South African National Blood Service Research Articles

The effect of COVID‐19 lockdown periods and societal restrictions on blood product usage in adult trauma patients: A retrospective observational study

Background. Blood products, though potentially lifesaving, are a scarce and costly resource. Trauma injuries, which contribute to the demand for these resources, increase in proportion to alcohol consumption. South Africa’s COVID-19 lockdown measures included a ban on alcohol sales and curfews.Objective. To investigate the effect of these societal measures on blood product usage. Methods. We retrospectively compared medical patient data from the South African National Blood Service database of red cell concentrate (RCC) usage in four disciplines during the COVID-19 period with data from the 3 years preceding the pandemic. We also examined trauma case patterns using an institutional database from the Harry Gwala Regional Hospital (HGRH) Emergency Department during the same periods. Results. In total, 16 922 RCCs at HGRH and 528 734 RCCs in KwaZulu-Natal were issued across the four disciplines, from March 2017 - March 2021. RCC usage significantly decreased among trauma patients at institutional and provincial levels during the COVID-19 period (provincial pre-lockdown mean 10.99 units per day; SD 6.89, 95% CI 10.63 - 11.35 v. lockdown 7.46 units per day; SD 5.42, 95% CI 6.14 - 8.79; p<0.01). Further, RCC usage significantly increased during the weekend immediately following the lifting of the first alcohol ban, along with a significant decrease in the number of trauma patients seen during hard lockdown periods. Conclusions. Societal restrictions, including curfews and banning alcohol consumption, decreased the use of RCCs in trauma patients. Government policies aimed at reducing alcohol-related traumatic injuries would likely have a significant impact on RCC usage.

Establishment of a stable proficiency testing matrix in transfusion microbiology in South Africa.

All medical laboratories must participate in proficiency testing (PT) programmes to ensure high-quality results. Proficiency testing samples mimic clinical samples; however, PT programmes for detection of bacteria in blood products are not routinely performed due to unavailability of matrix-equivalent samples. The aim of this study was to develop and test a matrix-equivalent PT programme using blood products as the basis matrix. A prospective cross-sectional study was conducted from April 2021 until June 2021, using 52 blood products comprising 36 pooled platelet and 16 red blood cell products at the South African National Blood Service PT laboratory in Gauteng. Products were manipulated into matrix-equivalent PT samples by spiking 42 products with known bacterial strains at specific concentrations and treating the remaining 10 products with preserving fluid containing antibiotics. The level of agreement between the researcher results and participating laboratories' results was assessed. Of the prepared matrices, 568 out of 572 (99%) were stable for 30 days. Bacteria could correctly be identified in spiked samples for up to 23 days. Samples treated with preserving fluid remained negative until day 30. For spiked samples, an average of 98% agreement (153/156) was achieved between the three participating laboratories when compared with the researcher's results; 100% agreement was achieved for unspiked samples. The kappa scores obtained from all tested variables presented with scores between 0.856 and 1.000, and the p-value was < 0.001 throughout. The developed PT matrix was therefore stable and suitable to be implemented in transfusion microbiology. This study demonstrated that a stable microbiology PT programme using platelets and red blood cells can be developed for use on bacterial detection analysers and could help to close the gap presented by unavailability of a blood PT matrix for transfusion microbiology.

“Blood Has No Colour”: Racialized Donor In/Ex-clusion in the South African National Blood Service

ABSTRACT Accounting for challenges with HIV transmission and testing, the South African National Blood Service (SANBS) transitioned toward eliminating race as a risk categorization in 2005 and actively recruiting black donors. I trace the racialization and nationalization of blood through an analysis of this transition, outreach efforts, and data from fieldwork with blood donors and SANBS staff. I examine indexicality as a semiotic means of in/ex-clusion in blood donation. Due to the sociocultural and medical significance of blood, an ethnographic account of blood services provides insights into biological citizenship and the dynamics of justice and reconciliation in post-apartheid South Africa.

