Even when there is blood available for transfusion, limited resources can cause problems. To provide safe transfusions, health-care providers require laboratory equipment for testing and processing donor blood, medical equipment to collect and transfuse the blood, and various consumable materials. This can be difficult when budgets are extremely limited and delivery systems are unreliable. As a result, important blood tests are sometimes not done.
Higher-income countries have helped provide both funding and material support. For example, when Canadian Blood Services recently amalgamated its labs and no longer needed a machine used for certain blood tests, it was donated to the Mulago National Referral Hospital. However, this strategy has its own challenges, such as adapting the donated equipment to the local environment (for example, different voltage requirements), and funds may be so limited that paying to transport and maintain a donated machine is not feasible. It may also be difficult to keep the machine consistently supplied with the blood test reagents needed – even something as simple as saline has been a challenge.
Health-care providers in low-income countries will always have many challenges. However, much has improved over the past few decades, and there is much more work still to be done.
Blood safety experts around the world contribute to global improvements in transfusion medicine by participating in regular meetings organized by the World Health Organization. These meetings are used to exchange knowledge, develop collaborations, and identify priority areas for improvement. One recent meeting (2013) had 250 participants including a representative from Canada (Dr. Marc Germain from Héma-Québec).
Blood products in Uganda are much safer than they used to be. The HIV prevalence in Uganda has fallen since 1990, when it was nearly 15 per cent. National campaigns that address stigma (such as home-based HIV counselling and testing) have increased voluntary HIV testing. The donor selection process has also been refined, cutting the percentage of HIV-positive Ugandan blood donors in half from 2004 to 2009.
A cultural shift towards altruistic blood donation has been encouraged through blood drives and targeted campaigns. Education is underway to reduce donor fears and improve the safety and efficiency of transfusion processes. Technological advances may also help; new techniques that reduce pathogens such as HIV in plasma products are already used in many countries, although more research is needed before these can be used for other blood products.
As Dr. Hume says, we “often cannot use the same solutions as those we are used to in high income countries, but that does not necessarily mean that there is not a solution!”
A shared love of volunteerism, Queen's Alumni Review 2015 (p.46)
Platelet transfusion therapy in sub-Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions in the journal Transfusion 15 April 2016.
Canadian Blood Services – Driving world-class innovation
Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantation—bringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration.
The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.