The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood

Abstract

As a resource, allogenic blood has never been more in demand than it is today. Escalating elective surgery, shortages arising from a fall in supply, a lack of national blood transfusion services, policies, appropriate infrastructure, trained personnel, and financial resources to support the running of a voluntary nonremunerated donor transfusion service, and old and emerging threats of transfusion-transmitted infection, have all conspired to ensure that allogenic blood remains very much a vital but limited asset to healthcare delivery particularly in Sub-Saharan Africa. This is further aggravated by the predominance of family replacement and commercially remunerated blood donors, rather than regular benevolent, nonremunerated donors who give blood out of altruism. The demand for blood transfusion is high in Sub-Saharan Africa because of the high prevalence of anemia especially due to malaria and pregnancy-related complications. All stakeholders in blood transfusion have a significant challenge to apply the best available evidenced-based medical practices to the world-class management of this precious product in a bid to using blood more appropriately. Physicians in Sub-Saharan Africa must always keep in mind that the first and foremost strategy to avoid transfusion of allogenic blood is their thorough understanding of the pathophysiologic mechanisms involved in anemia and coagulopathy, and their thoughtful adherence to the evidenced-based good practices used in the developed world in a bid to potentially reduce the likelihood of allogenic blood transfusion in many patient groups. There is an urgent need to develop innovative ways to recruit and retain voluntary low-risk blood donors. Concerns about adverse effects of allogenic blood transfusion should prompt a review of transfusion practices and justify the need to search for transfusion alternatives to decrease or avoid the use of allogenic blood. These strategies should include the correction of anemia using pharmacological measures (use of antifibrinolytics to prevent bleeding and the use of erythropoietin and oral and intravenous iron to treat anemia) use of nonpharmacologic measures (preoperative autologous blood transfusion, perioperative red blood cell salvage and normothermia to reduce blood loss in surgical patients). All these strategies will help optimize the use of the limited blood stocks.

Aerial drones for blood delivery

“…World Health Organization statistics reveal that in Africa, at least 285,000 children under the age of 5 years died of severe malaria, which accounts for 41% of deaths among this cohort . Infrastructure challenges, difficulty recruiting volunteer donors, and the lack of a national blood transfusion service adds pressure to a fragile logistics system . Therefore, it is not surprising that many areas in Africa experience chronic blood shortages.…”

Intra-operative cell salvage in South Africa: Feasible, beneficial and economical

“…This study, however, included only cases with penetrating abdominal wounds and the authors raised the concern that employment of technologists to perform CS would incur prohibitive costs. [3] In our study, the costs of CS blood (consumables only) were lower than purchasing the equivalent RCC from SANBS. When machine depreciation costs are included, the Cell Saver blood became marginally more expensive than RCC.…”

“…Alternatives to traditional blood sources need to be found. [3] One option is cell salvage (CS) and reinfusion of autologous blood. Misconceptions regarding the use of this system are common, [4] and few data exist relating to its use in the SA context.…”

Evidencing the Role of Erythrocytic Apoptosis in Malarial Anemia

“…The use of adjunctive therapy for severe malarial anemia has not been well explored, possibly due to the common requirement for blood transfusion. However, the prevalence of blood-borne infections such as HIV in malaria endemic areas limits the availability and safety of blood transfusion (Osaro and Charles, 2011). Furthermore, blood transfusion shows a trend toward presentation of severe adverse events and does not significantly decrease mortality rates, underscoring the need for new strategies for treating severe malarial anemia (Meremikwu and Smith, 2000; Obonyo et al, 2007).…”