The objective of this report is to provide an overview of the current status and trends in blood supply, safety, sufficiency and usage globally. The report is primarily based on data for the year 2013, which were reported by 156 of 195 Member States to the World Health Organization (WHO) Global Database on Blood Safety (GDBS). To give a more complete overview of the global situation, data for 2012 from 15 countries and for 2011 from nine countries were used where 2013 data were not available. 1 These 180 countries account for a total population of 7 billion, representing 98.3% of the global population.
The WHO GDBS was established in 1998 to provide data about the availability, safety and accessibility of blood for transfusion. The main objective of the survey is to collect and analyse data on national blood systems from all countries as the basis for effective action to improve access to safe blood and blood products and transfusion practices globally. The WHO Blood Transfusion Safety programme has undertaken biennial surveys on the safety and availability of blood in Member States since 1998. Since 2006, GDBS data are collected annually using a standardized tool, which is sent to national health authorities or national blood transfusion services for completion. Web-based tools were used for 2011, 2012 and 2013 data collection.
Standardized definitions of the terminologies used in the survey questionnaire were prepared to promote consistency of reporting. Where possible, efforts were made to validate the data reported to WHO with WHO regional and country offices, as well as with experts who visited countries on behalf of WHO. Countries were contacted for clarification or correction when discrepancies, inconsistencies or any unusual patterns were observed. Efforts were also made to validate GDBS data by comparing them with data available from other published sources. However, systematic verification was not performed for all data provided by all countries. In particular, answers to the questions on the existence of policies, programmes or mechanisms could be affected by individual interpretation of the questions asked.
2 Collection and supply of blood and blood components

# GLOBAL OVERVIEW OF BLOOD COLLECTION
It is estimated that a total collection of 112.5 million blood donations were made in the 180 countries during the reporting period. Of these, 100.6 million were whole blood donations and 11.9 million were apheresis donations (Table 1). These donations were collected from all types of blood donors: voluntary non-remunerated, family or replacement, and paid. This estimation has taken into consideration the partial data provided by countries. Annex 1 provides a note on how the estimation of global collection was performed. When the donation and population data are correlated and analysed by WHO region and World Bank income group, the level of availability of blood for transfusion is found to vary across WHO regions and World Bank income groups. For example, 46 countries in the WHO African Region collected a total of about 5.6 million blood donations; these accounted for only about 4% of global donations, though these countries are home to around 13% of the global population. The 11 countries in the South-East Asia Region reported the collection of 15% of global blood donations, though these countries represent 26% of the global population. In the European Region, the number of reported donations represented 30% of the global total, though the region is inhabited by only 11% of the global population. Similarly, countries in the high-income group collected 47% of the global donations, though their populations only account for 19% of the global population. Countries in the low-income and lower middle-income groups collected 2% and 22% of the global donations respectively, though their populations represent 9% and 39% of the global population respectively (Figure 1). AFR: African Region; AMR: Region of the Americas; EMR: Eastern Mediterranean Region; EUR: European Region; SEAR: South-East Asia Region; WPR: Western Pacific Region Figure 1. Regional distribution of population and blood donations by WHO region and World Bank income group, 2013
There were wide variations in blood donation rates among countries, ranging from 0.3 to 56 per 1000 population. The whole blood donation rate (median) was 32.1 donations per 1000 population per year (range 11.2-57.8) in highincome countries, 14.9 (range 6.7-39.7) in upper middle-income countries, 7.8 (range 0.7-20.6) in lower middle-income countries, and 4.6 (range 0.3-9.4) in low-income countries. Across WHO regions, the donation rates ranged as follows: 0.2 to 39.7 (median 5.7) in Africa, 2 2.7 to 36.5 (median 14.8) in the Americas, 2.3 to 27.8 (median 14.9) in the Eastern Mediterranean, 3.9 to 57.8 (median 33.6) in Europe, 1.8 to 30.8 (median 7.9) in South-East Asia, and 3.3 to 49.9 (median 13.1) in the Western Pacific.
Sixty-seven countries reported collecting less than 10 whole blood donations per 1000 population per year in 2013 (Figure 2). Of these, 38 countries are in the WHO African Region, five in the Region of the Americas, six in the Eastern Mediterranean Region, four in the European Region, six in the South-East Asia Region and eight in the Western Pacific Region (Figure 3).

# COLLECTION OF BLOOD COMPONENTS THROUGH APHERESIS PROCEDURE
Seventy-eight of the 180 responding countries reported collecting blood both as whole blood donations and through apheresis procedures. Of the total 99.5 million donations reported worldwide in 2013 3 89% were donated as whole blood and 11% were donated by apheresis (Figure 4). In high-income countries, 21% of all donations were collected through apheresis, compared to 4% in upper middle-income countries and 0.4% in lower middle-income countries. Across WHO regions, apheresis donations were mainly reported in the European Region, the Western Pacific Region and the Region of the Americas, where 20%, 15% and 8% (respectively) of the total donations were collected through apheresis procedures (Figure 5).

# Aphereis donations
Whole blood donations

# TYPES OF BLOOD DONATIONS
Of the 180 countries that reported to WHO GDBS, 178 provided information on donations given by different types of blood donors (voluntary non-numerated, family/replacement, paid). These countries collected 88.2 million whole blood donations and 11.0 million apheresis donations.
Overall, of the total 88.2 million whole blood donations, 83.3% were reported as voluntary non-remunerated donations, 16.4% as family or replacement donations, and 0.3% as paid blood donations.
Seventy-four countries collected more than 90% of their blood supply from voluntary non-remunerated blood donations: 30 in the European Region, 17 in the African Region, 13 in the Western Pacific Region, six in the Region of the Americas, five in the Eastern Mediterranean Region, and three in the South-East Asia Region. Fifty-seven countries reported collecting 100% (or more than 99%) of their blood supply from voluntary non-remunerated donations. Seventy-one countries (22 in Africa, 22 in the Americas, 10 in Europe, nine in the Eastern Mediterranean, five in the Western Pacific and three in South-East Asia) remained considerably dependent on family/replacement and paid blood donors, with these donations accounting for more than 50% of their blood supplies in 2013.
In 2013, the proportion of voluntary non-remunerated blood donations in highincome, upper middle-income, lower middle-income and low-income groups were 95%, 79%, 71% and 63%, respectively. Higher-income groups in general had a higher proportion of blood collected from voluntary non-remunerated blood donors in surveyed countries (Figure 6).
When analysed by WHO region, the proportion of voluntary non-remunerated whole blood donations varied from 51% in the Eastern Mediterranean Region to as high as 97% in the Western Pacific Region, with the European Region at 93%. The proportion of voluntary non-remunerated donations in the African Region, Region of the Americas and the South-East Asia Region was 67%, 69% and 84%, respectively (Figure 6).
An increase of 10.7 million blood donations from voluntary non-remunerated donors between 2008 and 2013 was reported in total by 159 countries that provided data for both years. The highest percentage increases in voluntary non-remunerated donations were observed in the South-East Asia Region, which reported an increase of 75%, followed by African Region, which reported an increase of 37%. The greatest increase in absolute numbers occurred in the South-East Asia Region, which reported an increase of 5.3 million voluntary non-remunerated donations (Table 2). The reported increase in voluntary non- Except for Europe, in which a marginal increase was observed, all WHO regions registered substantial increases in total collections from all types of blood donors, ranging from 13% in the Americas to 47% in Africa. South-East Asia reported increases in voluntary non-remunerated donations by a higher percentage than the total number of donations, meaning the increase in total blood collection was mainly contributed by the increase in voluntary non-remunerated donations. In the Eastern Mediterranean Region, the African Region and the Region of the Americas, the increases in total collections outpaced those in collections of voluntary non-remunerated donations (Table 2). Globally, 94% of 11.0 million apheresis donations for clinical transfusion were given by voluntary non-remunerated donors, 2.7% by family or replacement donors, and 3.3% by paid donors. In the European Region and the Western Pacific Region, while the majority of the collections reported were from voluntary non-remunerated donors, 321 707 (5%) of apheresis donations in Europe and 34 342 (0.9%) of apheresis donations in the Western Pacific were collected from paid donors; it is possible, however, that the data for Europe may reflect the inclusion of some plasma donations for fractionation.
In the Region of the Americas, the majority (93%) of the collections reported were from voluntary non-remunerated donors, while 92 921 (7%) of apheresis donations were collected from family replacement donors. In the Eastern Mediterranean Region, 46% of the total 36 731 apheresis donations were from voluntary non-remunerated blood donors, 33% were from family or replacement donors, and 21% were from paid donors; in addition, 15 965 apheresis donations collected through apheresis procedures were reported as apheresis component (platelet) units, though their donation type is unknown (Figure 7).
Figure 8 shows the geographical distribution by country of the proportion of voluntary non-remunerated blood donations (both whole blood and apheresis donations). 2.4 BLOOD DONOR PROFILE

