Bates Imelda, Hassall Oliver
Liverpool School of Tropical Medicine, Liverpool, UK.
Biologicals. 2010 Jan;38(1):65-7. doi: 10.1016/j.biologicals.2009.10.013. Epub 2010 Jan 20.
Lack of blood is common in SSA but quantification of the overall shortfall is hampered by a lack of evidence-based targets for blood collection. Despite recommendations that all blood donors should be voluntary and non-remunerated, replacement donors are common throughout sub-Saharan Africa (SSA). Voluntary donors are generally recruited through centralised systems whereas replacement donors are recruited by families and donate through hospitals. Blood from a centralised service is more expensive than from a hospital-based service due to the higher costs of donor recruitment, quality assurance processes and the maintenance of distribution networks. Information about the contribution of replacement donors to the blood supply is scanty and inconsistent but it is likely that they currently provide over half of the blood in SSA. WHO's guidelines for transfusion services deal exclusively with voluntary donors and neglect the substantial contribution made by replacement donors. Examples of how the supply and quality of blood from the replacement donors can be improved have been published but need to be evaluated and disseminated. Political will and open-mindedness to innovative ways to improve supply and safety of blood from all types of donors are essential to promote more evidence-based approaches to blood transfusion practice in low-income countries.
血液短缺在撒哈拉以南非洲地区很常见，但由于缺乏基于证据的采血目标，总体短缺量的量化受到阻碍。尽管有建议称所有献血者都应是自愿且无报酬的，但在整个撒哈拉以南非洲地区，替代献血者很常见。自愿献血者通常通过集中系统招募，而替代献血者则由家人招募并通过医院献血。由于献血者招募、质量保证流程以及配送网络维护成本较高，集中服务提供的血液比医院服务提供的血液更昂贵。关于替代献血者对血液供应贡献的信息稀少且不一致，但目前他们可能提供了撒哈拉以南非洲地区一半以上的血液。世界卫生组织的输血服务指南仅涉及自愿献血者，而忽视了替代献血者的重大贡献。已发表了关于如何改善替代献血者血液供应和质量的实例，但需要进行评估和传播。在低收入国家，要有政治意愿并以开放的心态接受创新方法来改善各类献血者的血液供应和安全性，这对于推广更基于证据 的输血实践方法至关重要。
