THE SAFETY OF THE BLOOD SUPPLY

Since the 1980s, widespread concern about AIDS has mobilised tremendous efforts to eliminate transfusion-transmitted disease (TTD). In spite of these global efforts, the ideal of a zero-risk blood supply is still not achievable. Meanwhile, a concerned public and the media demand that more be done to improve blood safety. TTD has influenced the way in which transfusion medicine has been practiced. It has i) changed policies on blood collection (e.g., increased use of autologous blood and demand for directed donations); ii) imposed new and more stringent criteria for donor selection; and iii) mandated improved testing of donated blood with newer and more sensitive tests. A multi-pronged approach is needed to improve the safety of the blood supply. This should include stringent donor selection criteria, pre-donation interviews designed to exclude donors at risk of transmitting infectious diseases, the use of appropriate technology for screening infectious agents in donated blood and education of both donor and public on the need for safe blood. Recruiting, educating and retaining safe blood donors is an important component to blood safety efforts. Emerging blood-borne infections that pose new threats to blood safety have to be considered. Organisations such as the World Health Organization (WHO) and the International Federation of Red Cross and Red Crescent Societies have assisted many countries in blood safety initiatives. In developed countries, the residual risk of TTD has been reduced to very low levels. However, in a study carried out to define problems in and to formulate solutions for improving blood safety in developing countries,(1) it was reported that, despite improvements between 1988 and 1992, only 66 % of developing countries (DGC) and 46 % of the least developed countries (LDC) screen all blood donations for antibodies to HIV. Seventy-two percent of DGC and 35 % of LDC test all donations for hepatitis B surface antigen. Syphilis testing was carried out in 71 % of DGC and 48 % of LDC. Many developing countries still rely heavily upon paid and replacement blood donors. Thus, improvements that can be made to blood safety vary and depend on the socio-economic state of development of the country and the competing priorities for limited health care resources