Universal Access to Safe Blood Transfusion

What this guideline says

GMJ summary

This report of a 2007 global consultation presents the WHO strategy for achieving universal access to safe blood transfusion worldwide. Globally, more than 100 million units of blood are donated annually, but less than 45% are collected in developing countries, home to 80% of the world’s population. The average donation rate is 10 times higher in high-income countries than in low-income countries. Of 73 countries with donation rates below 1% of the population in 2006, 70 are developing countries. Furthermore, 31 of 132 reporting countries (23.5%) have less than 100% screening for at least one of the four key infection markers (HIV, hepatitis B, hepatitis C, syphilis).

The WHO strategy addresses five key areas: establishment of nationally-coordinated blood transfusion services; collection from voluntary non-remunerated blood donors from low-risk populations; quality-assured testing for transfusion-transmissible infections, blood grouping and compatibility; safe and appropriate use with reduction in unnecessary transfusions; and quality systems covering the entire transfusion process. By 2006, only 54 countries had achieved 100% voluntary unpaid blood donation. The consultation emphasized that haemorrhage accounts for up to 44% of maternal deaths in some areas of sub-Saharan Africa, and timely access to safe blood is a life-saving intervention.

The document outlines detailed recommendations to WHO, national health authorities, and blood transfusion services for strengthening blood safety infrastructure, donor programmes, testing systems, clinical transfusion practice, quality management, workforce development, and effective partnerships. It emphasizes integration of blood transfusion services with maternal and child health, HIV/AIDS, malaria and anaemia programmes to achieve the health-related Millennium Development Goals.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. Countries should aim for blood donation rates equivalent to 1–3% of the population to meet national blood transfusion requirements
2. All donated blood must undergo 100% quality-assured screening for HIV, hepatitis B, hepatitis C and syphilis using validated test kits with external quality assessment
3. Voluntary non-remunerated blood donors from low-risk populations provide the safest blood; family/replacement and paid donors have higher infection rates
4. National blood programmes should be governed by policy and legislation, with a nationally-coordinated structure replacing fragmented hospital-based services
5. Hospital transfusion committees should be established in all hospitals performing transfusion, with >75% having operational committees as a target
6. Evidence-based national guidelines on clinical transfusion should be developed and implemented to reduce unnecessary transfusions and promote blood conservation
7. Haemovigilance systems must be established at national and regional levels for monitoring and improving transfusion safety with bi-directional traceability
8. Blood transfusion is one of eight key life-saving interventions that should be available in first-referral level healthcare facilities providing emergency obstetric care

From the guideline

Verbatim

“The equivalent of 1–3% of the population should donate blood to meet a country's needs.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

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