# Donor sex and age profile
Data from 118 countries on the sex profile of blood donors show that, overall, 30% of blood donations were given by female donors; of these, 18 countries reported less than 10% of donations by women. Across the WHO regions, the Eastern Mediterranean had the lowest proportion of donations given by female donors (Table 3). However, substantial variations exist among countries within the region. For example, of 12 countries in the Eastern Mediterranean reporting data on the sex distribution of blood donations, nine reported that less than 10% of donations were given by female donors. The other three countries (Egypt, Morocco and Tunisia) reported percentages of 54%, 40% and 35%, respectively. A total of 80 countries (high-income 23, upper middle-income 18, lower middle-income 22, low-income 17) reported data on number of donations given by donors of different age groups. Globally, 40% of donations were given by donors aged 25-44 years. Donors of the age groups 45-64 years and 18-24 years contributed 29% and 23% of the total donations, respectively. Of the total donations, 5% were given by donors in the group aged 65 years and over, and 3% were given by donors aged younger than 18 years. GDBS data show that proportionally more young people donate blood in low-and middle-income countries than in high-income countries: 42% of blood donations were given by donors aged below 24 years in low-income countries, 33% in lower-middle-income countries, 28% in upper-middle income countries and 21% in high-income countries (Figure 9). This may mainly reflect the age structure of the populations in developed and developing countries: proportionally there are more young people in developing countries and there are relatively more older people in developed countries.
Stratification of the donation rate by age group shows that the average donation rate for the group aged 18-24 years was highest in high-income and upper middle-income countries, while the donation rate for the group aged below 18 years was highest in lower middle-income and low-income countries. In lower middle-income and low-income countries, there was a clear pattern whereby donation rates for younger age groups were higher than those for older age groups; there was no such pattern in high-income countries, as shown in Figure 10(a). Several developing countries (see Figure 10(b) for examples) reported a relatively high donation rate by people aged below 18 years, mainly school students. This could be the result of the recruitment strategy of targeting young people, for example through the implementation of such programmes as Club 25. 4 Young people also had high donation rates in some developed countries. For example, in France, the donation rate by the group aged 18-24 years was 93 per 1000 population, while in the groups aged 25-44, 45-64 and 65 years and over, the rates were 60, 68 and 37 per 1000 population, respectively. Poland and Singapore also reported that the group aged 18-24 years had the highest donation rate. However, in other developed countries, such as Australia, the Netherlands, and New Zealand, the pattern was different, with older age groups (45-64 years and 65 years and over) having higher donation rates, as shown in Figure 10(b).
Demographic information about blood donors is important for formulating and monitoring donor recruitment strategies to meet blood requirements. This may include the strategies to address the barriers to blood donation that specific populations may face. 4 Tagny CT, Owusu-Ofori S, Mbanya D, Deneys V. "The blood donor in Sub-Saharan Africa: a review." Transfusion Medicine. 2010;20(1):1-10. doi:10.1111/j.1365-3148.2009.00958.x. Note: Forty countries (high-income 10, upper middle-income 5, lower middle-income 14, low-income 11) reported that no blood was collected from donors aged below 18 years, and 29 countries (high-income 5, upper middle-income 4, lower middle-income 9, low-income 11) reported no donations collected from donors aged 65 years and above, because of the age limit required by the donation criteria. Accordingly, age-specific (16-18 years or 65-70 years) population data from these countries were not included in calculating the average age group-specific donation rate by World Bank economic group.

# Repeat donors and first-time donors
A total of 110 countries (Europe 35, Africa 31, Western Pacific 18, Americas 11, Eastern Mediterranean 10, South-East Asia five) reported data on the number of voluntary non-remunerated whole blood donations given by first-time donors and repeat donors. Overall, the percentage of whole blood donations given by repeat voluntary non-remunerated blood donors in countries ranged widely from less than 0.1% to 100% (median 45%). 5 Table 4 shows the proportions of donations given by repeat voluntary non-remunerated blood donors, by WHO region.
5 Several countries in Europe have implemented a policy of testing without collecting blood from first-time donors and thus reported 100% collection of repeat donors. Figure 11 shows the proportion of whole blood donations by repeat voluntary non-remunerated donors in countries in the African and European Regions.
A proxy measure for regular blood donations is the frequency of donations per donor per year. Data reported to the WHO GDBS on the number of active whole blood donors and the number of donations these donors had given in 2013 were provided by 125 countries (low-income 23, lower middle-income 36, upper middle-income 24, high-income 42), accounting for 53.1 million whole blood donations. Overall, each donor donated 1.38 whole blood donations on average in 2013. This may be an underestimation of the actual donation frequency, as 48 countries (nine low-income, 21 lower middle-income, 10 upper middle-income and eight high-income) reported exactly the same number for active donors and donations, an error probably due to the lack of an appropriate donor database that can uniquely identify donations from the same donor. Figure 12 shows the donation frequency of the voluntary non-remunerated whole blood donors in 2013 in selected countries with a percentage of voluntary non-remunerated blood donations higher than 70%.
It is important to have a regular donor base to ensure a sufficient and safe blood supply. It is also important to continuously recruit new donors into the donor base.  Many countries were unable to provide information on the number of deferrals from blood donation and the underlying reasons. Collection of these data should be encouraged, as it is useful for countries in monitoring implementation of their donor selection guidelines and in identifying needs for improvement in donor education.

# PRE-DEPOSIT AUTOLOGOUS BLOOD DONATIONS
Sixty-four countries (Europe 21, Americas 22, Africa four, Western Pacific four, Eastern Mediterranean three) reported a total of 101 994 autologous donations in 2013. The median percentage of autologous donations among all whole blood donations was 0.08% (range less than 0.01% to 2.7%). Italy reported the largest absolute number of autologous donations -51 185 (accounting for 1.91% of its total reported whole blood donations). Argentina reported collecting 11 455 autologous donations in 2013, accounting for 1.20% of its reported whole blood donations. Many countries were not able to provide data on autologous donations, since they are collected in hospitals and currently many countries do not have established systems for data collection or reporting on activities from hospitals. It is probable therefore that the reported total number of autologous blood donations is an underestimation.

# Processing of whole blood donations into components
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 may be used more effectively if it is separated into components (red cell concentrates, fresh frozen plasma, cryoprecipitate and platelet concentrates), so that it can meet the needs of more than one patient and is used appropriately.
Based on data reported to the GDBS by 167 countries, 85% of whole blood donations collected globally were processed into components: 97% in high income countries, 92% in upper middle-income countries, 59% in lower middleincome countries and 50% in low-income countries.
Across the WHO regions, the lowest overall percentages for processing blood into components were in the South-East Asia Region (61%) and the Eastern Mediterranean Region (65%). The percentage was 69% in the African Region and greater than 90% in the Region of the Americas, the European Region and the Western Pacific Region (Figure 14). South-East Asia) and 55% (17/31 in the Americas) of countries reported that over 90% of whole blood donations were separated into components. Around 36% (15/41) of countries in Africa and 18% (2/10) of countries in South-East Asia reported that less than 25% of whole blood donations were separated into components. Using components produced per whole blood collection as an indicator of the productivity of the blood services in component preparations, GDBS data show that there are great country-level variations in the degree of processing of whole blood donations into different blood components across WHO regions. The African Region recorded the lowest productivity ratio for platelets, with an average of 0.10 units of platelet produced per single collection. The ratio in South-East Asia was 0.18 units of platelet produced per collection. Other regions had a productivity ratio for platelets higher than 0.3. The European countries and countries in the Western Pacific had slightly lower platelet production ratios than those of the Americas and the Eastern Mediterranean. This could be because Europe and the Western Pacific has a higher percentage of apheresis platelet collections. Europe had the highest level of plasma production per collection, with each collection producing 0.53 units of fresh frozen plasma and 0.23 units of frozen plasma (Figure 15).  4 Laboratory screening of blood donations

# LABORATORY SCREENING POLICY
The following subsections analyse the data on laboratory screening policy according to screening component.

# HIV, hepatitis B virus and hepatitis C virus
In the WHO GDBS questionnaire, questions were asked on the policy related to the minimum requirements for laboratory screening of blood. Of the 180 responding countries, 176 reported having a policy of screening all blood donations for HIV. Four countries did not answer the questions (three in the Region of the Americas and one in the Eastern Mediterranean Region). Overall, 70 countries reported testing for HIV-1/2 antibodies (Ab), while 106 countries reported testing for HIV-1/2 antibodies and antigens (Ab+Ag). A total of 44 countries reported testing HIV RNA using nucleic acid amplification testing (NAT) in addition to serological testing (Table 6).
Of the 180 responding countries, 176 reported having a policy of screening all blood donations for hepatitis B virus (HBV). Four countries (three in the Americas and one in the Eastern Mediterranean) did not answer the questions on HBV testing policy. All 176 countries reported having a policy of testing all blood donations for hepatitis B surface antigen (HBsAg). A total of 44 countries reported having a policy of testing all blood donations for anti-HBc in addition to testing for HBsAg, 13 countries reported selective testing for anti-HBc, and 42 countries reported using NAT for HBV in addition to serological testing (Table 7).
More countries in the Americas and the Eastern Mediterranean reported routinely testing blood for anti-HBc than was the case for South-East Asia and the Western Pacific. In Europe, nine countries reported routinely testing all blood for anti-HBc, and eight countries reported selective testing for anti-HBc. Countries reporting selective testing for anti-HBc indicated that the tests were performed for donors with higher risk of HBV infection or for new donors (Table 7).
Of the 180 responding countries, a total of 174 countries reported having a policy of serological testing of all blood for hepatitis C virus (HCV), with 140 countries having a policy of testing all blood for HCV antibodies, and 34 countries testing for HCV Ab+Ag. Forty-three countries reported also having a policy of testing all blood with NAT in addition to the serological testing. One country reported not testing donated blood for HCV before it was released for transfusion. Five countries (four in the Americas, one in the Eastern Mediterranean) did not answer the questions in this section (Table 8). Note: The "unanswered" status in countries of the Region of the Americas could result from the different form used for data collection.  Note: The "unanswered" status in countries of the Region of the Americas could result from the different form used for data collection.
Two European countries (Denmark, Iceland) reported implementing a policy of not routinely performing syphilis testing for blood donations. Norway reported testing all new donors for syphilis. Four countries (three in the Americas and one in the Eastern Mediterranean) did not answer the questions on syphilis testing policy. All other 173 responding countries have a policy of performing syphilis testing for all donations.
Eighteen countries, all in Latin America, reported having a policy of testing all blood donations for Trypanosoma cruzi. Twelve countries reported implementing selective testing for T. cruzi for donors who have travelled to at-risk areas or who have defined risk factors (Table 9).

# human T-lymphotropic virus
Thirty-seven countries reported having the policy of testing all blood donations for human T-lymphotropic virus (HTLV-I/II) antibody. Seven countries reported implementing selective testing for new donors or donors who have not been tested before (Table 10).

