Transfusion requirements in patients with COVID‐19

Since the emergence of COVID-19 in late 2019, our knowledge of the clinical implications of infection with SARS-CoV-2 has steadily grown. The clinical spectrum of COVID-19 is broad, ranging from asymptomatic infection to multi-organ failure. COVID-19 induces a proinflammatory state, activating systemic coagulation and resulting in markedly elevated D-Dimers, fibrinogen and a prolongation of the prothrombin time (PT) (Tang et al, 2020). Initial studies reported the development of Disseminated Intravascular Coagulation (DIC), associated with poorer outcomes (Tang et al, 2020). DIC results from perturbations in the normal haemostatic balance and may produce a clinical phenotype of thrombosis, bleeding or a combination thereof. Subsequently, the International Society on Thrombosis and Haemostasis (ISTH) issued guidance on the management of DIC in this setting (Thachil et al, 2020). This guidance was controversial, recommending admission based on coagulation parameters and more liberal transfusion thresholds (maintaining platelets >25 in non-bleeding patients). At this time, COVID-19 represented a particular challenge to transfusion services as concerns existed that transfusion requirements may be increased at a time of limited donor availability. Despite increasing data on thrombotic sequalae of COVID-19, there remains a paucity of information on transfusion requirements in this clinical setting. This is of importance, not only for physicians, but for clinical transfusion services in order to plan stock management during the pandemic. To address this deficit, we retrospectively analysed the transfusion records and outcomes of a large cohort of patients with COVID-19.