The transfusion center, the blood donor and the given blood in francophone African countries

Département d'hematologie, faculté de médecine et des sciences biomédicales de l'université de Yaoundé-I, BP 4806, Yaoundé, Cameroun.
Transfusion Clinique et Biologique (Impact Factor: 0.71). 09/2009; 16(5-6):431-8. DOI: 10.1016/j.tracli.2009.07.005
Source: PubMed


In subsaharan Africa, knowledge of the organization and methods of transfusion centers, as well as blood donor characteristics, is essential in choosing strategies to improve transfusion practices and the security of blood products on this Continent. The present study was based on a analysis led in partnership with the transfusion of seven francophone African countries (Burkina-Faso, Cameroon, Congo, Ivory Cost, Mali, Niger, and Rwanda). The results showed that withstanding significant progress has been realized in the organization and safety, but much remains to be undertaken over the years to come in order to improve the organization of the centers, the providing of blood products and the infectious and immunohematologic safety. This evolution, for the moment, is limited by the financial resources, insufficient training of personnel and cultural obstacles, but will necessarily pass through the pursuit of conjugated efforts of the scientific, international and local communities.

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    • "The residual transmission risk of HCV ID-NAT window phase donations was estimated at 1:21,000,000.58 Despite the known facts that proper blood donor recruitment and selection and adequate laboratory screening for infectious markers diminish the risk of TTIs and that HCV is among the greatest threats to blood safety in Sub-Saharan Africa, it is sad to note that some blood transfusion centers in Sub-Saharan Africa may not be screening blood donors for HCV.59 "
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    ABSTRACT: As a resource, allogenic blood has never been more in demand than it is today. Escalating elective surgery, shortages arising from a fall in supply, a lack of national blood transfusion services, policies, appropriate infrastructure, trained personnel, and financial resources to support the running of a voluntary nonremunerated donor transfusion service, and old and emerging threats of transfusion-transmitted infection, have all conspired to ensure that allogenic blood remains very much a vital but limited asset to healthcare delivery particularly in Sub-Saharan Africa. This is further aggravated by the predominance of family replacement and commercially remunerated blood donors, rather than regular benevolent, nonremunerated donors who give blood out of altruism. The demand for blood transfusion is high in Sub-Saharan Africa because of the high prevalence of anemia especially due to malaria and pregnancy-related complications. All stakeholders in blood transfusion have a significant challenge to apply the best available evidenced-based medical practices to the world-class management of this precious product in a bid to using blood more appropriately. Physicians in Sub-Saharan Africa must always keep in mind that the first and foremost strategy to avoid transfusion of allogenic blood is their thorough understanding of the pathophysiologic mechanisms involved in anemia and coagulopathy, and their thoughtful adherence to the evidenced-based good practices used in the developed world in a bid to potentially reduce the likelihood of allogenic blood transfusion in many patient groups. There is an urgent need to develop innovative ways to recruit and retain voluntary low-risk blood donors. Concerns about adverse effects of allogenic blood transfusion should prompt a review of transfusion practices and justify the need to search for transfusion alternatives to decrease or avoid the use of allogenic blood. These strategies should include the correction of anemia using pharmacological measures (use of antifibrinolytics to prevent bleeding and the use of erythropoietin and oral and intravenous iron to treat anemia) use of nonpharmacologic measures (preoperative autologous blood transfusion, perioperative red blood cell salvage and normothermia to reduce blood loss in surgical patients). All these strategies will help optimize the use of the limited blood stocks.
    Hematology Research and Reviews 02/2011; 2:7-21. DOI:10.2147/JBM.S17194
