The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood.
The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood.
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DOI：
10.2147/jbm.s17194
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发表时间：
2011
影响因子：
2
通讯作者：
Charles AT
中科院分区：
文献类型：
--
作者：
Osaro E;Charles AT
作为一种资源，异体血液的需求从未像今天这样大。选择性手术不断增加，供应减少造成短缺，缺乏国家输血服务、政策、适当的基础设施、训练有素的人员和财政资源来支持无偿献血者自愿输血服务的运作，以及输血传播感染的旧威胁和新威胁，所有这些都共同确保同种异体血液仍然是一种非常重要但有限的资产，特别是在撒哈拉以南非洲地区的医疗保健服务。由于家庭替代和有商业报酬的献血者占主导地位，而不是出于利他主义献血的定期慈善无偿献血者，这一情况进一步恶化。在撒哈拉以南非洲，由于贫血的高患病率，特别是疟疾和妊娠相关并发症，对输血的需求很高。输血领域的所有利益相关者都面临着一个重大挑战，即将最佳循证医学实践应用于这一宝贵产品的世界级管理，以更适当地使用血液。撒哈拉以南非洲地区的医生必须始终牢记，避免输注同种异体血的首要策略是他们对贫血和凝血病所涉及的病理生理机制的透彻理解，以及他们对发达国家所使用的基于证据的良好实践的深思熟虑的坚持，以潜在地减少许多患者群体输注同种异体血的可能性。迫切需要制定创新办法，招募和留住低风险自愿献血者。对异体输血不良反应的担忧应促使对输血实践进行审查，并证明需要寻找输血替代方案以减少或避免使用异体血。这些策略应包括使用药理学措施（使用抗纤维蛋白溶解剂预防出血，使用促红细胞生成素和口服及静脉铁剂治疗贫血）纠正贫血，使用非药理学措施（术前自体输血，围手术期红细胞回收和正常体温以减少手术患者的失血量）。所有这些策略将有助于优化有限血液储备的使用。
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.