Supply of blood for transfusion in Latin American and Caribbean countries

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Blood transfusions are necessary to improve or save the lives of children with severe anemia, mothers in obstetric emergencies, patients with hemoglobinopathies, cancer patients, transplant patients, patients with chronic age-related diseases, such as bleeding caused by vascular problems and orthopedic surgeries, people injured in accidents, among other causes.

In 2014, the countries of the Region of the Americas reaffirmed their commitment to universal health through the approval of the Action Plan for Universal Access to Safe Blood 2014-2019, approved by the 53rd Directing Council held in October 2014 (CD53.6).

This plan promotes universal access to safe blood for transfusions in the region, through voluntary unpaid donations, the organization of blood services, the implementation of quality and safety standards, and the application of governance actions.

Highlights

Of the 10.5 million blood donations collected in Latin America and the Caribbean, 95% of them are collected in high and medium-high income countries, where 93% of the population lives.

The highest percentages of voluntary donation correspond to the medium-high income level (47%), followed by the medium-low levels (42.4%), high (41%) and low (40.5%).

In total, 2 countries collect almost 60% of the total blood collected in the region; however, 34 countries collect the remaining 40%.

Donation rates per 1,000 people are higher in high-income 21.9 and upper-middle-income countries, and very low in low-income countries 2.6 units.

An increase of 1.2 million blood donations from unpaid voluntary donors was reported between 2014 and 2017.

16 countries exceeded 90% of voluntary donation. In 7 countries the percentage of voluntary donations does not reach 10%.

Only 7 out of 36 reporting countries produce plasma-derived medicines (PDMPs) through fractionation of the plasma collected in the reporting country.

21 countries reported the number of patients transfused with more than 3 million 420 thousand recipients.

Governance mechanisms

The provision and access to safe blood for transfusions are closely related to the organization and degree of development of blood services, with the governance and participation of society through voluntary unpaid donation.

The aspects of governance with the greatest progress in the countries are regulations 75.5%, networking 63.1%, the existence of a strategic plan 60.8%, and the existence of a computer system (56.1 %).

PAHO/WHO recommends that all activities related to the collection, analysis, processing, storage, and distribution of blood be coordinated at the national level through an effective organization and integrated blood supply networks. The national blood system should be governed by the national blood policy and legislative framework to promote the uniform implementation of standards and consistency in the quality and safety of blood and blood products.

Organization of blood services

The organization and improvement of the efficiency of services and the increase in voluntary donation are considered related variables since the models of dispersed banks with little capacity to collect and process tend to source replacement donations, a large number of countries presented low average processing per year per bank and in most the number of blood banks remained the same. A similar situation was presented by sanitary surveillance, hemovigilance programs where few countries showed progress, despite being these key indicators of the Action Plan for Access to Safe Blood.

More than 1,700 blood centers in 36 countries report having collected a total of 10.5 million donations.

In 8 countries the average units processed per bank year were greater than 10,000 units, in 20 countries this average was between 5,000 and less than 10,000 units, and in 8 countries the average processing units per year per bank below 5,000 units.

Collections at blood centers vary by income group. Median annual blood center donations are 1,300 in low-income countries, 4,100 in lower-middle-income countries, and 8,500 in upper- and middle-income countries, compared to 23,000 in countries high income.

Blood donors

Age and sex of blood donors

41.4% of donations come from women. Regarding the age of the donors, the group between 24 and 44 years old predominates with 41.9% in 2017, followed by donors younger than 24 years old with 30.6%. The 45-65 age group represented 24.8% of donors. The least represented age group was that of over 65 years with 2.7% of donors.

Types of blood donors

Blood analysis

100% of the blood transfused was tested for HIV, hepatitis B virus surface antigen, antibodies to hepatitis C and syphilis, and for the T. cruzi 95.2% screening test, all countries considered Endemics screened their blood units. In the analysis tests for HTLV I-II it was reached 90% and for the Anti-HBc tests 81%.

Blood processing

Blood collected in an anticoagulant can be stored and transfused into a patient in an unmodified state. This is known as a "whole blood" transfusion. However, blood can be used more effectively if it is processed into components, such as red blood cell concentrates, platelet concentrates, plasma, and cryoprecipitate. In this way, you can meet the needs of more than one patient.

Of the 10.5 million units collected, 92.8% separated or fractionated to obtain red blood cells. 114,215 units of red blood cells were obtained by apheresis.

Plasma Derived Drug Supply (PDMP)

Resolution WHA63.12 of the World Health Assembly urges Member States to establish, implement and support sustainable and coordinated blood and plasma programs at the national level according to the availability of resources, with the aim of achieving self-sufficiency. It is the responsibility of individual governments to ensure an adequate and equitable supply of plasma-derived drugs, namely immunoglobulins and clotting factors, which are necessary to prevent and treat a variety of serious conditions that occur worldwide.

Only 7 out of 36 reporting countries produce plasma-derived medicines (PDMPs) through fractionation of the plasma collected in the reporting country.

Clinical use of blood

Unnecessary transfusions and unsafe transfusion practices expose patients to the risk of serious adverse transfusion reactions and transfusion-transmissible infections. Unnecessary transfusions also reduce the availability of blood products for patients who need it.

For Latin America, 10 countries reported the number of patients transfused with more than 3,400,000 recipients. For the non-Hispanic Caribbean, 11 countries reported this information with more than 20,000 recipients.

The most frequently transfused blood component was red blood cells, with 57%, followed by platelets with 21.6% and fresh frozen plasma with 14%.

Components transfused according to type

Component	Num.	%
RBC	5,587,315	57.0
PL	2,114,175	21.6
FFP	1,370,667	14.0
CRYO	297,543	3.0
APH-PL	338,177	3.5
FP	61,813	0.6
WB	25,391	0.3
APH-RBC	5,026	0.1
Total	9,800,107	100

PAHO / WHO recommends:

Continue to develop defined strategies to improve universal access to safe blood.
Strengthen the reorganization of blood service networks in order to improve their efficiency.
Integrate blood systems to health systems in order to improve strategies such as surveillance, hemovigilance, and coordination of the service network.
Strengthen the analysis of information by relating the variables that allow analyzing aspects such as blood availability, use, safety, and the existence of monitoring and control mechanisms.

* Data source: Pan American Health Organization. Blood supply for transfusions in Latin American and Caribbean countries 2016-2017. Washington, D.C. OPS; 2020., available at http://iris.paho.org.