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Information for the blood donation article:

AABB News, April 2008

--Kenya: from 43,000 units in 2004 to 113,000 units in 2006. Voluntary donations have increased significantly, and 100 percent of the blood is now screened for transfusion-transmitted infections, or TTIs, creating improved access to safe blood for hospitals.

"The NBTS has grown rapidly in the last two years, doubling personnel, increasing budgetary inflows through PEPFAR and increasing blood collection,” said Nyamongo. “Creating a functional system to manage this has been a challenge.”

--S Africa: This was difficult at one point, according to Anthon Heyns, PEPFAR project director for SANBS. “The challenge was to provide sufficient safe blood to patients in a country where as many as 14 percent of the population is HIV positive,” he said.

Prior to PEPFAR, Heyns said HIV was transmitted to patients through transfusion at least one to two times a year. “With the introduction of individual donation NAT screening, there have been no observed or reported cases of transmission of viral diseases by transfusion,” he said.

Yet expanding the donor base to represent more of the South African population has been difficult. Only 10 percent of donations are from black donors. Heyns said the goal is to increase that number to 15 percent by 2010 by establishing fixed and mobile clinics in black communities — a strategy fully backed by PEPFAR. The program will target youth and aim to instill a culture of social responsibility by distributing information to help educate that segment of the population.

--Tanzania: Since partnering and receiving funding from PEPFAR, the Tanzanian National Blood Transfusion Service has increased the number of voluntary, nonremunerated blood donors from 20 percent in 2005 to 80 percent in 2007. The number of repeat donors also has increased from 5 percent to 20 percent in 2007. About 20,000 units are collected annually and all units are tested for four TTIs.

“There is a decreased prevalence of HIV among blood donors — from 5.5 percent three years ago to 3.9 percent in 2007,” said Efesper Nkya, program manager at the Ministry of Health’s National Blood Transfusion Service. “We expect further reduction with proper selection of donors and retention of voluntary, nonremunerated blood donors.”

Nkya said the biggest challenge now facing the Tanzanian National Blood Transfusion Service is retention of blood donors and blood shortages. “We are in the process of establishing blood donor clubs to help retain donors, and we use corporate and religious organizations during our shortages,” he said. “There is also inadequate awareness and poor acceptability of this program by some members of the community, but we have received support from political and religious leaders and use the media to promote the program.”

Another obstacle is the shortage in health care workers. Nkya has worked to put a quality manual in place and annual training to continually educate staff members. “Although the health care work force is inadequate, we try to do on-the-job training until we can get more financial resources to hire and train more staff,” he said.

Within the next five years, the Tanzanian National Blood Transfusion Service expects to have 100 percent voluntary blood donations and a safe blood supply to all hospitals in the country. “We also expect to separate blood units into components and continue delivering quality products and services to our customers,” Nkya added.

Zanzibar: Zanzibar is a cluster of islands made up of Zanzibar, the Pemba Islands and several islets. Located in the Indian Ocean about 25 miles from the Tanzanian coast, this 60-mile-long island has seen its blood donations transition from 100 percent replacement donations to 50 percent voluntary donations since partnering with PEPFAR.

Ghana: In the U.S., collecting blood from volunteer donors is relatively easy when compared with countries such as Ghana, where people often do not donate blood unless asked to provide a directed donation for a family member receiving medical care. In other parts of the world, units of rare blood may need to be flown in from other countries when a patient’s type cannot be found among local blood donors.

In this critical situation, the only solution to save the life of this young man was to fall on the facility’s blood bank,” said Daniel Somuah, MT (U.Gh.), senior medical technologist at the AngloGold Ashanti Hospital in Obuasi. In Ghana, it is still not common to obtain blood through voluntary collections, so family members usually step up to the plate.

Upon Somuah’s recommendation, the medical officer authorized the “loan” of two pints of blood for the patient — to be replaced later by other relatives. On the third day after his transfusion, the man’s hemoglobin level had shot up to 5.3g/dL. The blood bank helped save his life.

