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.

Blood platelet production: a novel approach for practical optimization.

BACKGROUND: The challenge of production and inventory management for blood platelets (PLTs) is the requirement to meet highly uncertain demands. Shortages are to be minimized, if not to be avoided at all. Overproduction, in turn, leads to high levels of outdating as PLTs have a limited "shelf life." Outdating is to be minimized for ethical and cost reasons. STUDY DESIGN AND METHODS: Operations research (OR) methodology was applied to the PLT inventory management problem. The problem can be formulated in a general mathematical form. To solve this problem, a five-step procedure was used. This procedure is based on a combination of two techniques, a mathematical technique called stochastic dynamic programming (SDP) and computer simulation. RESULTS: The approach identified an optimal production policy, leading to the computation of a simple and nearly optimal PLT production "order-up-to" rule. This rule prescribes a fixed order-up-to level for each day of the week. The approach was applied to a test study with actual data for a regional Dutch blood bank. The main finding in the test study was that outdating could be reduced from 15-20 percent to less than 0.1 percent with virtually no shortages. Blood group preferences and extending the shelf life of more than 5 days appeared to be of marginal effect. CONCLUSION: In this article the worlds of blood management and the mathematical discipline of OR are brought together for the optimization of blood PLT production. This leads to simple nearly optimal blood PLT production policies that are suitable for practical implementation.