Diagnoses and ordering practices driving blood demand for treatment of anemia in Tanzania.

BACKGROUND: Resource-limited countries in Africa experience blood shortages. Understanding clinical drivers of blood demand can inform strategies to increase blood availability. STUDY DESIGN AND METHODS: From a national representative sample of 42 hospitals in Tanzania, patient records and requests for whole blood (WB) and red blood cells (RBCs) to treat anemia were analyzed using data collected prospectively from June through September 2013. Abstracted data included cause of anemia, number of requested units, clinical signs, and pretransfusion hemoglobin (Hb) levels. Weighted projections of nationwide drivers of blood demand for the year, 2013, were calculated. Mean posttransfusion Hb levels were estimated, and blood requests were assessed for clinical appropriateness. RESULTS: Malaria was the leading driver of blood demand for anemia among children, accounting for 67% (55,949 units; standard deviation [SD], 1911 units) of projected units requested for children in 2013. Maternal hemorrhage was the leading driver of blood demand for anemia among adults, accounting for 21% (31,321 units; SD, 963 units) of projected units requested. Seventeen percent (26,133 units; SD, 1013 units) of projected requested units were deemed inappropriate. Adults with severe anemia had a mean Hb level of 3.7 g/dL and a mean of 1.6 WB or RBC units per request, resulting in an estimated mean posttransfusion Hb level of 5.3 g/dL. CONCLUSIONS: Strategies to prevent and treat underlying causes of anemia and decrease inappropriate blood requests will likely increase blood availability. Restrictive blood ordering practices seen in adults with severe anemia suggests undertreatment of anemia and may result in an underestimation of the national blood demand.

Prevalence and causes of blood donor deferrals among clients presenting for blood donation in northern Tanzania.

INTRODUCTION: Blood is an important requirement in different medical and surgical conditions with half of all donations are from developing countries. Lack of eligibility among blood donors who present for blood transfusion, called blood donor deferral is associated with the unsustainable and inadequate amount of blood collected by blood banks worldwide. However, the prevalence and causes of blood donor deferrals are not well known in Tanzania where less than one-third of actual needs of blood is collected, leading to unmet demand of blood for transfusion, and causing unwanted morbidity and mortality. MATERIALS AND METHODS: This was a retrospective analysis of blood donors at northern zone blood transfusion center, Tanzania from January to December. 2016. Donor's data were transferred to Statistical Package for Social Studies (SPSS) program version 20.0 for analysis. Descriptive statistics was used to summarize data and comparisons made by type of donor and deferrals using Chi-square test. RESULTS: A total of 14377 participants were studied whereby 12775 (88.9%) were voluntary non-remunerated blood donors. The blood donor deferral rate was 12.7% and deferral was significantly more likely in females, with increasing age above 31 years, who came from nearby regions from where the blood bank is located and/or a family replacement donor (P value <0.01). Overall, infections contributed to 62% of all deferrals and low hemoglobin was the leading cause of temporary deferrals while Hepatitis B lead the permanent deferral causes. CONCLUSIONS: Blood donor deferral is a significant problem in northern Tanzania and accounts for more than one-tenth of all prospective blood donors. Latent and active infections are the leading cause of blood donor deferrals, a picture that mirrors other low income countries especially those located in sub-Saharan Africa. Results of this study calls for appropriate preventive interventions to address prevalent causes of deferrals such as infections with HIV and HBV to tackle low hemoglobin.

Estimating Tanzania's National Met and Unmet Blood Demand From a Survey of a Representative Sample of Hospitals.

Estimating blood demand to determine collection goals challenges many low-income countries. We sampled Tanzanian hospitals to estimate national blood demand. A representative sample based on probability proportional to size sampling of 42 of 273 (15%) Tanzanian transfusing hospitals was selected. Blood bank registers, patient medical records, and blood component disposition records were reviewed prospectively from June to September 2013 to determine the number of components requested and the number and proportion issued, not issued due to nonavailability, and not issued for other reasons. Data were estimated for an annual national estimate. Of an estimated 278 371 components requested in 2013, 6648 (2.4%) were not issued due to nonavailability, 34 591 (12.4%) were not issued for other reasons, and 244 535 (87.8%) were issued. Of these 278 371 components, 86 753 (31.2%) were requested by adult medical, 74 499 (26.8%) by pediatric medical, and 57 312 (20.6%) by obstetric units. In these 3 units, the proportion of units not issued due to nonavailability was 1.8%. Private (4.1%) and large (6%) hospitals had the largest proportion of units not issued because of nonavailability. Of 244 535 issued components, 91 690 (37.5%) were collected, tested, and issued from blood banks that are not part of the Tanzania National Blood Transfusion Services (TNBTS). Nearly 98% of blood component demand was met. However, a large portion of the blood supply for the hospitals came from non-TNBTS blood banks. TNBTS could increase availability of safe blood through assuring the quality of donor selection and donation testing at non-TNBTS blood banks.