Fewer pet owners are bringing their pets to donate blood during the pandemic, yet demand for blood products is rising as advanced care becomes more routine.
Amid this shortage, veterinarians in California are also starting the transition from closed-colony commercial blood banks to local donor-based banks.
Dr. Anne S. Hale has founded and led animal blood service providers since the mid-1990s. Her recent work includes managing research and commercialization of veterinary blood products for The Platelet Farm in New Mexico and acting as chief technical officer for BodeVet, an animal blood products company.
Dr. Hale said the shortage of veterinary blood products has been growing over the past 20 years as transfusions have shifted from being a rarity to a daily element of emergency room and specialty veterinary practice. At the same time, fewer veterinarians secured donated blood supplies because fewer of them were working as solo-practice generalists.
“That doesn’t happen as often these days as we have more centralized ER and specialty practice,” she said.
As practices and hospitals grew, securing blood supplies needed a centralized source—such as a structured, national blood donation program—which hasn’t emerged.
“Our concerns are that, as we advance in critical care medicine, internal medicine, oncology, all of those have needs and wants for blood products as part of their treatment protocols,” Dr. Hale said. “We don’t have a real opportunity to bring together an organized way of providing blood products across the nation.”
Dr. Jimmy Barr, chief medical officer for BluePearl Specialty and Emergency Pet Hospital, said blood donations at company hospitals have been up and down quarterly, but they, overall, have been on a downward trend during the pandemic.
Eleven of BluePearl’s hospitals run local blood banks that typically supply enough blood for their own patients, although some of those hospitals supplement donated blood with commercial supplies. Others have enough to share with other hospitals with acute needs, which can include hospitals outside the company. BluePearl plans to increase coordination among those banks in 2022.
“We’re going to be more intentional about developing our volunteer donor program throughout the country and having, sort of, a national blood bank coordinated within BluePearl,” Dr. Barr said. “But that’s only to try to increase the number of donors within the industry—within the profession.”
Local donors can expand supplies
Veterinarians have made do, but they risk falling behind as demand for advanced care grows, said Dr. Hale, who currently works as a regional director for Pathway Veterinary Alliance, the medical director for the Albuquerque, New Mexico–based Veterinary Emergency and Specialty Centers, and an internal medicine clinician.
National-level commercial blood banks provide 30%-40% of needed blood products, Dr. Hale said. She thinks the profession needs veterinarians who specialize in securing blood donations in every community, similar to what the Red Cross does to secure blood donations for human medicine.
“I think that it is time for us to look nationally at establishing a volunteer donor program that is unified and capable of providing the resource that we need,” she said.
Clinicians should be able to decide whether to start a transfusion by judging what is best for the patient rather than how much blood is in the refrigerator, she said.
For now, veterinarians can establish networks of volunteer donors and develop relationships with commercial blood banks.
“We have individuals within our veterinary community who are looking at this resource, trying to develop it,” Dr. Hale said. “And we need to make sure that the veterinary community values a secure blood supply for our veterinary patients.”
Dr. Barr hopes that, by growing the blood supply for BluePearl, the company can both supply blood for its own hospitals and make blood products more available across the veterinary profession.
“The amount of equipment that’s needed to actually run a pretty good blood bank is not that complex,” he said.
A hospital can maintain a blood bank in a hospital’s back room with veterinary technicians running it. A list of blood donors can help when there’s an emergency need for a fresh whole-blood transfusion.
Blood donations have been up and down with an overall declining trend during the pandemic.
Dr. Barr said commercial blood banks are convenient sources, and he thinks fewer veterinary clinics and hospitals, overall, are collecting local blood supplies.
“People are relying more on the commercial blood banks,” he said. “And, to their credit, they have done a good job of matching supply and demand better over the last few years, I think, but still you run into issues of getting blood.”
Veterinarians need to be ready to gather blood, and it helps to keep a list of dog erythrocyte antigen 1.1–positive and –negative dogs whose owners they can call on in an emergency.
Despite the shortages reported in pet medicine, officials from the American Association of Equine Practitioners indicated they saw no shortage of blood products in equine medicine, and, in response to an inquiry from JAVMA News, one representative checked with three key suppliers to verify supplies remained adequate.
California transitioning to local sources
Amid the shortage, California’s state government is phasing out veterinarians’ use of closed-colony blood suppliers, which are to be replaced as veterinarians create local community-based blood donation networks. The California Department of Food and Agriculture is helping lead that transition, and department officials plan to help guide the veterinary community through the transition.
Dr. Annette Jones, California’s state veterinarian, said CDFA officials recognize the importance of publishing standards for the community blood suppliers and will seek expert input as a priority in 2022. But she said it’s difficult to predict how soon guidance will be available.
Dr. Grant Miller, director of regulatory affairs for the California VMA, noted that Assembly Bill 1282, signed into law by Gov. Gavin Newsom on Oct. 9, provides a $1 million appropriation to the CDFA to create an advisory committee of blood banking experts who can create guidance documents and help establish best practices. And each community blood bank will be subject to inspections by the state veterinary board.
Dr. Miller said that, prior to the change in law, veterinarians in the state were mostly limited to obtaining blood from the two closed-colony suppliers operating in the state: Hemopet in the south and Animal Blood Resources International in the north. The law provided narrow exemptions for blood drawn for use within the clinic or hospital and didn’t allow sale or transfer to other facilities. All other state systems that he is familiar with incorporate both commercial and local blood supplies.
“There certainly are shortages, and they’re everywhere,” Dr. Miller said. “I don’t think that you can call a veterinarian anywhere in the United States and have them feel totally comfortable in being able to obtain blood products that they need.”
Dr. Jones described California’s legal limitations as a safety issue. She said that veterinarians have always been able to operate community blood banks for use in their own patients, and the limitations prohibit sales or transfer of blood to other hospitals because such products lack regulatory oversight.
“The original California blood bank laws were put into place to ensure that these life-saving products were produced consistently and safely,” she said.
The previous blood bank laws incorporated standards and inspections to ensure the animals donating blood for sale or transfer were healthy and treated humanely, she said.
Dr. Miller said frozen plasma and concentrated platelets are often in short supply, and CVMA leaders have been concerned about the supply of blood as the state’s veterinarians embark on the transition to community-based veterinary blood banks.
But Dr. Miller noted that the CVMA had worked with legislators to ensure the closed-colony banks will remain available until California Department of Food and Agriculture officials verify the community-based banks can consistently supply adequate blood products. They will need to produce sufficient amounts of whole blood, frozen plasma, and concentrated platelets for four consecutive quarters, and the department maintains the ability to delay full transition if production declines.
Dr. Miller acknowledged that California is shifting to an unproven model, which is why the state is dipping a toe rather than diving in.
He thinks California’s veterinarians see the change in law as an opportunity to expand their practice capabilities.
He noted that the recently passed law provided assurances the state would give expert guidance, regulate bank safety, and ensure community-based banks were providing adequate, sustained supplies prior to completing the transition away from closed-colony banks. He hopes the community banks will help alleviate the shortage of blood products.