Retaining blood donors

Strong organisation-stakeholder relationships contribute to the former attaining its goals.This is also the case with blood services, such as the South African National Blood Service(SANBS). Blood services are dependent on people donating blood to unknown recipients, withoutremuneration. This paper reports the approach of the SANBS to relationship management with itsdonors, as well as the perceptions of blood givers of the quality of this relationship. The SANBS’srelationship management approach and activities are analysed from a qualitative approach,using mixed method research, namely qualitative semi-structured interviews and quantitativequestionnaires to answer the research questions.The SANBS’s relationship with blood givers is strong, especially regarding relationship satisfactionas outcome. The blood service staff’s behaviour and communication are the main contributors todonor satisfaction, since they provide education and comfort during the donation process. Twowaycommunication focusing on enhancing the outcomes of relationships, can therefore assistthe SANBS in recruiting and retaining donors.

Characterising differences in red blood cell usage patterns between healthcare sectors in South Africa: 2014-2019.

South Africa aims to transition from a two-tiered healthcare system (public and private) to universal health coverage. Data on red blood cell (RBC) product usage reveal disparities between the sectors. Blood transfusion services further need to understand differing disease profiles and transfusion prescribing practices between the sectors to ensure blood security should the transition to a two-tiered health system come to fruition. Operational data for public and private healthcare RBC requests between 1 January 2014 and 31 March 2019, obtained from the South African National Blood Service (SANBS), were retrospectively analysed. Sector-specific demographic and utilisation trends were compared for the dominant clinical disciplines. Pre-transfusion haemoglobin (Hb) patterns were also delineated for 2018. Between 2014 and 2019, 2,356,411 public and private sector RBC transfusion events resulted in the issue of 4,020,094 RBC units (1,553,159 transfusion events and 2,495,054 units within the public sector versus 803,282 transfusion events and 1,525,040 units in private). The dominant clinical disciplines within the public sector were Medical (32.9%), Gynaecology/Obstetrics (27.3%), General Surgery (13.6%), and Paediatrics (including Paediatric Surgery) (6.5%), compared to Intensive Care Units (33.2%), Medical (28.3%), General Surgery (10.4%), and Haematology/Oncology (8.3%) in the private sector. Median pre-transfusion Hb values for 2018 were lower in the public than in the private sector: 6.9 g/dL public sector versus 8 g/dL private sector. Clinical drivers of RBC usage within the public and private healthcare sectors in South Africa differ significantly. Disparate pre-transfusion Hb between the sectors are likely due to differing disease profiles and severity, as well as differences in practice in prescribing transfusions. Implementation of a nationally co-ordinated Patient Blood Management programme may help to address these disparities and help ensure a sustainable blood transfusion system.

Re-engineering the medical assessment of blood donors in South Africa: The balance between supply and safety.

The balance between ensuring blood donor and recipient safety while maintaining a sufficient blood supply can be affected by excessive deferral of blood donors. In 2018, a biannual regulatory review of donor eligibility criteria provided the South African National Blood Service (SANBS) the opportunity to review the existing criteria. Changes to these criteria were implemented in April 2019 after an extensive review. We conducted a cross-sectional study of SANBS whole-blood donor presentations to determine the impact of the changed donor eligibility criteria on deferrals and blood safety. We compared donor presentations, deferrals, and HIV-positive cases for the 12-month period (April 2019-March 2020) after the implementation of the updated donor eligibility criteria to those of the previous year. Of the 2,112,917 donor presentations, 51.1% (1079506) occurred in the post-implementation study period. Overall, deferrals decreased from 18.6% to 14.5%, whereas HIV-positive donations increased by 0.03%. A multivariable logistic regression analysis adjusted for sex, age, geographical location, donor, and clinic type showed significantly lower odds of deferral (OR 0.70; 95% CI: 0.69-0.70) and greater odds of HIV-positive cases in the study period than those in the control period (OR 1.17; 95% CI: 1.10-1.25). We confirmed that the change in donor eligibility criteria was associated with a decrease in deferrals and an increase in the country's blood supply. The impact of the increased number of HIV-positive donations on blood safety in a country performing individual donation nucleic acid amplification testing requires further investigation.

Rapid and Successful Implementation of a COVID-19 Convalescent Plasma Programme-The South African Experience.

