Blood beyond borders: Strategy to ensure blood availability during COVID-19 pandemic

Background: It's more than 2 years since the strike of a COVID-19 pandemic caused by severe acute respiratory syndrome Coronavirus 2. It had infected nearly 400 million populations globally and affected several important sectors worldwide such as the economy, social and healthcare services. To date, Malaysia recorded more than 3 million confirmed cases of COVID-19. The first nationwide Movement Control Order (MCO) started on 18th March 2020 then followed by multiple series of targeted MCOs on several states with a high surge up of cases. The National Blood Center (NBC) and State Blood Transfusion Services (SBTS) experienced significant reduction of blood collection, the shortage of blood availability and supply. The total blood collection in the year 2020 was 655,069 units, showing a 12% reduction compared with the year 2019. Blood supply management requires an integrated and holistic planning from all stakeholders to ensure the judicious use of blood and blood components in the normal situations, pandemics, crises, or during blood shortages. Aims: This study was to determine the characteristic of blood components mobilized during the COVID-19 Pandemic and to assess the coordination of inter-regional blood availability, supply, and transportation between the blood inventory of NBC, SBTS, or Hospital Blood Bank. Methods: A retrospective study was conducted from 18th March 2020 until 18th August 2021 where multiple series of MCOs were instated. Data from the blood inventory during the 18 months were analysed. All data were retrieved from Blood Bank Information System from NBC and SBTS. Results: A total of 17,144 units of blood components have been mobilized and distributed, comprised of 15,591 units of red cell, 1107 units of platelet concentrates, 299 units of Fresh Frozen Plasma, 125 units of Cryoprecipitate and 22 units of Convalescent Plasma. Overall, there were 20 blood collection centers comprised of NBC, state hospitals, and major hospitals involve as blood providers to the (Table Presented) several affected blood collection centers, beyond the state border. The states with major contributions for blood component mobilization were Kuala Lumpur, Sarawak and Johor while the collection centres that provided the most blood were National Blood Centre (4542 bags), Sultanah Aminah Hospital in Johor (1714 bags) and Malacca Hospital (1630 bags). The blood products have been shipped via hospitals' land transportation, air transportation by courier service and collaborative mercy flight by the Malaysian Air Force to the Malaysia East. The validated blood packaging and transportation procedure have been implemented to preserve the blood cold chain during blood mobilization through the air or by land transportation. Summary/Conclusions: The challenges during a pandemic are to deliver adequate, safe, and quality blood to the patient who needs blood transfusion for life-saving. Dynamic inter-state blood availability, supply and mobilization are essential to overcome the shortfall during a pandemic. Effective communication among NBC, SBTS, interagencies, governmental organizations, and postal service companies were among the great factors of success in transporting blood beyond borders to ensure blood availability. The plan was designed in response to the threat to the national blood supply from any untoward events that lead to blood shortages in a state, regional, or nationwide in Malaysia.

Analysis of common issues at blood donation campaigns by National Blood Centre

Background: National Blood Centre is an institution under the Ministry of Health Malaysia responsible for ensuring adequate and safe blood supply is always available for hospitals in Malaysia. Prior to COVID-19 pandemic, collection from the blood donation campaign was 80% of the total collection. However, during the pandemic collection from blood donation campaigns has reduced to almost only 60%. Identifying the issues is important because tackling these issues reduce barriers that impede people from becoming blood donors and increase the likelihood of blood donation campaigns organizers to continue supporting blood donation campaigns which are important for the sustainability of donations from regular blood donors. Aims: The purpose of this study is to better understand the issues faced at blood donation campaigns specifically related to location, equipment, and staff-related issues in view of paving the way to solving the issues later for the betterment of the service in terms of future intervention. Methods: This was a cross-sectional prospective study using a feedback form filled out by Blood Donation Campaign managers to give their input on the issues encountered during blood donation campaigns. The duration of this study was 4 months from 1st of September 2021 to 31st of December 2021 involving 711 blood donation campaigns organized by the National Blood Centre with blood donation campaign organizers using the purposive sampling method. These feedbacks were mainly categorized into three main categories involving location, equipment, and staff-related issues. The feedback form is given to Blood Donation Campaign managers on the day of the blood donation campaigns, with the feedback to be filled during campaign progress and to be returned at the end of the blood donation campaign on the same day. The outcome of this feedback is calculated by pointer system-where 0 = no issues, 1 = issue exist. Results: A total of 240 issues were highlighted involving 123 of the 711 blood donation campaigns between the 1 September 2021 to the 31 December 2021. 81.25% of the issues were due to blood donation campaign location and environment, 13.75% of the issues were due to staff issues and 5.0% of the issues were due to equipment issues. 24.62% of the issues were related to the lack of the locations' visibility and accessibility to potential blood donors. 22.05% of the issues related to the blood donation campaign locations were due to unsuitable environment temperature, which is vital for preserving the blood cold chain. 13.33% of the issues were due to staff issues such as failure to be prepared for departure on time. Unexpectedly high number of donors turn up contributed to 4.49% of issues related to inadequate equipment (blood bag and rations). Summary/Conclusions: This cross-sectional prospective study analysis has helped in identifying issues encountered at blood donation campaigns and pave the way for further intervention for the betterment of services needed. Choosing a proper location and adequate promotional materials may be useful in addressing visibility issues in recruiting potential donors. Unsuitable environment temperature can be overcome by bringing additional fans or air humidifiers to bring down the temperature around the campaign location. A possible solution to inadequate blood bags and ration is by bringing additional blood bags to blood donation campaigns that are going to be held in high population areas.

