Impact of COVID-19 on transfusion care of patients with hemoglobin disorders in India

As we navigate the first pandemic of our generation, we've been learning and adapting ourselves to this viral infection and its consequences. It's been more than two years since the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) pandemic, and the virus has crippled the healthcare services in almost all the countries of the world. The healthcare systems in various parts of the world are still in the phase of recovery from the effect of the pandemic, as each country is witnessing the emergence of various variants causing multiple waves of infection. As an important part of the health care system, blood banks were one of the affected services. Most of the blood centers in India reported a significant reduction in blood donation during the COVID-19 pandemic. As transfusion services constitute a crucial backbone for the management of transfusion-dependent patients with hemoglobinopathies, the substantial reduction in the timely blood supply drastically affected these patients. All major healthcare centers in India were designated as COVID-19 care centers, which left very few options for these patients to visit for their routine care. Every country managed this acute blood shortages and developed unique strategies to support patients requiring blood transfusion. This manuscript aims to provide a snapshot of the challenges faced by the blood banks and transfusion services in India in the care of patients with hemoglobinopathies, and the mitigation strategies that were adopted.Copyright © Annals of Blood. All rights reserved.

Impact of the COVID-19 pandemic on blood services operations: Korean experience

The coronavirus disease 19 (COVID-19) pandemic had a profound impact on blood services operations in Korea. Blood collection was affected due to decrease in donor availability caused by avoidance of public places, social distancing policies, and cancellation of blood drives. The negative impact on blood collection was more pronounced with the COVID-19 pandemic than with other outbreaks experienced previously such as the influenza (H1N1) outbreak or the Middle East respiratory virus (MERS) pandemic. To cope with the blood shortage, campaigns to appeal for blood donation, raise public awareness on the importance of blood donation and gain donor's confidence in safe blood donation were implemented using mass communication media such as TV and radio broadcasting as well as postings on various social media platforms. Upon Korean Red Cross Blood Services's (KRCBS) request, the Ministry of Health and Welfare (MoHW) approved the relaxation of the geographical restrictions regarding indigenous malaria thus enabling collection of more than 23,000 units of whole blood. To mitigate even a theoretical risk of transfusion-transmission of SARS-CoV-2 via blood donation from pre-symptomatic COVID-19 donors, the KRCBS received the data on COVID-19 identified cases from the Korean Disease Control and Prevention Agency (KDCA) from the early get-go of the pandemic for cross referencing to donors for further recipient investigation and recall of blood products not transfused. Communication with donors, staff members, national health authorities, hospital customers and other stakeholders was and remains of utmost importance to respond to this unprecedented situation which is still ongoing.Copyright © Annals of Blood. All rights reserved.

Impact of natural disasters and pandemics on blood supply: A systematic review

Background: Natural disasters and pandemics can be highly challenging to blood supply chains. This review aimed to assess the impacts of pandemics and natural disasters on blood donation globally, appraise any similarities and differences, and provide an overview of the mitigation strategies and optimizations applied as well as risks modelling undertaken. Method(s): Full text, peer-reviewed articles that studied the impact of any pandemic and natural disaster on blood donation, blood supply management, and modelling searchable in PubMed, Scopus, Web of Science, and Cochrane Library between Jan 1980 and Jan 2023, inclusive were included. We performed quality assessments and summarised potential lessons learned. Result(s): Overall, 98 studies were identified and assessed in this review, of which 58 were related to pandemics and 17 related to natural disasters. 97% of the studies on pandemics and blood donation were on COVID-19, while 88% of studies on natural disasters were on earthquakes. We confirmed that during the COVID-19 pandemic, blood donation numbers decreased compared to the pre-pandemic period, while just after an earthquake, blood donation numbers tended to increase, which in both cases put the blood supply chain under pressure (creating shortage or wastage). The increase of first-time donors was higher after a sudden destructive earthquake than after the COVID-19 pandemic. Public awareness campaigns, donors transportation, home visits, measures to minimize wastage of blood components, activation of contingency plans, and altering donor eligibility criteria were implemented to help the blood supply chain to respond to the demand and reduce wastage. However, no pandemic plans, per se were identified highlighting the lack of an emergency plan in collaboration with health authorities. Several optimization models were developed to help the blood supply chain reduce costs and identify faster transportation in times of earthquake, however, optimization models targeting a pandemic were lacking, as were risk modelling analyses for both events. Conclusion(s): Optimization models, risk modelling, serosurveillance and haemovigilance should be combined with infectious diseases case surveillance to better prepare the whole supply chain logistics to safely attend the demand. Findings on blood donor demographics were inconclusive during or after major events, which highlight the need for further investigations.Copyright © 2023 The Authors

Impact of the COVID-19 Pandemic on the Usage of Blood for Transfusions: A 2-Year Experience from a Tertiary Center in Korea.

