BLOOD SAFETY IN DEVELOPING-COUNTRIES

This study, based on responses to a questionnaire, was undertaken to d efine problems in and formulate solutions for improving blood safety i n developing countries as part of an effort to monitor the status of b lood transfusion services globally. Despite improvements between 1988 and 1992, only 66% of developing countries (DGCs) and 46% of least dev eloped countries (LDCs) screen all blood donations for antibodies to h uman immunodeficiency viruses; 72% DGCs and 35% LDCs test all donation s for hepatitis B surface antigen and 71 and 48%, respectively, for sy philis. The antihuman globulin test is performed routinely in 62% DGCs and 23% LDCs, and inadequate quality assurance in all aspects of prep aratory testing is a major weakness in many countries. The blood suppl y is usually insufficient: none of the LDCs and 9% of the DGCs collect 30 units or more per 1,000 of the population annually. Blood donor sy stems are totally voluntary and non-remunerated in 15% DGCs and 7% LDC s; 80% DGCs and 93% LDCs rely totally or partially on replacement dono rs and 25% of both groups on paid donations. The proportion of repeat donors is low (medians: 47% in DGCs, 20% in LDCs), and discard rates f or collected blood are often high (up to 33%). Most of the blood colle cted is transfused as whole blood, and most DGCs and LDCs have inadequ ate supplies of plasma substitutes for management of acute haemorrhage . The reasons for these problems and suggested solutions are discussed .