Global Blood Supply Estimates Show a Significant Unmet Need

Jennifer Garcia

October 17, 2019

The World Health Organization (WHO) recently added blood and its components to the Model List of Essential Medicines, underscoring the importance of an adequate blood supply to optimize patient care.

However, a new analysis finds that many countries are critically short of blood and that current targets for blood collection are often inadequate to meet local needs. These findings, based on data from 195 countries, were published online today in the journal The Lancet Haematology.

For the study, Christina Fitzmaurice, MD, MPH, from the University of Washington, Seattle, and colleagues estimated blood availability from the WHO Global Status Report on Blood Safety and Availability between 2011 and 2013. The authors then calculated disease-specific transfusion needs for 20 medical conditions using United States data collected between 2000 and 2014 for the Healthcare Cost and Utilization Project.

They then used data from the 2017 Global Burden of Disease study to determine disease prevalence in each of the 195 countries and estimate how much blood would be needed to treat every patient requiring a blood transfusion.

The researchers estimate that in 2017 the global blood supply was approximately 272 million units; however, the global demand was approximately 304 million units, resulting in a deficit of over 30 million units.

However, the supply gap was unevenly distributed among countries. Specifically, when the authors considered just the 119 countries where need outstripped supply, they uncovered a shortage of over 100 million units, equal to 1849 units per 100,000 population. Countries in sub-Saharan Africa, Oceania, as well as South Asia and Southeast Asia, had the greatest unmet need despite having relatively small blood needs across all causes.

The WHO suggests that 10 to 20 donations for every 1000 people is sufficient to provide adequate blood component supplies. The authors propose, however, that this target may underestimate actual blood needs, noting that all countries included in this study were above this goal. Assuming a ratio of five units of components for every unit of whole blood donated, 40 countries required more than 30 donations per 1000 people and four countries required more than 40 donations per 1000 people.

The authors acknowledge that the ideal blood usage rates by cause are unknown and transfusion recommendations outside of the US will differ based on disease severity. Further, estimates of blood need also assumed a standard of care similar to what is available in the United States and acknowledge that this may not be the case in middle- and low-income countries.  

The causes for blood transfusion also varied greatly among countries. Injuries and cardiovascular disease were the primary causes for blood transfusion in high-income countries, whereas respiratory diseases (eg, tuberculosis) and nutritional deficiencies were the more common causes in low-income countries.

"Many countries face critical undersupply of transfusions, which will become more pronounced as access to care improves," Fitzmaurice and colleagues write.

"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 authors write.

"This study is a reminder that a safe and sufficient blood supply is needed to manufacture unique cell based or protein therapeutic products," writes Thierry Burnouf, PhD, from the Taipei Medical University, Taiwan, in an accompanying editorial.

"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," he concludes.

Funding for this study was provided by the National Institutes of Health. The authors and editorialist have disclosed no relevant financial relationships.

Lancet Haematol.  Published online October 17, 2019. Abstract, Editorial

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