The coronavirus disease (COVID-19) outbreak affected the utilization and management of blood products in hospitals. Blood shortages occurred owing to social distancing policies and reduction in blood donors. However, only a few studies examined whether these changes affected blood usage and transfusion patterns. We retrospectively reviewed blood component usage according to hospital departments and phases of surgery in transfused patients admitted between 1 March 2019 and 28 February 2021, in a single center in Anyang, Korea. We also analyzed the length of hospital stay and mortality to determine prognosis. In 2020, 32,050 blood components were transfused to 2877 patients, corresponding to 15.8% and 11.8% less than the rates in 2019, respectively. Postoperative usage of blood products significantly decreased in 2020 (3.87 ± 6.50) compared to 2019 (7.12 ± 21.71) (p = 0.047). The length of hospital stay of the patients who underwent postoperative transfusion in 2019 (n = 197) was 13.97 ± 11.95 days, which was not significantly different from that in 2020 (n = 167), i.e., 16.44 ± 17.90 days (p = 0.118). Further, 9 of 197 postoperative transfusion patients died in 2019, while 8 of 167 patients died in 2020 (p = 0.920). The COVID-19 pandemic resulted in limited blood supply and reduced postoperative transfusions; however, patient prognosis was not affected.

A socio-economic optimization model for blood supply chain network design during the COVID-19 pandemic: An interactive possibilistic programming approach for a real case study.

In uncertain circumstances like the COVID-19 pandemic, designing an efficient Blood Supply Chain Network (BSCN) is crucial. This study tries to optimally configure a multi-echelon BSCN under uncertainty of demand, capacity, and blood disposal rates. The supply chain comprises blood donors, collection facilities, blood banks, regional hospitals, and consumption points. A novel bi-objective mixed-integer linear programming (MILP) model is suggested to formulate the problem which aims to minimize network costs and maximize job opportunities while considering the adverse effects of the pandemic. Interactive possibilistic programming is then utilized to optimally treat the problem with respect to the special conditions of the pandemic. In contrast to previous studies, we incorporated socio-economic factors and COVID-19 impact into the BSCN design. To validate the developed methodology, a real case study of a Blood Supply Chain (BSC) is analyzed, along with sensitivity analyses of the main parameters. According to the obtained results, the suggested approach can simultaneously handle the bi-objectiveness and uncertainty of the model while finding the optimal number of facilities to satisfy the uncertain demand, blood flow between supply chain echelons, network cost, and the number of jobs created.

Monitoring Blood Supply in Germany: A Regulatory Perspective.

Background and Objectives: A sufficient supply of safe, high-quality blood components for transfusion is essential to the healthcare system in Germany. The requirements for the current reporting system are laid down in the German Transfusion Act. The present work elaborates on the advantages and limitations of the current reporting system and investigates the feasibility of a pilot project that collects specific data on blood supply based on weekly reports. Materials and Methods: Selected data on blood collection and supply from 2009 to 2021 derived from the §21 German Transfusion Act database were examined. In addition, a pilot study over a period of 12 months was conducted on a voluntary basis. The number of red blood cell (RBC) concentrates was documented and stock availability was calculated weekly. Results: From 2009 to 2021, the annual number of RBC concentrates decreased from 4.68 to 3.43 million, the per capita distribution decreased from 58 to 41 RBC concentrates per 1,000 inhabitants. These figures did not change significantly during the COVID-19 pandemic. The data of the 1-year pilot project represented 77% of the released RBC concentrates in Germany. Percentage share of O RhD positive RBC concentrates fluctuated between 35% and 22% and for O RhD negative concentrates between 17% and 5%. The availability of O RhD positive RBC concentrate stocks varied between 2.1 and 7.6 days. Conclusion: The data presented shows a decrease in annual RBC concentrate sales over an 11-year period and no further change over the past 2 years. A weekly monitoring of blood components detects acute problems in RBC provision and supply. Close monitoring seems helpful but should be combined with a nationwide supply strategy.

Blood plasma supply chain planning to respond COVID-19 pandemic: a case study.

