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  • Title: The problem of transfusion-associated acquired immunodeficiency syndrome in Africa: a quantitative approach.
    Author: Heymann SJ, Brewer TF.
    Journal: Am J Infect Control; 1992 Oct; 20(5):256-62. PubMed ID: 1443758.
    Abstract:
    BACKGROUND: Transfusion-associated AIDS accounts for 10% of all cases of AIDS in Africa. The risk of HIV-1 contamination in transfusions continues to exist, even in countries where blood products are screened, because of limitations in test sensitivity, human error, and the window period. Furthermore, 30 African countries do not screen all of their blood products because of resource limitations. METHODS: This study used decision analysis to compare the survival outcomes of severely anemic patients who are transfused with those of patients who are not transfused. Sensitivity analyses were performed. RESULTS: When 5% of the blood supply is HIV-1 contaminated, every patient with a 6.6% or greater risk of dying from anemia should be transfused. Detailed results are provided for a wide range of HIV-1 contamination rates. CONCLUSIONS: This study provides a method for developing and evaluating locality-specific transfusion guidelines. This method can be applied to other regions, including the United States, and to other diseases transmitted by blood products. Blood and blood products are screened to some extent in many African countries. 30 African countries, however, do not screen all blood products because of resource constraints. Where blood is screened, transfusion patients still risk receiving HIV-infected blood as a result of test sensitivity limitations, human error, and the window period. Blood recipients in African countries run a 1-20% risk of receiving infected blood from any given blood unit. Under these conditions, research reveals that transfusion-associated AIDS accounts for 10% of AIDS cases in Africa. Despite the significant health risk of receiving blood transfusions throughout much of Africa, blood transfusion, however, is often needed as treatment to save the lives of anemic patients. Such critical instances include anemia during pregnancy, intrapartum and postpartum hemorrhage, severe parasitic infections, nutritional anemias, trauma, surgery, hemoglobinopathies, and blood-group incompatibilities in neonates. Policymakers and practitioners have often stated the need to transfuse less or only when absolutely necessary. These recommendations are, however, far too general to serve as practical guidelines for physicians. This paper considers how to develop a transfusion policy which maximizes the number of lives saved. Decision analysis was used to compare survival outcomes of severely anemic patients who receive transfusions against those who do not. Results indicate that when 5% of the blood supply is HIV-1 contaminated, everyone with 6.6% or more risk of dying from anemia should be transfused. Results for a broad range of HIV-1 contamination rates as well as a method for developing and evaluating locality-specific transfusion guidelines are also included. Methods presented may be adapted for application in other geographic regions and for other diseases transmitted by blood products.
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