Survey of blood collection and transfusion practices among institutions in Africa

Abstract

IntroductionDramatic improvements in blood transfusion have occurred during the last two decades. Transfusion medicine services and practices in Africa remain underexplored.MethodsA survey of blood bank/transfusion medicine (BBTM) practices, available blood products, blood product source(s), pre‐transfusion testing, and blood donor infectious disease testing methodologies across Africa was performed using the American Society for Clinical Pathology (ASCP) listserv. Survey recipients included hospital‐based laboratories/blood banks, national transfusion medicine services, and free‐standing laboratories (collectively referred to as institutions).ResultsResponses from a total of 81 institutions across 22 countries were analyzed. All 81 institutions provide at least one type of blood product—whole blood, red blood cells (RBCs), platelets, plasma, and cryoprecipitate, with whole blood (90.1%, 73 of 81) and RBCs (79.0%, 64 of 81) most common, while cryoprecipitate is least common (12.4%, 10 of 81). Only five countries had a responding institution that provides all types of products. Among institutions that collect blood onsite, the most common sources of blood products are patients' family members (94.1%, 48 of 51) and pre‐screened on‐demand volunteer donors (82.4%, 42 of 51). The most commonly screened infectious agents are HIV and hepatitis B virus (both 81.5%), while 70.4% (57 of 81) test for hepatitis C virus (HCV) and Treponema pallidum.DiscussionThis study highlights significant variability and restrictions in blood product availability, pre‐transfusion testing, and blood donor infectious disease testing across Africa. Further studies are needed to ascertain barriers to improving blood donor availability, blood product safety, and infectious disease testing.

The World Health Organisation's list of essential medicines and haemophilia treatment products

“…The most recent Global status report on blood safety and availability issued by the WHO 11 shows that the prevalence of blood‐borne viruses in Low to Middle Income Countries (LMIC) and Low Income Countries (LIC) is approximately two orders of magnitude higher than it is in High Income Countries (HIC), causing the WHO to point out that ‘Prevalence of an infection among blood donations or the proportion of blood donations with a positive result are directly related to the safety of the blood supply, because they have an impact on the residual risk of distributed blood components for transfusion, and also on the risk due to errors in blood quarantine and release (even though test‐positive donations should be discarded)’. In a recent survey of blood collection and testing practices in Africa, 12 reported that a high percentage of respondents use suboptimal testing strategies, including Rapid Detection Tests (RDTs) 13 and antigen tests in lieu of Nucleic Acid Testing NAT 14 . While these testing strategies, imposed by economic factors, are undoubtedly improving the safety of transfused blood in LMIC and LIC, the increased risk of transfusion‐transmitted infections for chronically treated patients such as haemophiliacs, as modelled for HIV, 8 emphasises the need for the exposure of such patients to be minimised through pathogen reduction.…”