The COVID-19 pandemic causes a severe threat to human lives worldwide. Convalescent plasma as supportive care for COVID-19 is critical in reducing the death rate and staying in hospitals. Designing an efficient supply chain network capable of managing convalescent plasma in this situation seems necessary. Although many researchers investigated supply chains of blood products, no research was conducted on the planning of convalescent plasma in the supply chain framework with specific features of COVID-19. This gap is covered in the current work by simultaneous regular and convalescent plasma flow in a supply chain network. Besides, due to the growing importance of environmental problems, the resulting carbon emission from transportation activities is viewed to provide a green network. In other words, this study aims to plan the integrated green supply chain network of regular and convalescent plasma in the pandemic outbreak of COVID-19 for the first time. The presented mixed-integer multi-objective optimization model determines optimal network decisions while minimizing the total cost and total carbon emission. The Epsilon constraint method is used to handle the considered objectives. The model is applied to a real case study from the capital of Iran. Sensitivity analyses are carried out, and managerial insights are drawn. Based on the obtained results, product demand impacts the objective functions significantly. Moreover, the systems' total carbon emission is highly dependent on the flow of regular plasma. The results also reveal that changing transportation emission unit causes significant variation in the total emission while the total cost remains fixed.

The management of blood donation and donor: Review

Blood donation is a major area of interest within the field of health care. Moreover, Coronavirus pandemic, which has disrupted various aspects of life, Blood donation is still necessary for human life. The optimization of the management of blood donation will ensure sustainable and secure blood supply to save patients. The purpose of this article is threefold: i) to provide an intelligent generic taxonomy to the literature on BDM with regard to relevant real-life problems;ii) to emphasize the specific characteristics of donors and blood donation;iii) to propose the best promotion activities of blood collection. We conduct a systematic review of studies addressing differents problems in order to determine the efficacy of taxonomy and to get insights for potential directions and opportunities for future research about blood donation promotion and management. © 2022 IEEE.

Evaluation of Retinal Microvascular Impairment after COVID-19 and its Clinical Correlates Using Optical Coherence Tomography Angiography.

Objectives: Retinal vascular complications have been described in patients with coronavirus disease 2019 (COVID-19). This study aimed to analyze retinal microvascular changes and their correlations with clinical findings. Materials and Methods: This case-controlled study was conducted in a university hospital. The right eyes of 52 otherwise healthy patients recovered from COVID-19 and 42 healthy controls were examined with optical coherence tomography angiography. Mann-Whitney U test was used to compare vessel density (VD) and foveal avascular zone (FAZ) parameters. Associations with treatment choices, pneumonia, and laboratory findings were analyzed. Results: Twenty-nine patients (56%) and 18 healthy controls (43%) were men. Mean age of the COVID-19 group was 39.00±13.04 years. Twenty-two patients had pneumonia, 18 (35%) received hydroxychloroquine (HCQ), 17 (33%) received HCQ plus low-molecular-weight heparin (LMWH), and 10 (19%) received favipiravir. The patient group had lower parafoveal VD in the superficial capillary plexus (SCP) and lower parafoveal VD and perifoveal VD in the deep capillary plexus (DCP) than controls (p=0.003, p=0.004, p=0.001). FAZ area did not differ significantly (p=0.953). Perifoveal VD in the DCP was also significantly lower in the HCQ+LMWH group than the HCQ group (p=0.020) and in the presence of pneumonia (p=0.040). C-reactive protein (CRP) and ferritin levels were negatively correlated with perifoveal VD in the DCP (r=-0.445, p=0.023; r=-0.451, p=0.040). Ferritin was also negatively correlated with parafoveal VD in the SCP (r=-0.532, p=0.013). Conclusion: Parafoveal and perifoveal VD was found to be lower in the COVID-19 group. Presence of pneumonia, need for LMWH prophylaxis, and levels of CRP and ferritin were found to be negatively associated with retinal VD. Large-scale studies are needed to evaluate the clinical importance.

A possibilistic-robust-fuzzy programming model for designing a game theory based blood supply chain network.

This paper presents a bi-level blood supply chain network under uncertainty during the COVID-19 pandemic outbreak using a Stackelberg game theory technique. A new two-phase bi-level mixed-integer linear programming model is developed in which the total costs are minimized and the utility of donors is maximized. To cope with the uncertain nature of some of the input parameters, a novel mixed possibilistic-robust-fuzzy programming approach is developed. The data from a real case study is utilized to show the applicability and efficiency of the proposed model. Finally, some sensitivity analyses are performed on the important parameters and some managerial insights are suggested.

