Role of donor self‐reporting in securing blood safety during COVID‐19 pandemic

This is the authors' abstract. We don't add key points for this paper.

Blood safety is of paramount importance, and many advances in transfusion medicine lower current transfusion risk. Emerging infectious diseases always put pressure on blood service with regard to the protection of blood safety. Although the transfusion transmissibility of SARS-CoV-2 in the COVID-19 pandemic has not been reported and remains theoretical,1-3 several precautious measures have been in place since early 2020 to ensure blood safety and ease public concerns. These include travel and contact history deferral, eligibility screening, use of face mask, hand sanitizer and temperature checking before and during blood donation.4 In addition, all donors should be reminded to report any symptom or sign of medical illnesses after blood donation so that mitigating measures can be taken as soon as possible. Even with this approach, there are still case reports of donors reporting to the blood centre with confirmed COVID-19 a few days after donation. Although their blood samples at donation were negative for viraemia, it continues to raise concerns regarding transmissibility and blood safety.3, 5 Reminding donors to report or about post-donation self-exclusion (PDSE) could be a simple but important tool to enhance blood safety. It not only allows opportunities for donors to provide additional health- or blood safety-related information, as in the case of confidential unit exclusions in preventing potential transfusion-transmitted viral diseases such as HIV and hepatitis, but also to report on any medical illness that is developed after blood donation.6, 7 Locally, the blood service has routinely implemented this voluntary PDSE reminder for more than 20 years as part of its comprehensive blood safety measures. Given the similarities between symptoms and signs of COVID-19 and upper respiratory tract infection (URTI), surveillance of URTI-related PDSE can play a surrogate role for the early detection of COVID-19 in blood donors, such that precautionary measures could be taken promptly to prevent the issue or transfusion of the blood components. For the period from January 2017 to December 2019, PDSE was reported in 0.37% of blood donations, with an average of 57% related to symptoms and signs of URTI. Some seasonal trends of increasing reports were seen when the influenza season prevailed (Figure 1). Interestingly, the number of URTI-related PDSE was observed to decrease significantly from 12 (0.06% of donation) in February 2020 to the lowest number of 2 in June 2020 (0.01% of donation). The findings are indeed consistent with local reports of fewer influenza cases during the same period.8, 9 It could be postulated that, during the COVID-19 epidemic, the public are concerned with stringent infection control measures such as social distancing and the use of face mask and hand sanitizer, which render them less likely to get or transmit the respiratory virus infection. As a result, this led to fewer reported URTI-related PDSE. On the other hand, the blood service continues to receive call-backs from donors for safety precautions as a result of either exposure or contact history with family members or colleagues who were diagnosed to have COVID-19. Over the same period, 24 donors reported to the blood service post-donation as they had recalled recent travel history (n = 3) or were informed of exposure to and/or contact with persons who were COVID-19 positive (n = 21). The donors' own follow-up actions were variable, from none and self-quarantine to COVID-19 testing. Nevertheless, upon contact by the blood service at 14 and 28 days, none of them were found to have COVID-19. In summary, the COVID-19 pandemic has put much pressure on the healthcare system and the society. Blood services are no exception, with continuous challenges in managing blood supply, the need to implement proactive measures in securing blood safety and efforts to follow up donors post-donation. Nevertheless, it not only creates an opportunity to enhance the existing contingency response plan to ensure business continuity but also engages donors further in securing blood safety. In this short review, it is recommended that reminding donors to report any symptoms developed after blood donation should be adopted as routine practice as an additional blood safety measure. The authors have no competing interests. SC Ng, CK So, CW Lau, JNS Leung - data collection SC Ng, CK Lee - writing the manuscript All - review manuscript.