Its been a while since I did a general update on how things are going, what the blood bank community is up to and forecasting how things are impacting our healthcare. Definite TLDR warning...
First: Antibody Testing
A majority of blood centers stopped testing for COVID19 antibodies in late spring early summer 2021. Multiple factors contributed to this decision, the largest being the decline in patient needs for convalescent plasma (CCP). From Late March 2020 until February 2021, CCP orders exceeded supply nearly daily. At our center's peak, we were shipping nearly 300 units/doses per day (January 2020). By the end of April, we were shipping less that 50 doses per day.
We were testing nearly 30,000 donors/month at a cost of over $100,000/month to help identify candidates and plasma that could be labeled as CCP. The decline in usage meant that we had to really look at the unbudgeted expense as not meeting our primary mission - to make transfusions possible. We had built a significant stockpile of CCP from March-May, that was projected to meet patient needs through the end of the year. That all changed at the end of July 2021.
Donor enthusiasm for the anti-body testing had waned as well. Initially we saw an increase in our first time donor rate (FTD), as the general community was looking to see if they had some sort of immunity to covid19 through antibodies. Our FTD levelled off by March of 2021, and we were not getting the same traction, and again had to look at the calculus of where best to spend money to meet patient needs.
All that being said, we started anti-body testing again at our center for select donors last week. We are trying to re-identify CCP donors to meet patient demand as the "surge' has continued. (I hate using that word, but its the only way I can best relate to circumstances in the world.)
Starting 8/31/2021 we will begin testing all donations for COVID19 antibodies again at our center. Other centers are possibly starting again as well.
Important note: The test that we utilize only looks to identify the antibodies created via natural infection. These are commonly referred to a "N" proteins. (Nucleocapsid proteins) Different assays test for different proteins. Currently, all available vaccinations induce an antibody response to the S protein or Spike protein. Our antibody test does not test for those as we are not able to utilize those antibodies in the production of convalescent plasma. However, it is not uncommon for someone who have CV19, and perhaps had a low antibody titer (level) receive the vaccine and their N protein titer skyrocket as the body's immune system jumps into gear. See the "Texas Care's Thread about antibody testing... lots of cool data there.
Convalescent Plasma:
Since Mid-July 2021 orders started to increase slightly and then peaked in the last couple of weeks. Within 6 weeks, we had diminished our stock pile, and we have been bringing units in from neighbor centers who had some excess. However, that supply has dwindled as well.
As stated above, patient demand is our driver for what actions we take and pivots made throughout the pandemic. With the increase in demand and our renewed antibody testing at end of August, we are trying to not just meet current patient needs, but restock for any possible future waves.
In order to qualify to be a CCP donor, you must have developed natural antibodies to CV19 (there is also a vaccination rule that I will try to explain below) and otherwise qualify to donate transfusable plasma, and have a "high titer" of CV19 antibodies.
It is important to note this, as community blood banks are NOT plasma centers that pay. Plasma centers that pay, resell the collected plasma to pharma companies to develop IvIg (Immunoglobulin) treatments. A necessary treatment for immunodeficient patients, but it is not used in hospital transfusions for those currently ill.
Vaccinations:
First answer: NO, there is no choice at bedside to ask for blood from someone who is not vaccinated. It doesn't work that way, and frankly.... your about to die from not having enough blood, take what you can get and keep breathing. A good link to read about if curious.
covid-vaccines-blood-transfusions - The Washington Post
Obvious question next is: "Then why do you now ask if a donor has received a CV19 vaccine?"
Answer - it helps us determine eligibility for CCP, thats it. FDA guidance on what can be labeled CCP, is that it must be from someone who has had CV19, is high titer AND if they have had a vaccine is no greater than 6 months from infection.
The goal is to be able to ensure the purity and potency of the treatment via CCP. We want to make sure the patient receive the best liquid gold available. and that is antibody rich plasma from someone who is naturally over their infection.
Blood Supply:
The Bad news:
The blood supply both locally and nationally is struggling to maintain daily needs. We are consistently meeting the need but only on a 24 hour timeline. Any major disruption or disaster could be cripple patient needs quickly. Similar to the freeze of this winter, we had days where we had no collections and then days where we had no products to ship. Daily inventory updates are being sent to hospitals, and we are triaging where units go to meet the most urgent need.
The Good News:
The fall forecast looks good locally. We have been re-engaged with our schools, and if they hold and continue to book/keep their donation dates, we may be able to crawl out of this deficit and build inventory into the winter. We are cautiously optimistic.
16-19 year old's account for nearly 25% of the community blood supply. Since March of 2020, we have only regained about 14% of our historical collections of young donors. This is not just causing the immediate impact, but long term we are worried that we are not engaging with the donors of tomorrow. Young adults that will be critical to community needs in the next 10-15 years who will have missed having that first positive experience.
We have rebuilt our religious/healthcare/community collections segments and hope that the schools hold to help. Business segment is coming back, but we need work from home to be a return to work for large companies so we can get back in their doors as well.
