Blood Supply Falls Short of Need in Most Countries, Study Finds

Most countries lack an adequate blood supply to meet their healthcare needs, with the shortage falling hardest on poor countries south of the equator, according to a study published today in Lancet Haematology.¹

The study, which used modelling based on World Health Organization (WHO) targets, found that “every country in central, eastern, and western sub-Saharan Africa, Oceania, and south Asia had insufficient blood to meet their needs.”

To calculate the shortfall, researchers from the University of Washington’s Institute for Health Metrics and Evaluation (IHME), and Children’s National Medical Center and George Washington School of Medicine in Washington, DC, developed blood availability estimates using WHO survey data from 2011 to 2013, which included responses from 180 of the 195 countries. Then, they calculated disease specific transfusion needs based on a US national inpatient data set that covered cases from 2000 to 2014. They applied these prevalence results to the data from the 195 countries to calculate the unmet need, using the 2017 Global Burden of Disease study, previously published by IHME and funded by the Bill & Melinda Gates Foundation.

They found that in 2017, the worldwide need for blood was 304,711,244 units, with a 95% uncertainty interval (UI) 293,064,637-314,049,479. However, the supply was only 272,270,243 (268,002,639-276,698,494), for a need-to-supply ratio of 1.12 (95% UI 1.07-1.16).

Worldwide, the gap was approximately 30 million units. But the global blood shortage is unevenly distributed: Out of 195 countries examined in the study, 119 had unmet need totaling more than 102 million units, the equivalent of 1849 per 100,000 population worldwide.

According to the authors, the problem starts with a mismatch between where blood is needed and where donations occur. Of the 112.5 million donations that happen worldwide each year, only 54% take place in low- and middle-income countries, which are home to 82% of the world’s population. Many of these countries face health challenges such as high levels of HIV/AIDS and hepatitis that limit who can donate.

Thus, the authors wrote, “Our data suggest that the gap between need and supply is large in many low-income and middle-income countries, and reinforce that the WHO target of 10-20 donations per 1000 population is an underestimate for many countries.”

Low-income countries had comparatively low demand for blood products, due to lower injury rates and less burden from chronic diseases such as cardiovascular disease. The supply of whole blood and its components—red blood cells, platelets, and plasma—varied widely from country to country.

Denmark had the best blood supply, with 14,704 products per 100,000 population. On the opposite end, South Sudan had 46 units per 100,000, yet that country’s needs were 75 times greater than its supply—researchers calculated South Sudan’s need at 3537 units per 100,000 population.

Bringing better healthcare to poor countries increases the need for blood products, noted study author Meghan Delaney, DO, MPH, from Children’s National Medical Center. “As more people are able to access care in low and middle income countries, the demand for blood transfusions will increase further, and—without financial, structural, and regulatory support—will widen the gap we’ve uncovered between global supply and demand of blood,” she said in a statement.

Also, the authors said based transfusion needs on US care patterns could lead to blood supply shortfalls in some countries, which see higher rates of malaria, tropical diseases, and certain maternal disorders. Patients with HIV may response to treatments differently and develop anemia, for example, if they have experienced malnutrition, the authors wrote.

In an accompanying editorial,² Thierry Burnoff, PhD, of Taipei Medical University, Taiwan, wrote that the findings are a reminder that a safe, adequate blood supply cannot be an afterthought of the healthcare system. “Substantial differences in the availability, safety, and quality of blood still exist around the world,” he wrote. “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.”

References

1. Roberts N, James S, Delaney M, Fitzmaurice C. The global need and availability of blood products: a modelling study [published online October 17, 2019]. Lancet Haematol. 2019; doi.org/10.1016/S2352-3026(19)30200-5.
2. Burnouf T. Blood products: unmet needs for essential medicines. [published online October 17, 2019]. Lancet Haematol. 2019; doi.org/10.1016/S2352-30269(19)30217-0.