Since the first wave of COVID-19 patients fluttered through our healthcare systems, managing patient’s anemia plays a critical role in providing communities with essential medical care, while helping to avoid critical blood shortages. When blood shortages are unavoidable hospitals need a comprehensive strategy and procedure in place to reduce the use of blood products when clinically acceptable.

Important steps we have seen clinical leadership take to manage anemia have included:

1. Inpatient transfusion algorithms
2. Alerting physicians to not transfuse asymptomatic anemia (for Hgb > 7),
3. Transfuse patients with symptoms, active bleeding or very high risk for acute coronary syndrome only.
4. Restrictive blood ordering unless active bleeding is present, consideration of IV iron within specific parameters, suggest all transfusions undergo critical review by transfusions services for the ordering provider, nursing and lab staff.

Communication between transfusion services and blood supplier is also critical.  We suggest the hospital appoint a “transfusion services liaison” who would manage the relationship with the contracted blood supplier and coordinate hospital communication on the availability and timing of blood product delivery.  The teams should establish streamlined mechanisms of information exchange (electronic) between blood center collections/distribution and hospital transfusion services/blood bank on a daily basis (pre-delivery) and in preparation for following days blood collections and distribution of blood products. This communication will ensure that all decisions related to patient prioritization (e.g. adapted admission HgB and discharge criteria, triage methods for red cells, prevention and control measures) are communicated to all relevant staff and stakeholders based on blood supply availability and ensure the availability of reliable and sustainable emergency blood product those who are in the most critical need.