{"doi":"10.1111/bjh.17005","title":"COVID‐19 insights from transfusion medicine","abstract":"The emergence of coronavirus disease 2019 (COVID-19) in the first months of 2020 resulted in a massive surge in admissions to hospitals and intensive care units due to the nature of the respiratory pathophysiology. In some countries, healthcare systems were rapidly overwhelmed, while in others their hospitals coped with the first wave and all patients received the level of care needed, depending upon both the containment measured and the level of development of the healthcare systems. Transfusion medicine services have prepared for possible blood shortages caused by a drop in blood donations, if donors became reluctant to participate in blood drives at the usual rate or became symptomatic and unable to donate.1, 2 However, shortages were often avoided, as the lack of donations was more than compensated for by an actual drop in blood component utilisation, as elective procedures with anticipated blood demand were postponed.3, 4 Planning with uncertain timelines and erring on the safe side had previously triggered surpluses with increased outdating of blood components.5 The first analyses of patients with COVID-19 in Wuhan, China did not report a substantial need for blood transfusion.4 For the patients who did require transfusion, the component types and clinical indications remained to be discerned. In this issue, Doyle et al.6 describe transfusion practice for patients with COVID-19 in intensive care units (ICUs), some requiring extracorporeal membrane oxygenation (ECMO), as one of the first reports on this topic. In this analysis of 235 patients, within 6 weeks, approximately 20% required one or more red cell transfusions, 3% required platelet transfusion and 2% each required fresh frozen plasma or cryoprecipitate. More than 50% of the patients with ECMO used blood components compared to 14% without ECMO. Plasma from convalescent donors was unavailable at the centre during these first 6 weeks. The transfusion requirements were low, unless ECMO was necessary. And blood usage seemed almost restricted to red cell components. During ECMO, the red cell usage in patients with COVID-196 resembled usage in patients without COVID-19.7 The indications for transfusion in patients without ECMO should be described in greater detail in future studies. One could explore the outcomes, for instance in those 15% of all red cell transfusions that were used for red cell exchanges alone. Which comorbidities are predisposing to blood transfusion and severity of viral disease? This short report from critical care at a large academic centre in London, UK6 may not be representative of general clinical settings in primary care hospitals. Hence, more such descriptions of transfusion requirements could be informative, which will eventually allow us to compare the practice among patient cohorts in different countries. There are hardly any reasons, however, to suspect blood component usage would be greater in patients with COVID-19 outside of critical care than inside. Should there be a blood shortage, this would be induced by the supply side rather than any blood demand of this pandemic. Why then should studying transfusion requirements be worthwhile in patients with COVID-19? To understand the pathophysiology of COVID-19, data analysis employs stratification of patients. Transfusion indications and requirements can serve as surrogate markers for the pathophysiology, such as disease severity. For instance, blood cell counts correlated with disease onset and recovery.8, 9 Proper patient blood management should always be applied,10 particularly to limit blood sampling for study purposes before prompting any transfusion need. In rapid reporting succession, patients with COVID-19 have been documented to develop cold agglutinin disease,11 the relatively more common autoimmune haemolytic anaemia12, 13 or immune thrombocytopenia14 and their combination as Evans syndrome.15 Each of these clinical entities can progress to require transfusions of red cells or pla","journal":"British Journal of Haematology","year":2020,"id":88303,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":10,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9489,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":347479,"name":"Willy A. Flegel","orcid":"0000-0002-1631-7198","position":0,"is_corresponding":true}],"reference_count":41,"raw_metadata":null,"created_at":"2026-07-18T22:00:56.736935Z","pmid":"32640485","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}