The following is applicable to all physicians as of March 18, 2020 as per Dr. Brian Berry, Director of Hematopathology.
Effective immediately, the National Advisory Committee on Blood and Blood Products has issued a Green Phase Advisory concerning all fresh blood components and plasma protein products in response to significant concerns that the national blood supply may come under pressure as a result of decreased donations in the context of the Covid-19 pandemic.
In order to preserve this life-saving resource, physicians should follow best transfusion practice and avoid unnecessary RBC transfusions:
- Transfusion requirements are primarily based on cardiovascular status (e.g. cardiac chest pain, congestive heart failure and hypotension unresponsive to fluid bolus).
- When transfusion is required, one unit at a time (based on cardiovascular features described above and current hemoglobin level) is generally best practice and should be followed by clinical re-evaluation before subsequent units are considered.
- A restrictive transfusion practice can avoid adverse outcomes and decrease transfusion requirements (e.g. 70 g/L threshold in stable hospitalized patients).
- Anemia related to nutritional deficiency (iron, vitamin B12 deficiency) are often well compensated through plasma volume expansion, even when anemia is severe. Transfusion decisions should be based on cardiovascular status primarily rather than hemoglobin level. The erythropoietic response to Iron/Vit B12 therapy is typically brisk and RBC transfusions can often be avoided.
For further information, please refer to Best Practice References for RBC Transfusion on the Transfusion Medicine intranet page.