From whole blood to component therapy: the economic, supply/demand need for implementation of component therapy in sub-Saharan Africa.
Blood may be transfused as whole blood or as one of its components. Because patients seldom require all of the components of whole blood, it makes sense to transfuse only that portion needed by the patient for a specific condition or disease. This treatment, known as "blood component therapy", allows several patients to benefit from one unit of donated whole blood. Blood components include red blood cells, plasma, platelets, and cryoprecipitate. A considerable literature has accumulated over the past decade indicating that leukocytes present in allogeneic cellular blood components, intended for transfusion, are associated with adverse effects to the recipient. These include the development of febrile transfusion reactions, graft-versus-host disease, alloimmunization to leukocyte antigens, and the immunomodulatory effects that might influence the prognosis of patients with a malignancy. Moreover, it has become evident that such leukocytes may be the vector of infectious agents such as cytomegalovirus (CMV), Human T-Lymphotrophic Virus 1/11 (HTLV-I/II), and Epstein Barr (EBV) as well as other viruses. Effective stewardship of blood ensuring that several patients potentially benefit from components derived from one unit of donated whole blood is important for economic, supply/demand reasons and to protect the national inventory at times of national blood shortage. Blood safety in developing countries can be improved by more appropriate use of blood components rather than whole blood transfusion and the provision of alternatives such as oral and intravenous iron, erythropoietin, saline and colloids. This will facilitate the optimal use of the limited blood supply. Political will and open-mindedness to innovative ways to improve supply, appropriateness, optimal use and safety of blood from all types of donors are essential to promote more evidence-based approaches to blood transfusion practice in sub-Saharan Africa.
Department of Blood Sciences, Royal Bolton Hospital NHS Trust UK, 4, Minerva Road, BL4 0JR Bolton, United Kingdom. n-osaro@yahoo.com
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D017954:Africa South of the Sahara; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D001782:Blood Donors; D058731:Blood Safety; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005169:Factor VIII; D005340:Fibrinogen; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000627:therapeutic use; D047589:Leukocyte Reduction Procedures; D065227:Transfusion Reaction; D014777:Virus Diseases / Q000635:transmission; D000515:alpha 1-Antitrypsin / Q000627:therapeutic use
D001779:Blood Coagulation Factors; D007136:Immunoglobulins; D000515:alpha 1-Antitrypsin; C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen