Blood Transfusion Safety in Low-Resourced Countries: Aspiring to a Higher Standard
Authors: Evan M. Bloch, Eric A. Gehrie, Paul M. Ness, Jeremy Sugarman, Aaron A.A.R. Tobian
Journal: Annals of Internal Medicine (2020)

Ideas and Opinions15 September 2020Blood Transfusion Safety in Low-Resourced Countries: Aspiring to a Higher StandardEvan M. Bloch, MBChB, MS, Eric A. Gehrie, MD, Paul M. Ness, MD, Jeremy Sugarman, MD, MPH, MA, and Aaron A.A.R. Tobian, MD, PhDEvan M. Bloch, MBChB, MSJohns Hopkins University School of Medicine, Baltimore, Maryland (E.M.B., E.A.G., P.M.N., A.A.T.), Eric A. Gehrie, MDJohns Hopkins University School of Medicine, Baltimore, Maryland (E.M.B., E.A.G., P.M.N., A.A.T.), Paul M. Ness, MDJohns Hopkins University School of Medicine, Baltimore, Maryland (E.M.B., E.A.G., P.M.N., A.A.T.), Jeremy Sugarman, MD, MPH, MABerman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland (J.S.), and Aaron A.A.R. Tobian, MD, PhDJohns Hopkins University School of Medicine, Baltimore, Maryland (E.M.B., E.A.G., P.M.N., A.A.T.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-0203 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Blood transfusion safety remains a pervasive public health challenge in low-income and lower-middle–income countries (LLMICs) (1). Suboptimal donor recruitment, selection, and retention continue to strain the abilities of transfusion services in LLMICs to collect sufficient blood to meet clinical demand. This has forced—or at least contributed to—a tacit acceptance of suboptimal transfusion practices in many LLMICs that would not be tolerated in other settings.The underlying deficiencies that contribute to suboptimal transfusion practices defy geography (2) and span the complete vein-to-vein continuum from collection through infectious disease testing, quality oversight, and transfusion itself. Foremost is suboptimal donor mobilization. Without donors, ...References1. Weimer A, Tagny CT, Tapko JB, et al. Blood transfusion safety in sub-Saharan Africa: a literature review of changes and challenges in the 21st century. Transfusion. 2019;59:412-427. [PMID: 30615810] doi:10.1111/trf.14949 CrossrefMedlineGoogle Scholar2. Custer B, Zou S, Glynn SA, et al. Addressing gaps in international blood availability and transfusion safety in low- and middle-income countries: a NHLBI workshop. Transfusion. 2018;58:1307-1317. [PMID: 29542130] doi:10.1111/trf.14598 CrossrefMedlineGoogle Scholar3. 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Google Scholar8. Allain JP, Owusu-Ofori AK, Assennato SM, et al. Effect of Plasmodium inactivation in whole blood on the incidence of blood transfusion-transmitted malaria in endemic regions: the African Investigation of the Mirasol System (AIMS) randomised controlled trial. Lancet. 2016;387:1753-61. [PMID: 27116282] doi:10.1016/S0140-6736(16)00581-X CrossrefMedlineGoogle Scholar9. Horton S, Sullivan R, Flanigan J, et al. Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action. Lancet. 2018;391:1953-1964. [PMID: 29550030] doi:10.1016/S0140-6736(18)30460-4 CrossrefMedlineGoogle Scholar10. Katz LM, Donnelly JJ, Gresens CJ, et al. Report of a workshop on ensuring sustainable access to safe blood in developing countries: International Blood Safety Forum, March 24, 2017. Transfusion. 2018;58:1299-1306. [PMID: 29542121] doi:10.1111/trf.14591 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Johns Hopkins University School of Medicine, Baltimore, Maryland (E.M.B., E.A.G., P.M.N., A.A.T.)Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland (J.S.)Disclaimer: The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Bloch is a member of the U.S. Food and Drug Administration (FDA) Blood Products Advisory Committee. Any views or opinions expressed in this manuscript are Dr. Bloch's and are based on his own scientific expertise and professional judgment; they do not necessarily represent the views of the Blood Products Advisory Committee or the formal position of the FDA and also do not bind or otherwise obligate or commit either the Advisory Committee or the FDA to the views expressed.Financial Support: Dr. Bloch is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number K23HL151826.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0203.Corresponding Author: Evan M. Bloch, MBChB, MS, Associate Professor, Department of Pathology, Johns Hopkins University School of Medicine, 600 North Wolfe Street/Carnegie 446 D1, Baltimore, MD 21287-6667; e-mail, ebloch[email protected]edu.Current Author Addresses: Dr. Bloch: Associate Professor of Pathology, Johns Hopkins University School of Medicine, Transfusion Medicine Division, Department of Pathology, Johns Hopkins Hospital, 600 North Wolfe Street/Carnegie 446 D1, Baltimore, MD 21287.Dr. Gehrie: Assistant Professor of Pathology, Johns Hopkins University School of Medicine, Transfusion Medicine Division, Department of Pathology, Johns Hopkins Hospital, 1800 Orleans Street, Zayed 3081A/Blood Bank, Baltimore, MD 21287.Dr. Ness: Professor of Pathology, Medicine, and Oncology, Johns Hopkins University School of Medicine, Transfusion Medicine Division, Department of Pathology, Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie 446, Baltimore, MD 21287.Dr. Sugarman: Harvey M. Meyerhoff Professor of Bioethics and Medicine, Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205.Dr. Tobian: Professor of Pathology, Medicine, and Oncology, Johns Hopkins University School of Medicine, Transfusion Medicine Division, Department of Pathology, Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie 446, Baltimore, MD 21287.Author Contributions: Conception and design: E. Bloch, E. Gehrie, P. Ness.Analysis and interpretation of the data: E. Bloch.Drafting of the article: E. Bloch, E. Gehrie, A.A.A.R. Tobian.Critical revision for important intellectual content: E. Bloch, E. Gehrie, P. Ness, J. Sugarman, A.A.A.R. Tobian.Final approval of the article: E. Bloch, E. Gehrie, P. Ness, J. Sugarman, A.A.A.R. Tobian.Administrative, technical, or logistic support: E. Bloch, E. Gehrie.Collection and assembly of data: E. Bloch.This article was published at Annals.org on 16 June 2020. 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