Brazil: The federal government in Brazil considers blood a universal right, a resource that must be available whenever and wherever it is needed. Blood donors — often traveling to blood collection facilities by bus on multiple-leg trips that could take as long as 90 minutes — are not required to pay the and are often given the afternoon off work for this civic duty.

CRH’s Hemocentro collects blood in nearby cities as well. “We use a place like a school or a health care facility that we have visited beforehand and has been approved as a qualified place to perform a collection,” Zanelli said. For this type of mobile blood collection, “we take all of the staff, the material and the equipment, including the notebooks that make it possible to work online.”

Unlike facilities in the U.S. and in many other regions of the world, Brazilian blood establishments cannot charge medical institutions for blood or blood products. Paying those who donate blood or blood components also is illegal. “In Brazil, we are surprised about paid donors elsewhere. In Brazil, facilities must not directly or indirectly pay the donors,” explained Zanelli.

Honduras: Financial and technical limitations have forced hospitals and blood banks in Honduras to rely on patients’ families to provide or replace blood donations, “and the trend to use the replacement donors is becoming stronger,” Vinelli noted. In 2006, the share of replacement donors was 83 percent. “Some hospitals refused to stop collections from family and replacement donors for fear that we will not be able to meet all of their needs and because they are concerned that the population will not donate otherwise,” she said. “Close work and education is needed with hospital officials and physicians to reverse this trend.”

"There are many factors exposing the Honduran population to an inadequate or unsafe blood supply, including ignorance and lack of or poor access to health care facilities to negative attitudes, myths, scarcity of professional staff or lack of adequate donation facilities. Limited fixed and mobile sites are a considerable obstacle for retaining regular donors,” said Vinelli. “Poor access to donation and/or transfusion services and information is further exacerbated in rural areas affected by annual storms, floods or landslides leading to poor availability of transfusion blood parallel to an increased need for blood.” She explained that the fear of blood shortages and poor information in general creates further dependency on family and replacement donors among public and private hospitals, often making it difficult to supply them with blood products collected from voluntary, nonremunerated blood donors.

Despite these seemingly insurmountable obstacles, the Honduras Red Cross National Blood Program meets close to 50 percent of the need for red cells — more than 26,000 units in 2007 — and nearly 80 percent of the need for platelets and fresh frozen plasma, with more than 40 public and private hospitals relying on the organization to supply them with products in a timely fashion. In addition to testing routinely performed in the U.S., the blood program also tests units for antibodies to T. cruzi and T. Pallidum. Nucleic acid testing is scheduled to start late next year.

India: (ditto western)

China: The health community in China has had its share of challenges, including the threat posed to the safety of the blood supply by rural Chinese who are glad to earn cash for blood donations. This is a reflection of the desperation in areas where economic opportunities are few and an illustration of the growing lengths some Chinese pharmaceutical companies are going to meet the rising demand for blood plasma. The country’s blood community — which strives to collect blood only from volunteer, nonremunerated donors — has coped with these issues and more, often under the international spotlight.

Moldova: In addition, 100 percent of donated blood is now tested for HIV, hepatitis B and C, and syphilis. “And tha

Another difficulty is a lack of financial resources for promoting voluntary blood donation. “There is no dedicated staff for this purpose and no money for undertaking these activities,” said Cebotari. “In addition, there are no constant partners among nongovernmental and community organizations that would take on this responsibility. The Moldovan Red Cross stepped away from donor recruitment and blood donation promotion in the 1990s because of a lack of funding.” She explained that the NBTC, with assistance from the Preventing HIV and Hepatitis B and C Project, has developed a national plan for donor recruitment and promotion, and is currently negotiating with various parties to encourage assistance in implementing donor recruitment activities.

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Contraindications to being a blood donor
Blood donation centers in different countries may have different guidelines about who can serve as a blood donor. Common contraindications to being a blood donor fall into two main groups: conditions which might cause a problem for the recipient and conditions which might cause a problem for the donor. A donor who is found ineligible is "deferred" from donation, though in some cases this may be a permanent deferral and the donor is not expected to return.