The role of artificial cells in the fight against COVID-19: deliver vaccine, hemoperfusion removes toxic cytokines, nanobiotherapeutics lower free radicals and pCO2 and replenish blood supply.

This review concentrates on how artificial cells can contribute to helping patients with COVID-19. Artificial cells have led to mRNA vaccines with more improvements to come. Excessive cytokines in severe COVID-19 can damage organs leading to death. Artificial cell-based collodion macroporous activated charcoal adsorbent can effectively remove middle molecular weight range molecules in patients. A novel hemoperfusion device based on collodion membrane macroporous synthetic resin effectively removes cytokines and recovery in COVID-19 patients. This has been approved as an emergency treatment for COVID-19 in China, Europe, and Canada. A recent nanobiotherapeutic containing haemoglobin and up to six times the concentration of red blood cell enzymes: catalase, superoxide dismutase and carbonic anhydrase. In an animal study, this can effectively lower the damaging increase in free radicals and the removal of increased tissue pCO2. This can also help as blood substitute for the severe and critical problem of COVID-19 pandemic donor blood supply crisis.KEY MESSAGESCOVID-19 and its variants have resulted in major pandemics, severe sicknesses, and deaths around the world. COVID-19 and its variants has only started less than 3 years ago, and it is even more recently that we know more about its mechanisms, requirements, prevention, and treatment. This being the case, this is the first review on the present status and future perspectives of the use of the principle of artificial cells for COVID-19 related to vaccines, treatment, and critical donor blood supply shortage.

A flexible robust model for blood supply chain network design problem.

World Health Organization (WHO) declared COVID-19 as a pandemic On March 12, 2020. Up to January 13, 2022, 320,944,953 cases of infection and 5,539,160 deaths have been reported worldwide. COVID-19 has negatively impacted the blood supply chain by drastically reducing blood donation. Therefore, developing models to design effective blood supply chains in emergencies is essential. This research offers a novel multi-objective Transportation-Location-Inventory-Routing (TLIR) formulation for an emergency blood supply chain network design problem. We answer questions regarding strategic, operational, and tactical decisions considering disruption in the network and blood shelf-life. Since, in real-world applications, the parameters of the proposed mathematical formulation are uncertain, two flexible uncertain models are proposed to provide risk-averse and robust solutions for the problem. We applied the proposed formulations in a case study. Under various scenarios and realizations, we show that the offered robust model handles uncertainties more efficiently and finds solutions that have significantly lower costs and delivery time. To make a reliable conclusion, we performed extensive worst-case analyses to demonstrate the robustness of the results. In the end, we provide critical managerial insights to enhance the effectiveness of the supply chain. Supplementary Information: The online version contains supplementary material available at 10.1007/s10479-022-04673-9.

Passive order auditing associated with reductions in red blood cell utilization: National blood shortage experience.

BACKGROUND: Decreased blood collection during the Coronavirus Disease 2019 (COVID-19) pandemic resulted in long-term red blood cell (RBC) shortages in the United States. In an effort to conserve RBCs, the existing passive alert system for auditing inpatient transfusions was modified to activate at a lower hemoglobin threshold (6.5 g/dL instead of 7.0 g/dL for stable, nonbleeding inpatients) during a 9-month shortage at an academic medical center. Hemoglobin levels prior to RBC transfusions were compared for inpatients receiving RBC transfusions to determine whether RBC utilization changed during the intervention. STUDY DESIGN AND METHODS: This retrospective study compared the number of single-unit RBC transfusions and hemoglobin levels prior to RBC transfusion among inpatients during the 9 months of the intervention (Period 2, 06/01/2021-2/28/2022) to the same period of the previous year (Period 1, 06/01/2020-2/28/2021). RESULTS: Overall full unit RBC transfusions to inpatients decreased by 15% from 5182 to 4421. Of all transfusions, 50.3% and 49.8% were single-unit RBC transfusions in Period 1 and Period 2, respectively. The incidence rate difference and incidence rate ratio of single RBC units transfused per 1000 patient days were significantly decreased (p = 0.0007). The average pre-transfusion hemoglobin level significantly decreased from 7.18 g/dL to 7.05 g/dL (p = 0.0002), largely due to significant decreases in hemoglobin transfusion triggers for adult inpatient ward transfusions. DISCUSSION: Modification of the passive alert system was associated with significantly decreased RBC utilization during a long-term RBC shortage. Modification of transfusion criteria recommended by passive alerts may be a feasible option to decrease RBC utilization at centers during long-term RBC shortages.

