José Ramiro Cruz

Safety of the Blood Supply in Latin America

SUMMARY Appropriate selection of donors, use of sensitive screening tests, and the application of a mandatory quality assurance system are essential to maintain the safety of the blood supply. Laws, decrees, norms, and/or regulations covering most of these aspects of blood transfusion exist in 16 of the 17 countries in Latin America that are the subject of this review. In 17 countries, there is an information system that, although still incomplete (there are no official reports on adverse events and incidents), allows us to establish progress made on the status of the blood supply since 1993. Most advances originated in increased screening coverage for infectious diseases and better quality assurance. However, in 2001 to 2002, tainted blood may have caused infections in 12 of the 17 countries; no country reached the number of donors considered adequate, i.e., 5% of the population, to avoid blood shortages, or decreased significantly the number of blood banks, although larger blood banks are more efficient and take advantage of economies of scale. In those years, paid donors still existed in four countries and replacement donors made up >75% of the blood donors in another eight countries. In addition, countries did not report the number of voluntary donors who were repeat donors, i.e., the healthiest category. In spite of progress made, more improvements are needed.

Availability, safety, and quality of blood for transfusion in the Americas

OBJECTIVES This article has two objectives: (1) to present for countries and territories of the Region of the Americas data on the number of blood donations, proportion of voluntary blood donors versus remunerated blood donors, coverage of screening for infectious agents, and separation of donated blood into its components and (2) to explore the relationships of those characteristics with economic and organizational factors in the countries and territories. METHODS We carried out comparative analyses using population and health information gathered annually by the Pan American Health Organization (PAHO) from national health officials from the countries in the Americas, as well as economic information (gross national product (GNP) per capita) obtained from publications of the World Bank. RESULTS There is a direct correlation between the availability of blood for transfusion and GNP per capita. Seven countries with a GNP per capita above US

Estudio de factores socioculturales relacionados con la donación voluntaria de sangre en las Américas

10 000 per year account for 38% of the Regional population but 68% of the Regional blood donations. Voluntary blood donation is more common in the countries with better blood availability. There is no association between GNP per capita and coverage of screening for infectious agents. Nevertheless, of the six countries with a GNP per capita below US

Safety of blood supply in the Caribbean countries: Role of screening blood donors for markers of hepatitis B and C viruses

1 000, only one of the six screens all units for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B surface antigen (HBsAg). Countries with a higher proportion of voluntary blood donors tend to have lower prevalence rates of infectious markers. Separation of blood into its components is also more common in countries with higher blood donation rates. CONCLUSIONS The availability, safety, and quality of blood for transfusion in the Americas needs to be improved. As part of that effort, national policies and strategies must be put into place so that the resources already allocated for blood services are better utilized.

Achieving self-sufficiency of red blood cells based on universal voluntary blood donation in Latin America. The case of Nicaragua

OBJECTIVE To obtain baseline data for countries of the Americas on knowledge, attitudes, and practices related to voluntary blood donation as well as on the current level and quality of services that blood banks provide to donors. METHODS The study was conducted in 15 countries in the Americas: Argentina, Bolivia, Colombia, Costa Rica, Cuba, the Dominican Republic, Ecuador, El Salvador, Guatemala, Jamaica, Nicaragua, Panama, Paraguay, Peru, and Venezuela. Technical cooperation for the study came from the Pan American Health Organization. A qualitative formative methodology was applied, utilizing interviews with donors, health workers, and members of the general public; direct observation; focus groups; knowledge tests; and a review of documents. RESULTS Information was generated on peoples knowledge of donation; their beliefs, perceptions, attitudes, and motivations; and their barriers to donating. Knowledge was also gained as to the best means for disseminating messages supporting voluntary donation. CONCLUSIONS This information will serve as a foundation for designing a strategy in the countries of the Americas that is aimed at establishing and building the loyalty of voluntary blood donors. This strategy can support the implementation of changes needed in the care of donors, and it can also help in motivating donors to regularly return to donate blood.

Basic components of a national blood system

BACKGROUND Blood transfusions carry risks of untoward reactions, including the transmission of infections, such as hepatitis B and C. Proper blood donor recruitment and selection, and adequate laboratory screening for infectious markers diminish the risk of transfusion-transmitted infections. OBJECTIVES To estimate the potential risk of acquiring transfusion-transmitted infections by hepatitis B or hepatitis C in 24 Caribbean countries during the period of 1996 to 2003. STUDY DESIGN Official national reports for 1996, 2000-2003 of the yearly number of blood donors, screening coverage, and prevalence of serological markers for infectious diseases were used to estimate the risk of patients receiving an HBV- or HCV-positive unit of blood, and of developing an infection after receiving a positive unit. Estimates of number of infections transmitted through transfusion and number of infections prevented by screening of blood were also obtained. RESULTS During the period analyzed, HBV screening coverage among blood donors was 100% in all countries with the exception of Grenada (0% in 1996) and Saint Lucia (99.5% in 2002). For HCV, only 10 countries reported universal screening in 1996, while 15 did in 2003. The number of countries that did not screen any units for HCV decreased from 11 in 1996 to five in 2003. In general, high prevalence rates of HBV (10-75 per 1000 donors) and HCV (7-19.3 per 1000 donors) markers were found in the majority of countries. We estimated that 235 infections by HCV (1:12471 donations) and two infections by HBV (1:1465373) were transmitted through transfusion because of lack of screening. On the other hand, screening of blood for transfusion prevented 21 005 HCV and 22 100 HBV infections. CONCLUSIONS Blood donor recruitment and coverage of screening for transfusion-transmitted infections, especially HCV, must be improved in the Caribbean countries.

Safety of blood supply for infectious diseases in Latin American countries, 1994-1997.

In 2007, the blood collection rate in Nicaragua was 106.6 units per 10,000 inhabitants. Voluntary donation was 39%. The health authorities decided to pursue self sufficiency of blood by eliminating replacement donation and consolidating blood processing in two centers. Replacement donation was terminated in 2009, voluntary donation reached 100% in 2010, and the blood collection rate increased to 125.9 in 2011. The rate of red blood cell transfusion improved from 96.0 to 119.1 units per 10,000 during the 4-year period. The political will of the government, pertinent technical leadership, and a country-wide approach were essential for attaining those goals.

Comparativo de legislaciones sobre sangre segura

En este articulo se resumen la mision y las funciones de los servicios de sangre de un pais y se examinan los componentes necesarios para el funcionamiento adecuado y eficiente de un sistema nacional de servicios de sangre. La sangre para transfusion es un recurso nacional y, por tanto, las autoridades sanitarias deben garantizar su disponibilidad, seguridad, calidad y uso eficiente. Para alcanzar estas metas, cada pais debe tener un marco juridico reglamentario para los centros donde se extrae, procesa y transfunde la sangre. Las leyes y los reglamentos sirven de base para la organizacion del sistema de servicios nacional, identifican las tareas de los interesados directos y garantizan la disponibilidad de los recursos que necesita el sistema. Esas leyes y reglamentos deben basarse en solidos criterios medicos y tecnicos. Dentro de este marco, es importante tener presentes las diversas funciones de los distintos departamentos del ministerio de salud, asi como de otras instituciones, organizaciones no gubernamentales y grupos academicos y de los profesionales vinculados con el sistema nacional de servicios de salud.