1. OMS em África
  2. Blood Safety

Blood Safety

Blood Safety

    Overview

    Blood transfusion saves lives and improves health, but many patients requiring transfusion do not have timely access to safe blood.

    The African Region faces a high demand for blood transfusion due to bleeding related to pregnancy and childbirth, high prevalence of malaria with the attendant complication of severe malarial anemia, high rates of road traffic accidents and other types of injury as well as other indications for blood transfusion.

    Ensuring universal access of all the population to a safe blood supply faces several challenges in the region. These include a high burden of disease transmissible through blood transfusion, including HIV, HBV, HCV and syphilis; posing difficulties in selecting donors at reduced risk of infection, unstable economies, lack of suitable infrastructure to provide blood services, inadequate human resources as well as lack of conducive career development structures for BTS staff in many member states. Reliance on family replacement donations, limited coverage and quality of testing, inappropriate blood transfusion and poorly developed quality systems pose additional challenges.

    There is a constant need for regular blood donation because it can only be stored for a limited time before use. A sufficient number of regular Volunteer Non-Remunerated Blood Donors (VNRBD) and the ability to process whole blood into components are needed to ensure that safe blood will be available whenever and wherever it is needed.

    All blood donations need to be screened for HIV, hepatitis B, hepatitis C and syphilis prior to use. Irregular supply of test kits is one of the most reported barrier to comprehensive screening.

    WHO Response

    The risk of transmission of serious infections, including HIV and hepatitis, through unsafe blood and chronic blood shortages brought global attention to the importance of blood safety and availability. With the goal of ensuring universal access to safe blood and blood products, WHO has been at the forefront to improve blood safety and availability, and recommends the following integrated strategy for blood safety and availability:

    • Establishment of a national blood system with well-organized and coordinated blood transfusion services, effective evidence-based and ethical national blood policies, and legislation and regulation, that can provide sufficient and timely supplies of safe blood and blood products to meet the transfusion needs of all patients.
    • Collection of blood, plasma and other blood components from low-risk, regular, voluntary unpaid donors through the strengthening of donation systems, and effective donor management, including care and counselling.
    • Quality-assured screening of all donated blood for transfusion-transmissible infections (TTIs), including HIV, hepatitis B, hepatitis C and syphilis, confirmatory testing of the results of all donors screen-reactive for infection markers, blood grouping and compatibility testing, and systems for processing blood into blood products (blood components for transfusion and plasma derived-medicinal products), as appropriate, to meet health care needs.
    • Rational use of blood and blood products to reduce unnecessary transfusions and minimize the risks associated with transfusion, the use of alternatives to transfusion, where possible, and safe and good clinical transfusion practices, including patient blood management.
    • Step-wise implementation of effective quality systems, including quality management, standards, good manufacturing practices, documentation, training of all staff, and quality assessment

    Through its Blood and Transfusion Safety programme, WHO supports countries in developing national blood systems to ensure timely access to safe and sufficient supplies of blood and blood products and good transfusion practices to meet the patients’ needs. The programme provides policy guidance and technical assistance to countries for ensuring universal access to safe blood and blood products and work towards self-sufficiency in safe blood and blood products based on voluntary unpaid blood donation to achieve universal health coverage.

    Main Health issues

    The unavailability of timely, safe blood transfusions has led to many otherwise avoidable deaths. A consistent supply of blood is a cornerstone of any health-care system, but this relies on regular donations and effective health-care infrastructure.

    Huge gaps exist between low, middle- and high-income countries regarding blood donation. Currently, African countries collect only 5.2 units of blood for every 1,000 people, below the ten donations or more per 1,000 people recommended by WHO and far from the 31.5 donations in high-income countries, 16.4 donations in upper-middle-income countries and 6.6 donations in lower-middle-income countries.
    In addition, only 18 out of 47 countries had reached the regional target of at least 80% of blood supply from Volunteer Non-Remunerated Blood Donors. Yet, the demand for blood remains constant, while the supply often falls short.

    Compounding insufficient collection rates is the inability of many health-care systems to adequately screen 100 % of transfused blood units for the mandatory TTIs as recommended: in 2022 the average percentage of blood units collected, screened before transfusion was 99.9% for HIV and HBV, 97.3% for HCV and 97.1% for syphilis while only 62.2% of the countries participated in an external quality assessment scheme for  TTIs.
    Inadequate testing contributes to the spread of transfusion-transmissible infections, which can compromise the patient’s wellbeing and further strain health-care systems.
    Blood can be used more effectively if it is processed into components, such as red cell concentrates, platelet concentrates, plasma, and cryoprecipitate. Up to now, the average percentage of whole blood collected and separated into blood components is 59.7% undermining the patient’s right to benefit from the appropriate blood component at the wright time.  
    Most of the countries in the African Region experience a dire shortage of Plasma Derived Medicinal Products (PDMPs) which are needed to prevent and treat a variety of serious conditions: only one country produces all or part of its PDMPs through the fractionation of plasma collected locally.

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