International Society of Blood Transfusion survey of experiences of blood banks and transfusion services during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has impacted blood systems worldwide. Challenges included maintaining blood supplies and initiating the collection and use of COVID-19 convalescent plasma (CCP). Sharing information on the challenges can help improve blood collection and utilization. MATERIALS AND METHODS: A survey questionnaire was distributed to International Society of Blood Transfusion members in 95 countries. We recorded respondents' demographic information, impacts on the blood supply, CCP collection and use, transfusion demands and operational challenges. RESULTS: Eighty-two responses from 42 countries, including 24 low- and middle-income countries, were analysed. Participants worked in national (26.8%) and regional (26.8%) blood establishments and hospital-based (42.7%) institutions. CCP collection and transfusion were reported by 63% and 36.6% of respondents, respectively. Decreases in blood donations occurred in 70.6% of collecting facilities. Despite safety measures and recruitment strategies, donor fear and refusal of institutions to host blood drives were major contributing factors. Almost half of respondents working at transfusion medicine services were from large hospitals with over 10,000 red cell transfusions per year, and 76.8% of those hospitals experienced blood shortages. Practices varied in accepting donors for blood or CCP donations after a history of COVID-19 infection, CCP transfusion, or vaccination. Operational challenges included loss of staff, increased workloads and delays in reagent supplies. Almost half of the institutions modified their disaster plans during the pandemic. CONCLUSION: The challenges faced by blood systems during the COVID-19 pandemic highlight the need for guidance, harmonization, and strengthening of the preparedness and the capacity of blood systems against future infectious threats.

A Simulation-based Analysis of the Blood Supply Chain during Covid-19

Based on interviews at Indonesian Red Cross in Yogyakarta, there has been a 30% decrease in blood supply since the Covid-19 pandemic occurred. This study aims to create system dynamics model of the blood supply chain, analyze the fulfillment of blood demand, create policy scenarios to significantly increase blood supply, and provide recommendations. The research stages consist of dynamic hypothesis, system dynamics model, policy scenarios, comparative analysis, and conclusions. There are many requests for blood from hospitals and blood transfusion units that have not been fulfilled. Policy scenarios that can significantly increase blood supply are made, namely: socialization of blood donation through short message applications, collaboration with agencies to donate blood, combined scenarios of socialization of blood donation and collaboration with agencies. Based on the capacity of Indonesian Red Cross in Yogyakarta, it can be concluded that the combined scenario with the combination of targets number 5 (contacting 14, 723 people and collaborating with 5 agencies), 6 (contacting 17, 667 people and collaborating with 4 agencies, ), and 7 (contacting 20 people and collaborating with 3 agencies) is recommended to apply. © 2021 IEEE.

COVID-19 pandemic and blood transfusion services: The impact, response and preparedness experience of a tertiary care blood center in southern Karnataka, India.

INTRODUCTION: With the outbreak of COVID-19 and its containment measures, blood centers faced a huge challenge in balancing blood demand and supply and devising a preparedness plan to withstand the uncertain situation. This study assesses the effect of the COVID-19 pandemic on blood transfusion services and discusses the appropriate mitigation strategies adopted. METHODS: We analyzed our center's blood transfusion services during the first half-period of the pandemic (Y3) and non-pandemic years 2018(Y1) and 2019(Y2) in two-quarters Q1 (pre-lockdown), from January to March and Q2 (post-lockdown), from April to June. The blood donation variables, the packed red blood cells (PRBCs) demand and the utilization pattern were compared between pandemic (Y3) and non-pandemic years (Y1 and Y2) in each quarter. The mitigation strategy adopted at every step of the transfusion service is highlighted. RESULTS: During post-lockdown (Q2) of the pandemic year (Y3), the blood donation was majorly by repeat donors (83%) from the in-house site (82.5%). Furthermore, the proportion of outdoor donation, deferral, blood collection, demand and issue demonstrated a significant drop of 50%, 32.6%, 33%, 31.8% and 32.3%, respectively, in comparison to Q2 of the non-pandemic years (Y1 and Y2), with a statistically significant difference for surgical and hemorrhagic indications (p < 0.05). Coping strategies, such as blood donor education and motivation using e-platforms emphasizing eligibility during the pandemic, staggering of donor in-flow, postponement of elective surgeries and donor and staff' COVID-19 safety assurance, were followed. CONCLUSION: The timely adoption of coping strategies played a crucial role in the better handling of shortcomings at our center's blood transfusion services caused by the COVID-19 pandemic.

