Blood transfusion in sub‐Saharan Africa: understanding the missing gap and responding to present and future challenges

Abstract

Blood transfusion in sub-Saharan Africa (SSA) is at a crossroad. Significant recent developments may help meet local needs in safe blood products and fulfil a global health target, as highlighted by the World Health Organization (WHO) Millennium and Sustainable Development Goals, in improving supply and safety, and ensuring the gradual implementation of selective haemotherapy. When WHO recommended the evaluation of convalescent blood or plasma to treat Ebola-infected patients during the recent epidemics, substantial gaps in local blood collection, testing and technology infrastructure and safety, as compared to best accepted quality standards, became evident. This evidence should now serve as an 'electro-shock'/awakening call used to highlight the needs for local governments to support National Blood Transfusion Services and establish robust national regulatory authorities that are mandated to bear regulatory responsibilities of blood establishments. A nationally co-ordinated blood programme is the best tool to gather reliable epidemiological data, address local needs in blood and blood products and serve public health. A literature review using WHO website and PubMed was conducted in this article to outline the current clinical use of blood products and plasma derivatives in SSA. This text also intends to highlight the gaps to be filled in the coming years with respect to quality, safety, supply and efficacy of blood and plasma products, in line with WHO guidelines for transfusion.

Rethinking the definition of maternal near‐miss in low‐income countries using data from 104 health facilities in Tanzania and Uganda

“…11,22 Massive transfusions of 5 units or more were extremely rare in the present study, reflecting the problems in blood transfusion services, as described elsewhere. 23 In both countries, a linear association was observed between the number of blood units transfused and organ dysfunction, suggesting that there is no clear optimal cut-off level.…”

Red Blood Cell Alloimmunization in Transfused Patients With Sickle Cell Disease in Sub-Saharan Africa; a Systematic Review and Meta-Analysis

“…At present, this may not be feasible because 1) most transfusions are given in emergency situations, 2) the limited availability of donor blood in SSA and 3) the cost. However, since patients with SCD are likely to be multiply transfused a more pragmatic approach to increase safety would be to Strengthening of haemovigilance systems in SSA are important, to accurately document the incidence of post transfusion complications including acute and delayed hemolytic transfusion reactions [12,71]. This would help quantify the extent of the clinical consequences of alloimmunization in patients with SCD.…”

The long and winding road to pathogen reduction of platelets, red blood cells and whole blood

“…Still, as noted in a recent FDA public workshop, affordability is a major limiting factor for broader PRT use in wealthy countries (Atreya et al , ). Future political, academic and commercial programmes should expand local considerations to include specific needs and economic capacities of geographical regions where the risks of transfusion‐transmitted infections exceed by several logs those observed in the advanced countries where PRTs have been developed and are, or will soon be, commercially available (Drew et al , ; Butler & McCullough, ; Ware et al , ; Barro et al , ; Weimer et al , ).…”