Blood safety and availability

Key facts
?    Of the 108 million blood donations collected globally, approximately half of these are collected in the high-income countries, home to 18% of the world’s population. This shows an increase of almost 25% from 80 million donations collected in 2004.
?    In low-income countries, up to 65% of blood transfusions are given to children under 5 years of age; whereas in high-income countries, the most frequently transfused patient group is over 65 years of age, accounting for up to 76% of all transfusions.
?    Blood donation rate in high-income countries is 36.8 donations per 1000 population; 11.7 donations in middle-income and 3.9 donations in low-income countries.
?    An increase of 8.6 million blood donations from voluntary unpaid donors has been reported from 2004 to 2012. In total, 73 countries collect over 90% of their blood supply from voluntary unpaid blood donors; however, 72 countries collect more than 50% of their blood supply from family/replacement or paid donors.
?    Only 43 of 156 reporting countries produce plasma-derived medicinal products (PDMP) through the fractionation of plasma collected in the country, whereas the majority of the other 113 countries import PDMP from abroad.

The theme of this year’s campaign of World Blood Donor Day is "Thank you for saving my life". It focuses on thanking blood donors who save lives every day through their blood donations and strongly encourages more people all over the world to donate blood voluntarily and regularly with the slogan “Give freely, give often. Blood donation matters.” The campaign aims to highlight stories from people whose lives have been saved through blood donation, as a way of motivating regular blood donors to continue giving blood and people in good health who have never given blood to begin doing so.
National blood policy and organization
Blood transfusion saves lives and improves health, but many patients requiring transfusion do not have timely access to safe blood. Providing safe and adequate blood should be an integral part of every country’s national health care policy and infrastructure.
WHO recommends that all activities related to blood collection, testing, processing, storage and distribution be coordinated at the national level through effective organization and integrated blood supply networks. The national blood system should be governed by national blood policy and legislative framework to promote uniform implementation of standards and consistency in the quality and safety of blood and blood products.
In 2012, 70% countries had a national blood policy, compared with 60% countries in 2004. Overall, 62% countries have specific legislation covering the safety and quality of blood transfusion:
81% high-income countries ;
60% middle-income countries; and
44% low-income countries.
Blood supply
About 108 million blood donations are collected worldwide. More than half of these are collected in high-income countries, home to 18% of the world’s population.
About 10 000 blood centres in 168 countries report collecting a total of 83 million donations. Collections at blood centres vary according to income group. The median annual donations per blood centre is 3100 in the low- and middle-income countries, as compared to 15 000 in the high-income countries.
There is a marked difference in the level of access to blood between low- and high-income countries. The whole blood donation rate is an indicator for the general availability of blood in a country.
The median blood donation rate in high-income countries is 36.8 donations per 1000 population. This compares with 11.7 donations in middle-income countries and 3.9 donations in low-income countries.
75 countries report collecting fewer than 10 donations per 1 000 population. Of these, 40 countries are in WHO’s African Region, 8 in the Americas, 7 in the Eastern Mediterranean Region, 6 in Europe, 6 in South-Eastern Asian and 8 in the Western Pacific. All are low- or middle-income countries.
Blood donors
Age and gender of blood donors
Data about the gender profile of blood donors show that globally 30% of blood donations are given by women, although this ranges widely. In 20 of the 111 reporting countries, less than 10% donations are given by female donors.
The age profile of blood donors shows that more young people donate blood in low- and middle-income countries, proportionally than in high-income countries. Demographic information of blood donors is important for formulating and monitoring recruitment strategies.
Types of blood donors
There are 3 types of blood donors:
voluntary unpaid;
family/replacement; and
paid.
An adequate and reliable supply of safe blood can be assured by a stable base of regular, voluntary, unpaid blood donors. These donors are also the safest group of donors as the prevalence of bloodborne infections is lowest among this group. World Health Assembly resolution (WHA63.12) urges all Member States to develop national blood systems based on
voluntary unpaid donation and work towards the goal of self-sufficiency.
Data reported to WHO shows significant increases of voluntary unpaid blood donations in low- and middle-income countries:
An increase of 8.6 million blood donations from voluntary unpaid donors from 2004 to 2012 has been reported by 162 countries. The highest increase of voluntary unpaid blood donations is in the South-East Asia (78%) and African (51%) Regions. The maximum increase in absolute numbers was reported in the Western Pacific Region.
73 countries collect more than 90% of their blood supply from voluntary unpaid blood donations (38 high-income countries, 26 middle-income countries and 9 low-income countries). This includes 60 countries with 100% (or more than 99%) of their blood supply from voluntary unpaid blood donors.
In 72 countries, more than 50% of the blood supply is still dependent on family/replacement and paid blood donors (8 high-income countries, 48 middle-income countries and 16 low-income countries).
25 countries still report collecting paid donations in 2012, around 1 500 000 donations in total.
Blood screening
WHO recommends that all blood donations should be screened for infections prior to use. Screening should be mandatory for HIV, hepatitis B, hepatitis C and syphilis. Blood screening should be performed according to the quality system requirements.
25 countries are not able to screen all donated blood for 1 or more of the above infections.
Irregular supply of test kits is one of the most commonly reported barriers to screening.
97% blood screening laboratories in high-income countries are monitored through external quality assessment schemes, as compared to 33% in middle-income countries and 16% in low-income countries.
The prevalence of transfusion-transmissible infections (TTI) in blood donations in high-income countries is considerably lower than in low- and middle-income countries.