A Cross-Platform Blood Donation Application with a Real-Time, Intelligent, and Rational Recommendation System

Blood or plasma transmission is one of the most effective treatments for critical diseases like Covid 19. Nowadays, voluntary blood donation has become the major source of blood supply. Several mobile applications are currently available to establish the initial communication between blood donors and receivers. Recommending the right potential donor during a blood search can save the life of a critical patient with an immediate response from the donor. However, the requirement of an advanced recommendation system has not been addressed by any of the existing mobile applications. In our research work, we have designed a real-time, intelligent, and rational recommendation system using sentiment analysis of the user's feedback, response rate of the donor, and the current geo-location information and finally develop a cross-platform application for blood collection and distribution system. To process and generate features from the user feedback, we have designed a Bi-directional LSTM-based deep learning model. The quality of the recommendation of the potential donors has significantly improved. Moreover, we have conducted rigorous requirement analysis from real users and evaluated the performance of our application through both indoor and outdoor testing. © 2021 IEEE.

Integrating GIS in reorganizing blood supply network in a robust-stochastic approach by combating disruption damages.

As supplying adequate blood in multiple countries has failed due to the Covid-19 pandemic, the importance of redesigning a sensible protective-resilience blood supply chain is underscored. The outbreak-as an extensive disruption-has caused a delay in ordering and delivering blood and its by-products, which leads to severe social and financial loss to healthcare organizations. This paper presents a robust multi-phase optimization approach to model a blood supply network ensuring blood is collected efficiently. We evaluate the effectiveness of the model using real-world data from two mechanisms. Firstly, a Geographic Information System (GIS)-based method is presented to find potential alternative locations for blood donation centers to maximize availability, accessibility, and proximity to blood donors. Then, a protective mathematical model is developed with the incorporation of (a) blood perishability, (b) efficient collation centers, (c) multiple-source of suppliers, (d) back-up centers, (e) capacity limitation, and (f) uncertain demand. Emergency back-up for laboratory centers to supplement and offset the processing plants against the possible disorders is applied in a two-stage stochastic robust optimization model to maximize the level of hospitals' coverage. The results highlight the fraction cost of considering back-up facilities in the total costs and provide more resilient decisions with lower risks by examining resource limitations.

COVID-19 and the impact on blood availability and transfusion practices in low- and middle-income countries.

BACKGROUND/CASE STUDIES: The coronavirus disease 2019 (COVID-19) pandemic disrupted the global blood supply. Low- and middle-income countries (LMICs) already experienced blood supply deficits that preceded the pandemic. We sought to characterize the challenges experienced during the pandemic, and adaptations, such as COVID-19 convalescent plasma (CCP). STUDY DESIGN/METHODS: A cross-sectional survey explored blood availability, challenges, and adaptations. The survey contained 31 questions, e-mailed in English, French, or Spanish, to selected LMIC blood transfusion practitioners. Data acquisition occurred between October 28 and December 28, 2020. A mixed methods analysis followed. RESULTS/FINDINGS: A total of 31 responses from 111 invitations represented 26 LMIC countries. Languages included English (22, 71%), Spanish (7, 22.6%), and French (2, 6.4%). Most respondents (29/31, 93.5%) collected blood; 58% also transfused blood (18/31). The supply of blood came from hospital-based blood donations (61%, 11/18); blood suppliers (17%, 3/18); and both sources (22%, 4/18). Collectively, 77.4% (24/31) of respondents experienced a decline in blood availability, ranging from 10% to 50%. Contributing factors included public fear of COVID-19 (21/24); stay-at-home measures (18/24); logistics (14/24); and canceled blood drives (16/24). Adaptations included increased collaboration within and between institutions (17/27), donor eligibility changes (21/31); social media or phone promotion (22/39); and replacement donation (3/27). Fifteen of 31 responses reported CCP donation (48.4%); CCP transfusion occurred in 6 (19.4%). The primary barrier was engaging recovered patients for donation (7/15). CONCLUSION: Our survey describes challenges experienced by LMIC blood systems during the COVID-19 pandemic. While the decline in blood supplies was severe, adaptive measures included collaboration, outreach, and CCP programs.