Many patients requiring transfusion, however, do not have timely access to safe blood and blood products. Every country needs to ensure that supplies of blood and blood products are sufficient and free from HIV, hepatitis viruses and other infections that can be transmitted through transfusions.
In high-income countries, transfusion is most commonly used for supportive care in cardiovascular surgery, transplant surgery, massive trauma, and therapy for solid and hematological malignancies. In low and middle incomes countries it is often used for management of pregnancy related complications, childhood malaria complicated by severe anaemia, and trauma-related injuries.
Often transfusions are prescribed when simple and safe alternative treatments might be equally effective. As a result, such a transfusion may not be necessary. An unnecessary transfusion exposes patients to the risk of infections such as HIV and hepatitis and adverse transfusion reactions.
In 2011, 71 countries reported collecting more than 90% of their blood supply from voluntary and unpaid blood donors, among them 60 countries collect 100% of blood supply from voluntary unpaid donors. But in 73 countries, less than 50% of blood supplies come from voluntary unpaid donors, with much of their blood supply still dependent on family/ replacement and paid blood donors.
About 50% of these are donated in low and middle-income countries where nearly 85% of the world’s population lives. The average blood donation rate is more than 9 times greater in high-income countries than in low-income countries.
About 100,000 blood centres in 168 countries reported collecting a total of 83 million blood donations. The median annual blood donations per centre is 15,000 in high-income countries, as compared to 3,100 in middle and low-income countries.
The median blood donation rate in high-income countries is 39.2 donations per 1000 people. This compares with 12.6 donations per 1000 people in middle-income countries and 4.0 donations in low-income countries.
All donated blood should always be screened for HIV, hepatitis B, hepatitis C and syphilis prior to transfusion. Yet 25 countries are not able to screen all donated blood for one or more of these infections. Testing is not reliable in many countries because of staff shortages, poor quality test kits, irregular supplies, or lack of basic quality in laboratories.
Separating blood into various components allows a single unit of blood to benefit several patients and provides a patient only the blood component which is needed. About 97% of the blood collected in high-income countries, 78% in middle-income countries and 40% in low-income countries is separated into blood components.
Adequate and reliable supply of safe blood can only be assured through a stable base of regular, voluntary, unpaid blood donors. They are the safest group of donors because the prevalence of blood-borne infections is lowest among them. WHO urges Member States to develop national blood system based on voluntary, unpaid blood donations to achieve the goal of self-sufficiency in safe blood and blood products.