These differences reflects the variation in prevalence among population who are eligible to donate blood, the type of donors (such as voluntary unpaid blood donors from lower risk populations ) and the effectiveness of the system of educating and selecting donors.
Blood processing
Blood collected in an anticoagulant can be stored and transfused to a patient in an unmodified state. This is known as ‘whole blood’ transfusion. However, blood can be used more effectively if it is processed into components, such as red cell concentrates, platelet concentrates, plasma and cryoprecipitate. In this way, it can meet the needs of more than one patient.
The capacity to provide patients with the different blood components they require is still limited in low-income countries: 45% of the blood collected in low-income countries is separated into components, 80% in middle-income countries and 95% in high-income countries.
Supply of plasma-derived medicinal products (PDMP)
World Health Assembly resolution (WHA63.12) urges Member States to establish, implement and support nationally-coordinated, efficiently-managed and sustainable blood and plasma programmes according to the availability of resources, with the aim of achieving self-sufficiency. It is the responsibility of individual governments to ensure sufficient and equitable supply of plasma-derived medicinal products namely immunoglobulins and coagulation factors, which are needed to prevent and treat a variety of serious conditions that occur worldwide.
43 countries (23 high-income, 18 middle-income, 2 low-income) of the 156 reporting countries, reported producing all or part of the PDMP through the fractionation (e.g. domestic or/and contract fractionation) of plasma collected in the country.
35 of the 43 countries report plasma fractionation carried out within the country.
8 of the 43 countries report plasma sent for contract fractionation in another country.
95 countries report that all PDMP are imported: 15 countries report that no PDMP were used during the reporting period; 3 countries report that plasma collected in the country was sold to the manufacturers of plasma-derived medicinal products and products purchased from PMDP suppliers in the market.
Around 10 million litres plasma from 35 reporting countries (22 high-income countries, 12 middle-income countries and 1 low-income countries, covering a population of 2.76 billion) was fractionated for the production of PDMP during the year. This includes around 50% plasma recovered from the whole blood donations.
Clinical use of blood
Unnecessary transfusions and unsafe transfusion practices expose patients to the risk of serious adverse transfusion reactions and TTI. Unnecessary transfusions also reduce the availability of blood products for patients who are in need.
WHO recommends the development of systems to monitor and improve the safety of the transfusion process such as hospitals transfusion committees and haemovigilance.
111 countries have national guidelines on the appropriate clinical use of blood.
Transfusion committees are present in 70% of the hospitals performing transfusions in high-income countries and in about half of the hospitals in middle- and low- income countries.
Clinical audits are conducted in 89% of hospitals performing transfusion in the high-income countries and in 52% of hospitals in the middle- and low- income countries.
Systems for reporting adverse transfusion events are present in 93% of hospitals performing transfusion in high-income countries and 63% in middle- and low- income countries.
77% high-income countries have a national haemovigilance system, compared to only 30% of middle- and low- income
countries.
Blood transfusions
There are great variations between countries in the age distribution of transfused patients. For example, in the high-income countries, the most frequently transfused patient group is over 65 years, which accounts for up to 76% of all transfusions. In the low-income countries, up to 65% of transfusions are for children under the age of 5 years.
In high-income countries, transfusion is most commonly used for supportive care in cardiovascular surgery, transplant surgery, massive trauma, and therapy for solid and haematological malignancies. In low- and middle-income countries it is used more often to manage pregnancy-related complications and severe childhood anaemia.
WHO response
The risk of transmission of serious infections, including HIV and hepatitis, through unsafe blood and chronic blood shortages brought global attention to the importance of blood safety and availability. With the goal of ensuring universal access to safe blood and blood products,
WHO has been at the forefront to improve blood safety and availability, and recommends the following integrated strategy for blood safety and availability:
Establishment of a national blood system with well-organized and coordinated blood transfusion services, effective evidence-based and ethical national blood policies with the goal of achieving self-sufficiency,
and legislation and regulation, that can provide sufficient
and timely supplies of
safe blood and blood
products to meet the
transfusion needs of all patients.
Collection of blood, plasma and other blood components from low-risk, regular, voluntary unpaid donors through the strengthening of donation systems, the phasing out of family/replacement donation, the elimination of paid donation, and effective donor management, including care and counselling.
Quality-assured screening of all donated blood for transfusion-transmissible infections (TTI), including HIV, hepatitis B,
hepatitis C and syphilis, confirmatory testing of the results of all donors screen-reactive for infection markers, blood grouping and compatibility
testing, and systems for processing blood into blood products (blood components for transfusion and plasma derived-medicinal products), as
appropriate, to meet health care needs.
Rational use of blood and blood products to reduce unnecessary transfusions and minimize the risks associated with transfusion, the use of
alternatives to transfusion, where possible, and safe and good clinical transfusion practices,
including patient blood management.
Step-wise implementation of effective quality systems,
including quality management, standards, good manufacturing practices, documentation,
training of all staff and quality assessment.
Through its Blood and Transfusion Safety programme, WHO supports countries in developing national blood systems to ensure timely access to safe and sufficient supplies of blood and blood products and good transfusion practices to meet the patients’ needs.
The programme provides policy guidance and technical assistance to countries for ensuring universal access to safe blood and blood products and work towards self-sufficiency in safe blood and blood products based on voluntary unpaid blood donation to achieve universal health coverage.
source: WHO

