by David Therkelsen

Two prominent physicians spoke to Red Cross retirees via Zoom on July 17, reviewing current blood banking issues, and especially the impact of COVID-19 on the blood supply and on therapeutic practices. We heard from Pampee Young, MD, PhD, chief medical officer at American Red Cross, and Jeff McCullough, MD, now a transfusion medicine consultant but once Red Cross’ senior vice president for Biomedical Services.

Dr. McCullough led off with a discussion of changing transfusion practices, and how they have affected the blood supply, and the financial soundness, of American Red Cross and other blood banking organizations. He said that as far back as the 1950s, Mayo Clinic had determined that a patient undergoing general anesthesia should have a hemoglobin level of 10 grams per deciliter; below that a transfusion should be given. Over time that became the standard for all procedures.

But about 15 years ago doctors and scientists began to question that standard, and determined that patient hemoglobin levels as low as 7 or 8 were safe for medical procedures, without administering blood. Very quickly, blood transfusions fell off. This was a good thing for patients, Dr. McCullough said, but not so good for the financial health of blood centers; they found they could not reduce costs as quickly as demand for blood was falling.

Still, even with blood demand falling, there is still plenty of need. From a peak of about 16 million units of blood donated in 2008, hospitals and their patients still need about 12 million units to be donated annually.

Dr. Young then spoke about the current experience of American Red Cross. She described how, in the early weeks of COVID-19 response, Red Cross lost access to huge numbers of donors because normal collections sites – companies, schools, churches – were closed. In March and April, 14,000 blood drives were canceled and 400,000 planned units went uncollected; Red Cross was able to collect just 53% of its goal.  Fortunately blood utilization was also down, but not as sharply. By mid-May, blood usage had surged above pre-COVID levels.

As collections rebound, Red Cross, like virtually all public-facing entities stepped up its cleaning procedures, began doing temperature checks of all employees, donors and volunteers, and imposed its own form of social distancing by requiring appointments for all blood donations, thereby smoothing out the flow of donors.

Dr. Young then spoke about the central role Red Cross is playing in providing COVID-19 Convalescent Plasma – CCP. This involves collecting plasma from donors who have recovered from COVID, for transfusion to current patients. Antibodies in these donors’ plasma may, in current patients, prevent the virus from replication. Red Cross is identifying suitable donors, collecting and distributing blood, within FDA guidelines.

The early clinical experience with CCP use is encouraging, and scientific studies, while not yet numerous or methodologically robust, are also promising. In fact, doctors treating COVID-19 patients are ordering CCP in high enough quantities that shortages may occur in the very near future. Dr. Young said this is a large concern for ARC, because for the treatment to work patients need CCP to be administered early in their therapy.

There followed a vigorous Q&A period, including cameo appearances by Dr. Lew Barker, head of American Red Cross Blood Services in the 1970s and 80s, and Dr. Gerald Sandler, also a senior physician at Red Cross.

 If you were not able to join the webinar you can click here to listen to an audio recording.