The theme for World Blood Donor Day June 14, 2017 is Give Blood. Give Now. Give Often. The World Health Organization is using the occasion to raise awareness on the need for frequent blood donations from people across the globe. According to WHO, Of the 112.5 million blood donations collected globally, approximately half of these are collected in high-income countries, home to 19% of the world’s population.
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.
Based on samples of 1000 people, the blood donation rate is 32.1 donations in high-income countries, 14.9 donations in upper-middle-income countries, 7.8 donations in lower-middle-income countries and 4.6 donations in low-income countries.
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.
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 32.1 donations per 1000 people. This compares with 14.9 donations per 1000 people in upper-middle-income countries, 7.8 donations per 1000 people in lower-middle-income countries, and 4.6 donations per 1000 people in low-income countries.
67 countries report collecting fewer than 10 donations per 1000 people. Of these, 38 countries are in the WHO African Region, 5 in the WHO Region of the Americas, 6 in the WHO Eastern Mediterranean region, 5 in the WHO European Region, 6 in the WHO South-Eastern Asia Region, and 8 in the WHO Western Pacific Region. All are low- or middle-income countries.
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 blood borne 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 donations and to 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:
WHO recommends that all blood donations should be screened for infections prior to use. Screening for HIV, hepatitis B, hepatitis C, and syphilis should be mandatory. Blood screening should be performed according to the quality system requirements. Of reporting countries, 13 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. 99.6% of the donations in high-income countries are screened following basic quality procedures, as compared to 97% in upper-middle-income countries, 81% in lower-middle-income countries and 66 % in low-income countries. The prevalence of transfusion-transmissible infections 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 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: 50% of the blood collected in low-income countries is separated into components, 59% in lower-middle-income countries, 92% in upper-middle-income countries, and 97% 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.
Clinical use of blood
Unnecessary transfusions and unsafe transfusion practices expose patients to the risk of serious adverse transfusion reactions and transfusion-transmissible infections. Unnecessary transfusions also reduce the availability of blood products for patients who are in need.
WHO recommends the development of systems, such as hospitals transfusion committees and haemovigilance, to monitor and improve the safety of transfusion processes.
There are great variations between countries in terms of the age distribution of transfused patients. For example, in the high-income countries, the most frequently transfused patient group is over 65 years of age, 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.
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, 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, and effective donor management, including care and counselling.
Quality-assured screening of all donated blood for transfusion-transmissible infections, 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.