Description
Blood supplies in high income countries (HICs) are usually sufficient and have low risks of transfusion-associated adverse events due to well-organized and coordinated blood systems; the use of (relatively) effective donor education, recruitment and interviewing; sensitive laboratory testing strategies; process automation and the application of good manufacturing and laboratory practices. However, such measures have not been adequately implemented in low and middle income countries (LMICs), especially in low resource settings. Some of the measures may also not be appropriate, practical, or validated for LMIC settings. The potential adverse events for recipients include transfusion-transmitted infections (TTI) including but not limited to human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) as well as transfusion-associated injuries due to errors, bacterial contamination, fluid overload, and transfusion reactions. The potential adverse events for donors can include incomplete or inaccurate testing leading to incorrect donor notification and an inability to follow up on donors with positive screening tests.
There are significant gaps between demand and blood supply in LMICs. National reports to the World Health Organization (WHO) Global Database for Blood Safety (GDBS) as well as published data further suggest that poor quality or lack of blood donation screening could be the most important gap in blood safety internationally. In most LMIC countries, the blood supplies rely on volunteer non-remunerated as well as family/replacement donors in ratios ranging between 0 and 100%. While the number of paid blood donations has been reduced in some settings, with successful conversion to voluntary donation, paid donation of labile blood and components may still account for a significant proportion of transfusion-transmissible infections globally due to the higher risk of infections associated with such donations. Inadequate or inconsistent supplies and acute shortages of blood for transfusion in low resources settings, often coupled with the questionable quality of the available blood supply, pose real risks to the health of patients who need blood transfusion. Such patients include those in need of transfusion secondary to malaria, sickle cell disease, thalassemia, obstetric hemorrhage, and trauma.
At the National Institutes of Health (NIH), research on blood availability and transfusion safety is supported by the National Heart, Lung, and Blood Institute (NHLBI). To identify key research priorities for improving global blood availability and transfusion safety, NHLBI convened a workshop on April 18-19, 2017 in Bethesda, MD, which was jointly organized by the Division of Blood Diseases and Resources (DBDR) and the Center for Translation Research and Implementation Science (CTRIS) of NHLBI. DBDR has a major responsibility for research to assure the adequacy and safety of the blood supply and transfusion safety while CTRIS plans, fosters, and supports integrated and coordinated programs of research to understand optimal and sustainable implementation strategies for evidence-based interventions. The focus of the workshop was to identify strategies and research opportunities to foster implementation research to improve the safety and availability of blood and blood components in LMICs.
Experts from LMICs of various regions (Africa, Middle East and North Africa, Southeast Asia, Latin America and the Caribbean, Asia and the Pacific, Eastern Europe and Central Asia) and experts from HICs were invited to participate in the workshop. Representatives from WHO, the Centers for Disease Control and Prevention (CDC), the International Society for Blood Transfusion (ISBT), AABB (formerly American Association for Blood Banks) and the America’s Blood Centers (ABC) as well as other agencies within and outside of NIH were also invited to participate in the workshop.
Three conference calls were held prior to the workshop to discuss challenges and opportunities in international blood availability and transfusion safety, and to identify gaps as well as potential key scientific priorities and research strategies to be further discussed at the in-person meeting. In addition, seven regional working groups were formed, each including at least one expert from the local region and other experts in transfusion medicine and implementation research. The seven working groups held multiple calls and were asked to identify key scientific priorities and research strategies for their region. The findings from these working groups were presented and discussed by all participants at the workshop on April 18-19, 2017. Invited experts who were not able to attend the in-person meeting in Bethesda, MD also provided input through their active participation by teleconference, both prior to and during the workshop.