Abstract
Blood transfusions are an important resource of every health care system, with often limited supply in low-income and middle-income countries; however, the degree of unmet need for blood transfusions is often unknown. We therefore aimed to estimate the blood transfusion need and supply at national level to determine gaps in transfusion services globally.
Methods
We did a modeling study involving 195 countries and territories. We used blood component preparation data from 2011–2013 to estimate blood availability for 180 (92%) of 195 countries from the WHO Global Status Report on Blood Safety and Availability. We calculated disease-specific transfusion needs per prevalent case for 20 causes in the USA using the National (Nationwide) Inpatient Sample dataset between the years 2000 and 2014, and the State Inpatient Databases between 2003 and 2007 from the Healthcare Cost and Utilization Project. Using prevalence estimates for the USA from the Global Burden of Disease (GBD) 2017 study, we estimated the ideal disease specific-transfusion rate as the lowest rate from the years 2000 to 2014. We applied this rate to GBD prevalence results for 195 countries to estimate transfusion needs. Unmet need was the difference between the estimated supply and need.
Findings
In 2017, the global blood need was 304,711,244 (95% uncertainty interval [UI] 293,064,637–314,049,479) and the global blood supply was 272,270,243 (268,002,639–276,698,494) blood product units, with a need-to-supply ratio of 1.12 (95% UI 1.07–1.16). Of the 195 countries, 119 (61%) did not have sufficient blood supply to meet their need. Across these 119 countries, the unmet need totalled 102,359,632 (95% UI 93,381,710–111,360,725) blood product units, equal to 1,849 (1,687–2,011) units per 100,000 population globally. Every country in central, eastern, and western sub-Saharan Africa, Oceania, and south Asia had insufficient blood to meet their needs.
Interpretation
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 1,000 population is an underestimate for many countries. A continuous expansion and optimization of national transfusion services and implementation of evidence-based strategies for blood availability is needed globally, as is more government support, financially, structurally, and through establishment of a regulatory oversight to ensure supply, quality, and safety in low-income and middle-income countries.
