As a resource, allogenic blood has never been more in demand than it is today. Escalating elective surgery, shortages arising from a fall in supply, a lack of national blood transfusion services, policies, appropriate infrastructure, trained personnel, and financial resources to support the running of a voluntary nonremunerated donor transfusion service, and old and emerging threats of transfusion-transmitted infection, have all conspired to ensure that allogenic blood remains very much a vital but limited asset to healthcare delivery particularly in Sub-Saharan Africa. This is further aggravated by the predominance of family replacement and commercially remunerated blood donors, rather than regular benevolent, nonremunerated donors who give blood out of altruism. The demand for blood transfusion is high in Sub-Saharan Africa because of the high prevalence of anemia especially due to malaria and pregnancy-related complications. All stakeholders in blood transfusion have a significant challenge to apply the best available evidenced-based medical practices to the world-class management of this precious product in a bid to using blood more appropriately. Physicians in Sub-Saharan Africa must always keep in mind that the first and foremost strategy to avoid transfusion of allogenic blood is their thorough understanding of the pathophysiologic mechanisms involved in anemia and coagulopathy, and their thoughtful adherence to the evidenced-based good practices used in the developed world in a bid to potentially reduce the likelihood of allogenic blood transfusion in many patient groups. There is an urgent need to develop innovative ways to recruit and retain voluntary low-risk blood donors. Concerns about adverse effects of allogenic blood transfusion should prompt a review of transfusion practices and justify the need to search for transfusion alternatives to decrease or avoid the use of allogenic blood. These strategies should include the correction of anemia using pharmacological measures (use of antifibrinolytics to prevent bleeding and the use of erythropoietin and oral and intravenous iron to treat anemia) use of nonpharmacologic measures (preoperative autologous blood transfusion, perioperative red blood cell salvage and normothermia to reduce blood loss in surgical patients). All these strategies will help optimize the use of the limited blood stocks.

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The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood.

Background. Intraoperative blood salvage (IBS) reduces homologous transfusion in orthotopic liver transplantation (OLT), but may carry with it the risk of reinfusing tumor cells in patients with hepatocellular carcinoma (HCC). The use of leukocyte depletion filters (LDFs) for the removal of tumor cells is rarely reported in clinical OLT. The aims of this study were to evaluate the frequency of tumor cell contamination in surgical field during OLT for HCC recipients and to investigate the efficiency of additional LDFs for eliminating tumor cells from IBS. Methods. Thirty-two HCC patients with preoperatively elevated serum alpha-fetoprotein (AFP) underwent OLT. The blood from the surgical field was collected and processed by an autotransfusion device (Cell Saver 5), followed by 2 consecutive LDF filtrations. The HCC cells in IBS samples and filtered samples were determined using a nested RT-PCR technique to detect the AFP mRNA. Results. The shed blood samples from 20 (62.5%) of the 32 HCC patients were contaminated with HCC cells and 15 of them remained positive after Cell Saver processing. Patients within the Milan or UCSF criteria were less likely to have HCC cell contamination and the contaminated HCC cells were more likely to be removed by the Cell Saver in these patients as compared to other patients (P<0.01). After filtration through an additional LDF, most cases (13/15) became negative except for those with ruptured tumors (P<0.05). Conclusions. Our results suggest that blood filtration with the LDF can efficiently remove tumor cells and the use of an additional LDF after use of the Cell Saver could markedly reduce the risk of tumor cell reintroduction during the OLT in HCC recipients with nonruptured tumors.

Intraoperative blood salvage during liver transplantation in patients with hepatocellular carcinoma: efficiency of leukocyte depletion filters in the removal of tumor cells.

