History of Blood Transfusion in Sub-Saharan Africa

Abstract

The adequacy and safety of blood transfusion in sub-Saharan Africa is the subject of much concern, yet there have been very few studies of its history. An overview of that record finds that transfusions were first reported in Africa (sub-Saharan and excluding South Africa) in the early 1920s, and organized transfusion practices were established before the Second World War. Blood transfusion grew rapidly after 1945, along with the construction of new hospitals and expanded health services in Africa. Significant differences existed between colonial powers in the organization of transfusion services, but these converged after independence as their use continued to grow and decentralized and hospital-based practices were adopted. It was only after the oil crisis in the mid-1970s that health spending declined and the collection, testing, and transfusion of blood began to level off. Thus, when the AIDS crisis hit transfusion services, they were already struggling to meet the needs of patients. At this time, foreign assistance as well as the World Health Organization and the League of Red Cross Societies helped respond to both the immediate problem of testing blood, and for some countries, support existed for the broader reorganization of transfusion. Overall, the history shows that transfusion was adopted widely and quickly, limited mainly by the availability of knowledgeable doctors and hospital facilities. There was less resistance than expected by Africans to receive transfusions, and the record shows a remarkable flexibility in obtaining blood. The dangers of disease transmission were recognized from an early date but were balanced against the potential lifesaving benefits of transfusion.

Hemoglobin concentrations and RBC transfusion thresholds in patients with acute brain injury: an international survey

“…Second, previous surveys have been focused only on physicians in North America, whereas we report that a conservative (i.e., 7–8 g/dl) threshold of Hb was more often used in Asia/Africa and Oceania than in Europe to initiate transfusion. The lower threshold used in African and Asian countries may be due to limited resources and less blood availability, as well as to shortage of other supplies (e.g., bottles, bags) and greater risk of blood contamination [22]. The differences between Europe and Oceania may be explained by national and statewide initiatives in Australia/New Zealand to encourage implementation of patient blood management programs as a cost-effective standard of care in their public health system, whereas this approach is not entirely integrated into routine management in Europe [23, 24].…”

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

“…In low‐income countries, up to 65% of blood transfusions are given to children under 5 years of age, whereas in high‐income countries, approximately 76% of the blood supply is received by patient groups over 65 . While whole blood was the sole immediate choice as blood product during the recent past of transfusions in SSA , modern medical practitioners utilize components of the blood, such as red blood cells, platelets, plasma and fractions enriched in clotting factors for better selective therapy of patients and to maximize the benefits of each transfusion. Whole blood can be readily separated into different products, namely red cell concentrate (RCC), platelet concentrate (PC), fresh frozen plasma (FFP, defined as a plasma that is frozen within 24 h after blood collection), as well as cryoprecipitate when needed.…”

Red Blood Cells Derived from Whole Blood Treated with Riboflavin and UV Light Maintain Adequate Cell Quality through 21 Days of Storage

“…The approach that many national and international organizations have taken in providing support to these centres is to attempt to move treatment towards what is commonly done in high-income index (HII) nations [2,3]. For blood banking practices, that means the use of components, screening, blood collection and separation technology, blood storage technology and blood testing methods that were developed over decades in Western medical practices and in parallel with the expansion and development of new methods in treatment of patients requiring transfusion support.…”