Field Stephen P, Allain Jean-Pierre
Welsh Blood Service, Pontyclun, Wales, UK.
J Clin Pathol. 2007 Oct;60(10):1073-5. doi: 10.1136/jcp.2006.043505. Epub 2007 Apr 5.
This review examines the current state of transfusion services in sub-Saharan Africa and presents the argument for and against the Western model of a centralised blood service with 100% voluntary non-remunerated blood donors as advocated by the World Health Organization. The current practice of family replacement donors in hospital-based blood service is the most economical option, but in the face of high child and maternal mortality rates the blood supply has proved to be insufficient. With estimates of 5-10% of HIV transmission in Africa being the result of contaminated blood transfusions, there is a need to improve testing for transfusion transmissible diseases and the selection of blood donors. Of major concern, with respect to testing, is the quality of kits being used and the continuity of supply. The need to produce components is discussed in the context of the transfusion needs in sub-Saharan Africa. The running costs of establishing and maintaining centralised blood services need careful consideration as such projects need to be sustainable in the future. It is concluded that both options are viable while centralised programmes are being developed, and a pragmatic approach should be taken to ensure that the patients' needs are met and that resources are suitably utilised to ensure sustainability.
本综述考察了撒哈拉以南非洲地区输血服务的现状，并就支持和反对世界卫生组织所倡导的、以100%自愿无偿献血者为基础的集中式血液服务西方模式展开了讨论。医院血液服务中目前采用的家庭替代献血者做法是最经济的选择，但鉴于儿童和孕产妇死亡率居高不下，事实证明血液供应不足。据估计，非洲5%-10%的艾滋病毒传播是由受污染的输血导致的，因此有必要改进对输血传播疾病的检测以及献血者的筛选。在检测方面，主要关切的是所使用试剂盒的质量和供应的连续性。在撒哈拉以南非洲地区输血需求的背景下讨论了生产血液成分的必要性。建立和维持集中式血液服务的运营成本需要仔细考虑，因为此类项目未来需要具备可持续性。得出的结论是，在发展集中式项目的同时，两种选择都是可行的，应采取务实的方法，以确保满足患者需求，并合理利用资源以确保可持续性。