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    ABSTRACT: As a resource, allogeneic blood has never been more in demand than it is today. Escalating elective surgery, an aging population, periodic shortages arising from a fall in supply, old and emerging threat of transfusion-transmissible infections and spiraling costs because of various safety introductions have all conspired to ensure that allogeneic blood remains very much a vital but limited asset to the National Health Service. However, there are increasing demands for alternatives/complementary strategies to allogeneic blood transfusion. Autologous transfusion, predeposit autologous donation, acute normovolemic hemodilution and perioperative cell salvage is reliable, cost-effective, safe, does not involve type and screen, not associated with isoimmunization to foreign proteins, is indicated in patients with rare blood groups or complex red cell antibodies, comes handy for some religious sect like the Jehovah's Witnesses as well as being suitable in a significant number of patients undergoing elective surgeries. Autologous transfusion improves postoperative microcirculation, tissue perfusion and reduces the risk of thromboembolism. Benchmarking transfusion activity, ensuring that it is clinically indicated and justified, will help eliminate inappropriate use of blood products and help conserve our allogeneic blood stock. Erythropoietin (EPO) has drastically and significantly altered red cell transfusion practices. There might be many patients groups who would benefit from the use of EPO analogues and thus help conserve the allogeneic blood stock for patients in whom EPO is contraindicated. There is need to formulate policies on ways to seriously and innovatively attract and retain new donors. The National Blood Service and indeed the Department for Health can do well by promoting the use of autologous blood and other alternatives therapies to complement the UK allogeneic blood transfusion program in a bid to solving the periodic and envisage future shortages in allogeneic blood particularly with an aging UK population and increasing concerns about safety arising from old and emerging transfusion-transmissible infections. This will maximize the use of the limited allogeneic blood resource particularly for patients in whom autologous blood transfusion is contraindicated.
    Transfusion Alternatives in Transfusion Medicine 05/2010; 11(2):72 - 81. DOI:10.1111/j.1778-428X.2010.01132.x
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    ABSTRACT: Background The entire African continents counties are classified as developing countries according to the World Bank criteria. It is ironic that poverty is a cause of endemic disease which in turn is a cause of poverty. It has been described in the 2008 UNAIDS report that sub-Saharan Africa remains the region most heavily affected by HIV, accounting for 67% of all people living with HIV and 75% of all AIDS deaths in 2007 and in this environment millions of units of blood are collected.Aims The aim of this review is to discuss the various different screening strategies of blood donations used in developing countries and to highlight some of the advantages and disadvantages.Material & Methods This paper is based on a review of the literature as well as information provided by various transfusion services in Africa.Results There are various systems for the provision of blood, the hospital based systems which consist mainly of transfusion units attached to laboratories at the hospital, most of which use donor replacement schemes or the more centralized transfusion centers that usually have a system for voluntary non remunerated altruistic donors. Currently most countries have a hybrid of these two systems with 70% of the blood coming from donor replacement schemes.A range of screening strategies are used in Africa and it was estimated in 2004 that only 80% of the blood was screened for Transfusion Transmissible infections (TTI’s). One hundred and fifty five countries reported to the WHO global database that 100% screening was performed but of these only 71 were performed in a quality assured manner. Various assay systems with differing sensitivities and specificities are used. A rapid assay is performed prior to donation in some settings which has advantages and disadvantages. Studies have shown that performing two different rapid assays in serial or parallel is more sensitive than as a single test but may not be feasible in resource limited settings. The majority of African countries test using an ELISA method which is the recommendation of the WHO. Many creative studies have been performed to try and make the screening as cost effective as possible without too much loss in sensitivity. One such study showed that if a serial testing algorithm was used that tested HBsAg first and then HIV on the seronegative donations and then syphilis on the subsequent seronegative donations and finally HCV the costs per annum in screening could be reduced by €90 860 per annum in Ghana. The final screening strategy that is used in some developing countries is Nucleic acid testing (NAT), this strategy is used in South Africa, Namibia, Egypt and Ghana. Although this strategy increases the safety of the blood supply it has been shown that in some settings it is not cost effective and should be clearly investigated prior to implementationConclusion There are various screening strategies in Africa and due to a large amount of work performed by different organizations the plan is to have 100% voluntary blood donors and 100% screening by 2012. To do this a National blood screening programme and budgeting nationally for blood will be required.
    ISBT Science Series 06/2010; 5(n1):308 - 313. DOI:10.1111/j.1751-2824.2010.01385.x
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