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Background Transfusion services aim to maintain sufficient blood inventory to support patients, even with challenges introduced by COVID-19. Objectives To review blood usage and wastage before, during, and after COVID-19 surges, and to evaluate effects on inventory. Methods In a retrospective review, we evaluated the association between time periods corresponding to the initial wave of COVID-19 (pre–COVID-19, quarantine, and postquarantine) and blood usage/wastage. Data were stratified by period, and χ 2 testing was used to examine the association between these time periods and blood usage/wastage. Results In the period before COVID-19, the transfusion service used more units, and in the period after quarantine, more units went to waste. Across all time periods, the most-used product was RBCs, and the most wasted product was plasma. A statistically significant association existed between usage (χ 2 [6/3209 (0.2%)]) = 24.534; P ≤.001; Cramer V = 0.62), wastage (χ 2 [6/775 (0.8%)]) = 21.673; P =.001; Cramer V = 0.118), and time period. The postquarantine period displayed the highest wastage costs ($51,032.35), compared with the pre–COVID-19 period ($29,734.45). Conclusion Changes in blood inventory use and waste are significantly associated with the onset and continuation of COVID-19. [ABSTRACT FROM AUTHOR]