As a result of social restrictions and health risk concerns related to the COVID-19 pandemic, blood donations have decreased compared to prior years. Sean Stowell, MD, associate professor of pathology at Brigham and Women’s Hospital in Boston, and colleagues compared plasma donations to whole blood donations from 2019 to 2021 to examine the effect of COVID-19. Their results are published in Blood.
“All blood donation decreased immediately following the onset of the [COVID-19] pandemic,” Dr. Stowell told ASH Clinical News. “However, while red blood cell and platelet donations began to recover, source plasma donations remained below pre-pandemic levels.”
Plasma is a hospital staple, supplying clotting factors and immunoglobulins for surgeries and treatment of hematologic, renal, and other conditions. Plasma for these products can take up to a year to process, and unlike regionally sourced platelets and whole blood, it only comes from the U.S. and four other countries where it is legal to compensate plasma donors.
“Based on our analysis, the effect of the pandemic on source plasma donation and the subsequent availability of plasma-derived therapeutics may represent a hidden problem that may be felt for some time after the pandemic,” Dr. Stowell said.
To investigate the risk of an impending plasma shortage, the researchers analyzed the number of plasma units processed by Qualtex, a large U.S. based blood and plasma product testing laboratory, from September 2019 to July 2021. The analysis included about 500 collection centers in the U.S. There was a sharp drop in total units for both whole blood and plasma immediately following the onset of the pandemic in March 2020. Although there was an uptick in the number of whole blood donations (35-45,000 units/month), they did not return to pre-pandemic volumes (50-60,000 units/month).
Plasma donations did not rebound and stabilize like whole blood donations. Among the 22 largest plasma centers, there was a sharp decrease in supply in spring 2020, a modest recovery in summer and fall, and then another decrease starting in January 2021 to 40% of pre-pandemic levels.
The authors noted that despite the decrease in plasma donations at the largest centers, smaller centers have been established, though these are not enough to reverse the negative trend.
Since it can take up to a year for plasma to be processed into various plasma-derived medicinal products, the effect of its shortage in health care is not experienced as acutely as that of red blood cells and platelets. As a result, a lack of a sufficient plasma supply can continue relatively unnoticed for a long time before the health care system feels the effects.
“As plasma-derived proteins are used in a variety of clinical settings, including clotting factor replacement therapy, fluid replacement during procedures, and for a variety of autoimmune conditions, shortages in plasma-derived products could affect our ability to treat many different patient populations,” Dr. Stowell noted.
For Dr. Stowell, this plasma sourcing issue that has been laid bare during the COVID-19 pandemic raises the question of whether the U.S. should re-evaluate the mechanisms by which source plasma is collected. About two-thirds of the source plasma used to make plasma-derived clinical products worldwide comes from the U.S.
“The pandemic has taught us that this approach to plasma donation is uniquely vulnerable to economic and other pressures a pandemic can create,” he said. “This includes a need for convalescent plasma, which may or may not be used as source plasma for manufacturing therapeutics. While appropriate attention to blood shortages offers a well-established mechanism to increase blood donation for red blood cell and platelet units, a similar strategy does not exist to correct deficits in source plasma donation."
Any conflicts of interest declared by the authors can be found in the original article.
Covington ML, Voma C, Stowell SR. Shortage of plasma-derived products: a looming crisis? [published online ahead of print, 2022 Mar 8]. Blood. doi: 10.1182/blood.2021015370.