WORLD HEALTH DAY 2000 April 7th 2000
	Safe Blood Starts With Me — Safe Blood Saves Lives

Strengthening Blood Banks

Strengthening blood banks in the countries of the Americas is essential to achieve the goals adopted by the Ministers of Health of this Region: that all blood for transfusions be screened for infection with hepatitis B and C, syphilis, Trypanosoma cruzi, which causes Chagas' disease, and human immunodeficiency virus (HIV), and that all blood banks participate in quality control programs. PAHO is working with its 35 member countries to improve the safety of blood banking services throughout the Western Hemisphere.

Blood Safety

Voluntary, non-remunerated blood donation, universal screening of donated blood, quality assurance of the processes, and appropriate use of blood are the pillars to achieve the complete safety of blood banking services. PAHO is working throughout the Americas to eliminate inequities in the delivery of blood services and assure safety for everyone.

Blood Banks in the Americas

Blood for transfusion is universally obtained from voluntary, unpaid donors in only a small proportion of countries and territories in the Americas. At the national level, only five countries report 100 per cent voluntary donations. Only 16 countries-eight in the English-speaking Caribbean, six in Latin America, and Canada and the United States-report screening 100 per cent of donated units for HIV, HBV, and HCV. The available data for the Region, excluding Canada and the United States, indicate that 99 per cent of all units of blood collected are screened for HIV and HBV and 60 per cent for HCV. This means that, annually, around 50,000 units are transfused that have not been screened for HIV and HBV, and around 1,500,000 are transfused that have not been screened for HCV.

A significant consequence of this situation is the inequity in the quality of blood bank services and in the blood products that are transfused into patients. Data collected by PAHO highlight the importance of screening all units of blood collected by blood banks for transfusion-transmitted infections.

Types of Donors

Although some countries say that as many as 24 per cent of blood donors are paid donors, the vast majority of blood obtained in the Region comes from replacement donors, those who are asked to give blood for a family member or friend requiring it for surgery or other reasons.

Implications

The implications for blood safety are clear. The economic situations of individuals who sell blood are often precarious; low socioeconomic status in itself is a risk factor for acquiring infections that then can be transmitted through transfusions. Furthermore, when the motivation is economic, potential donors may deny risk behaviors and undermine the purpose of the pre-donation interview. Similarly, the pressures of family or friendship that are exerted on replacement donors do not make for optimal selection.

Challenges

The greatest challenges today to promoting voluntary blood donation are insufficient mass communication efforts and the inadequate structure of the services that care for potential donors in the blood banks. Appropriate messages are needed so that people in the countries will understand and accept blood donation-messages that will lead to the desired changes in behavior. Social marketing studies are required to determine knowledge, attitudes, and practices on blood donation. Modifications are needed in the physical infrastructure of the areas that care for donors, and health workers must be trained to discourage replacement donation and retain and educate volunteer donors.

PAHO Activities

As a result of PAHO initiatives, there has been a significant increase in the proportion of units of blood screened for HIV, HBV, HCV, and T. cruzi in the past four years. Laws, regulations, and standards governing blood transfusions in the Latin American countries have been promulgated or amended. National blood commissions have been established in some countries, and in others, technical committees have been formed to find ways to improve the quality of the blood banks. PAHO has set up training programs for national personnel and a Distance Learning Program on Safe Blood and Blood Products in 11 countries. National information systems help evaluate progress in each country and identify priority areas for intervention. Academic institutions, professional associations, and others also are involved to guarantee that the training reaches physicians, nurses, laboratory staff, and personnel who work with blood donors.

Needs for Future Action

Activities to promote voluntary, unpaid, and repeated blood donation are crucial. Countries need national blood donation programs that educate the population and health workers, and strengthen technical areas and infrastructure devoted to the care of blood donors. The first responsibility of the health sector is to ensure that the donation areas are accessible, comfortable, and safe; that they permit confidentiality; and are open with a donor-friendly schedule. Second, it is vital that the common practice of requiring replacement donation be terminated. Third, training should emphasize the responsibility of health personnel to protect donors and related information. Screening all units of blood collected for HIV, HBV, HCV, T. cruzi, and syphilis requires adequate staff, equipment and reagents in all the centers that conduct serological testing in each country. National blood commissions and technical committees--vital for achieving the goals of safe blood in every country--also need support.

To promote voluntary blood donation, PAHO will work at the regional level with the International Federation of Red Cross and Red Crescent Societies. At the country level, academic institutions, professional associations, and the communications media, in addition to the blood banks, need to become more involved.