78 Blood Transfusion

Heather Hume 08/11/18

WHO states adequate blood transfusions should be at least 10 per 1000 population. Most countries in East Africa do not acheive that.

RBC demand massively outweighs supply in Africa.

Kids die from lack of blood In FEAST: for kids with Hb < 5. If transfused, 5% mortality, if not transfused 50% mortality.

Women die from lack of blood: 1/4 of LMIC maternal mortality is from bleeding, and 1/4 of those deaths are due to inadequate blood supple

WHO wants 100% of blood donors to be voluntary non-renumarated donors. This is because the donors you get if you’re paying or coercing them, have higher risks of having HIV/HBV/HCV (when compared to repeat volunteer donors, first time donors are about the same risk).

What about components vs whole blood? In low income setting < 1/2 of blood is converted into components. Whole blood is cheaper, and you don’t use seperate components as much in LMIC.

What about utilisation? 17% of blood requests are inappropriate whn studied in Tanzania.

How to prevent blood transfusions being needed? Called “patient blood management”. Think about systematic delayed cord clamping, treating IDA, use hydroxyurea in sickle cell disease, protocols for managing massive haemorrhage.