Transfusion Safety: Lessons Learned In Ibero-America And Considerations For Their Global Applicability

Abstract

The safety of blood used for transfusions has historically been the main focus of the international health community. In the Americas, during the first decade of the 21st Century, the attention switched to the patients who need transfusions and to the individuals who donate blood, that is, to transfusion safety. Timely and universal access to blood components implied adequate availability to sufficient blood components by patients who require transfusions in every hospital of every country. Clinical conditions and local non-medical factors influence decisions to admit and transfuse ill individuals. Locally-developed pertinent transfusion guidelines contribute to better estimate blood needs. Replacement blood donation hinders access to blood stocked in the hospitals blood banks and results in excessive component expiry and financial losses. Focusing on patient transfusion needs and on patient outcomes permits implementing national blood collection, processing and distribution, in consonance with the national health system. Analyses of general health conditions, by using the national Human Health Indexes, and the operational characteristics of blood services, by using the blood center density index, permit identification of locally pertinent interventions to improve transfusion safety. For this article, the analytical approaches used in Ibero-America were applied to blood data from South-East Asian and African countries. Data collection and validation were identified as priorities for Asian countries. Estimating blood component requirements at the local level and adjusting blood collection, processing and distribution systems are important in Africa.

Keywords:

• blood safety
• transfusion safety
• blood donors
• Human Health Index
• Ibero-America

Abbreviations

AFCO, African countries; BCDI, blood center density index; HHI, Human Health Index; IBCO, Ibero-American countries; IMR, infant mortality rate; LLMC, low- and lower-middle income countries; MMR, maternal mortality ratio; PAHO, Pan American Health Organization; RBC, red blood cells; RBD, REPLACEMENT blood donation; SECO, South-East Asian countries; TTI, transfusion-transmissible infections; VBD, voluntary blood donation; WHA, World Health Assembly; WHO, World Health Organization.

Data Availability

Pan American Health Organization. Supply of blood for transfusion in Latin American and Caribbean countries 2012 and 2013. https://apps.who.int/iris/handle/10665/310766?show=ful. World Health Organization. 2016 Global Status Report on Blood Safety and Availability. https://apps.who.int/iris/bitstream/handle/10665/254987/9789241565431-eng.pdf?sequence=1. Pan American Health Organization. Supply of blood for transfusion in Latin American and Caribbean countries 2014 and 2015. https://apps.who.int/iris/handle/10665/310766?show=ful.

Acknowledgments

The author acknowledges Ms. Donna Eberwine-Villagran for her editorial support.

Disclosure

The author was Regional Advisor on Laboratory and Blood Services (1994–2011) and Senior Advisor on Health Technologies for Quality of Care (2009–2011), Pan American Health Organization, Regional Office for the Americas, World Health Organization. He was also a member of AABB Global Standards Committee (2015–2017). He is an honorary member of Grupo Cooperativo Ibero-Americano de Medicina Transfusional (GCIAMT, 2013–present), a member of Education Committee of the African Society for Transfusion Medicine (2017–present). The author reports no other conflicts of interest in this work.