Blood Experts Stress the Importance of Blood Safety and Availability in Countries with Limited Resources

Blood transfusion should be considered a global health priority, according to a new opinion piece published in the New England Journal of Medicine, written by a group of experts from the blood community. The authors, including leaders and members of AABB, note substantial disparities in blood availability and safety between high-resource countries and low- and middle-income countries (LMICs) and outline a number of steps that could be taken to prioritize transfusion access.

“Under the current circumstances, the continued neglect of blood safety and availability represents a tacit acceptance of suboptimal standards for LMICs,” the authors wrote.

The World Health Organization has deemed blood and blood components to be essential medicines, meaning that they are necessary to meet health care needs for most of the world’s population — and should, therefore, be in adequate supply and accessible. The shortage of safe blood and blood products in LMICs hampers adequate care for many medical conditions and injuries.

“The global blood deficit has wide-ranging adverse effects, given that many clinical disciplines (e.g., obstetrics, pediatrics, hematology, oncology, emergency medicine, and surgery) depend on blood transfusion. There are notable effects on maternal and child health,” the experts wrote.

The authors argue that while there are large gaps in blood collection, quality, safety, and access in a large swath of the world, there are three considerations that would go far in minimizing those gaps.

First, the donor pools in LMICs should reflect the realities of donor recruitment and retention unique to the location with consideration given to paid donations. “We aren’t advocating for paid donation; voluntary donation should remain the goal,” the experts wrote. “There is support, however, for emphasizing donor retention rather than categorization of donors by voluntary, paid, or replacement status alone, at least pending attainment of a voluntary donor pool.”

Second, LMICs need to work toward significantly minimizing the inappropriate use of blood, which includes ensuring that transfusions are only given for proper indications, that the appropriate amount of blood is administered, and that clinicians consider alternative treatments (e.g., iron supplementation for stable patients with iron deficiency).

Third, LMICs need to limit their dependence on outside funding. The experts recommend that “deliberate, phased transitions to self-reliance in LMICs should be carefully considered as part of funding efforts.”

In addition, the authors highlight several successful initiatives in LMICs aimed at blood safety; donor education, recruitment, and retention; and quality systems that could serve as models for other LMICs. They encourage a holistic approach “to address each element in the pathway from blood collection to transfusion.” Such an approach could include more effective messaging about blood as an essential medicine, working to prioritize transfusion in national health systems, the adoption of evidence-based transfusion practices, and situational analysis to identify and understand local blood deficits.