Blood transfusion safety in sub‐Saharan Africa: A literature review of changes and challenges in the 21st century

Abstract

BACKGROUND Access to a safe, adequate blood supply has proven challenging in sub‐Saharan Africa, where systemic deficiencies spanning policy, collections, testing, and posttransfusion surveillance have long been recognized. Progress in transfusion safety in the early 2000s was in large part due to intervention by the World Health Organization and other foreign governmental bodies, coupled with an influx of external funding. STUDY DESIGN AND METHODS A review of the literature was conducted to identify articles pertaining to blood safety in sub‐Saharan Africa from January 2009 to March 2018. The search was directed toward addressing the major elements of the blood safety chain, in the countries comprising the World Health Organization African region. Of 1380 articles, 531 met inclusion criteria and 136 articles were reviewed. RESULTS External support has been associated with increased recruitment of voluntary donors and expanded testing for the major transfusion‐transmitted infections (TTIs). However, the rates of TTIs among donors remain high. Regional education and training initiatives have been implemented, and a tiered accreditation process has been adopted. However, a general decline in funding for transfusion safety (2009 onwards) has strained the ability to maintain or improve transfusion‐related services. Critical areas of need include data collection and dissemination, epidemiological surveillance for TTIs, donor recruitment, quality assurance and oversight (notably laboratory testing), and hemovigilance. CONCLUSION Diminishing external support has been challenging for regional transfusion services. Critical areas of deficiency in regional blood transfusion safety remain. Nonetheless, substantive gains in education, training, and accreditation suggest durable gains in regional capacity.

Malaria parasitemia among blood donors in Uganda

“…While RDTs are likely the most practical malaria screening tool for blood donors, deferral of malaria positive donors in high prevalence areas may further exacerbate shortages in the blood supply. Approximately 40 countries in sub‐Saharan Africa fail to meet the WHOʼs donation goal of 10 units per 1000 population . Implementation of malaria screening would reduce the ability for endemic countries to meet current blood needs, thus leading to increased morbidity and mortality.…”

Inactivation of a broad spectrum of viruses and parasites by photochemical treatment of plasma and platelets using amotosalen and ultraviolet A light

“…Geographic differences in the risk of TTI remain influenced by socioeconomic factors, as screening is either not available or not practical . Areas of high pathogen prevalence may experience a high rate of donor deferral and subsequent lack of blood availability . In this situation, PRT may be beneficial in mitigating the risk of TTI and in improving blood availability.…”

Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

“…It is also an index of severity for morbidity outcomes given that both obstetric hemorrhage (OH) and antenatal anemia are major drivers of transfusion. OH, specifically, is a leading cause of maternal death, particularly in low‐middle‐income countries, where ready access to blood products is frequently lacking …”

“…Reasons that have been postulated for these increased rates of transfusion include a high prevalence of antenatal anemia, rendering some patients unable to tolerate the physiological blood loss associated with delivery. High incidence of peripartum blood transfusion is not unique to South Africa; rather, it is a major challenge in sub‐Saharan Africa, where there is already inability to meet regional transfusion demand . Indeed, an estimated quarter of all maternal deaths in sub‐Saharan Africa are attributed to lack of timely access to blood transfusion in times of emergency …”

“…High incidence of peripartum blood transfusion is not unique to South Africa; rather, it is a major challenge in sub-Saharan Africa, where there is already inability to meet regional transfusion demand. 3 Indeed, an estimated quarter of all maternal deaths in sub-Saharan Africa are attributed to lack of timely access to blood transfusion in times of emergency. 1 While there is a growing literature on peripartum blood transfusion, data on blood transfusion in the antenatal period (i.e., during pregnancy but >48 hr before delivery) are virtually absent.…”