# COVERAGE AND QUALITY OF LABORATORY SCREENING OF BLOOD DONATIONS
Based on GDBS data, 13 countries (Africa six, Americas three, Western Pacific three, the Eastern Mediterranean one) reported not being able to test 100% of the blood collected for one or more of the four transfusion-transmissible infections -HIV, HBV, HCV and syphilis -as required by the national testing policy. Seven countries (Americas three, Africa two, Eastern Mediterranean one, Western Pacific one) reported not being able to test all donations for HIV. The percentages of donations tested in these countries ranged from 91.6% to 99.7%. Nine countries (Africa four, Americas three, Eastern Mediterranean one, Western Pacific one) reported not being able to test all donations for HBV, with the percentage of donations tested in these countries ranging from 26.8% to 98.5%. Eleven countries (Africa five, Americas three, Western Pacific two, Eastern Mediterranean one) reported not being able to test all donations for HCV. The percentages of donations tested ranged from 17.5% to 99%. One country in the Western Pacific Region reported not testing donated blood for HCV. Nine countries (Africa three, Americas three, Eastern Mediterranean two, Western Pacific one) reported not being able to test all donations for syphilis. The percentages of donations tested ranged from 66.0% to 98.4%. Three European countries reported not routinely testing for syphilis as the result of a change in the national policy.
One country in Africa, three countries in the Eastern Mediterranean, two in the Americas and one in the Western Pacific were not able to provide data on the coverage of one or more screening tests for the four key infectious makers of HIV, HBV, HCV and syphilis.
Tables  show the status of coverage of laboratory screening for HIV-1/2, HBV, HCV and syphilis by WHO region.  One potential barrier to the implementation of 100% screening policies for four key transfusion-transmitted infections (HIV, HBV, HCV and syphilis) is the irregular supply of test kits. In 2013, 35 countries (20 in Africa, seven in the Americas, four in Africa, two in the Eastern Mediterranean, and one each in South-East Asia and the Western Pacific) reported stock-outs of test kits for transfusion-transmissible infections at the national or regional level during the reporting period.
To assess whether blood screening was conducted in a quality-assured manner, data were collected on two aspects of quality assurance: use of standard operating procedures and participation in external quality assessment. Reports were received from 137 countries on the percentage of blood donations that were screened in facilities that met these quality assurance criteria. Overall, 97% of the donations reported by these countries were screened following these basic quality-assured procedures. In high-income countries, 99.6% of the donations were screened following basic quality-assured procedures, compared to 97% in upper middle-income countries, 81% in lower middleincome countries and 66% in low-income countries. 6 See Annex 1 for an explanatory note on the issue of varying testing/confirmatory strategies in countries, on which the reported numbers of positive/reactive test donations and proportion of positive/reactive results in blood donations tested were based.

# PREVALENCE OF MARKERS OF INFECTION IN BLOOD DONATIONS
Prevalence of an infection among blood donations or the proportion of blood donations with a positive result is directly related to the safety of the blood supply, because it has an impact on the residual risk of distributed blood products for transfusion and also on the risk due to errors in blood quarantine and release (even though test-positive donations are discarded).
Prevalence of an infection in blood donations is dependent on the prevalence of an infection in the population from which blood donors are selected, and on the effectiveness of donor recruitment and selection processes. Table 15 shows the proportion of blood donations with positive or reactive 6 results in screening tests for HIV, HBV, HCV and syphilis, by income group. Globally, the proportions vary greatly, with the lowest proportions in developed countries and the highest in developing countries for all infections. Figure 17 illustrates the prevalence of HIV infections in the general and blood donor population in selected countries of sub-Saharan Africa that reported confirmatory positive HIV results of blood donations to WHO. It shows that a high prevalence of HIV in the general population in a country does not mean that the prevalence rate of HIV in blood donors will inevitably be high. The figure also relates the percentage of voluntary non-remunerated donations in all collections and the percentage of repeat voluntary non-remunerated donations in selected sub-Saharan African countries, and shows that a blood collection system based on repeat and voluntary non-remunerated blood donors can greatly reduce the prevalence of HIV infection among the blood donors recruited. 5 Discard of blood Information on discarded blood donations was provided by 150 countries (48 high-income, 43 upper middle-income, 40 lower middle-income, and 19 low-income). Reactivity for markers of transfusion-transmissible infection, outdated stock, and incomplete collection were among the main reasons for discard (Figure 18). The median total discard rate was 9.0% in lowincome countries, 10.9% in lower middle-income countries, 6.7% in upper middle-income countries and 5.7% in high-income countries (Table 16). Transfusion-transmissible infection was the most common reason for discard in low-income countries, with a median discard rate of 7.4%. Discard rates due to reactivity for markers of transfusion-transmissible infection for lower middle-income, upper middle-income, and high-income countries were 5.1%, 3.9% and 1.1%, respectively (Table 17). Globally, it is estimated that 1.8 million blood donations collected were discarded in 2013 due to transfusiontransmissible infection reactivity.    6 Clinical use of blood

# TRANSFUSION OF BLOOD AND BLOOD COMPONENTS
There is evidence of significant differences in patterns of blood use between high-, middle-and low-income countries. In high-income countries, transfusion is most commonly used for supportive care in cardiovascular and transplant surgery, massive trauma, and therapy for solid and haematological malignancies.
In low-and middle-income countries, on the other hand, it is more often used to treat pregnancy-related complications and severe childhood anaemia. 7
Data reported to WHO indicate significant differences in the age distribution of patients transfused. In high-income countries, the most frequently transfused patient group is aged over 60 years, which accounts for up to 79% of all transfusions. In low-and middle-income countries, up to 67% of all transfusions are for children under the age of 5 years, usually followed by females aged between 15 and 45 years. Figure 19  A measure of variation in clinical use is the proportion of blood that is transfused as whole blood rather than blood components, which can target specific deficiencies. GDBS data reveal great variations in the use of whole blood for transfusion among different country income groups. In highincome countries, whole blood is rarely used for transfusion, while in upper middle-, lower middle-and low-income countries, 1%, 24% and 85% of blood respectively was transfused as whole blood (Table 19). As health systems develop and become able to offer a wider range of diagnostic and treatment options, component therapy becomes increasingly important for the clinical management of patients. Upper middle (n=39) 1.0 (0-10.7) High (n=48) 0 (0-0.2)
A rate of 32.0 units of red cell components (including whole blood and red cells transfused) per 1000 population (range 7-49) was reported by high-income countries, whereas the transfusion rate was 12.5 units (range 6.1-37.4) in upper middle-income countries, 5.38 units (range 0.42-17.4) in lower middle-income countries, and 3.41 units (range 0.32-10.0) in low-income countries. Figure 20 shows the units of red cells/whole blood transfused per 1000 population in countries.
Transfusion rates of other blood components can be calculated in a similar way. Varying rates of units of fresh frozen plasma transfused per 1000 population were reported by high-income countries, ranging from 2.2 units to 18.9 units per 1000 population (median 7.6). Upper middle-income countries reported rates ranging from below 0.1 units to 22 units transfused per 1000 population (median 3.3). The comparable rates reported by countries in the lower middle-income group and low-income group ranged from below 0.1 to 14.8 units (median 0.83) and from below 0.01 to 1.0 units (median 0.06) per 1000 population, respectively. Figure 21 shows the units of fresh frozen plasma transfused per 1000 population in countries, grouped by WHO region.
Regarding platelet transfusions, high-income countries reported a rate ranging from 0.81 to 11.8 units of platelet transfused (in units of the dosage equivalent to apheresis platelet/adult dosage) per 1000 population (median 3.54), and upper middle-income countries reported a rate ranging from 0.01 to 4.38 units (median 0.87) per 1000 population. The rate reported by lower middle-income and low-income groups ranged from below 0.01 to 1.95 units (median 0.02) per 1000 population.
Platelets can be prepared from whole blood (whole blood-derived platelets) or can be prepared through the apheresis procedure (apheresis platelets). Figure 22 shows the units of platelets (adult dosage) transfused per 1000 population in countries reporting to WHO. It also shows that different strategies were adopted in countries for the supply of platelets for transfusion. Countries such as Belgium, China, Czech Republic, Germany, Hungary, Iceland, Japan, Kazakhstan, Kuwait, Lithuania, Namibia, Slovakia, Switzerland, the United Kingdom, the United States and Viet Nam mainly provided platelets through apheresis collection; Other countries provided platelets entirely or mainly through the preparation of whole blood collections.

# Figure 20. Units of whole blood and red cells transfused per 1000 population in countries by WHO region
Note: Caution should be taken in interpreting data on the number of units transfused in low-and lower middle-income countries. It is possible that in some cases the paediatric units derived from an adult unit were counted as multiple units when reported to WHO. Paediatric units in some countries in these groups are very frequently supplied and transfused. Many countries reported number of components issued instead of transfused, if the transfused numbers are not available.

