As more patients in the United States seek medical care amid the continuing Covid-19 pandemic and a recent increase in violent crime, the nation's blood supply has hit a "dangerously low" level—forcing some hospitals to delay or ration care.

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An 'unprecedented' shortage

Blood is always in high demand, ABC News reports. According to Red Cross, which provides about 40% of the nation's blood supply, U.S. patients require a total of 7,000 units of platelets and 36,000 units of red blood cells per day.

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Amid this high demand, experts say that "[p]eriodic, localized blood shortages are not uncommon," Modern Healthcare reports, a problem that hospitals usually address by shipping in blood from elsewhere.

Currently, however, the nation is facing dangerously low supply that is "unprecedented in its scope," according to American Association of Blood Banks CMO Claudia Cohn. As a result, hospitals and other medical facilities can no longer rely on other organizations having blood to share.

"The majority of blood centers are now reporting a one-day supply or less of blood, far below the levels for which they normally strive," Cohn added. "Since we are already experiencing a critical shortage at the beginning of summer, many blood centers are concerned that we will face chronic severe shortages all summer."

Specifically, the AABB Interorganizational Task Force on Domestic Disasters and Acts of Terrorism earlier this month said the nation's blood supply in June dropped to "red" levels, ABC News reports, which indicates a "dangerously low supply at blood centers nation-wide."

And Red Cross, which typically has a five-day supply of all types of blood on hand, currently has just a half-day's supply of type O blood, the blood type that—because it can be used for people with any blood type—is in highest demand among hospitals, the Boston Globe reports. "It's going out faster than it's coming in," Kelly Isenor, a spokesperson for the Red Cross of Massachusetts, said.

According to Cohn, this shortage could ultimately affect patient care. "When blood supply is less than adequate, patients may be affected," she said. "It means blood may not be available for all patients when it is needed, leading to suboptimal care for some patients."

What caused the shortage?

The shortage appears to have stemmed from a surge in demand coupled with a marked slowdown in blood collection amid the pandemic, the Globe reports.

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Specifically, experts say that in the wake of the pandemic, hospitals are performing more surgeries—and more intensive surgeries—than normal to meet the pent-up demand for procedures delayed amid the worst of Covid-19. The patients who delayed care "are now presenting with more advanced disease progression, so there's a greater chance they need blood transfusions," Isenor explained.

In addition, Isenor said there have been more "traumas and emergency room visits" this year than average. According to the Red Cross, the demand for blood from hospitals with trauma centers has increased by 10% in 2021 compared with 2019, and by more than five times in other facilities that provide transfusions.

In particular, the incidence of gunshot wounds is "significantly higher than it was prior to Covid," Babak Sarani, director of trauma and acute care surgery and co-medical director of critical care at George Washington University Hospital, said.

This increased demand has drained already limited blood collection organizations, "Over the last three months, the Red Cross has distributed about 75,000 blood products more than expected to meet hospital needs, significantly decreasing our national blood supply," Jessa Merrill, director of biomedical communications at the Red Cross, said.

Simultaneous with this increased demand, ABC News reports, is a severe decline in blood collection. Typically, according to ABC News, blood drives at schools contribute significantly to the overall national supply of blood. But many schools were closed amid the pandemic. And when school blood drives taper off in the summer, blood collection organizations typically rely on workplace blood drives, but many of those have also been cancelled, the Globe reports.

In addition, as people emerge from social distancing and isolation amid the pandemic, few are going to blood donation centers. "It's not surprising that giving blood isn't at the top of the list of what people want to do" after spending months indoors amid the pandemic, Isenor said.

As a result, according to Cohn, "[s]ome blood collections facilities have reported declines by as much as 50% below normal levels."

How hospitals are responding

In response to the shortage, some hospitals are triaging patients to ensure those most in need can access blood. Certain facilities said if the situation continues to worsen, they may once again delay scheduled procedures.

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For instance, Xiomara Fernandez, medical director of transfusion medicine and coagulation at the George Washington University Hospital, said, "We're screening based on criteria that has kicked in because now we're in a critical situation with all of our products. Any orders that don't meet our thresholds, so if anyone has a platelet count above 50 (and a platelet transfusion is ordered), that is definitely a red flag."

Some hospitals are also preparing to send incoming patients elsewhere, ABC News reports. "Last weekend I had the medical director from Washington Hospital, who was also a trauma center, calling me for help," Fernandez said. "She was afraid that, because of their inventory, if they had a trauma coming in, could they send them to us. Could our blood supply support it? Other medical directors have reached out to me and we're tightly monitoring our inventory."

Meanwhile, UMass Memorial Health has implemented measures to control blood use by verifying the need for any requested transfusion, reusing patients' lost blood by washing and recycling it, and curbing the risk of bleeding, according to Vishesh Chhibber, director of transfusion medicine at UMass Memorial. "We haven't seen anything like this in about 30 or 40 years at least," Chhibber said.

Similarly, Mass General Brigham has started to assess its options and prepare for the chance that the shortage could last for several months, according to Tom Sequist, the organization's chief patient experience and equity officer. He added that in a worst-case scenario, the health system may limit or reschedule certain procedures.

And Beth Israel Lahey Health said it has started to postpone certain scheduled procedures. It is also identifying patient's blood type on admittance, so the health system will not have to use type O blood supplies if not necessary.

Agencies call for donors

To address the shortage, Red Cross and other blood collection organizations have put out a call for donations.

For its part, Red Cross this week is asking for platelet and type O blood donations. The organization added that because of the recent decline in new Covid-19 cases and uptake of Covid-19 vaccinations, it has relaxed blood donation requirements and will no longer require fully vaccinated donors to wear masks or socially distance. Further, Red Cross said it would give donors a $5 Amazon gift card if they give blood by June 30.

Separately, Cohn called on eligible donors to give blood six times over the course of a year. "What we need is a sustained response. We need wave after wave after wave of donations,” she said, adding, "Blood is a critical, lifesaving therapy for millions of patients throughout the world—and the only source of blood is the generosity of donors" (Rosen, ABC News, 6/20; Knutson, Axios, 6/18; Freyer/Caldera, Boston Globe, 6/17; AP/Modern Healthcare, 6/20).