Blood Transfusion Safety in Africa: A Literature Review of Infectious Disease and Organizational Challenges
Section snippets
Organization and Management: Situational Analysis and Oversight
Organization and oversight provide the impetus and support for any health intervention strategy and are crucial to pilot a blood safety infrastructure. Foremost, establishment of a functioning blood transfusion service demands national coordination, government support, and policy adapted to the needs of a given country. However, one size does not necessarily fit all: the regional countries have vastly different resources and infrastructure, often despite geographic continuity, and each
Donor Recruitment and Mobilization
Blood donor selection remains the first level of defense against TTIs; the deferral of high-risk prospective donors is a primary strategy to reduce risk. The favored source of blood collection in the developed world is VNRBD because such donors have been found to have lower risk for TTIs, at least in developed countries. For this reason, VNRBD is exclusively advocated by the WHO and is component of the 2012 objectives, that is, at least 80% VNRBD.
Voluntary donors are typically recruited through
Transfusion-Transmitted Infections
In addition to the major transfusion-transmissible pathogens encountered in the industrialized world, for example, HIV, HBV, HCV, and syphilis, several other agents with either established or theoretical transfusion risk are endemic to Africa. These pathogens span the complete microbiological spectrum including bacteria; protozoa (for example, malaria[16]); viruses (for example, CHIKV[17] and other arboviruses[18]); and nematodes (for example, filariasis [19]). The prevalence of TTI varies
Biological Testing of Blood Products
In the absence of safeguards in recruitment and selection of low-risk donors, prevention of TTIs relies on biological testing of blood products. Unfortunately, the cost of testing for all known agents is not feasible because even a select test panel is often prohibitively expensive. Consequently, blood screening in Africa, with few exceptions, for example, HTLV-1/2 testing in Gabon, is limited to HIV, HBV, HCV, and syphilis owing to a regional prevalence of 0.5% to 16%, 3% to 22%, 2% to 7%, and
Rational Blood Use Policy
Despite shortfall in blood availability, there continues to be inappropriate blood use and concomitant wastage. This exposes patients unnecessarily to the hazards of transfusion and, when coupled with deficient biological testing, compounds the already high risk of TTI [69]. Overtransfusion stems, in part, from lack of defined policy or clinical guidelines for appropriate use either at a national or local level. In the WHO African region blood safety survey, only 24 of the 46 countries surveyed
Hemovigilance and QA
Hemovigilance is a term dubbed for the collective audit of transfusion safety, referring to both active and passive surveillance mechanisms to detect adverse outcomes among transfusion recipients and, to a lesser extent, among donors. This composite mechanism addresses all aspects of transfusion from recruitment and donation to posttransfusion surveillance in which sentinel events, including transfusion reactions and TTIs, are investigated [73]. Of the steps in the collection to transfusion
Conclusion: the Next Step
Transfusion-transmitted infection remains a formidable problem in Africa. The diverse array of pathogens is mirrored by a similarly broad constellation of economic and organizational problems in the region; this argues for a holistic approach encompassing legal, institutional, and training interventions as advocated by the WHO. This should not neglect the contribution of innovative, targeted approaches, for example, donor recruitment, and technologies, for example, rapid testing, NAT, and PI,
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