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Tue 14 Jun 2005 04:00 AM

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Majority of people have no access to safe blood

Despite the millions of blood donors that save countless lives each day, a World Health Organisation report has revealed more than 80% of the population still remain inadequately covered.

Despite the millions of blood donors that save countless lives each day, a World Health Organisation report has revealed more than 80% of the population still remain inadequately covered.

The research shows that about 60% of the worldwide blood supply goes to just 18% of the global population — leaving the remainder with inadequate cover.

News that the chances of receiving a safe transfusion — or any transfusion at all — vary enormously from country to country emerged on World Blood Donor Day 2005, staged today.

"Safe blood is a fundamental need for the health system of any country," said Dr Lee Jong Wook, director general of the World Health Organisation (WHO).

"WHO's 192 Member States have recently agreed that World Blood Donor Day will be an officially recognised annual event. This will help raise awareness of the continuing need for safe blood and safe donors."

WHO and other organisations have advocated clear strategies to increase universal access to safe blood. These are based on promoting regular, voluntary, unpaid donations and on nationally coordinated blood transfusion services.

Malawi, a country with 14.4% incidence of HIV/AIDS and huge development challenges, has managed to set up a functioning blood service based on voluntary unpaid donation in just two years. Since 2004, when safe blood became available, the death rate among children at a major hospital in Blantyre has dropped by 60% for children with severe anaemia due to malaria, and the maternal mortality rate due to pregnancy complications has fallen by more than 50%. At the heart of Malawi's efforts to ensure universal access to safe blood was the move to a system of 100% regular voluntary, unpaid blood donors.

Experience has shown that the safest donor is one who gives blood at least twice a year without receiving money or goods in exchange, understands the principle of altruism, answers questions for donor selection honestly and will defer or exclude him/herself from donation if there is any risk to the recipient. Because such donors generally have a sense of responsibility towards their community, they tend to keep themselves healthy so as to be able to keep giving safe blood. However, much more progress is needed globally. In the early 1990s, unsafe transfusions were estimated to be responsible for up to 10% of all HIV infections, many of them in high-income countries. HIV-contaminated blood now accounts for approximately 5% of HIV infections in Africa today.

In many countries more and more testing is being done to make blood safe, but the majority of developing nations still do not carry out even the most basic mandatory tests for diseases such as HIV or hepatitis B and C. Annually, some six million tests that should be done to check for infections are not done. Most countries still lack a nationally coordinated blood transfusion service. Despite some recent improvements in this important area, fewer than 30% of countries have a well-organised service in place.

Too many countries still rely on family replacement or paid donors. Argentina, for instance, relies heavily on replacement donors, who make up 92% of its blood supply. Although Pakistan has increased its voluntary unpaid blood donation in the last five years to 20% of its blood supply, replacement donors made up 70% and paid donors 10% of blood supplies in 2004.

Family replacement donors may feel under pressure to donate and may therefore hide aspects of their health and lifestyle, which could mean that their blood is more likely to contain infection. In the case of paid donors, governments may think that the financial incentive will motivate more donation and boost supplies, but paid donors are often pushed by need and are therefore also more likely to avoid mentioning important details about their health status.

Many blood transfusions are unnecessary. Patients around the world risk being infected during blood transfusions when alternatives — such as intravenous replacement fluids — would be equally effective.

It is clear that quality checking is also vital to a safe blood supply. A reliable system needs to be in place to ensure proper screening and proper matching of blood. The error of giving the wrong blood can be fatal to a patient. Centralised blood collection systems coordinated nationally have several advantages over small blood banks — better trained personnel, better equipment, for instance — and those benefits contribute substantially to blood safety.

These centres can also provide better attention to donors, which is important for increasing voluntary, unpaid donations, and are better equipped to break blood down into its component parts. In many cases, full blood transfusions are not needed as the patient may only require one component of the blood for his or her condition. Overuse or misuse of whole-blood transfusions is not only less cost-effective; it also increases the risk of transmitting infections.

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