Hawaii faces “a state crisis right now” in its blood supply, with donation appointments plunging as much as 80% late last week before recovering slightly to deficits averaging about 35% each day this week, the Blood Bank of Hawaii said Wednesday.

At the same time, the COVID-19 crisis has forced the blood bank to suspend all of its neighbor island blood drives through at least April. Typically, the blood bank said, such donations supply about 20% of the state’s total.

The crisis situation was disclosed at a news conference led by Dr. Kim-Anh Nguyen, Blood Bank of Hawaii’s chief executive officer. Nguyen is a clinical pathologist and blood banking expert. She has led the local blood bank since 2013.

Nevertheless, Nguyen and other Blood Bank of Hawaii officials insisted they are confident the state can get through the COVID-19 crisis in terms of maintaining enough of a blood supply to meet the needs of hospitals on Oahu and the neighbor islands.

A phlebotomist for Blood Bank of Hawaii, Robert Protzman, prepares to take blood from volunteer Tiffani Loo during a blood drive at the Straub Medical Center in Honolulu last week. Blood Bank officials say they are facing a crisis now as appointments to donate drop. Ronen Zilberman/Civil Beat/2020

Nguyen said several aspects of Hawaii’s blood situation are unique and create special challenges to maintaining adequate stocks of blood and blood products.

For one thing, she said, only about 3.5% of Hawaii blood donors have blood type O-negative, generally known as the “universal donor” because it can be given safely to people with any other blood type. On the mainland, she said, about 7% have that type.

On the other hand, she said, because of Hawaii’s history of Polynesian and Pacific Island ethnicities, the state is the nation’s largest repository for an extremely rare type, Jk3-negative, which is so difficult to find that major mainland medical centers often find that the Blood Bank of Hawaii is the only available source.

“We must keep this repository up, for our children and family,” as well as for people who live elsewhere and may need Jk3-negative to survive certain medical and surgical procedures, Nguyen said.

Nguyen and Todd Lewis, the blood bank’s chief operating officer, said the organization typically needs to draw about 1,100 units of blood per week to keep up with ongoing statewide demand. But as the COVID-19 pandemic has hit, Lewis said, about 4,500 future donor appointments have been canceled.

Last Friday, Nguyen said, the blood bank had only 233 appointments on the books, an 80% shortfall. “When we look forward to an 80% deficit, we look at a critical shortage. We don’t know how long COVID-19 could last.”

By the middle of last weekend, she said, the situation had improved somewhat and the organization had 600 appointments booked. On Monday and Tuesday of this week, there have been about 135 appointments booked per day — still a shortfall below a daily objective of 200, but far better than the situation that presented itself last week, she said.

In addition to wiping out all blood donation efforts in Kauai, Hawaii and Maui counties, Nguyen and Lewis said, requirements for so-called “social distancing” and other public health tactics to slow the spread of the virus required that Blood Bank of Hawaii also suspend its normal collection routine in Honolulu.

Over the weekend, they said, the organization switched to an appointment system that limits donations to two permanent facilities and four temporary collection centers. The number of individuals permitted inside each collection center is being strictly limited to six to 10 at a time. Walk-ins cannot be accommodated.

Kiana Eldredge of the Hawaii Blood Bank takes blood from blood donor William Davis. The blood drive was sponsored by Straub Medical Center. Ronen Zilberman/Civil Beat/2020

Nguyen said the blood bank has concluded it will be unable to increase donations to the normal level as COVID-19 surges to new levels of penetration.

“Our goal is not to make up the capacity that we had before COVID-19,” she said. “Our goal was to prevent patients from dying. Where we are now is probably about 70% capacity. We’re not going for 100%. We cannot. We don’t have the bandwidth.”

Around the state, health officials said they have been monitoring the Blood Bank of Hawaii situation carefully. Lt. Gov. Josh Green, who is himself an emergency room physician, said that “as an ER doctor, I am concerned about blood shortages. Even during pandemics, critical blood needs don’t stop.”

People who have symptoms that might be consistent with COVID-19 should not make blood donation appointments.

Jason Chang, chief operating officer of The Queen’s Health Systems and president of The Queen’s Medical Center, said on Wednesday that the blood bank has worked closely with health care providers in alerting them to the potential for severe blood shortages.

Chang said the blood bank notified Queen’s of potential shortages and, as the state’s major trauma center, has been working with doctors on blood conservation.

He noted that Queen’s has an adequate blood supply currently.

A spokesman for Hawaii Pacific Health, which operates Wilcox Memorial Hospital on Kauai and Kapiolani Medical Center, Pali Momi Medical Center and Straub Medical Center on Oahu, said medical center officials are working closely with the blood bank to manage the blood supply.

Blood Bank of Hawaii officials stressed that, although there is no test available to check for the presence of the COVID-19 virus in donated blood, there is no reason for potential donors to be concerned about their safety since influenza strains and other coronaviruses do not survive in blood at levels that could threaten the health of a donor or recipient.

People who have symptoms that might be consistent with COVID-19 should not make blood donation appointments, nor should they place themselves in close physical proximity to any of the donation points, the blood bank said.

If an apparently well person donates blood, but then later experiences COVID-19 symptoms, the blood bank said the donor should call and the blood that was drawn will be pulled from any existing supply. People with potential COVID-19 symptoms will not be permitted past a security checkpoint at each donation center.

The collection locations include Blood Bank of Hawaii’s headquarters at 2043 Dillingham Blvd., and its primary collection center at 1907 Young St., both in Honolulu. In addition, pop-up locations have been sited at Kailua Town Center, Kaneohe Bay Shopping Center, Waikele Center and KROC Center Hawaii. The blood bank has put a special page on its website that details procedures and processes that will be followed to keep the state blood supply safe for the duration of the COVID-19 emergency.

The blood bank said it has not yet experienced delays in blood deliveries to neighbor island medical centers. The organization said Hawaiian Airlines, within the last few days, renewed its ongoing commitment to transport needed blood products between islands as quickly as possible.

“Every type is precious and every type is needed,” said Nguyen.

Right now, she said, “We’re short. We’re low on appointments. I think this state is in crisis right now, but it is not a crisis in the way we normally experience crises.”

She said that relying on mainland sources to make up any blood shortfall in Hawaii is not realistic and that many blood centers there are also experiencing shortfalls of their own as people withdraw to their homes under the lockdown orders that are increasingly common.

“As with everything, Hawaii has to provide for its own,” Nguyen said. “But I’m not concerned. Hawaii’s blood supply is walking around in the people of Hawaii.”

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