# MECHANISMS TO IMPROVE AND MONITOR SAFE AND APPROPRIATE BLOOD TRANSFUSION
Although many factors operate to explain the considerable variation in transfusion practice between countries (and within countries), one key factor is variable uptake and implementation of best practice, informed by high-quality research. A 2016 update of earlier Cochrane systematic reviews 9 on the use of red cell transfusions highlighted an expanding number of randomized controlled trials which provided good evidence for avoiding unnecessary transfusions with allogeneic red cells in most patients at haemoglobin thresholds above 7.0 to 8.0 grams per decilitre. Strategies to implement this research would minimize risk of exposure to blood for transfusion, which is particularity important given variability in practices of laboratory screening for potential transfusion-transmitted infections.    Many countries did not answer, or only partially answered, the questions in this section, thereby limiting the ability to report on this measure. Caution must therefore be used when extrapolating the data beyond those countries that reported data to WHO. Lack of national data on the situation in both developed and developing countries reflects that this is an area of blood transfusion safety where more attention and possibly more interventions are required. In addition, operational studies in clinical use of blood are required so that more information and evidence are available. 7 Plasma used for fractionation and the provision of plasma-derived medicinal products
Fifty-one countries reported various arrangements for utilizing plasma collected in the country for fractionation. Of those, 37 countries reported that the plasma was fractionated through domestic or contract fractionation, eight countries reported selling the plasma to the fractionator and purchasing plasma-derived medicinal products (PDMP) from the market (not necessarily the product produced through manufacturing of the plasma originated from the countries), and six countries reported having both above options. One country (Croatia) reported closing the fractionation plant and changing the strategy for the provision of PDMP during the year.
Data on the volume of plasma sent for fractionation by the blood services in 2013 were obtained from 44 countries, which reported the collection of a total of around 14.4 million litres of plasma for fractionation. A review of modern plasma fractionation in 2007 by Burnouf 10 indicated that between 23 million and 28 million litres of human plasma are fractionated annually in the world. The lower volume derived from the WHO GDBS could be due to the fact that not all collections of source plasma have been reported to the GDBS. A total of 96 countries reported that all PDMP are imported: 17 countries reported that no PDMP were used during the reporting period. 16 countries did not answer the question.
An analysis by collection method (recovered from whole blood or by apheresis) shows that 41% of the plasma sent for fractionation by the blood establishment is from recovered plasma. In Europe, 4.1 million litres of recovered plasma were fractionated, accounting for 58% of the fractionated plasma in the region.
In the Western Pacific Region, more than 1 million litres of recovered plasma were fractionated, accounting for 17% of the total volume of fractionated plasma reported in the region. Of the plasma fractionated in the Western Pacific Region, 83% (5.3 million litres) was collected through the apheresis procedure (Table 23). The volume of plasma for fractionation (and processing for PDMP) per 1000 population varied considerably between countries, ranging from 0.4 to 53.7 litres, with a median of 5.7 litres.
Twenty-six countries provided information on supplies of albumin, intravenous immunoglobulin and factor VIII (excluding recombinant products) and the proportion of products supplied through fractionation (domestic or contract fractionation) of plasma collected in the country. Denmark, Finland, Luxembourg, the Netherlands, New Zealand, Slovakia and South Africa reported that 70% or more of the three PDMP (Albumin, IVIG factor VIII) were provided by fractionation of plasma collected in the country; Australia, Canada, Japan and Republic of Korea reported 70% or more for at least two of these three products were provided by fractionation of plasma collected in country. Annex 10 provides information on the proportion of supplies of different PDMP manufactured through fractionation (domestic or contract fractionation) of the plasma collected in the country.
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 plasmaderived medicinal products, including immunoglobulins and coagulation factors, which are needed to prevent and treat a variety of serious conditions that occur worldwide.  Overall, 57 (32%) of countries reported that the government budget had a specific line item for the blood transfusion services. Twenty-nine countries (16%) reported that they had a cost recovery system for blood transfusion services; 60 (33%) reported having both a specific budget for blood services and a cost recovery system; 20 (11%) reported that there was neither a specific budget nor a cost recovery system for blood transfusion services (Figure 24). Across WHO regions, 67% of countries (29 of 43)  financed the blood services solely through government budget allocation (Figure 24).

# Figure 24. Systems of blood services financing
Sixty-three countries reported receiving financial support from international agencies or other organizations for blood services. These included 36 (accounting for 78% of the reporting countries) in Africa, three (9%) in the Americas, five (25%) in the Eastern Mediterranean, four (10%) in Europe, eight (73%) in South-East Asia and seven (28%) in the Western Pacific. Eighty-seven countries reported receiving technical support from international agencies or organizations for their blood services, including 38 countries (83%) in Africa, 15 (44%) in the Americas, seven (35%) in the Eastern Mediterranean, eight (19%) in Europe, nine (82%) in South-East Asia and 10 (40%) in the Western Pacific.
Annex 12 lists the agencies that provide financial or technical support to the countries to support national blood services, as reported by the countries to WHO GDBS.
Sixty-two countries provided data on the total funding for the operation of the blood centres covered by the report. Sixty countries also provided the funding sources (government budgetary allocation, cost recovery, or financial support from external donors). Looking at the relationship between total funding and total blood donations reported, varying funding levels per collection were found across the country income groups (Table 24). In general, funding per collection was higher in more economically developed countries. There were also variations among countries in the same income group. It is of concern   that many low-and lower middle-income countries reported that funding per collection was very low, or that the funding source was heavily dependent on external financial support (Figure 25).  The national blood service should be organized and coordinated by the ministry of health in a manner that ensures the most efficient and cost-effective use of resources. Blood transfusion services may operate either under a single service provider, such as a national blood transfusion service, or through multiple organizations and institutions. Whichever service delivery model is in place, blood transfusion services should be coordinated at national, regional and provincial levels, with critical activities such as blood screening and processing preferably consolidated in strategic locations.
Globally, a total of 13 282 blood centres was reported in 2013. There were 2375 (18%) stand-alone blood centres, and 7 671 (58%) hospital-based blood centres. Five countries reported a total number of 3 236 (24%) blood centres without differentiating the types of the centres. More than half of the blood centres in the Western Pacific Region were stand-alone blood centres. The average test samples processed per blood-screening blood centre or laboratory were also highest in the Western Pacific Region, among all WHO regions (Figures 26 and 27). South East Asia: data from India are not included for the calculation.

# QUALITY ASSURANCE AND MONITORING
A total of 155 countries (accounting for 87% of the total reporting countries) reported the existence of national standards for the collection, testing, processing, storage and distribution of blood and blood products. Across the WHO regions, 44 countries (96%) in Africa, 41 (95%) in Europe, 25 (74%) in the Americas, 21 (84%) in the Western Pacific and nine (82%) in South-East Asia and 15 (75%) in the Eastern Mediterranean reported having national standards.
Ninety-eight countries (55%) reported that there was a system of regular inspection of the blood transfusion services by the national regulatory agency or another entity. Across the WHO regions (ranked by percentage), 15 (33%) of countries in Africa, 14 (40%) in the Americas, 11 (55%) in the Eastern Mediterranean, 14 (56%) in the Western Pacific, eight (73%) in South-East Asia and 36 (84%) in Europe reported the existence of a system of regular inspection.
A total of 100 countries (57%) reported there was a system of licensing of the blood transfusion services by the national regulatory agency or another entity. Across the WHO regions (ranked by percentage), 17 (37%) countries in Africa, 11 (44%) in the Western Pacific, 19 (53%) in the Americas, 11 (55%) in the Eastern Mediterranean, six (55%) in South-East Asia, and 36 (84%) in Europe reported having such a system.
A total of 120 countries (67%) reported that there was a national external quality assessment scheme for laboratory screening for transfusion-transmissible infections. Ninety-four countries (52%) reported that there was a national external quality assessment scheme for blood group serology and compatibility testing. Across the WHO regions (ranked by percentage), 14 (56%) countries in the Western Pacific, 28 (61%) in Africa, 21 (60%) in the Americas, 13 (63%) in the Eastern Mediterranean, 34 (79%) in Europe and ten (91%) in South- East Asia reported having a national external quality assessment scheme for laboratory screening for transfusion-transmissible infections. Eleven (44%) in the Western Pacific, nine (45%) in the Eastern Mediterranean, 16 (47%) in the Americas, 22 (48%) in Africa, Six countries (55%) in South-East Asia, and 30 (70%) in Europe reported having a national external quality assessment scheme for blood group serology and compatibility testing.
Overall, 54 countries (30%) reported that their national blood transfusion services were accredited. Across WHO regions (ranked by percentage), three (7%) countries in Africa, three (27%) in South-East Asia, seven (28%) in the Western Pacific, 10 (29%) in the Americas, six (30%) in the Eastern Mediterranean and 25 (58%) in Europe reported that their (national) blood transfusion services were accredited. In total, 771 blood centres were accredited, according to the report. Of these 54 countries, 21 countries reported that all the blood centres in their countries were accredited, and the rest reported only a few of the total number of centres were accredited, with the percentage range from 1.1% to 84.5%.
A total of 115 countries (64%) reported the existence of a programme of continuing education for personnel involved in blood transfusion. Seventythree countries (41%) reported the existence of educational programmes that offered a nationally recognized university degree or diploma in blood transfusion medicine or science. Across WHO regions (ranked by percentage), 16 (46%) countries in the Americas, 23 (50%) in Africa, 16 (64%) in the Western Pacific, 15 (75%) in the Eastern Mediterranean, nine (82%) in South-East Asia and 36 (84%) in Europe reported having such a programme of continuing education for personnel involved in blood transfusion. Ten (22%) countries in Africa, five (25%) in the Eastern Mediterranean, seven (28%) in the Western Pacific, 15 (43%) in the Americas, six (56%) in South-East Asia and 30 (70%) in Europe reported the existence of educational programmes that offered a nationally recognized university degree or diploma in blood transfusion medicine or science.
9 Discussion and conclusions

# AVAILABILITY OF BLOOD AND BLOOD PRODUCTS FOR TRANSFUSION
There are currently no global standards for the estimation of national requirements for blood and blood products. The need for blood and blood products is dynamic and is dependent on many factors related to health service coverage, the level of development and sophistication of the health care system and hospital blood usage. Nevertheless, the whole blood donation rate per 1000 population can be considered as a general indicator for the availability of blood for transfusion in a country and as an indicator of comparability in countries at similar levels of economic and social development. Although there has been a general increase in blood collections in all the WHO regions and World Bank income groups, the current levels of blood collection in low-income countries remain too low to cover the blood requirements of their health care systems. Strategies to improve blood collection in these countries need to be developed or strengthened and effectively implemented.
Regular voluntary non-remunerated blood donation is a key component for any successful blood programme. This ensures adequacy and sustainable availability of quality blood and blood products. There was an increase of 10.7 million voluntary blood donation units in the reporting period between 2008 and 2013. However, 70 countries remained considerably dependent on family/ replacement and paid blood donors, with these donations accounting for more than 50% of their blood supplies in 2013. Greater efforts and investment are required to increase the collection of voluntary non-remunerated blood donations so as to reduce the reliance on family/replacement and paid blood donors for the national blood supply.
Donor retention is important in further improving the safety and quality of the blood supply. Countries in the European Region have higher retention rates than the other regions. These countries also have safer blood supplies.
Countries such as South Africa, where the retention rate is over 80%, have managed to keep the prevalence of transfusion-transmissible infections among blood donors at much lower levels than in the general population. Donor retention strategies need to be emphasized in all the other countries and regions to achieve the same level of safety.
Treatment using labile blood components is gradually being expanded in medical practice in developing countries and increased quantities of recovered plasma will become available for fractionation into PDMP to meet their needs. It is important for such countries to develop appropriate standards for donor recruitment, selection and care and to put in place appropriate blood component separation technology and fractionation capacity, quality systems and good manufacturing practices to improve the quality of plasma for fractionation and also explore the development of alternative mechanisms for contract fractionation of recovered plasma in this developmental and transitional period.

