Callum Narita, Editorials and Publications Team PMSA
A common and potentially lifesaving intervention in modern medicine is the administration of blood products. Blood transfusion relies on regular donation from generous blood donors. These vary from red cell transfusions to fresh frozen plasma and pooled platelets (1). Of these, only plasma can effectively be stored for a long time, with platelets having the shortest shelf life of five days and red cells a shelf life of 35 days. There are certain issues that arise around blood transfusion, and these are pertinent in the Pacific region.
Given the relatively short time blood products can be kept, many donors are required to give blood with regularity to ensure supplies remain adequate. The rate of blood donation and therefore supply of blood products tends to be proportional to the wealth of a nation (2). Therefore, there can be a lack of transfusion availability in developing nations, including many of the Pacific Islands. The rate of donation has been shown to improve with the use of mass media campaigns, however few of these countries have programs implemented (3).
One other prevalent issue associated with blood transfusion is the risk of transfusion-associated infections. Testing of blood products for infectious diseases varies amongst countries. In Australia, rigorous screening is undertaken to minimise the risk of transfusion-related disease. However, screening is less rigorous in other nations, and not all blood products undergo the same level of scrutiny. Concerningly, a high percentage of donated blood products tested in Sub-Saharan Africa contained human immunodeficiency virus (HIV) (2). Given some Pacific regions have a high prevalence of the virus, it is likely that there are similarly high rates within donated products, indicating the significance of blood product screening, particularly in regions where infectious diseases are prevalent. Zika virus is a disease of recent interest, and the virus has been found in some Pacific Island nations. Importantly, transfusion-associated transmission has been noted (4). Despite this, it is not yet part of routine blood product screening.
Hepatitis C virus (HCV) is yet another bloodborne disease that can have significant impacts on health. Whilst most countries routinely screen blood products for the virus, two Western Pacific nations reported being unable to screen all blood products for HCV, whilst one reported that there was no testing for the virus (2). This demonstrates the significant difference in infectious disease screening that occurs.
Blood transfusion is a significant weapon in the arsenal of a physician, particularly in emergency situations. However, both availability of the blood products and the risk of infections hamper this, particularly in developing nations. Whilst conditions are improving, public health campaigns promoting the donation of blood can assist with availability. Policy change to better the screening of blood products, including more contemporary diseases such as Zika virus, should be introduced to limit the risk of transfusion-associated diseases.
1. United Kingdom Blood Services, Norfolk D. Handbook of Transfusion Medicine. Chapter 3.3: Blood products. 5th Ed ed. Norwich UK: The Stationery Office; 2013.
2. World Health Organization. The 2016 global status report on blood safety and availability. 2017:[Available from: http://apps.who.int/iris/bitstream/handle/10665/254987/9789241565431-eng.pdf;jsessionid=6E2655406580C071F8036097B60A3962?sequence=1].
3. Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. The Lancet. 2010;376(9748):1261-71.
4. Musso D, Aubry M, Broult J, Stassinopoulos A, Green J. Zika virus: new emergencies, potential for severe complications, and prevention of transfusion-transmitted Zika fever in the context of co-circulation of arboviruses. Blood Transfusion. 2017;15(3):272.