Sustaining blood supply in the National Blood Centre, Kuala Lumpur during the COVID-19 pandemic

Background: Following the second wave of the COVID-19 outbreak, Malaysian authorities issued a Movement Control Order (MCO) on March 18, 2020. The emergency lockdown, while necessary to stop the spread, resulted in lower public attendance, cancellation of blood donation drives and eventually a nationwide blood shortage. Total blood collection decreased 21% by March 2020 compared to the previous year with the first 2 weeks of MCO witnessing 52% decline in collection. Consequently, emergency steps must be taken to secure a reliable blood supply. Aims: Explore interventions to mitigate the blood supply reduction during a pandemic. Methods: A forecast system using blood collection and supply data was utilized to discuss, formulate and implement an action plan. Daily to weekly meetings were held to assess and revise plans. Results: The key concept of sustaining blood supply is to balance a stable collection and allocating supply appropriately while preserving blood safety. Following initial discussions, staff were organized into three primary working groups to execute the plans. During the 84-days MCO and conditional MCO period, the blood reserve was below the safe threshold three times (3.6%). However, with these strategies in place, the blood reserve did not fall below critical level and 73% of hospital blood requests were met. Summary/Conclusions: In ensuring blood availability during a crisis, teamwork with various departments and clinicians plays a critical role. The ability of the transfusion service to adapt is critical, and key efforts done during the pandemic can be turned into effective blood supply preservation measures in the future.

Social media as a channel of communication during the COVID-19 pandemic

Background: Diversity of reception of knowledge from social media has made it one of the crucial bases for knowledge update especially during the COVID-19 pandemic. Worldwide blood donation collections were greatly impacted due to disease transmission and movement restrictions imposed in order to curb the outbreak. In Malaysia, including National Blood Centre (NBC), a steady increment of blood collection had been documented before the pandemic. However, the increasing number of COVID-19 infections has led to significant reduction of blood collection. In order to have a sustainable number of blood supply for patients in need, diverse strategies have been applied to promote blood donation activities. NBC Facebook (FB) was created on 17 December 2012 and it has been the major medium for providing blood donation awareness, education and communication to the society. Aims: To determine the impacts of FB posts on blood collection in NBC during COVID-19 pandemic from 2019 till 2021. Methods: Retrospective data from the Blood Bank Information System (BBIS) and FB posts from 2019 until 2021 were analysed. FB posts were categorized into blood donation campaign information, educational videos, latest blood stock status, donor appreciation, educational infographic and sharing promotional posts either from other state blood banks or international institutions. The outcome of the total followers and total blood collections were captured. Results: The increased number of reach as well as engagement from the FB users towards the FB posts had resulted in sustainable blood collection during COVID-19. FB posts have contributed significantly in promoting blood donation to society, recruiting more new donors in order to ensure sustainable blood collection during COVID-19 pandemic. Table 1 showed that there was a significant increase of FB posts consisting of different categories. In 2019, there were 1565 FB posts, followed by 1622 in 2020 and further increment to 1929 in 2021. Type of post that had the highest reach from followers was the blood stock update, which showed information about the latest red blood cells stock in NBC. An increment of FB followers has been recorded in 2020 (n = 34,040) from 2019 (n = 16,883). In 2020, postings shared by the Ministry of Health (MOH) Malaysia have remarkably contributed to an increase (n = 34,040) on number of followers compared to 2021 (n = 21,825). In 2021, MOH focused on promoting COVID-19 vaccination to society and more sectors were opened and people started working as usual. Total blood collection in 2019 was 199,721 units, and total blood collection during Covid-19 pandemic in 2020 and 2021 were 171,106 and 174,872 units respectively. Despite reduction in blood collection, blood supply to patients is manageable via good clinical justification for blood usage together with patient blood management awareness and strategies. Summary/Conclusions: Social media has contributed as one of the mechanisms in disseminating information to society in ensuring good sustainable demand for blood requisition for patients especially during COVID-19 pandemic. (Table Presented).