Most countries don't have enough blood units to meet medical needs, with 100 million more required to plug the gap
Many countries are critically short of blood, and at least 100 million more blood units are needed in places with low supplies each year, shows an assessment of its global demand and supply to meet medical needs.
Researchers found the gap between need and supply is significant in many low-income and middle-income countries. According to estimates by the research team - which examined 195 countries - the total global blood supply in 2017 was around 272 million units. However, the total global demand in 2017 was approximately 303 million units, which is a shortfall of about 30 million blood units.
Across the 119 countries with insufficient supply, the shortfall totaled over 100 million units, which was equal to around 1,849 units per 100,000 people, says the team from the University of Washington, the Children's National Hospital, and The George Washington University School of Medicine and Health Sciences, US.
"In 2017, the global blood need was 304,711,244, and the global blood supply was 272,270,243 blood product units, with a need-to-supply ratio of 1:12. Of the 195 countries, 119 (61%) did not have sufficient blood supply to meet their needs. Across these 119 countries, the unmet need totaled 102,359,632 blood product units, equal to 1,849 units per 100,000 population globally. Every country in central, eastern, and western sub-Saharan Africa, Oceania, and South Asia had insufficient blood to meet their needs," says the study published in The Lancet Haematology, and funded by the National Institutes of Health.
Currently, the World Health Organization (WHO) recommends that for every 1,000 people in any country, a target of 10 to 20 donors is needed to provide adequate supplies. However, the new findings, says the research team, suggest that the gap between need and supply is substantial in many low-income and middle-income countries, and reinforce that the WHO target is an underestimate for many countries. Accordingly, the researchers have recommended that donation targets should instead vary by country, according to the types of diseases that are most prevalent.
"Other studies have focused on blood safety, such as the risk of transmitting infections such as HIV, but our study is the first to identify where the most critical shortages lie, and therefore where the most work needs to be done by governments to increase donation, scale-up transfusion services and develop alternatives," says affiliate assistant professor Christina Fitzmaurice from the University of Washington.
The team conducted a modeling study involving 195 countries and territories. They used data from the WHO Global Status Report on Blood Safety and Availability and the Global Burden of Disease (GBD) 2017 study, which are both updated regularly.
"Blood transfusions are an important resource of every health-care system, with often limited supply in low-income and middle-income countries; however, the degree of unmet need for blood transfusions is often unknown. We, therefore, aimed to estimate the blood transfusion need and supply at national level to determine gaps in transfusion services globally," says the team.
They add, "A more detailed understanding of a country's blood needs will allow stakeholders such as ministries of health, non-governmental entities that focus on global health, and national transfusion services and blood banks to better predict the needed supply and plan for adequate transfusion services."
The Findings
The researchers found that low-income countries had relatively low demand compared to high-income countries, which can be attributed to a lower disease burden from injuries and chronic diseases. However, these countries were also estimated to have the greatest shortfalls in supply. The supply of whole blood and the three components derived from it - red blood cells, platelets, and plasma - therefore varied sharply between countries, shows analysis.
In most high-income countries, supply was able to meet demand. For example, Denmark was estimated to have the greatest supply of all three blood components, with 14,704 blood product units per 100,000 people. In contrast, South Sudan had the lowest supply at 46 units per 100,000. According to assessments, South Sudan's needs were 75 times greater than supply (3,537 units needed per 100,000 people versus 46 units supplied per 100,000 people).
Madagascar had the second greatest shortage, with demand outstripping supply by 26 times (3,568 units per 100,000 people needed versus 134 supplied). India had the largest absolute shortage, being short of nearly 41 million units in 2017 (52.5 million needed versus 11.3 million supplied), says the study.
"A large discrepancy exists in the scale of unmet need along socio-economic lines, with no countries in Australasia, southern Latin America, and western Europe, but every country in central sub-Saharan Africa, eastern sub-Saharan Africa, Oceania, South Asia, and western sub-Saharan Africa not having sufficient blood supply to meet need," the findings state.
Injuries, digestive diseases, and cardiovascular diseases caused the greatest need globally, but there was variation regionally, such as a large burden due to injuries in central and eastern Europe, neoplasms in high-income North America, and respiratory infections and tuberculosis in low-income regions such as sub-Saharan Africa and Oceania.
Demand in high-income countries was mainly caused by injuries and cardiovascular diseases. In central Europe, for example, nearly 30% of transfusions were for treating injuries (1,716 units per 100,000), and over 20% were for cardiovascular diseases (1,283 per 100,000). In western, eastern, and central sub-Saharan Africa, nutritional deficiencies, which include iron deficiencies, were the principal need for more than 300 units per 100,000 population, or more than 10% of the total transfusion need, says the analysis.
"Respiratory infections and tuberculosis caused more than 20% of blood transfusions in Oceania (858 units per 100,000 of 4,017 total) and southern sub-Saharan Africa (789 units per 100,000 of 3,797 total), and less than 5% in high-income North America (196 units per 100,000 of 4,812 total). In high-income North America, 645 units per 100,000 were needed for blood transfusions related to neoplasms, whereas in South Asia and central, eastern, and western sub-Saharan Africa, neoplasms accounted for less than 1% of transfusion needs," says the study.
The researchers say that to meet demand in 2017, all 195 countries would have needed to exceed the WHO goal of 10-20 donations per 1,000 people. They add that assuming that around 1.5 units of blood components can be derived from a donation, 40 countries required more than 30 donations, while four in eastern Europe required more than 40 donations per 1,000 of the population.
"As more people are able to access care in low and middle-income countries, the demand for blood transfusions will increase further, and - without financial, structural and regulatory support - will widen the gap we have uncovered between global supply and demand of blood," says Dr Meghan Delaney from the Children's National Hospital in Washington DC.
In a linked comment, Professor Thierry Burnouf from Taipei Medical University, Taiwan, says that the study is a reminder that safe and sufficient blood supply is needed to manufacture unique cell-based or protein therapeutic products.
"Substantial differences in the availability, safety, and quality of blood still exist around the world. Although an integral part of the public health system, financial, organizational, and infrastructural reasons contribute to blood-derived and plasma-derived products as being neglected medicines in low-income and middle-income countries. Comprehensive strategies, through national and regional commitment, international cooperation, and transfer of technologies to blood establishments, can help fill the gap and strengthen local blood systems, so that patient access to life-saving blood therapies gradually improves," says Burnouf.