Background: COVID-19 convalescent plasma (CCP) has been considered internationally as a treatment option for COVID-19. CCP refers to plasma collected from donors who have recovered from and made antibodies to SARS-CoV-2. To date, convalescent plasma has not been collected in South Africa. As other investigational therapies and vaccination were not widely accessible, there was an urgent need to implement a CCP manufacture programme to service South Africans. Methods: The South African National Blood Service and the Western Cape Blood Service implemented a CCP programme that included CCP collection, processing, testing and storage. CCP units were tested for SARS-CoV-2 Spike ELISA and neutralising antibodies and routine blood transfusion parameters. CCP units from previously pregnant females were tested for anti-HLA and anti-HNA antibodies. Results: A total of 987 CCP units were collected from 243 donors, with a median of three donations per donor. Half of the CCP units had neutralising antibody titres of >1:160. One CCP unit was positive on the TPHA serology. All CCP units tested for anti-HLA antibodies were positive. Conclusion: Within three months of the first COVID-19 diagnosis in South Africa, a fully operational CCP programme was set up across South Africa. The infrastructure and skills implemented will likely benefit South Africans in this and future pandemics.

Mind the gap: Patterns of red blood cell product usage in South Africa, 2014 - 2019.

A key component of any successful healthcare system is the availability of sufficient, safe blood products delivered in an equitable manner. South Africa (SA) has a two-tiered healthcare system with public and privately funded sectors. Blood utilisation data for both sectors are lacking. Evaluation of blood utilisation patterns in each healthcare sector will enable implementation of systems to bring about more equality. To conduct a critical evaluation of red blood cell (RBC) product utilisation patterns at the South African National Blood Service (SANBS). Operationally collected data from RBC requests submitted to SANBS blood banks for the period 1 January 2014 - 31 March 2019 were used to determine temporal RBC product utilisation patterns by healthcare sector. Demographic patterns were determined, and per capita RBC utilisation trends calculated. Of the 2356441 transfusion events, 65.9% occurred in the public and 34.1% in the private sector. Public sector patients were younger (median (interquartile range (IQR)) 33 (22 - 49) years) than in the private sector (median (IQR) 54 (37 - 68) years), and mainly female in both sectors (66.2% in the public sector and 53.4% in the private sector). Between 2014 and 2018, per capita RBC utilisation decreased from 11.9 to 11.0/1 000 population in the public sector, but increased from 34.8 to 38.2/1 000 population in the private sector. We confirmed distinctly different RBC utilisation patterns between the healthcare sectors in SA. Possible drivers for these differences may be healthcare access, differing patient populations and prescriber habits. Better understanding of these drivers may help inform equitable public health policy.

The prevalence of coeliac disease-associated human leukocyte antigens in South African transplant donors and recipients.

Coeliac disease (CD) is an autoimmune condition occurring in genetically predisposed individuals exposed to an environmental trigger. The human leukocyte antigen (HLA) haplotypes HLA-DQ2.5 and HLA-DQ8 have the strongest association with CD, and 90 - 95% of CD patients bear these haplotypes. The susceptibility of the South African (SA) population to CD has not been studied previously. To describe the genetic propensity of the SA population to CD. The South African National Blood Service database was used to analyse the prevalence of HLA-DQ2.5 and HLA-DQ8 in potential donors and recipients of organ transplants. Self-reported ethnic group was used to estimate the prevalence among different population groups. The overall prevalence of HLA-DQ2.5 and HLA-DQ8 was 19.8%. The prevalence was lower in black participants (15.9%) than in whites (28.6%). Coloured (22.0%) and Indian (17.4%) participants had an intermediate prevalence. There was no significant difference between potential transplant donors and recipients. The prevalence of HLA-DQ2.5 and HLA-DQ8 differed among SA study participants of different ethnicities. However, the notion that CD does not occur in black South Africans owing to lack of a genetic predisposition is incorrect.

Undisclosed HIV status and antiretroviral therapy use among South African blood donors.

