Status of hospital-based blood transfusion services in low-income and middle-income countries: a cross-sectional international survey.
| Autor: | Barnes LS; Doctor of Public Health Leadership, University of Illinois--Chicago, Chicago, Illinois, USA lbarne23@gmail.com.; American Association of Blood Banks, Bethesda, Maryland, USA., Stanley J; Quality Focus, Moraga, California, USA., Bloch EM; Pathology, Johns Hopkins Medicine, Baltimore, Maryland, USA., Pagano MB; Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA., Ipe TS; Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA., Eichbaum Q; Pathology, Immunology and Microbiology | Medical Education and Administration, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Wendel S; Hospital Sirio Libanes Blood Bank, Sao Paulo, Brazil., Indrikovs A; Pathology, Northwell Health, Manhasset, New York, USA., Cai W; Stanford Health Care, Stanford, California, USA., Delaney M; Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA. |
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| Jazyk: | angličtina |
| Zdroj: | BMJ open [BMJ Open] 2022 Feb 15; Vol. 12 (2), pp. e055017. Date of Electronic Publication: 2022 Feb 15. |
| DOI: | 10.1136/bmjopen-2021-055017 |
| Abstrakt: | Objectives: Blood transfusion is life-saving for patients experiencing acute blood loss and severe anaemia. In low-income and middle-income countries (LMICs), low blood donation rates and unavailability of whole blood and blood components (blood products) impairs timely blood transfusion. To fulfil patient-specific blood orders, a hospital blood transfusion service (HBTS) receives orders from a prescriber for blood transfusion, tests and prepares blood products for the patient. This study sought to describe the current state of LMIC HBTS. Design: A cross-sectional survey explored LMIC HBTS access to blood products, testing methods, policies and structure. Surveys were administered in English, Spanish, French and Russian, followed by a mixed-methods analysis. Setting: HBTS within LMICs. Participants: From among 124 public and private facilities invited to participate, we received 71 (57%) responses. Of these responses, 50 HBTS from 27 LMICs performed on-site blood transfusions. Results: Most LMIC HBTS perform blood collection to generate blood products for their patients (36/47, 77%); few relied exclusively on an external supply of blood products (11/47, 23%). The primary reason for blood transfusion was adult anaemia for non-malignant conditions (17/112, 15%). Testing methods varied by gross national income per capita. Blood transfusion delays to patients were common (17/30, 57%) attributed to inadequate blood inventories (13/29, 45%). Other barriers included lack of regular clinician education about transfusion (8/29, 28%) and sustainable financial models for the HBTS (4/29, 14%). Conclusion: This survey describes the status of HBTS in diverse LMICs, illustrating that the availability of blood products remains a principal problem, requiring HBTS to generate its own facility's blood supply. Currently, blood shortages are not reported as a patient-specific adverse event making systematic tracking of delays in transfusion difficult. These findings highlight areas for further exploration related to the lack of available blood inventories for transfusions at HBTS in LMICs. Competing Interests: Competing interests: LSB reports personal fees and non-financial support from X-CellSystem, GLG, and AABB; LSB is a technical advisor to PAHO. JS is a contractor at Roche Molecular Systems. EB reports personal fees and non-financial support from Terumo BCT, Grifols Diagnostics Solutions and Abbott Laboratories outside of the submitted work; EB is a member of the US Food and Drug Administration (FDA) Blood Products Advisory Committee. TSI is a consultant for Terumo Blood Cell Technologies and Alexion Pharmaceuticals Inc. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) |
| Databáze: | MEDLINE |
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