# LABORATORY SCREENING AND TESTING
Obtaining data on testing of donor blood is critical in getting a global picture of the blood safety situation from the testing point of view. The report however indicates that there are some countries in the various regions that are as yet unable to test for one or more of the markers of transfusion-transmissible infections among their donor populations. This poses a serious compromise in the safety of the blood supply in these countries and requires urgent action by national authorities to avert the risk to the blood supply. Caution should be exercised in interpreting coverage of laboratory screening for transfusion-transmitted infections for individual countries when the coverage was calculated based on partial data, as the information is not necessarily representative of the whole country. In most situations, data are mostly reported by the major urban centres and the statistics calculated based on these data probably present a more favourable picture than the real situation in the entire country, as the unreported segment of the activity in these countries is likely to perform less well than the reported segment. Transfusion of unscreened or partially screened blood units could exist in larger scale than was reported to the WHO GDBS. Blood transfusion safety is still a concern, especially in low-and middle-income countries, where the prevalence of transfusion-transmissible infections among blood donors is high but quality and coverage of blood screening is inadequate.

# CLINICAL USE OF BLOOD
Appropriate clinical use of blood is an important aspect of blood safety. It reduces unnecessary exposure of patients to allogeneic blood with its attendant risks while ensuring judicious utilization of a scarce resource. Evidence-based transfusion guidelines and transfusion audits are useful tools in the education of those ordering blood components, potentially resulting in the reduction of inappropriate use of blood components. The randomized controlled trial literature suggest that in patients who do not have acute coronary artery disease, red cell transfusion should be withheld in the presence of haemoglobin concentrations as low as 7.0 to 8.0 grams per decilitre and in the absence of notable bleeding. In countries where there are concerns about the microbiological screening and safety of donated blood, the existing randomized trial data constitute a strong basis for avoiding liberal red cell transfusion in many clinical settings. The benefits of minimizing allogeneic red cell transfusion are likely to be greatest where there is doubt about the safety of the blood supply, and implementation of research findings into the practice of transfusion should be a greater priority.
The presence of structures such as hospital transfusion committees can provide leadership within a hospital for optimizing the use of blood. Fifty-four countries reported not having national guidelines, or the status was unknown. Although 126 countries reported the existence of national transfusion guidelines, that does not indicate whether they were effectively implemented. According to GDBS data provided to WHO, the percentage of transfusion-performing hospitals that had or participated in hospital transfusion committees and performed clinical audits was low in all WHO regions except Europe. More effort and investment is required for countries to develop and implement evidence-based policies and guidelines, educate and train health workers working for blood transfusion, and implement an effective system to monitor the clinical use of blood and products and transfusion practices.
Obtaining accurate data on the clinical use of blood and blood products is challenging due to the wide diversity of institutions and hospital settings that perform transfusion, and the highly variable policies and procedures for documentation and recording of transfusion. A measure of variation in clinical use is the proportion of blood that is transfused as whole blood rather than blood components. GDBS data reveal great variations in the use of whole blood for transfusion among different income groups of countries. As health systems develop and become able to offer a wider range of diagnostic and treatment options, component therapy becomes increasingly important for the clinical management of patients. In addition, macro-level transfusion indicators based on GDBS data that were reported to WHO show marked variations in blood components (red cells, plasma and platelets) across and within income groups. Reporting of higher transfusion rates per 1000 population for certain components in some countries -for example, the high amounts of fresh frozen plasma/plasma transfused per 1000 population in some countries in Eastern Europe -could suggest possible non-optimal use of blood components and products. More micro-level studies, such as reviewing the transfusion data or conducting clinical audits, should be conducted to assess the actual situation at national (and subnational) level, and, where needed, to inform the update of national guidelines and improve actual transfusion practices.

# POLICY, LEGISLATION, REGULATORY OVERSIGHT AND GOVERNANCE MECHANISMS
The provision of safe and adequate blood is a government responsibility and should be an integral part of each country's national overarching health care policy and health care infrastructure. WHO recommends that every country should put in place policies, systems and structures to ensure the safety, quality, accessibility and timely availability of blood and blood products to meet the needs of all patients who require transfusion. WHO also recommends that the policy be supported by appropriate legislation and regulatory framework to promote uniform implementation of standards and consistency in the quality and safety of blood and blood products.
A high percentage of developing countries, in particular in the WHO African and South-East Asia Regions, reported having national blood policies and strategic plans. This reflects the commitment of national governments in the two regions to improve blood safety and adequacy of supply. The European Region reported the highest number of countries with legislation to support their policies. Other regions reported having a lower percentage of countries with specific legislation, including South-East Asia and Africa, though several countries in those regions had reported the existence of policies and plans. Blood policies and plans need to be implemented for a blood service to realize tangible outcomes. Supportive systems, such as a functioning national committee or its equivalent, are needed to ensure the effective implementation of the national blood policy and strategic plan.
Similarly, a very high percentage of countries in the world have national standards for the collection, testing, processing, storage and distribution of blood and blood components -key elements for a quality system for blood transfusion services. However, except in Europe, a low percentage of countries reported having mechanisms for quality oversight and monitoring, or programmes to enforce the implementation of standards and sustain the functionality of the quality systems. There is an urgent need to establish sustainable quality systems and strengthen the capacity for regulation and quality oversight in many countries.
Governments should ensure that adequate, sustainable financing for the national blood programme is integrated within the financial structure of national health care systems, through mechanisms such as specific budget allocation, cost recovery and health insurance, or a combination of these. Inadequate financing of blood services impedes efforts to improve blood safety, particularly in developing countries. Investment in blood services in many low-and lower middle-income countries is often too low to achieve sufficient and safe blood supplies. In many countries belonging to these income groups, a substantial proportion of the funding for the operation of blood services comes from external donors. Such funding needs to be gradually replaced by domestic sources to ensure sustainability of the blood transfusion services in those countries.
The existence of a data collection and reporting system is an important element of a well managed nationally coordinated blood transfusion programme. Adequate national data on blood availability and safety allow countries to set priorities and to further strengthen the national blood system. There is a need to establish systems of surveillance on the incidence and prevalence of HIV, HBV, HCV and other infections in blood donors and vigilance on the transfusion outcomes of recipients, including post-transfusion risk of infection. Information on clinical transfusion forms the basis for the monitoring of clinical transfusion practice and provides critical performance measures to influence desirable changes in prescribing and administration of blood and reduce variations in transfusion practice. Countries providing partial data should consider instituting standardized systems for data collection and management at national level. There is a need for national blood transfusion services to provide greater structure and support for the information management system and for hospitals to establish mechanisms for improving data collection, donor tracking, traceability and overall haemovigilance.
In conclusion, the WHO survey continued to show significant variations in the availability, safety and use of blood and blood components between developed and developing countries. Blood transfusion safety is still a concern, especially in low-and middle-income countries, where the prevalence of transfusion-transmissible infections among blood donors is high but quality and coverage of blood screening is inadequate. Furthermore, low-and middleincome countries still lack enough voluntary unpaid blood donors, with low blood donation rates accompanied by high rates of discard. A blood system that gives patients access to safe blood and blood products in sufficient quantity is a key component of an effective health system. More effort is therefore still required to strengthen national blood systems so as to ensure sufficient and safe blood supplies worldwide, especially in low-and middleincome countries.
While best attempts have been made to obtain accurate data from countries, the data submitted by national health authorities have not been independently verified. Data accuracy therefore depends on the data collection systems in countries and this report can only reflect the information provided by WHO Member States. While many countries report comprehensive national data on blood availability and safety, others provide limited information on the activities of a subset of blood centres in the country. Incomplete data and potentially different interpretations of some indicators affected our ability to analyse some of the information received from countries.

# Annexes Partial data
Sixty-two countries provided partial data with estimated percentages of the national number of donations covered by the report ranging from 10.3% to 99.6%. Of those 62 countries, 21 reported more than 90% of national collections. Eight countries reported data less than 50%. In generating the global overview, the percentages were used to calculate adjusted numbers. The percentages were also used to calculate the donations per 1000 population. Some countries reported coverage percentage but did not provide any sampling frame or basis. Decisions had to be made as to whether to apply the estimated percentage to obtain an adjusted total collections and donations rate.
In some cases, in order to provide aggregate data, it has been necessary to assume that this partial information is representative of the whole country. It is recognized that this may present a more favourable picture than in reality, particularly for low-and middle-income countries where, when partial data are provided, the data often relate to major cities; these tend to have better facilities, equipment and management, and have wider coverage, leaving other areas with a poorer situation unreported. Caution should be taken not to generalize these data.

# Updated indicators
Due to slight differences in the availability of country data and the adjustment of data submitted by a small number of countries as the result of validation, some indicators in this report may differ from WHO Fact Sheet 279: Blood safety and availability (updated July 2016) and the published regional reports.

