Chronic Blood Shortages Affect People With Cancer

COVID-19 Has Contributed to Chronic Blood Shortage

A woman with colorectal cancer with borderline low levels of hemoglobin was forced to wait for a transfusion until her hemoglobin dropped to a critical level. A 17-year-old had to delay chemotherapy for her leukemia due to low platelets and no available transfusion. These are a few stories that have appeared on social media and local news sites in recent months.

Behind these transfusion delays is a persistent blood supply problem with roots in the COVID-19 pandemic, according to Baia Lasky, MD, medical director of Biomedical Services at the American Red Cross. The organization has repeatedly put out messages about emergency blood and platelet shortages, stating in late November 2021 that the organization was entering the holiday season with its lowest blood supply for the time of year in more than a decade. Ideally, the Red Cross needs a five-day supply of blood on its shelves, Dr. Lasky said. Some days, it has less than half a day’s supply for certain blood types.

The shortages affect many people, but perhaps cancer patients most of all. People with cancer need more blood transfusions than those with any other disease, and they use about a quarter of the blood supply. Roughly half of all platelet donations go to people with cancer.

“It’s scary, because one major surgery or one major auto accident could take out the blood supply for an area,” said Claudia Cohn, MD, PhD, chief medical officer for the Association for the Advancement of Blood & Biotherapies and medical director of the Blood Bank at the University of Minnesota in Minneapolis. Dr. Cohn has seen many temporary shortages throughout her career, and they’re “an annoyance” but easy to deal with, she says. “This is the first time I’ve seen a shortage where we’re really worried because it’s chronic. It’s getting worse and worse.”

COVID-19 is the root of the shortage. High schools, colleges, and businesses – the main sites for blood drives – have drastically scaled back in-person gatherings, Dr. Lasky said. Even as many of these institutions have returned to in-person operations, they haven’t resumed their blood drives. Additionally, many donors have stopped visiting donation centers, again out of COVID-19 fears.

Blood supply problems began in March 2020 when donors began staying home to avoid the disease, Dr. Cohn said. At the time, she feared the worst. But then the Surgeon General ordered her hospital to stop elective surgeries because intensive care units were filling up with COVID-19 patients. This ended up saving a considerable amount of blood. For a while, the blood supply recovered. Then hospitals resumed elective surgeries, and the shortage became dire again. “Patients began to return to the hospitals in droves, I suppose to make up for lost time,” Dr. Cohn said.

For a short time in early 2021, Dr. Cohn began to see a return to normal. With increasing vaccination rates, the U.S. seemed to be emerging from the pandemic. But then the Delta variant began circulating in spring and early summer of 2021, and she heard whispers of blood shortages again. “I wasn’t yet worried. I thought they were just ripples in the system, essentially. But those things that I thought were going to be minor shortages, that was just the beginning of what we’re seeing now,” she said.

Donations usually dip in the summer, with schools closed and many people away on vacation. Blood donors usually return in the fall, but they haven’t in 2021. As of late September 2021, donations were down 10% compared to August, according to the Red Cross. That’s a major concern because donations usually fall again in winter due to the holiday school break. Additionally, winter snowstorms prevent people from reaching donation centers and blood drives.

The workforce shortage affecting businesses across the country is also hurting blood donation. “Blood centers simply are not having enough employees available to collect the blood,” Dr. Cohn said.

Cancer patients need blood for many reasons. By impairing organs such as the spleen and kidneys, cancer can lower blood counts, according to the American Cancer Society. People with blood cancers often need transfusions because they can’t make enough blood cells on their own. Some cancers, particularly those of the digestive system, can cause internal bleeding, which leads to anemia from too few red blood cells. And when a person has any type of cancer for a long time, they may develop anemia that requires treatment through transfusion.

Many cancer treatments also call for transfusions. Surgical treatments can lead to blood loss, and that blood often needs to be replaced. Side effects of chemotherapy can include damage to bone marrow, which is where the body makes red blood cells; this often leads to low blood counts and potentially life-threatening infections or bleeding. Radiation that targets large parts of bones can lead to similar damage of the bone marrow.

The severity of the blood shortage means that cancer patients who need transfusions can’t always get them immediately. “We have to start making choices. Do we give it to that trauma victim who’s come in with a car crash? Or do we give it to the cancer patient who needs it to continue functioning?” Dr. Cohn said. “Those are horrible, difficult choices to make. And hospitals are starting to have to make them because the blood shortage is getting that bad.”

Hospitals can tweak their normal blood transfusion processes to save some of their supply. But that’s not enough to solve the crisis, which is why blood bank managers are encouraging people who are eligible to donate blood, or to encourage their family, friends, and care partners to do so. “I really want to encourage people to please, if they have donated before, please come and donate again. If they have not donated before, please consider it,” Dr. Lasky said. “Every unit has a chance to save someone’s life. So, we really need people to roll up their sleeves and donate.”