For recipient safety:
 * Donors who recently received a blood transfusion: All recipients of blood have potentially been exposed to a source of transfusion transmitted infections.  Additionally, alloimmunization can occur which can lead to positive antibody testing, which can cause significant problems in crossmatching.
 * Recent pregnancy: Pregnancy can also cause alloimmunization, and donors are deferred for the same reason.
 * History of cancer: Although the evidence suggests that cancer is not readily transmittable by blood transfusion, any donor who has ever had leukemia or lymphoma or other neoplastic diseases involving blood is typically permanently excluded. Similarly, other cancer patients are usually also excluded for five or more years. However, due to recent developments, some of these practices may change in the future.
 * Any current infection or acute disease: Even a minor infection, such as the common cold, could be dangerous to some recipients.
 * Current disease or at high risk for a disease that can be transmitted by transfusion:
 * Malaria: Donors are considered to be at high risk for malaria if they live in or have recently traveled to a malarial risk area. This is far more difficult to implement in countries that are endemic for malaria and all residents are considered to be high risk.
 * Hepatitis (B or C): Donors are considered to be at high risk for hepatitis if they live with a person who has hepatitis, have recently had a non-sterile tattoo or piercing, or have ever used intravenous drugs (other than prescribed medications).
 * HIV: Donors are considered to be at high risk for HIV if they have ever used intravenous drugs (other than prescribed medications), have been in certain African countries where HIV is extremely common, engaged in high-risk sexual behaviors, or had sex with anyone who is in any of those risk groups. High-risk sexual behaviors include prostitution and men who have sex with men (MSM).  The deferral of every man who has had sex with another man since 1977 is controversial.  Donors who have had a recent needlestick injury are also deferred.
 * CJD and vCJD: In America, and some other countries, donors who have spent substantial time in areas at high risk for vCJD (typically the United Kingdom and Europe) are typically excluded, though like malaria this is difficult to implement in the countries that are at risk. Donors who have ever received human pituitary growth hormone are also excluded because of their higher risk for these diseases.
 * Chagas Disease, Babesiosis, and Leishmaniasis are also causes for deferral.
 * Some medications remain in the bloodstream for a long time and can cause complications for a recipient. For example, Avodart causes birth defects and transfusing a blood product containing it to a pregnant woman could have serious adverse effects.

For donor safety:
 * Donors who are not healthy enough to tolerate the process are generally excluded. Conditions of concern include cardiovascular disease, current pregnancy, high blood pressure, tuberculosis, a history of seizures, and many others.  Some blood banks will simply refuse to accept donors over a certain age because of possible health risks.
 * Before donation, a blood sample is taken to check the iron level (i.e. hematocrit) to ensure that the donor will not be made anemic by the donation. This is a common reason for deferral, especially in pre-menopausal women.
 * Younger donors are excluded from donating allogeneic blood because they cannot give legal consent for the process. Very young donors also may not understand the process and may injure themselves.

For the donor
Donating whole blood at a modern, well-run blood collection center is safe. The biggest risk is probably that of vasovagal syncope, or "passing out". A large study, involving 194,000 donations during a one-year period at an urban U.S. blood center, found 178 cases of syncope, for an incidence of 0.09%. Only 5 of these incidents required emergency room attention, and there was one long-term complication. Most syncopal episodes occurred at the refreshment table following donation, leading the authors to recommend that donors spend at least 10 minutes at the refreshment table drinking fluids after donation. A Greek study of over 12,000 blood donors found an incidence of vasovagal events of 0.89%. Another study interviewed 1,000 randomly selected blood donors 3 weeks after donation, and found the following adverse effects: None of these were severe enough to require medical attention in this study. There is virtually no risk of acquiring an infection at a modern, well-run blood donation center.
 * Bruise at the needle site — 23 percent
 * Sore arm — 10 percent
 * Hematoma at needle site — 2 percent
 * Sensory changes in the arm used for donation (eg, burning pain, numbness, tingling) — 1 percent
 * Fatigue — 8 percent
 * Vasovagal symptoms — 5 percent
 * Nausea and vomiting — 1 percent

Donation of blood products via apheresis is a more complex procedure and can entail additional risks, although this procedure is, overall, still very safe for the donor. ""