When people have medical issues, they assume they are going to get good care, said Sarah Bay of Peterborough, a nurse practitioner and midwife who works at St. Joseph’s Hospital in Nashua.

“Everybody just thinks, ‘If I get in a car accident, people will be able to fix me,” she said.

However, she said that level of care isn’t always available right now because of a lack of resources, in particular, blood. She said the hospital usually has upwards of 40 units available, but was down to four, when a trauma like a shooting or car accident can require eight to 12 units.

“This is something the average person can do something about by giving blood,” said Bay, who is in her 11th year in the field. “Everyone else who’s healthy and well needs to go out and help others, and donating blood is one way to do that.”

In January, Bay was part of a routine delivery, but one in which the mother had a postpartum hemorrhage. According to Bay, even small hospitals like St. Joseph’s or Monadnock Community Hospital in Peterborough have a handful of hemorrhages per year, but was always confident they would be able to handle them. However, in this case, Bay stated they were told by the blood bank that they could not have the requested blood until the mother had lost 2,000cc, as only seriously ill patients were eligible for blood replacement due to shortages.

Medicines eventually stopped the bleeding, but Bay said it shook everybody because in normal times it was something they would have handled, but in 10 more minutes the mother probably would have had to be sent to Boston for treatment or even died.

According to Bay, the mother did eventually receive two units of blood, but when mothers go home after considerable blood loss, she said they could be anemic, which could affect their recovery, including the ability to produce breast milk.

“Your body is working so hard to rebuild its own resources, it can’t feed someone else,” she said.

Bay said she and her colleagues are now trying to build mothers’ red blood cell counts before birth with iron supplements and medicines, so that they won’t need to go to the blood bank. But it’s not just mothers who need red blood cells, Bay said. They affect healing in many circumstances, including cancer treatment or car accidents

“We all know someone who needs blood,” she said.

Blood shortages in and of themselves are not uncommon, according to Red Cross Regional Communications Manager Mary Brant.

“There is only one source of blood, and that’s a healthy volunteer donor,” she said. Prior to the pandemic, only about 3% of the United States population were blood donors, and donated blood only has a shelf life of 42 days, making it so that blood is always a critical need.

But this shortage is different, Brant said. In January, the Red Cross declared that the shortage was national, the first time it has done that in the history of the organization, according to Brant. It’s the worst blood shortage in more than a decade, and is becoming critical.

Its causes, Brant said, are mostly due to COVID-19, much like impacts on many other organizations. Of the 3% of Americans donating before the pandemic, there has been about a 10% decline. Additionally, a lack of staffing for blood drives has shut many of them down, making it so there aren’t local places to donate.

A key factor, according to Brant, is the closure of schools and colleges. Many donation drives are organized through schools, and Brant said that the Red Cross has seen a 62% drop in these. In 2019, Gen Z donors accounted for a quarter of all donors. In 2021, they made up just about 10%.

This is all happening despite efforts from the Red Cross to appeal to donors and ask for more support.

“Usually when we do that, we see an immediate rise in appointments and people coming out to help,” Brant said. “That bounce-back never happened.”

These compounding factors and the long months that this pattern has held have created this crisis, according to Brant. Now, she said, there needs to be a push to have as many people donate blood as possible, especially those with the universal blood type, O-negative.

“Every community in America needs blood on a daily basis,” she said. “It’s the blood on the shelves that saves lives.”

At Monadnock Community Hospital, the blood shortage has not gone so far as to affect individual patients, according to Chief Medical Officer Dan Perli.

“We’ve been very fortunate that we’ve not had to restrict any of our usage, or the shortage affecting our patient care,” he said.

That being said, the hospital has had to be careful and make what laboratory manager Deborah Morris referred to as contingency plans related to the blood shortage.

“We’re a small, critical-access hospital, and one of the things that we did even prior to last year was start enhancing our communications about the blood supply with our neighboring hospitals and with all the blood bank hospitals in New Hampshire,” she said.

Perli said these elevated levels of communication involved conversations around how to keep the shortage under control.

“We’ve had conversations around adjusting thresholds for transfusion and tightening up the indications, waiting a little bit longer,” he said.

These conversations are a positive impact of the pandemic, according to Morris, something that developed naturally with COVID-19 and helps enhance patient care.

Morris said that along with other hospitals, MCH is in constant contact with the Red Cross, communicating about the shortage and how to address it. She said that she is seeing signs of blood drives coming back, and that people should get out and donate if they are able.

“The biggest impact on our blood supply is our donors,” she said. “Now we’re just starting to see the beginnings of the blood supply getting, I won’t say normal, but getting back that way.”

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