Critical crossroads: The unseen toll on healthcare workers in the face of a lingering blood shortage
Key Takeaways
Blood donations have decreased by 40% over the last 20 years, with the American Red Cross declaring an emergency blood shortage this month.
Experts say that the blood shortage is forcing physicians to make hard decisions about who should or should not receive a transfusion. However, clinicians are also in a unique position to refresh their transfusion practices and make better blood management decisions.
There are a number of things that could be done to boost donor turnout, from undertaking mass media campaigns to reopening donor sites.
The American Red Cross (ARC) declared an emergency blood shortage on January 7, part of an ongoing issue that has seen a 40% decrease in blood donation over the last 20 years. Between Christmas and New Year’s Day in 2023, there was a 7,000-unit shortfall in blood donations, leading to “a huge impact on the availability of blood products and dramatic consequences for those in need of emergency blood transfusion,” according to the ARC.[]
There are many reasons for the drop, the ARC posits. First, there were eligibility issues, including raising the minimum hemoglobin thresholds. This change led to donor deferrals, especially among 16–18-year-old donors. Shifts in blood transfusion protocols in hospitals also impacted the demand for blood. More so, the COVID-19 pandemic created major barriers to donor turnout.
The ARC warns that seasonal respiratory illnesses, like the flu, could further disrupt blood donor turnout, compounding an already critical situation.
What does the blood shortage mean for practitioners?
Eric Gehrie, MD, an executive medical director at the ARC, echoes this sentiment. “As a former hospital-based blood bank director, I can tell you that a blood shortage can challenge any hospital to meet the needs of all their patients,” Dr. Gehrie tells MDLinx.
Jagdish Khubchandani, PhD, Professor of Public Health at New Mexico State University, explains that the shortage leads to a national—and global—rationing of blood. “Clinicians in parts of the world are making difficult decisions [about] who should or should not get a transfusion. This is not an ideal practice for patient survival and health outcomes,” Khubchandani says.
For example, Dr. Gehrie says that it’s not uncommon for a mother experiencing a severe postpartum hemorrhage to require up to hundreds of units of blood to be stabilized. “In a shortage, [however,] it takes longer for those units to be replaced and could mean that doctors have to postpone other important care, like heart surgeries and transfusions for patients with cancer or sickle cell disease, while waiting for the blood supply to be replenished.”
Khubchandani also provides a few examples of real-life situations made worse by a lack of blood: “Trauma centers that are dealing with more injuries and violent crime–related trauma would be an example of emergency need for blood,” he says. “They constantly have to be supplied adequately to transfuse blood as needed to save lives.”
Another example?: Patients needing blood for non-life-threatening conditions or, say, chemotherapy, would see a delay in treatment. “In both instances, the care becomes suboptimal, and patient health outcomes may worsen,” Khubchandani adds.
What can be done to manage blood supply and boost donor turnout?
According to a 2022 piece published in Annals of Surgery, the blood shortage is a symptom of an “overburdened, over-consumed healthcare system.” Unlike in other areas of the world, “healthcare providers in the United States have often practiced with
Surgeons can play a key role in proper blood management, according to the aforementioned article. “The main tenets include optimizing perioperative strategies to enhance red cell mass, intraoperative strategies to reduce blood loss (such as intraoperative cell salvage), and thoughtful management of anemia,” the authors write, sharing suggestions from The American College of Surgeons.
little regard for resource utilization—perhaps until now.”[]
To manage this reality, Khubchandani says that “healthcare practitioners should sensitize themselves to good transfusion practices, [like] liberal versus conservative [transfusions] or transfusions for clinical indications versus laboratory values. [But] more research is needed on this topic as it relates to clinician training [and the] benefits/harms of each approach,” he says.
“Surgeons are uniquely positioned to provide the bedside decisions regarding product utilization and to have a larger engagement creating proactive policies to address a long-lasting sustainable supply…The onus is on clinicians to maintain the evidence-based transfusion recommendations,” they continue.
To boost turnout, Khubchandani encourages the reopening of donation sites and drives at schools, colleges, and worksites, incentivizing donors, and creating mass media campaigns involving celebrities.
At healthcare facilities, health workers and visitors could be encouraged to donate as well. In a hospital setting, Khubchandani says, “Reduce waste. Assess hospital-wide usage and conduct quality improvement assessments of usage. Transfuse only the amount needed to reach a clinical parameter.”