The attainment of blood transfusion safety in Nigeria (and probably the rest of Sub-Saharan Africa) remains an uphill task due to a number of factors, ranging from shortage of blood, poor implementation of blood transfusion guidelines, infrastructural deficits to high prevalence of transfusion-transmissible infections (TTIs), particularly hepatitis and human immune deficiency viruses. We reviewed available data on blood transfusion practices and safety in Nigeria using the PubMed, PubMed Central, Google Scholar, and African Index Medicus search engines, through a combination of word and phrases relevant to the subject. The World Health Organization has been in the forefront of efforts to establish safe, available, and affordable blood transfusion services in most parts of Africa through encouraging adequate blood donor recruitment, donor blood testing, and collection as well developing strategies for the rational use of blood. Even though modest improvement has been recorded, particularly with regards to donor blood screening for common TTIs, considerable efforts are needed in the form of robust public enlightenment campaigns (on blood donation) and continuous system improvement to drive the current transfusion practices in the country toward safety and self-sustenance.

Blood transfusion safety; current status and challenges in Nigeria.

SUMMARY
Objective

This study aims to compare the changes and progress made to Iranian Blood Transfusion Organization (IBTO) during 1974–2014 in order to identify the shortcomings.



Background

The History of Blood transfusion in Iran can be traced back to the 1940s. IBTO was established in 1974 as a national centralised organisation, supported by Iranian government for its budget and supplies and provides its products free of charge to both public and private hospitals.



Methods

The statistics have been derived from IBTO Statistical Center. Also related literature has been reviewed.



Results

From 1974 to 2014, donation per population has been increased about eight times. IBTO reached 100% voluntary blood donation in 2007, but the number of female blood donors in Iran is six times lower than average global rate. On one hand, the prevalence rate of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) in blood donors was dropped in to one fifth and one third, respectively during past 8 years. On the other hand, irrational blood usage and lack of integrated blood stock management systems and non self-sufficiency on plasma-derivedmedicines are considered as main challenges of IBTO.



Conclusion

Forty years since the establishment, IBTO managed to achieve considerable improvements in different fields but many challenges still remain, which need to be addressed urgently. Great gap between the number of male and female blood donors in Iran has to be filled. The improvement of knowledge and practice on patient blood management and use of alternatives are on the agenda of IBTO in next coming years.

Four decades of National Blood Service in Iran: outreach, prospect and challenges.

Liang T-B, Li J-J, Li D-L, Liang L, Bai X-L, Zheng S-S. Intraoperative blood salvage and leukocyte depletion during liver transplantation with bacterial contamination. Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.01091.x © 2009 John Wiley & Sons A/S.



Abstract:  Background:  Bacterial contamination is considered to be a contraindication for intraoperative blood salvage (IBS) during OLT. The aims of this study were to evaluate the efficiency of the autotransfusion device with an additional leukocyte depletion filter (LDF) for eliminating bacterial contaminations, and its clinical outcomes in terms of post-operative infections during OLT.



Methods:  Forty-five patients with end-stage liver disease and cirrhotic ascites were enrolled in this study. The blood from the surgical field was collected and processed by an autotransfusion device (Cell Saver 5) and a LDF for bacteriological analysis. Among them, 12 patients with chronic severe hepatitis B received autologous transfusion for analysis of the effect on post-operative infections.



Results:  Spontaneous bacterial peritonitis (SBP) (p < 0.05, OR = 20.1) and a long duration of operation (p < 0.01, OR = 8.3) were found to be critical risk factors for contamination. Autotransfusion devices with an additional LDF significantly eliminated bacterial contaminants from shed blood (p < 0.05). About 33% (4/12) of the patients who received autologous transfusion with salvaged and filtered erythrocytes got post-operative bacterial infection.



Conclusions:  Autotransfusion devices with an additional LDF could significantly eliminate bacterial contaminants of shed blood during OLT. The new mode of IBS might be a good option in reducing post-operative infections, and deserves a large-scale clinical trial.

Intraoperative blood salvage and leukocyte depletion during liver transplantation with bacterial contamination.

The discovery of HIV and other transfusion-transmissible infections has increased the demand for alternatives to allogeneic blood transfusion. One such alternative is autologous transfusion. This review presents an analysis of autologous transfusion. We conclude that autologous transfusion should form part of a strategy to minimise the risk associated with allogeneic transfusion in Nigeria and other developing countries. South African Journal of Surgery Vol. 44 (3) 2006: pp. 114-119

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Teddy Charles

Papers

Autologous blood transfusion--a review.