# Confirmatory testing
It should be noted that a higher proportion of middle-and low-income countries only reported reactive results for testing of transfusion-transmissible infection. Countries that did not provide confirmatory test results may also have higher percentages of positive results among donations than those included. In addition, it should be noted that the strategies and protocols for conducting screening and confirmatory tests may differ between countries. In some countries, a sample was considered as positive when found twice repeatedly reactive. The samples were not confirmed with additional tests.
- - - - - - - - - - - - - - - - - - - - - Azerbaijan - - - - - - - - - - - - - - - - - - - - - Bahamas 0 3 3 0 3 3 0 3 3 0 3 3 0 3 3 0 3 3 Bahrain 0 3 0 1 1 75 0 3 3 0 1 1 75 0 3 3 0 1 1
Cook Islands 0 1 1 0 1 1 0 1 1 0 1 1 0 1 1 0 1 1 Costa Rica ... ...
Djibouti ... ... ... ... ... ... - - - - - - - - - - - - - - Dominica 0 1 1 0 1 1 0 1 1 0 1 1 0 1 1 0 1 1 Dominican Republic ... ...
Equatorial Guinea - - - - - - - - - - - - - - - - - - - - - Eritrea 1 0 1 1 0 1 84.1 1 0 1 1 0 1 94 11 1 0 1 1 0 1 89 10
The Egyptian blood transfusion system is composed of many stakeholders who provide blood and blood components throughout Egypt. The data included in this report are those of the National Blood Transfusion Services only, with its 24 regional blood banks covering most of the Egyptian governorates. 11 625 blood units that were collected in hospital-based blood banks were not included, which accounted for 6%.  12 The French Establishment for Blood is composed of 17 regional facilities. There is also an army blood centre (CTSA), the data of which are integrated to the extent possible into this report. 13 Estimation was made based on responses provided by hospital-based blood centres. 14 Estimation was made based on responses provided by the hospital-based blood centres. Some hospital-based blood centres are not covered in this report, contributing an estimated 10% of the data on blood services. 15 19 blood depots based in hospitals to deliver blood and blood components. 16 Medecins Sans Frontieres (MSF) Belgium collects about 1 000 blood units. Kiribati 0  18 Total number of blood collections by the Ministry of Health (111 812) as a proportion of the total collections in the country (199 501). 19 Total number of blood collections by the Ministry of Health (113 378) as a proportion of the total collections in the country (200 916). 20 An estimated 300 000 units of blood were collected annually. KNBTS collected a total of 158000 units of blood, which is roughly 50% of the total requirement. 21 The main hospital laboratory that provided data has more blood donations each year, since it caters for the majority of the population. The other two have fewer blood donations, accounting for approximately 5% and 15%.  34 The services that are not covered by the report are small, using about 20 units per month. 35 The services that are not covered by the report are small, using about 20 units per month. 36 The annual collection is estimated at 3 million. 37 The total donations reported in 2012 were 1282278. However, the annual collection is estimated to be 3 million. 38 The estimated national collections are 3.5 million; the reported collections are 2.3 million. 39 Hospital San Miguel Acangel and Centro Medico Paitilla not included. 40 21 out of 35 centres that submitted their statistics. Two centres gave data for 8 months and 9 months. 41 21 out of 33 blood centres sent in their data; 224 out of 396 months of data were received. 42 The coverage percentage is calculated based on the actual months of the total 12 months that each centre reported data to the national centre.  Saint Kitts and Nevis
- - - - - - - 1 0 1 1 0 1 - - - - - - - Iceland 0 1 1 0 1 1 0 1 1 0 1 1 - - - - - - -
3 3 0 3 0 80 21 - - - - - - - - - - - - - - Kuwait 1 0 1 0 0 0 - - - - - - - - - - - - - -
Namibia 1 0 1 1 0 1 1 0 1 1 1 1 0 1 1 0 1 Nauru 0 1 1 0 1 1 - - - - - - - - - - - - - - Nepal
0 1 1 0 1 1 97 - - - - - - - 0 1 1 0 1 1 Saint Lucia 0 1 1 0 1 1 ... ... .... ... ... ... ... ... ... .... ... ... ... ...
Saint Vincent and the Grenadines 0  43 The number of centres reported for 2013 is much smaller than that reported in other years. 44 There are more than 200 blood services facilities, but only 101 facilities submitted reports. 45 About 20000 donations were collected by the establishment under the Ministry of Interior. 46 One of 23 blood centres did not report data on blood donations in 2012. The data covered 96% of blood donations in the country. 47 The remaining centre has an annual collection representing less than 1% of the total. 48 Data from the Army Blood Transfusion Centre are not available; estimated annual collection is around 4000 units, representing about 0.9% of the overall national collection. 49 The hospital in Savaii also collects blood units but a very small number. Often patients are referred to the main hospital (covered by this report). 50 The majority of the transfusions and patients are in the main hospital in Apia, on which this report is based. 51 The second blood centre is at the Hospital in Savaii. Most transfusions are done at the main hospital in Apia, on which this report is based. The hospital in Savaii collects approximately 37 units per month.    52 According to data reported from all blood establishments, excluding military blood establishments. Reporting is mandatory. 53 Estimation is based on the total blood donations collected in stand-alone blood centres against collections for both stand-alone and hospital-based blood centres. 54 Estimation is based on the total blood donations collected in stand-alone blood centres against collections for both stand-alone and hospital-based blood centres. 97.2% of blood donations in Singapore are collected by the Blood Services Group. 55 Estimation is based on the total blood donations collected in stand-alone blood centres against collections for both stand-alone and hospital-based blood centres. 97.7% of blood donations in Singapore are collected by the Blood Services Group. 56 The eight hospitals out of a total of 38 that did not report are all from the private sector. 57 This is a rough estimate based on the fact that there are a number of privately owned hospitals that conduct blood collections and donations. Also, parts of the country are inaccessible due to insecurity, and for this reason no data are received from transfusion centres in those locations. 58 Blood services in South Africa are delivered by two independent blood services -SANBS (South African National Blood Service) and WPBTS (Western Province Blood Transfusion Service). This report is a national summary covering activities of both services. 59 Estimated total national blood donations are about 5000 units, and 2331 collections constitute about 46% of that estimated total. 60 The two hospitals with available data for 2013 are Juba Teaching Hospital and Al Sabah Children's Hospital. These could constitute about 75% of the estimated national total. 61 The donations collected in the military and police force hospitals are not reported to the directorate, and their collection does not exceed 10% of the national collection.   The number of centres reported for 2012 is much bigger than the number reported in other years. 63 Total blood donation in the whole country is 1937564 units. Blood donation for the National Blood Centre, Bangkok, is 591192 units. 64 The percentage is calculated based on blood collection information for the National Blood Centre as a proportion of the blood collection for the whole country. 65 This estimation is made according to the annual report (2011) of Turkey. The total number of collected blood and blood components in 2011 from all blood centres (including hospital-based) in Turkey is 2182394. Annual data collected from hospital-based transfusion centres are not included in this report. 66 Military hospitals: 3% of national collection. 67 The estimation is based on a blood needs assessment study, 2014, conducted by NBTS in collaboration with CDC and other partners. 68 All stand-alone blood centres were sampled and a response rate of 94.1% (128/136) was obtained. This sample was then weighted based on the size and output of the blood centres and used to estimate total blood donations for the country. Approximately 98% of hospital-based blood centres responded and these responses were not weighted. Hospital-based blood centres account for less than 4% overall of the collected blood supply. 69 Market share of the blood services (American Red Cross, Blood System Inc. and New York Blood Center) the report covers. 70 Market Share of the blood services (American Red Cross, Blood System Inc. and New York Blood Center) the report covers.  71 Each service sends a monthly report -of the 888 reports that should be received, only 52 were missed. 72 In remote areas where there is no blood centre, some hospitals collect blood from relatives of donors, but only when there is not enough blood in an emergency case. Those blood donations are not included in the report. 73 Based on reports from other blood centres in the whole country. 74 The estimation is based on a previous study made during the period November 2010 to December 2010.
1 1 0 1 1 0 1 1 0 1 1 0 1 1 0 1 1 Samoa 0 2 2 0 1 1 95 49 0 2 2 0 1 1 95 50 0 2 2 0 1 1 95 51 San Marino - - - - - - - - - - - - - - - - - - - - - Sao Tome and Principe - - - - - - - - - - - - - - 0 1 1 0 1 1 Saudi Arabia
Slovenia 3 0 3 3 0 3 3 0 3 3 0 3 3 0 3 3 0 3 Solomon Islands 0 1 1 0 1 1 0 1 1 0 1 1 - - - - - - - Somalia 0
Suriname 1 0 1 1 0 1 1 0 1 1 0 1 1 0 1 1 0 1 Swaziland 1 0 1 1 0 1 1 0 1 1 0 1 - - - - - - -
Togo 2 1 3 2 1 3 2 1 3 2 1 3 2 0 2 2 0 2 Tonga - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - Tuvalu 0 1 1 0 1 1 0 1 1 0 1 1 0 1 1 0 1 1 Uganda 7
Blood donations 2011-2013  3 The total number of donations in not equal to the sum of the number of donations from first-time donors + donations of repeat donors as 40% of firsttime donors became regular donors within the same year. 4 No collection from first-time donors (only test) in four of five regions. In the fifth region, blood collection two months after first contact from donor (to exclude window period). 5 13 846 of the units collected were not classified by blood donor type. The data given in this section are from NBTS and Lagos State Blood Transfusion Service. 10 27 512 of the units collected were not classified by donor type. 11 29 841 of the units collected were not classified by donor type.  25 18 Data on the number of first-time and repeat donors are provided by Scottish National Blood Transfusion Service, which reported a total whole blood collection of 195000. 19 It was estimated that the number of blood donations reported (from American Red Cross, Blood Systems Inc. and New York Blood Center) covered 60% of the national data. 20 It was estimated that the number of blood donations reported covered 60% of the national data (from American Red Cross, Blood Systems Inc. and New York Blood Center). 21 Directed donations: 358. 22 Sum of the donations by different types of donors was not equal to the total number. 23 59.1% donations with blood volume of 250 ml or less/donation unit, 40.9% with blood volume of 350 ml or more/unit. 24 Number of repeat donors. 25 All donations: 67420; usable donations: 56958.
- - - - - - - - - - - - - - - - - - - - - Azerbaijan - - - - - - - - - - - - - - - - - - - - -
Blood donations 2011-2013 (continued)          5 There are three levels of blood services in the Democratic Republic of the Congo: National Blood Transfusion Centre (CNTS) at national level; provincial (regional) blood transfusion centres (CPTS) at middle level; and hospital blood banks (CHRTS) at peripheral level. For the EQA, hospital blood banks send samples to the regional blood transfusion centre, and the regional blood transfusion centre sends samples to the National Blood Transfusion Centre for retesting. Testing includes HIV, hepatitis (B, C) and syphilis, and blood grouping with the frequency of twice a year. The National Blood Transfusion Centre sends samples to the national laboratory of the HIV control programme for retesting for HIV.  11 Ten blood centres and two NAT centres. 12 All the nine screening laboratories of the Japanese Red Cross Society Blood Programme participated in the national EQA for (HBV, HCV, HIV) NAT screening. However, there is no EQA scheme for serological tests. 13 At the two regional blood banks and donation centres both rapid testing and ELISA are done; at the 38 facility blood banks only rapid testing is done.
1 030 0 0 0 1 030 0 - - - - - - - - - India - - - - - - - - - Yes ... ... ... ... ... ... ... ... Yes ... ... ... ... ... ... ... ... Indonesia Yes ... ... ... ... ... ... ... ... Yes ... ... ... ... ... ... ... ...
... ... ... ... ... ... ... 0 Lebanon - - - - - - - - - - - - - - - - - - Yes ... ... ... ... ... ... ... ... Lesotho No 0 No ... Yes 12 0 12 0 0 12 ... Liberia No ... - - - - - - - - - No ... Libya - - - - - - - - - - - - - - - - - - Yes ... ...... ... ... ... .... ... Lithuania - - - - - - - - - Yes ... ... ... ... ... ... ... ... - - - - - - - - - Luxembourg
Maldives No ... No ... No ... Mali No ... - - - - - - - - - ... ... Malta - - - - - - - - - - - - - - - - - - - - - - - - - - - Marshall Islands No ... - - - - - - - - - - - - - - - - - - Mauritania No
... ... ... ... ... ... ... Turkmenistan - - - - - - - - - - - - - - - - - - - - - - - - - - - Tuvalu No 0 No 0 No 0 Uganda No ... No ... No ... Ukraine - - - - - - - - - - - - - - - - - - - - - - - - - - - United
Afghanistan Y Y Y Y Albania Y Y Y Y Y Algeria Y Y Y Y Y Andorra - - - - - - - - - - - - - - - - - - Angola Y Y Y Y Y Y Antigua and Barbuda Y Y Y Y Y S Argentina Y Y Y Y Y Y Y Y Y S Y Armenia Y Y Y Y Y Y Australia Y Y Y S Y Y Y Y 1 S 2 Y Austria - - - - - - - - - - - - - - - - - - Azerbaijan - - - - - - - - - - - - - - - - - - Bahamas Y Y Y Y Y Y Y Bahrain Y Y Y Y Y Y Y Bangladesh Y Y Y Y Y Barbados Y Y Y Y Y Y Belarus Y S Y S Y S Y Belgium Y Y Y S Y Y Y Y S S Belize Y Y Y Y Y Y Y Benin Y Y Y Y Y Bhutan Y Y Y Y S 3 S Bolivia Y Y Y Y Y 4 Y Y Y Y 5 Bosnia and Herzegovina - - - - - - - - - - - - - - - - - - Botswana Y Y Y Y Y Y Brazil Y Y Y Y Y Y Y Y S S Y Brunei Darussalam Y Y Y Y Y Bulgaria Y Y Y Y Y Y Burkina Faso Y Y Y Y Burundi Y Y Y Y Y Cambodia Y Y Y Y Cameroon Y Y Y Y Y Canada Y. Y Y Y Y Y Y Y S Y Cape Verde Y Y Y Y Y Y Central African Republic Y Y Y Y Y Y Y Chad Y Y Y Y Chile Y Y Y Y Y Y Y Y Y China Y Y Y Y Y Y Y Y Colombia Y Y Y Y Y S 6 Comoros Y Y Y Y Congo Y S Y Y S Y Cook Islands Y Y Y Y Costa Rica Y Y Y Y Y Y Y Y Cote d'Ivoire Y Y Y Y Y Croatia Y Y Y Y Y Y Cuba Y Y Y Y Y Y
Cyprus Y Y Y Y Y Czech Republic Y Y Y Y Y Democratic People's Republic of Korea Y Y Y Y S Democratic Republic of the Congo Y S Y Y Y S Denmark Y Y Y S Y Y Y S 7 Djibouti ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dominica Y Y Y Y Y Dominican Republic ... ... Ecuador Y Y Y Y Y Y Y Y Y S Egypt Y Y Y Y S Y Y Y Y El Salvador Y Y Y Y Y 8 Y Equatorial Guinea - - - - - - - - - - - - - - - - - - Eritrea Y Y Y Y Estonia Y Y Y Y Y Y Y Y Ethiopia Y Y Y Y Y Fiji Y Y Y Y Y Finland Y Y Y Y Y Y Y S France Y Y Y Y Y Y Y Y S S S Y Gabon Y Y Y Y Y Y Y Y Y Gambia Y Y Y Y Georgia Y Y Y Y Y Germany Y Y Y Y S Y Y Y S Ghana Y Y Y Y Y Greece Y Y Y Y S Y Y S Y Y S Y Y
... Guatemala Y Y Y Y Y Y Y Y Guinea Y S Y Y Y S Y Guinea-Bissau Y Y Y Y Y Y Y Y Y Guyana Y Y Y Y Y Y Y Haiti Y Y Y Y Y Honduras Y Y S Y Y S Y S Y Y S Y Hungary Y Y Y S Y Y Iceland Y Y Y Y S India Y Y Y Y Y Y Y 10 Indonesia Y Y S Y S Y S Y S Iran (Islamic Republic of) Y Y Y Y Y S Iraq Y Y Y Y Y Y Ireland Y Y Y Y Y Y Y Y Y Israel Y Y Y Y Y Y Y Y Italy Y Y Y Y Y Y Y Jamaica Y Y Y Y Y 11 S Y Japan Y Y Y Y Y Y Y Y S Y Jordan Y Y Y Y Y S Y S 12 Kazakhstan Y Y Y Y Y Y Y Y Kenya Y Y Y Y Y Kiribati Y Y Y Y Kuwait Y Y Y Y Y Y Y Y S 13 Y Kyrgyzstan Y Y Y Y Y Lao People's Democratic Republic Y Y Y Y Y Latvia Y Y Y Y Y Y Y Lebanon Y Y Y Y Y Y Lesotho Y Y Y Y Y Liberia Y Y Y Y Y Y Y Y Y Libya Y Y Y Y Lithuania Y Y Y Y Y Y Y Luxembourg Y Y Y S Y
Madagascar Y Y Y Y Malawi Y Y Y Y Y Y Malaysia Y S S Y S Y S S Y S Maldives Y Y Y Y Mali Y S Y Y S Y Malta - - - - - - - - - - - - - - - - - - Marshall Islands Y Y Y Y Mauritania Y Y Y Y Y Y Mauritius Y Y Y S Y Y Mexico Y Y Y Y Y S Micronesia (Federated States of) Y Y Y Y Monaco - - - - - - - - - - - - - - - - - - Mongolia Y Y Y Y Y Y Y Montenegro Y Y Y Y Y Morocco Y Y Y Y Y Y Mozambique Y Y Y Y Y Myanmar Y S Y Y Y Namibia Y Y Y Y Y Y Y Nauru  Y Y Y Y Nepal Y Y Y Netherlands Y Y Y Y Y Y Y Y S 14 Y S 15 New Zealand Y Y Y Y Y Y Y S S 16 S Nicaragua ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Niger Y Y Y Y Y Nigeria Y Y Y Y Y Y Y Niue Y Y Y Y Norway Y Y S Y S Oman Y Y Y Y Y Y Pakistan Y Y Y Y Y Y Palau - - - - - - - - - - - - - - - - - - Panama Y Y Y Y Y Y Y Y Y Papua New Guinea Y Y Y Paraguay Y Y Y Y Y Y Y Y Peru Y S Y Y Y Y S Y Philippines Y Y Y Y Y Y Y S Poland Y Y Y Y Y Y Y Portugal Y Y Y Y Y Y Y Y S 17 S Qatar Y Y Y Y Y Y Y Y Y Y Y Republic of Korea Y Y Y Y Y Y Y S 18 S S 19 Republic of Moldova Y Y Y Y Y Y Y Y Romania Y Y Y Y Y Y Y Russian Federation Y Y S Y S Y S Y Rwanda Y Y Y Y Y Saint Kitts and Nevis Y Y Y Y Y Saint Lucia Y Y Y Y Y Saint Vincent and the Grenadines Y Y Y Y Y Y Samoa Y Y No No Y Y San Marino - - - - - - - - - - - - - - - - - - Sao Tome and Principe Y Y Y Y Y Saudi Arabia Y Y Y Y Y Y Y Y Y Y Y 20 Y Y 21 Senegal Y Y Y Y Y Serbia Y Y Y Y Y Seychelles Y Y Y Y Y Y Sierra Leone Y Y Y S Y Y Y
Singapore Y Y Y Y Y Y Y S 22 Slovakia Y Y Y Y Y Y 23 Slovenia Y Y Y Y Y Y Y Y Solomon Islands Y Y Y Y Somalia Y Y Y Y Y Y Y South Africa Y Y Y S Y Y Y Y Y 24 South Sudan Y Y Y Y Spain Y Y Y Y Y Y Y S S S Sri Lanka Y Y Y Y Y Y Sudan Y Y Y Y Suriname Y Y Y Y Y Y Y Y Swaziland Y Y Y Y Y Sweden Y Y Y S Y Y S S 25 Switzerland Y Y Y Y Y Y Y S S Syrian Arab Republic - - - - - - - - - - - - - - - - - - Tajikistan Y Y Y Y Y Y Y Y Y Y Thailand Y Y Y Y S Y Y Y Y The former Yugoslav Republic of Macedonia Y Y Y Y Y Timor-Leste Y Y Y Y Y Y Y Y Y Y Y Togo Y Y Y Y Y Tonga - - - - - - - - - - - - - - - - - - Trinidad and Tobago Y Y Y Y Y Y Y Tunisia Y Y Y Y Y Y Turkey Y Y Y Y Y Y Y Y Y Y Turkmenistan - - - - - - - - - - - - - - - - - - Tuvalu Y Y Y Y 26 S Uganda Y Y Y Y Y Y Y Ukraine - - - - - - - - - - - - - - - - - - United Arab Emirates Y Y Y Y Y Y Y Y Y Y United Kingdom of Great Britain and Northern Ireland Y Y Y Y S Y Y Y Y S S 27 Y United Republic of Tanzania Y Y Y Y Y United States of America Y Y Y Y Y Y Y Y S Y Uruguay Y Y Y Y Y Y Y Y Uzbekistan - - - - - - - - - - - - - - - - - - Vanuatu Y Y Y Y Y Venezuela (Bolivarian Republic of) Y Y Y Y Y Y Y Y Viet Nam Y Y Y Y Y Y Yemen Y Y Y Y Y Y Y 28 Zambia Y Y Y Y Y Zimbabwe Y Y Y Y

