1. © 2013 Winton Gibbons
As Health Care Systems Worldwide Evolve, So Do
Sourcing, Testing and Distribution of Blood for Donation
Family
Limited
volunteers
Volunteer,
required,
and paid
Volunteer
Patient history
and ABO
matching
Serology
Homebrew
nucleic acid
testing
Centralized
nucleic acid
testing
At use
Local clinic
| hospital
Mixed site
and
distribution
Broad
distribution
Donor registers
Health history and mini physical
1 pint of blood and several small test
tubes collected
Bag, test tubes and the donor record
labeled with identical bar code
Donation stored in iced coolers until
transported to a center
Donated blood scanned into database,
and test tubes sent for testing in
parallel
Most blood centrifuged into
transfusable components – red cells,
platelets, and plasma
Primary components like plasma, can
be further manufactured into
components such as cryoprecipitate
Red cells leuko-reduced
Single donor platelets leuko-reduced
and bacterially tested
Test tubes received (one of five Red Cross
National Testing Laboratories)
Dozen tests performed on each unit of
blood – establishes blood type, and tests
for infectious diseases
Test results transferred electronically to
manufacturing facility within 24 hours
If test result positive, unit discarded and
donor notified. Results confidential and
shared with donor, except as required by
law
Blood is available to be shipped
to hospitals 24 hours a day, 7
days a week
When test results received, units
suitable for transfusion labeled
and stored
Red Cells stored in at 6º C up to
40 days
Platelets stored room temperature
in agitators up to 3-5 days
Plasma and cryo frozen and
stored in freezers up to 1 year
Even Developed Process has Some Potential Left
$100
$1,000
$10,000
$100,000
$10$100$1,000$10,000
GDP/capita
Healthcare spending / capita
$100
$1,000
$10,000
$100,000
$10$100$1,000$10,000
GDP/Capita
HC Spending/Capita
China-High
China-Medium
India-Medium
India-Low
0.0%
0.1%
1.0%
10.0%
100.0%
$10$100$1,000$10,000
HIVPrevalence
Healthcare Spending / Capita
High-High
How-Mid
High-Low
Medium-High
Medium-Mid
Medum-Low
Low-High
Low-Mid
Low-Low
High
Medium
Low
0%
20%
40%
60%
High Mid Low
PercentofPopulation
High Mid Low
High 1% 0% 19%
Medium 0% 10% 59%
Low 1% 3% 8%
$451
$348
$90
$399
$280
$2,122
$604
Developed-
equivalent low
HC $ / capita
Developed-
equivalent mid
HC $ / capita
Non-tracked
NAT not
adopted
Tracked NAT
not adopted
Other
Roche
Novartis |
HOLX
57,000,000 9,676,437
55,000,000 143,500,659
40,822,904
High
Medium
Low
Donations tested Donations not tested Potential donations
Donation
Systems
in
Developing
Countries
Show
Clinical
Need
• 50% of donations in high-income countries with only 15% of the world's
population. This implies a total equivalent, potential market of 310 million
donations at a similar donation rate for all countries.
• 39 countries (of 159 reporting) unable to screen all blood donations for one or
more of these transfusion-transmissible infections: HIV, hepatitis B, hepatitis C
and syphilis.
• Only 13% of low-income countries have a national hemovigilance system to
monitor and improve safe blood transfusion.
Source: WHO, American Red Cross, AABB, CIA Factbook, various companies public presentations
Donation
in
US
Could
still
be
Increased
• Donations
– 10.8 million volunteers donate blood each year
– 17 million units of whole blood and red blood cells
– 29 percent of which are first-time donors
• Who donates blood?
– Only 38 % of the US population eligible
– Less than 10 percent do so annually.
– Patients scheduled for surgery may be eligible to donate blood for
themselves(autologous blood donation)
International
Blood
Donations
Provide
Testing
Opportunities
• 92 million blood donations every year
• 50% collected in high-income countries with only 15% of the world's population, leading to
a developed-country total equivalent market of 310 million donations.
• Approximately 8,000 blood centers in 159 countries report on blood donations.
• Average, annual blood donations per blood center in high-income countries is 30,000
versus 3,700 low-income countries
• Only 62 countries have national blood supplies entirely from voluntary, unpaid blood
donations.
Neglected
Tropical
Diseases
(NTDs)
• Babesiosis
• Buruli ulcer
• Chagas disease
• Cysticercosis
• Dengue fever
• Dracunculiasis (Guinea Worm
Disease)*
• Echinococcosis
• Fascioliasis
• Human African Trypanosomiasis
(African Sleeping Sickness)
• Leishmaniasis
• Leprosy (Hansen's disease)
• Lymphatic filariasis*
• Malaria
• Onchocerciasis*
• Rabies
• Schistosomiasis*
• Soil-transmitted Helminths (STH)
(Ascaris, hookworm, and
whipworm)*
• Trachoma*
• Yaws
Targeting
Should
Occur
in
Highest
Population
at
the
Right
Stage
of
Economic
Development
Example: Target Countries with Medium HC Spending / Capita
and >1% HIV
Obviously other
issues, such as
political and
regulatory
considerations
are also
important
Example: Country Prioritization by HIV Prevalence
China
and
India
Should
be
Considered
by
Region,
Not
in
Total
Rough Donations and Testing by Healthcare Spending / Capita
Nucleic
Acid
Testing
Potential
Substantial
at
Current
Equivalent
Price
of
$14
per
Donor