Blood transfusions

Anaemia

Anaemia is a reduction in the number of red blood cells in the blood. Many people with cancer will develop it at some point during their illness. This can be due to the cancer or its treatment, including chemotherapy and radiotherapy.
If the number of red blood cells in your blood is low, you may become very tired and feel like you have no energy. You may also become breathless. These symptoms occur because the red blood cells contain haemoglobin (Hb), which carries oxygen around the body.
You will have a blood test to check your haemoglobin level if you have symptoms of anaemia or are having cancer treatment. This is known as a full blood count (FBC). Your doctors may recommend that you have a blood transfusion if your haemoglobin level is low. A blood transfusion involves having blood given into one of your veins by a drip (infusion).
The transfusion increases the number of red blood cells in your blood, which means that more oxygen can be carried around the body to the tissues and organs. You will then have more energy and the breathlessness will be eased.
Blood
transfusions
There are different treatments for anaemia depending on what's causing it. Blood transfusions are a simple way of treating anaemia. The symptoms of anaemia are often relieved quickly, and you should notice a benefit 24 hours after having the transfusion.
Transfusions may be used alone or together with other forms of treatment for anaemia. The beneficial effects of a blood transfusion can be temporary and some people may need further transfusions.
Before a blood transfusion is given, the blood must be cross-matched to ensure that it’s compatible with your own blood.
This involves taking a sample of your blood to identify your blood group and matching it with suitable donor blood. This procedure ensures that the blood you are given will not make you unwell.
The transfusion itself involves a small tube called a cannula being placed into a vein in your hand or arm. This is connected to a drip. The blood is then run through the drip (infusion) into your bloodstream. Some people have a transfusion given through a larger tube put into a vein in the chest (central line) or the crook of their arm (PICC line). Blood for transfusion is stored in small plastic bags. Each bag is called a unit of blood. Transfusions usually involve giving 2-4 units depending on how anaemic you are.
Each unit is given over a period of 1-4 hours. When the transfusion is finished, the cannula is removed.
If you need several units of blood you may need to stay in hospital overnight. However, a transfusion of only 1-2 units of blood can usually be given to you as an outpatient.
During the transfusion, you will have your temperature, pulse and blood pressure checked regularly by the nurses to detect any reaction to the blood. Common side effects that can occur are headaches, a slight rise in temperature or a skin rash. These effects can be relieved by drugs such as paracetamol. Severe side effects from blood transfusions are rare because blood is cross-matched first.
Many people will need only one or two transfusions during their illness, although it is possible to have repeated transfusions if necessary. If you need to have lots of blood transfusions over many months, there is a very small risk of iron overload.
This is only likely if you have had at least 20 transfusions.
Iron overload can happen because the red blood cells in each unit of blood contain a small amount of iron that builds up in the body. Iron overload is potentially harmful, and you may need treatment to help stop this from occurring. Your doctor or nurse will explain more about this treatment if necessary.
Are blood transfusions safe?
Some people worry that the blood they are given may be infected by disease. People who donate blood are carefully screened to assess their risk of having an infection or virus such as hepatitis or HIV. This is to make sure the blood they donate is as safe as possible.
Other precautions are taken to minimise the risk of infection.
All donated blood is tested in the laboratory for infection. Very occasionally, these tests fail to find an infection, but the risk of being given infected blood is extremely small. If you have any concerns about receiving a blood transfusion, talk these over with your doctor or specialist nurse.
Source: www.macmillan.org.uk