Blood transfusion practices and blood-banking services in a Kenyan hospital

Lackritz, Eve; Tk, Ruebush; Zucker,; Je, Adungosi; Jb, Were; Campbell, C. C.

doi:10.1097/00002030-199307000-00014

Cited by 54 publications

(57 citation statements)

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“…Moreover, only banked blood will be available early during hospitalization, when transfusion may be most effective to increase survival. 7,9 Because of the increasing HIV prevalence among blood donors in most African settings, safe blood has become a scarce and costly resource. It was estimated to cost $14 to remove one HIV-contaminated unit by blood screening in Kenya (Lackritz EM and others, unpublished data).…”

Section: Discussionmentioning

confidence: 99%

“…7,8 The prevalence of HIV infection among blood donors has increased in most developing countries, and at least 10% of all African pediatric acquired immunodeficiency syndrome (AIDS) cases may have arisen from contaminated blood transfusions. 2,[9][10][11] Many African countries, particularly where P. falciparum malaria is endemic and HIV/AIDS is a major health issue, cannot maintain an adequate blood supply, and fail to screen all their donated blood. [11][12][13][14] Even screened blood can be infectious, with a risk that depends on the background seroprevalence among the blood donors and on the quality of the screening.…”

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confidence: 99%

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Blood transfusions for severe malaria-related anemia in Africa: a decision analysis.

Obonyo

Oloo²,

Habbema³

1998

The American Journal of Tropical Medicine and Hygiene

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Abstract. Severe childhood malarial anemia is commonly treated using blood transfusion. Although transfusion may decrease short-term mortality, the risk of human immunodeficiency virus (HIV) transmission is considerable in Africa. We constructed a decision tree to weigh the short-term mortality benefit of transfusion against HIV infection risk. Probability estimates were derived from published studies. The base-case was a two-year-old child with a 13.5% mortality risk to be transfused with screened or unscreened blood (1% or 13% HIV contamination risk, respectively), with reduction of mortality to 5.5% by transfusion (odds ratio ϭ 2.7), and a 2.4% risk of fatal transfusion complications. A sensitivity analysis was performed to assess the influence of variation in these estimates. If a child developed acquired immunodeficiency syndrome, survival was weighed as one-tenth of normal survival. For the base-case, we found that transfusion with screened blood provided a survival benefit of 5%. In contrast, transfusion with unscreened blood decreased survival by 2%. Patients with a mortality risk Ͻ 5% derived no benefit from a transfusion with screened blood. Other important factors for the benefit of transfusion were the effectiveness of transfusion in reducing mortality and the risk of blood contamination. A blood transfusion was clearly beneficial if the mortality risk was high and the risk of contamination was low. Our findings can be used as a basis for a clinical transfusion policy that limits transfusions to situations in which they are likely to be beneficial. This will in turn optimize child survival and prevent unnecessary exposure of low risk children to the transfusion risks.With the risk of transmission of the human immunodeficiency virus type-1 (HIV-1), the use of blood transfusion in the management of severe pediatric anemia has become an important clinical decision problem in Africa.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Blood transfusions for severe malaria-related anemia in Africa: a decision analysis.

Obonyo

Oloo²,

Habbema³

1998

The American Journal of Tropical Medicine and Hygiene

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“…HIV incidence and prevalence, injection, and fertility rates were calculated from a general population cohort in rural Masaka (1989-2000) (11,22,23). Transfusion rates and transfusion and injection safety were estimated from observational studies in Masaka and Mbarara districts, Uganda, and the WHO region that includes Uganda (9,13,(24)(25)(26)(27)(28)(29). HIV transmission probabilities were estimated from a systematic literature review and other observational studies (1,4,(6)(7)(8)30).…”

Section: Methodsmentioning

confidence: 99%

Quantifying HIV-1 transmission due to contaminated injections

White

Cooper²,

Kedhar³

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

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Assessments of the importance of different routes of HIV-1 (HIV)transmission are vital for prioritization of control efforts. Lack of consistent direct data and large uncertainty in the risk of HIV transmission from HIV-contaminated injections has made quantifying the proportion of transmission caused by contaminated injections in sub-Saharan Africa difficult and unavoidably subjective. Depending on the risk assumed, estimates have ranged from 2.5% to 30% or more. We present a method based on an agestructured transmission model that allows the relative contribution of HIV-contaminated injections, and other routes of HIV transmission, to be robustly estimated, both fully quantifying and substantially reducing the associated uncertainty. To do this, we adopt a Bayesian perspective, and show how prior beliefs regarding the safety of injections and the proportion of HIV incidence due to contaminated injections should, in many cases, be substantially modified in light of age-stratified incidence and injection data, resulting in improved (posterior) estimates. Applying the method to data from rural southwest Uganda, we show that the highest estimates of the proportion of incidence due to injections are reduced from 15.5% (95% credible interval) (0.7%, 44.9%) to 5.2% (0.5%, 17.0%) if random mixing is assumed, and from 14.6% (0.7%, 42.5%) to 11.8% (1.2%, 32.5%) under assortative mixing. Lower, and more widely accepted, estimates remain largely unchanged, between 1% and 3% (0.1-6.3%). Although important uncertainty remains, our analysis shows that in rural Uganda, contaminated injections are unlikely to account for a large proportion of HIV incidence. This result is likely to be generalizable to many other populations in sub-Saharan Africa.

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“…14 It is questionable whether hospital based family replacement blood banks are ever going to be able to maintain adequate blood supplies to meet these needs. 15 There is also clear evidence that a strictly volunteer donor system does not provide sufficient blood, estimated to range between 15 and 20 units/ 1000 inhabitants. 16 In sub-Saharan Africa, neither centralised national systems nor hospital-based systems even reach 10 units/1000, 7 suggesting that, at least for some years to come, both systems should coexist in order to provide patients with the blood they critically need.…”

Section: Adequate Blood Supply and Mortalitymentioning

confidence: 99%

Transfusion in sub-Saharan Africa: does a Western model fit?

Field¹,

Allain

2007

J Clin Pathol

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This review examines the current state of transfusion services in sub-Saharan Africa and presents the argument for and against the Western model of a centralised blood service with 100% voluntary non-remunerated blood donors as advocated by the World Health Organization. The current practice of family replacement donors in hospital-based blood service is the most economical option, but in the face of high child and maternal mortality rates the blood supply has proved to be insufficient. With estimates of 5–10% of HIV transmission in Africa being the result of contaminated blood transfusions, there is a need to improve testing for transfusion transmissible diseases and the selection of blood donors. Of major concern, with respect to testing, is the quality of kits being used and the continuity of supply. The need to produce components is discussed in the context of the transfusion needs in sub-Saharan Africa. The running costs of establishing and maintaining centralised blood services need careful consideration as such projects need to be sustainable in the future. It is concluded that both options are viable while centralised programmes are being developed, and a pragmatic approach should be taken to ensure that the patients’ needs are met and that resources are suitably utilised to ensure sustainability.

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Blood transfusion practices and blood-banking services in a Kenyan hospital

Cited by 54 publications

References 0 publications

Blood transfusions for severe malaria-related anemia in Africa: a decision analysis.

Blood transfusions for severe malaria-related anemia in Africa: a decision analysis.

Quantifying HIV-1 transmission due to contaminated injections

Transfusion in sub-Saharan Africa: does a Western model fit?

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