TLDR: Donate blood, host a blood drive, don't worry about vaccinated vs. non-vax blood
First: Antibody Testing
A majority of blood centers stopped testing for COVID19 antibodies in late spring early summer 2021. Multiple factors contributed to this decision, the largest being the decline in patient needs for convalescent plasma (CCP). From Late March 2020 until February 2021, CCP orders exceeded supply nearly daily. At our center's peak, we were shipping nearly 300 units/doses per day (January 2020). By the end of April, we were shipping less that 50 doses per day.
We were testing nearly 30,000 donors/month at a cost of over $100,000/month to help identify candidates and plasma that could be labeled as CCP. The decline in usage meant that we had to really look at the unbudgeted expense as not meeting our primary mission - to make transfusions possible. We had built a significant stockpile of CCP from March-May, that was projected to meet patient needs through the end of the year. That all changed at the end of July 2021.
Donor enthusiasm for the anti-body testing had waned as well. Initially we saw an increase in our first time donor rate (FTD), as the general community was looking to see if they had some sort of immunity to covid19 through antibodies. Our FTD levelled off by March of 2021, and we were not getting the same traction, and again had to look at the calculus of where best to spend money to meet patient needs.
All that being said, we started anti-body testing again at our center for select donors last week. We are trying to re-identify CCP donors to meet patient demand as the "surge' has continued. (I hate using that word, but its the only way I can best relate to circumstances in the world.)
Starting 8/31/2021 we will begin testing all donations for COVID19 antibodies again at our center. Other centers are possibly starting again as well.
Important note: The test that we utilize only looks to identify the antibodies created via natural infection. These are commonly referred to a "N" proteins. (Nucleocapsid proteins) Different assays test for different proteins. Currently, all available vaccinations induce an antibody response to the S protein or Spike protein. Our antibody test does not test for those as we are not able to utilize those antibodies in the production of convalescent plasma. However, it is not uncommon for someone who have CV19, and perhaps had a low antibody titer (level) receive the vaccine and their N protein titer skyrocket as the body's immune system jumps into gear. See the "Texas Care's Thread about antibody testing... lots of cool data there.
Convalescent Plasma:
Since Mid-July 2021 orders started to increase slightly and then peaked in the last couple of weeks. Within 6 weeks, we had diminished our stock pile, and we have been bringing units in from neighbor centers who had some excess. However, that supply has dwindled as well.
As stated above, patient demand is our driver for what actions we take and pivots made throughout the pandemic. With the increase in demand and our renewed antibody testing at end of August, we are trying to not just meet current patient needs, but restock for any possible future waves.
In order to qualify to be a CCP donor, you must have developed natural antibodies to CV19 (there is also a vaccination rule that I will try to explain below) and otherwise qualify to donate transfusable plasma, and have a "high titer" of CV19 antibodies.
It is important to note this, as community blood banks are NOT plasma centers that pay. Plasma centers that pay, resell the collected plasma to pharma companies to develop IvIg (Immunoglobulin) treatments. A necessary treatment for immunodeficient patients, but it is not used in hospital transfusions for those currently ill.
Vaccinations:
First answer: NO, there is no choice at bedside to ask for blood from someone who is not vaccinated. It doesn't work that way, and frankly.... your about to die from not having enough blood, take what you can get and keep breathing. A good link to read about if curious.
covid-vaccines-blood-transfusions - The Washington Post
Obvious question next is: "Then why do you now ask if a donor has received a CV19 vaccine?"
Answer - it helps us determine eligibility for CCP, thats it. FDA guidance on what can be labeled CCP, is that it must be from someone who has had CV19, is high titer AND if they have had a vaccine is no greater than 6 months from infection.
The goal is to be able to ensure the purity and potency of the treatment via CCP. We want to make sure the patient receive the best liquid gold available. and that is antibody rich plasma from someone who is naturally over their infection.
Blood Supply:
The Bad news:
The blood supply both locally and nationally is struggling to maintain daily needs. We are consistently meeting the need but only on a 24 hour timeline. Any major disruption or disaster could be cripple patient needs quickly. Similar to the freeze of this winter, we had days where we had no collections and then days where we had no products to ship. Daily inventory updates are being sent to hospitals, and we are triaging where units go to meet the most urgent need.
The Good News:
The fall forecast looks good locally. We have been re-engaged with our schools, and if they hold and continue to book/keep their donation dates, we may be able to crawl out of this deficit and build inventory into the winter. We are cautiously optimistic.
16-19 year old's account for nearly 25% of the community blood supply. Since March of 2020, we have only regained about 14% of our historical collections of young donors. This is not just causing the immediate impact, but long term we are worried that we are not engaging with the donors of tomorrow. Young adults that will be critical to community needs in the next 10-15 years who will have missed having that first positive experience.
We have rebuilt our religious/healthcare/community collections segments and hope that the schools hold to help. Business segment is coming back, but we need work from home to be a return to work for large companies so we can get back in their doors as well.
TLDR: Donate blood, host a blood drive, don't worry about vaccinated vs. non-vax blood
