As the coronavirus disease 2019 (COVID-19) continues to spread in Africa, unprecedented disruptions at all levels of human endeavours including healthcare delivery systems have been recorded.¹ One of the major areas of healthcare systems affected is blood supply – a commodity needed for the survival of many patients. Blood and blood products such as cryoprecipitate, plasma, immune globulins, platelets, etc., are required for the management of medical conditions including but not limited to trauma, renal impairment, cancer, sickle cell anaemia, haemorrhagic shock, and other medical conditions related to acute or chronic loss of blood.

Despite the COVID-19 pandemic, health problems and accidents occur including maternal morbidities, malnutrition, blood-transmitted infectious diseases (HIV and AIDS, hepatitis C virus infection, hepatitis B virus infection, syphilis and anaemia-inducing infectious diseases such as malaria, which is particularly worse in rainy seasons in countries such as Malawi and Nigeria,² kidney disease, liver disease, and cancer, etc.). Hence, blood donation shortages caused by the COVID-19 pandemic are wrecking Africa’s already overwhelmed blood transfusion services and are a guaranteed threat to a positive patient outcome, particularly for children under the age of 5, who are the recipients of 54% of the 118.5 million blood collected in low-income countries.³

In countries that rely on voluntary blood donations, particularly from students, the trends of blood supply and donation are likely to decline in many other countries if the COVID-19 pandemic continues. This will consequently and adversely affect beneficiaries in various hospitals, particularly in countries whose sole blood donors are volunteers and students.⁴

Blood transfusions save lives, hence the need to maintain an adequate supply of blood. Blood donors have made it possible for blood to be available for transfusion to other patients. These donors can either be family members, voluntary non-renumerated donors, or paid donors. The World Health Organization preferentially recommends voluntary non-renumerated donors as the major source of blood for transfusion purposes.^5,6 The uncertainty in the pattern of blood demand and supply and the inadequacy of human resources (which can be reduced due to ill health) are some of the most pressing challenges posed by the COVID-19 pandemic.⁷ The major contributors to low donations in Africa are restricted movements, lockdowns, and closure of blood donation institutions.⁸ Others include fear of contracting COVID-19 by both donors and healthcare workers due to limited knowledge on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. In Zambia, for instance, there was a sharp decline in the number of blood donations because donors were afraid that by donating their blood, they could contract the virus. The lockdown imposed in the country was also a precipitating factor.⁵ However, the challenge might be more severe in countries where blood donation is not a culture. For instance, in Kenya, less than 1% of the 47 million Kenyans donated blood in the 2018/2019 year.⁹ In South Africa, there was a decreased blood supply and increased blood demand when schools and colleges were shut down because over 30% of the below 1% daily blood donors are younger than 25 years old.¹⁰

COVID-19 has caused some blood transfusion centres to miss their blood collection targets. For instance, the Zambia National Blood Transfusion Services target for the first quarter of 2020 was 18 750 units, but the institution barely collected 6516 units, representing 34.7% of the initial target.⁵ The Botswana Blood Transfusion Service had enjoyed an annual collection of 25 000 units, but due to COVID-19 preventive measures, only 11 000 units had been collected as of May 2020. This implied an impending decrease in the units of blood obtainable in a pandemic-affected year.⁸ The National Blood Transfusion Services in Botswana was able to collect only about 23 000 units of blood and blood products against the 45 000 units set as the target for the year 2020.¹¹ In Kenya, COVID-19 has also reduced blood collection manpower (staff) due to ill health, social distancing measures placed in all institutions, and the lack of sufficient effective protective equipment to ensure staff and client safety.⁹

A study conducted at a teaching hospital in Nigeria revealed that 71.4% of patients with various types of malignancies such as acute myeloid leukaemia, bladder cancer, extra-orbital malignancy, prostate cancer, and lung cancer died due to the lockdown imposed in the country which disrupted the availability of blood donors.¹² To this end, transfusion institutions – both hospital and independent blood transfusion units – have a key role to play in monitoring the demand and supply of blood and blood products to ensure that these products are adequately available.

When considering issues related to the availability of blood and blood products for clinical management, the principle of demand and supply should be evaluated.¹³