
Volunteers : The System ’ s Lifeblood Who donates blood – and why – is a long-standing question that experts say affects blood availability and safety . The WHO asserts that unpaid , voluntary donors represent the lowest-risk population , as they do not have an incentive to conceal an adverse health condition . Since 1975 , the WHO has asked all countries to aim to obtain all blood through voluntary , unpaid donors . 2
The WHO and the International Federation of Red Cross and Red Crescent Societies have reiterated that achieving 100 % unpaid , voluntary blood donation ensures that the blood supply is self-sufficient , sustainable , and safe . In a 2010 report , the organizations outlined strategies for phasing out family / replacement blood donation and eliminating paid donation . 3
“ Without a system based on voluntary , unpaid , blood donation – particularly regular voluntary donation – no country can provide sufficient blood for all patients who require transfusion ,” the report stated .
Many countries are progressing toward voluntary donation systems . In a 2020 report , the WHO found that , from 2013 to 2018 , blood donations from voluntary unpaid donors increased by 7.8 million across 156 countries . The biggest jumps occurred in the Americas ( 25 %) and Africa ( 23 %). 1
Seventy-nine countries ( mostly high- and middle-income ) collected more than 90 % of their blood supply from voluntary unpaid donors . However , in 56 countries , more than half of the blood supply is dependent on family / replacement and paid blood donors . Just 16 countries reported paying for blood donations in 2018 , according to the WHO , accounting for about 276,000 donations .
In Greece , where family / replacement donations account for so much of the blood supply , the practice is a barrier , Dr . Stamoulis said . Since donors know their blood will be needed for a family member , they are less willing to donate to a stranger . This cuts into the potential pool of voluntary donors . “ All of these things were accentuated with COVID-19 ,” he said .
In Latin America , the percentage of donations from volunteers has been inching higher in recent years , increasing from 44.2 % in 2015 to 46.1 % in 2017 . 4 That year , Latin American countries obtained more than 1.6 million blood
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