# Data year
No. blood centres that perform laboratory screening of blood donations for TTI
No. blood centres performing laboratory screening that participate in EQAS for TTI  17 In Rwanda, the TTI testing is centralized in the national centre. 18 The Blood Transfusion Institute of Serbia (which collects, tests and processes approximately 40% of blood in Serbia) was the only laboratory performing screening that participated in the EQAS for TTIs in 2011. 19 Three major regional centres and 44 hospital blood banks perform laboratory screening for TTIs, i.e. all blood transfusion establishments in Serbia. 20 Three regional blood centres participated in the EQAS for TTIs.                  11 Based on national data covering 20 blood centres in the country. 12 For hepatitis B and C, the figures given are for screening positive numbers. Confirmatory testing was not performed. 13 Partial data from National Blood Centre, Bangkok.
- - - - - - - - - - - - - - - - - - - - Azerbaijan - - - - - - - - - - - - - - - - - - - - -
Andorra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Angola 1
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Azerbaijan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Djibouti ... ... ... ... ... ... ... ... ... ... ... ... - - - - - - - - - - - - - - - - - - - - - - - -
... 2.1 - - - - - - - - - - - - ... ... ... ... ... ... ... ... ... ... ... ... Libya - - - - - - - - - - - - - - - - - - - - - - - - ... ... ... ... ... ... ... ... ... ... ... ... Lithuania - - - - - - - - - - - - ... ... ... ... ... ... ... ... ... ... ... ... - - - - - - - - - - - - Luxembourg 0
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Marshall Islands ... ... ... ... ... 0.07 ... ... ... ... ... 0.05 - - - - - - - - - - - - - - - - - - - - - - - -
Nauru ... ... ... ... ... ... ... ... ... ... ... ... - - - - - - - - - - - - - - - - - - - - - - - - Nepal
Palau - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
... ... ... ... ... ... ... ... ... ... ... San Marino - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

