Impact of COVID-19 pandemic on blood utilization in hospital Tengku Ampuan Rahimah Klang, Selangor, Malaysia

ABSTRACT

Background: Coronavirus are a family of viruses that can cause respiratory illnesses in human. Special features of Coronavirus is the 'crown like spikes' seen on the surface of the virus. Currently, the entire world are aware of the new strains of the coronavirus that was first reported in Wuhan, China in December 2019 named COVID-19. COVID- 19 pandemic has disrupted the transfusion services in Malaysia in terms of blood collection and potential transfusion needs in total. The pandemic has also caused plausible impact on blood utilization in Hospital Tengku Ampuan Rahimah, Klang, which also the only collection centre in the State of Selangor. Aims: We quantified the impact of COVID-19 on blood utilization in year 2019 until the emerging of COVID-19 pandemic, stratified by most utilized blood products and enumerated blood utilization by different departments. We then specifically analysed the blood utilization in hospitalized COVID-19 patients. Methods: This retrospective cross-sectional study was conducted at Transfusion Medicine Department, Hospital Tengku Ampuan Rahimah Klang from January 2019 to December 2021. Data on transfusion records from Quality Assurance database were collected, summarized and analysed. Overall blood utilization were computed on yearly basis, comparison of blood utilization among respective departments, different type of blood product utilized and overall trend of transfusion in COVID-19 patients were estimated. Results: For the past 3 years, a total of 82,056 units of blood product were utilized. 32,271 units in year 2019, 30,172 units in year 2020, and 19,613 units were used in year 2021. There was a significant reduction in blood utilization after the emerging of COVID-19 pandemic at about 6.50% in 2020 and 39.22% in 2021 compared to year 2019. The most utilized blood product during last 3 years were red cells ranging from 10,516-17,882 units, followed by random platelets 3376-6041 units, and fresh frozen plasma 3739-4662 units. However, there were no significant statistical impact of COVID-19 pandemic observed in utilization of different types of blood product. Average reduction in blood utilization in the year 2020 and 2021 compared to year 2019 in Emergency Department were (44.0%). We have observed a reduction in blood utilization for surgical-based departments, namely Orthopaedic Department (25.9%) and General Surgical Department (22.6%). During the early phase of pandemic in year 2020, the trend of COVID-19 cases was still on the rise and escalated in year 2021 and that was consistent with our findings for hospitalized COVID-19 patients as the red cells transfused in 2020 was only 908 units but in 2021 was 3120 units were transfused which comprised of 8.3% and 29.7% of total red cells utilization. Summary/Conclusions: Following notification of Hospital Tengku Ampuan Rahimah as a State referral and COVID-19 Hybrid Hospital, there was an influx of COVID-19 patients and re-direction of other cases to nearby facilities. Declined blood utilization during COVID 19 pandemic was associated with postponements of elective surgical procedures, reduction in trauma cases due to Movement Control Order and judicious transfusion in COVID-19 patients. An ongoing effective pandemic response and efforts made by various departments had good impact in rationale use of blood products at Hospital Tengku Ampuan Rahimah, Klang.