ABSTRACT
Background/Case Studies: Available scientific evidence of transmission, incubation, clinical and laboratory evolution of COVID-19 from other countries was very worrisome. This virus has an unknown, potential, or confirmed risk of blood transfusion transmission and there is a lack of information if cancer patients are at higher risk. Therefore, we decided to implement more restrictive rules for clinical screening of blood donors, trigger retrospective screening tests after post-donation notification of infection, and perform the transfused patients follow up. Here we evaluate results from 140 days period of implemented actions in a cancer center blood bank in Brazil. Study Design/Methods: Number of blood donation candidates, non-eligible donors due to risk of COVID-19, post-donation notifications and impact in receipt patients were retrospectively evaluated. Clinical screening included questions if candidates were in regions with local transmission of disease, contact with people with COVID-19 and if they had clinical or laboratory diagnosis of COVID-19. Donors were instructed to report any signs or symptoms of infections within fourteen days after donation. After any post-donation notification, all blood products from last donation were immediately traced: if still in stock, they were segregated;if any was transfused, frozen blood sample from these donors, collected on the same day of blood donation, were tested for SARS-COV2RT-PCR and patients were submitted to a close clinical follow up. Results/Findings: Data from Feb 27 to Jul 15, 2020 included 6288 blood donation candidates. Out of them, 31 (0.49%) were non-eligible to blood donation due to COVID-19 risk at screening. Post-donation notifications had one of contact with people with COVID-19, and nine notifications of flu-like symptoms within less than two weeks from donation, with six confirmed RT-PCR positive (0.09%). All blood products were traced and eight were transfused - two platelet apheresis, one red blood cell, and five random platelets. Available frozen blood samples from these donors were tested negative for SARS-CoV-2 RT-PCR and, due to these negative results, not all patients were tested for COVID-19 but had close clinical follow up. One patient had RT-PCR positive 5 days after transfusion, but no correlation to blood transfusion was confirmed. Conclusions: Further investigation is needed to better understand the potential risk of blood transfusion transmission of COVID-19, mainly for cancer patients. Clinical screening of blood donation candidates is the main tool at this moment to reduce risk of virus transmission since there is no regulation for testing all blood donors. In addition, donors' commitment to post-donation information is very important, reducing the risk of transfusion transmission of COVID-19.
ABSTRACT
Background/Case Studies: The COVID-19 virus outbreak is primarily transmitted by the respiratory route and this virus has an unknown potential or confirmed risk of blood transfusion transmission. Social distancing to protect against the coronavirus pandemic was implemented as obligatory in our region. The epidemic has the potential to reduce supply of blood components and adversely affect blood system activities, mainly for an oncology hospital. The aim of this study is to evaluate results from 140 days period of implemented actions in a cancer center blood bank in Brazil, how to address the need of blood components with protection of donor health and provide safe blood supply for patients. Study Design/Methods: Actions were implemented to maintain adequate blood supplies during the COVID-19 pandemic with focus on donor and patient safety. For donors protection, scheduled blood donations were implemented in groups with no more than five people/ hour to avoid agglomerations and guarantee quality of care for donors, contact and agreement with local Companies to allow employees to schedule blood donation during work time, communication to community about the need of blood supply and how to schedule a donation, increased number of blood bank staff for a more agile service, committed with standards of safety and infection control, and following social distancing practices between donors. For patient protection, more restrictive rules for clinical screening of blood donors, collecting blood only from individuals who were at no risk of COVID-19. Also, donors were instructed to report any signs or symptoms of infectious process within fourteen days after donation. Results/Findings: Data from Feb. 27 to July 15, 2020 included 6288 blood donation candidates. Out of them, 31 (0.49%) were non-eligible to blood donation due to COVID-19 risk at screening. Ten (0.16%) post-donation notifications included one contact with people with COVID-19, and nine notifications of flu-like symptoms with six confirmed positive to COVID-19 (0.09%). Traced blood products from these donations were discarded except eight that had already been transfused. Comparing data with the same period from 2019, there was a 40% decrease of blood donation candidates and 34.2% decrease of total of collected bags. The proportion of deferrals at clinical screening due to flu-like symptoms decrease from 0.71% to 0.49%. No impact on blood transfusion occurred in this period. Conclusions: We are facing a very different scenario of reclusion, social distancing and even hospitals with fewer elective procedures being scheduled due to COVID-19 pandemic. However, for a cancer institution with lower or no decrease in oncology patients' care, it is very important to adapt to the new environment to guarantee protection of blood donors and a safe blood supply for patients.