# Sao Tome and Principe
- - - - - - - - - - - - 0 1 441 0 0 1 441 0 ... ... ... ... ... ... 0 1 610 0 0 1 610 0 ... ... ... ... ... ... Sierra Leone ... ... ... ... ... ... ... ... ... ... ... ... - - - - - - - - - - - - 1
... ... ... ... ... ... ... ... ... ... ... Turkmenistan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ukraine - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - United
14 HBV and HCV are positive data; reactive data are 0.45% and 0.25% respectively. HIV and syphilis are reactive data.  15 The data for these fields originate from the subsection of blood centers that account for approximately 57% of the country's blood supply (American Red Cross=42%, New York Blood Center=7%, Blood Systems=8%) 16 Values in sections 4.5 to 4.8 are for all donations (7250222), including autologous. Units incompletely tested for a given TTI are removed from 7250222 for that TTI denominator count. The positive counts derived from the risk factor (RF) study and reported here are based on a very tight consensus definition of "positive" for HBV, HCV and HIV. Generally, both seropositive and nucleic acid positive tests were required for RF positivity. The individual centres would report a higher number of positives based on less stringent definitions of positive, e.g. HCV confirmed seropositive, nucleic acid neg is generally accepted as positive but insufficient for the RF study. To demonstrate the impact of this stringent definition on the prevalence rates, the overall ARC rates per 10000 were 0.80, 3.20 and 0.26 for HBV, HCV and HIV respectively. For RF these were 0.67, 2.09 and 0.24 for HBV, HCV and HIV respectively. Chagas disease testing (T. cruzi antibody) was done selectively. Donors who had already been tested previously were not retested. The denominator was based on only those donors screened for Chagas during the year.
The data for these sections originate from the section of blood centers that account for approximately 57% of the country's blood supply (American Red Cross=42%, New York Blood Center=7%, Blood Systems=8%). The number is bigger than the total whole blood collection. 5 Of the 54 678 red cell concentrates prepared, 20 691 or 37.84% are paediatric units. 6 One unit of red cells: preparation from 200 ml whole blood donations. 7 All 28 centres prepare at least the red cells. Only Brazzaville and Pointe Noire centres prepare plasma components. 8 FFP sent for fractionation is not included. 9 Apheresis plasma in litres. 10 The red cell concentrates are prepared by sedimentation in all centres. The concentrated platelets and FFP are prepared in four centres (Kinshasa, Monkole, North Kivu and South Kivu). 11 The separation in remote areas is done by simple decantation using a plasma extractor. 12 Partial data. 13 One major centre did not have its data reported and an estimation was made.
14 Data on component production only available from one blood centre. 15 In Finland, only solvent detergent-treated FFP is used. 16 This section presents data from six blood banks.  17 1 814 767 units of whole blood were separated. The reported units of blood components are partial data. 18 Including 1158 units collected through plasmapheresis. 19 Data included are only for apheresis procedures performed by MDA centre. 20 Adult-sized blood bag was 400 ml in Japan, and 200 ml bags were used as well. The 200 ml bag was counted as 0.5 unit for whole blood, red cells and FFP. 21 For apheresis platelets, 200 x 109 platelets were counted as 1 unit of adult size; 400 x 109 platelets were calculated as 2 units in this table. The actual number of prepared bags of apheresis platelets was 837 323.   22 Component preparation only started in September 2011. 23 Red cells from whole blood + apheresis: 91 793 units. 24 FFP from whole blood + apheresis: 81 223 units. 25 CNTS and six CRTS preparing blood components. 26 The percentage is 87%, based on data from the National Blood Service. 27 Data given in this section are from Maldivian blood services and IGMH only. 28 Red cells and plasma can only be prepared by leaving the whole blood to stand for some time in the fridge or at room temperature if it is going to be used soon. But there is hardly any request for plasma. 29 Two of five blood banks have a component centrifuge. Blood centres without such a centrifuge prepare packed red cells by gravity sedimentation. These units have not been counted as red cell preparations.  34 Plasma can be produced by standing the blood at room temperature until the plasma and the red cells separate. 35 In 2012 all FFP was apheresis plasma. Apheresis plasma was also collected for fractionation. 36 Cryoprecipitate in New Zealand is prepared from apheresis plasma. 37 Only the CRTS in the capital prepares blood components. 38 The data given in this section are from Lagos State Blood Transfusion Service. 39 One unit of platelets made from whole blood is from four buffy coats. 40 The data given on blood components are only for the centre preparing blood components: Port Moresby BTS. 53 Data in this section were provided by the Scottish National Blood Transfusion Service (SNBTS) and Welsh Blood Service (total collection of 271 262 was reported in the year). 54 Data are from all three centres (BSI, ARC and NYBC). BSI WB denominator = 654 791, ARC WB denominator = 5 387 891, NYBC WB denominator = 320 000. 55 One unit of whole blood derived platelets is defined as the preparation from 1000 ml whole blood (pool of platelets preparation from 4 bags of 250 ml or 3 bags of 350 ml whole blood)  Although nine hospitals can do transfusions, only three recorded transfusions in the current year. 5 Units of blood and components transfused are partial data. 6 Including platelets derived from whole blood and apheresis platelets. 7 Including platelets derived from whole blood and apheresis platelets. 8 The data are from 130 reporting blood banks that support greater numbers of hospitals. Data are not given by hospitals directly. 9 From 188 hospitals, only 148 perform blood transfusion on a regular basis. 10 Incomplete data representing around 97% of issued components. 11 Only plasma for clinical purposes was included (in litres). 12 Partial data. Blood components distributed to the Health facilities under ministry of public health. 13 The hospitals numbered are those under the Ministry of Health. 14 The hospitals numbered are those under the Ministry of Health.  22 Hospitals belonging to the public health system. 23 The units of blood components issued only include MDA data. 24 An adult-sized blood bag is 400 ml in Japan, and 200 ml bags are used as well. The 200 ml bag was counted as 0.5 bag for whole blood, red cells and FFP. In the case of apheresis platelets, a component of 200 x 109 platelets is regarded as adult-sized. 400 x 109 components were calculated as 2 units in this table. The actual number of bags of apheresis platelets was 821 680.  25 Total red cells and whole blood: 42 389. 26 Whole blood and component transfused are partial data. 27 Data on whole blood and components issued/transfused are for Ministry of Health facilities only. About 20-30% of blood collected in Ministry of Health facilities was supplied to private health care facilities under an individual memorandum of understanding. 28 Data given in this section are from IGMH and Maldivian blood services only. 29 The number of hospitals includes five regional public hospitals and 22 private health institutions. 30 Total red cells and whole blood: 39 374. 31 Estimated number. 32 Data on number of units of blood components issued/transfused only cover the blood transfusion centre in Montenegro. 33 The data provided are the units of blood components issued. 34 Partial data 35 The data given in this section are from the Lagos State Blood Transfusion Service. Country data are not available. 36 Units of blood components issued/transfused are partial data from facilities under the Ministry of Health.
Liberia 0 0 - - - - - - - - - - 0 0 Libya - - - - - - - - - - - - - - - - - - - - ... ... ... ... ... ... ... ... ... ... Lithuania - - - - - - - - - - 4 ...
- - - - - - - - - - - - - - - - - - - - - - - - Azerbaijan - - - - - - - - - - - - - - - - - - - - - - - - Bahamas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bahrain
37 Data on number of units of blood components issued/transfused only cover the Blood Transfusion Service in Port Moresby. 38 Numbers of blood component units issued/transfused are partial data. Not all reporting facilities included data on transfusion. 39 Including both plasma and FFP. 40 Cryosupernatant. 41 The units transfused include units that were shared between patients. Each of the split units was counted as a unit. 42 About 900 units of blood were supplied from Kenya during the crisis in 2013 when fighting broke out. This accounts for the excess number of transfused units compared to what was collected at the hospitals. 43 Units of platelets include both the platelets derived from whole blood and apheresis platelets. 44 Cryosupernatant. Subnational data. 45 Data in this section only cover the issued data from the National Blood Centre (Bangkok). 46 The National Institute of Transfusion Medicine can give data only for the issued blood units. There is not a proper budget line for blood transfusion but the NBTS receives some subsidies from the government to purchase reagents, inputs and equipment. There is also the payment of staff salaries. All blood centre activities are financed by the government through taxes. Blood is free of charge for wards and patients. Adapted from Caribbean regional standards and internal SOPs. The policy is undergoing revision pending approval by the authorities. Each hospital requests a direct payment from the users of blood services. The fee varies from hospital to hospital. Direct funding from government to the blood services were in the form of reagents for blood screening, premises, equipment and mobile unit vehicles.
The responsibility for governing all activities related to blood and blood components is delegated to the headquarters of IBTO under the supervision of the High Council.