National Blood Policy and Organization
Blood transfusion saves countless lives, yet many patients globally still struggle to access safe blood in a timely manner. The integration of safe and adequate blood provision into national health care policies is crucial for improving health outcomes. As highlighted by the World Health Organization (WHO), the coordination of blood collection, testing, processing, storage, and distribution is essential for a national-level blood supply network. This coordination is primarily located within a legislative framework designed to ensure the consistent implementation of safety and quality standards for blood and blood products.
Prevalence of National Blood Policies
As of 2018, a significant number of countries have recognized the importance of a solid national blood framework; 73% of reporting countries (125 out of 171) had established a national blood policy. Among these countries:
- 79% were high-income nations.
- 63% were classified as middle-income countries.
- 39% were from the low-income category.
This disparity demonstrates the need for improved blood governance in low-income countries, where access remains significantly limited.
Blood Supply Overview
On a global scale, about 118.54 million blood donations are collected each year. Strikingly, 40% of these donations come from high-income countries, despite these nations constituting only 16% of the world’s population. Blood center data from 169 countries show varied collection rates based on income categories:
- Low-income countries: Median of 1,300 donations per blood center.
- Lower-middle-income countries: Median of 4,400 donations.
- Upper-middle-income countries: Median of 9,300 donations.
- High-income countries: Median of 25,700 donations per center.
The stark disparity in donation rates illustrates a lack of access, particularly in lower-income nations, where the whole blood donation rate can be an indicator of overall availability. For instance, high-income countries report a median of 31.5 donations per 1,000 people compared to just 5.0 in low-income regions.
Profiles of Blood Donors
Age and Gender Demographics
Survey data reveals that globally, women contribute only 33% of blood donations, a stark contrast in some countries where female contributions fall below 10%. Age distribution shows a greater proportion of younger blood donors in low- and middle-income countries, pointing to distinct demographic trends that can inform donor recruitment strategies.
Types of Blood Donors
Blood donors can be categorized into three primary types:
- Voluntary Unpaid Donors
- Family/Replacement Donors
- Paid Donors
The safest and most reliable blood supply is derived from voluntary unpaid donors, as they typically come from lower-risk populations. WHO advocates for the development of a national blood system based on this donor model, aspiring toward self-sufficiency.
Between 2008 and 2018, voluntary unpaid blood donations increased by 10.7 million, particularly spiking in regions such as Southeast Asia (127% increase) and Africa (81% increase). Still, 54 countries continue to rely heavily on family/replacement and paid donors for over 50% of their blood supply.
Blood Screening Practices
WHO emphasizes the necessity of screening for infections—including HIV, hepatitis B, hepatitis C, and syphilis—before blood can be utilized for transfusions. While high-income and upper-middle-income countries boast 99% screening rates, lower-middle-income countries showcase only 83%, and low-income countries follow with 76%. This lack of comprehensive screening in lower-income regions correlates with higher prevalence rates of transfusion-transmissible infections.
Infection Prevalence Table
| Income Group | HIV | HBV | HCV | Syphilis |
|---|---|---|---|---|
| High-Income | 0.002% | 0.02% | 0.007% | 0.02% |
| Upper Middle-Income | 0.10% | 0.29% | 0.19% | 0.35% |
| Lower Middle-Income | 0.19% | 1.70% | 0.38% | 0.69% |
| Low-Income | 0.70% | 2.81% | 1.00% | 0.90% |
These figures highlight how an effective screening system can significantly mitigate health risks associated with blood transfusions.
Blood Processing Techniques
Blood can either be transfused in its whole form or processed into various components like red cell concentrates, platelet concentrates, plasma, and cryoprecipitate. This component separation enhances the utility of donated blood, accommodating multiple patients’ needs. However, in low-income countries, only 38% of collected blood is separated into components, compared to 96% in high-income countries.
Supply of Plasma-Derived Medicinal Products (PDMP)
The World Health Assembly has called for nations to establish organized blood and plasma programs, aspiring for self-sufficiency. Alarmingly, only 56 out of 171 reporting countries generate PDMP internally. Many nations rely solely on imports: 91 countries reported complete reliance on external sources for PDMP.
In the previous year, 19 million liters of plasma were fractionated, with significant variability in production rates across countries.
Clinical Use of Blood
Improper transfusion practices can lead to adverse reactions and increased transmission risks. WHO advocates for robust systems, such as hospital transfusion committees and haemovigilance systems, designed to enhance blood safety. Key statistics reveal a significant divide:
- 128 countries have developed guidelines on appropriate clinical blood use.
- 48% of hospitals performing transfusions have established transfusion committees.
Blood Transfusions and Demographics
Transfusion patterns vary significantly by region. In high-income countries, the majority of transfusions (up to 76%) are for patients over 60, primarily for surgeries. Conversely, in low-income countries, children under five years old account for a substantial portion of transfusions, predominantly due to treatable conditions like anemia.
WHO’s Strategic Response
In response to the pressing need for safe blood, WHO aims to improve safety and availability through an integrated strategy. This framework includes establishing organized national blood systems, promoting voluntary unpaid donations, ensuring rigorous blood screening, advocating for rational blood use, and implementing quality systems across donation and transfusion processes.
WHO’s support extends to providing technical assistance and crafting policies that bolster universal access to safe blood and blood products, ensuring health equity across different populations.
This information is derived from the WHO Global Database on Blood Safety, encompassing various countries and years to present a comprehensive overview of global blood safety efforts.