Undisclosed antiretroviral drug (ARV) use among blood donors who tested HIV antibody positive, but RNA negative, was previously described by our group. Undisclosed ARV use represents a risk to blood transfusion safety. We assessed the prevalence of and associations with undisclosed ARV use among HIV-positive donors who donated during 2017. South African National Blood Service (SANBS) blood donors are screened by self-administered questionnaire, semi-structured interview, and individual donation nucleic acid amplification testing for HIV. Stored samples from HIV-positive donations were tested for ARV and characterized as recent/longstanding using lag avidity testing. Of the 1462 HIV-positive donations in 2017, 1250 had plasma availability for testing of which 122 (9.8%) tested positive for ARV. Undisclosed ARV use did not differ by gender (p= .205) or ethnicity (p= .505) but did differ by age category (p< .0001), donor (p< .0001), clinic type (p= .012), home province (p= .01), and recency (p< .0001). Multivariable logistic regression found older age (adjusted odds ratio [aOR] 3.73, 95% confidence interval [CI] 1.98-7.04 for donors >40 compared with those <21), first-time donation (aOR 5.24; 95% CI 2.48-11.11), and donation in a high HIV-prevalence province (aOR 9.10; 95% CI 2.70-30.72) compared with Northern Rural provinces to be independently associated with undisclosed ARV use. Almost 1 in 10 HIV-positive blood donors neglected to disclose their HIV status and ARV use. Demographic characteristics of donors with undisclosed ARV use differed from those noted in other study. Underlying motivations for nondisclosure among blood donors remain unclear and may differ from those in other populations with significant undisclosed ARV use.

Donor deferral and return patterns – a South African perspective

AbstractBackgroundDonor eligibility assessment and subsequent return after deferral are key in maintaining an adequate and safe blood supply. Eligibility criteria should be reviewed regularly to ensure regional relevance and impact on donor deferral and return. Large‐scale studies investigating donor deferral and return in Africa are currently lacking.Study design and methodsOperationally collected blood donation data on whole blood donations at the South African National Blood Service during the five years from January 2015 to December 2019 were extracted and analysed. Separate multivariable logistic regression models for factors associated with donor deferral and donor return were developed.ResultsOf the 5 068 638 donor presentations, 869 840 (17·2%) resulted in deferral of which out of range haemoglobin was most common (45·9%). New (aOR 3·99; 95% CI 3·97–4·01), female (aOR 2·51; 95% CI 2·50–2·53) and Black African (aOR 1·90; 95% CI 1·89–1·91) donors had greater odds of being deferred compared to Repeat, male and White donors, respectively. Of the donors deferred during 2015–2018, 328 306 (47·2%) returned within 12 months. Odds of returning increased with increasing age. Lower odds of return were noted among female (aOR 0·82; 95% CI 0·81–0·83) and Black African (aOR 0·75; 95% CI 0·74–0·76) donors.ConclusionWe confirmed high proportions of deferral among SANBS donors with almost half returning within 12 month. Donor deferral and return patterns differed significantly by donor characteristics, the latter also by deferral indication. Further understanding the interaction between haemoglobin deferral and changing donor demographics may assist in refining eligibility criteria and recruitment efforts.

Implementation of a script for predonation interviews: impact on human immunodeficiency virus risk in South African blood donors.

The way in which the donor history questionnaire is conducted plays a crucial role in the self-disclosure of behavioral risk factors for human immunodeficiency virus (HIV) infection by prospective donors. The South African National Blood Service changed its policy on the process of donor assessment in May 2015 by implementing a compulsory interviewer script used to assess donor eligibility. A pre- and postevaluation study to determine the impact of scripted interviews on high-risk deferrals and recently acquired HIV infections. We used historical data to compare 18 months before and after the implementation of the script. We recorded a total of 3,169,656 donor presentations during the two 18-months periods, of which 52.2% (1,655,352) were made during the scripted period. A multivariable logistic regression analysis adjusting for donor and demographic characteristics found the odds of high-risk deferral to be slightly greater (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.05-1.07) during the scripted period. A separate multivariate logistic regression model, also adjusting for donor and demographic characteristics, showed that the odds of recently acquired HIV infection were significantly lower (OR, 0.88; 95% CI, 0.79-0.97) during the scripted period. This study showed that implementation of a scripted interview was associated with increased HIV risk deferral and decreased recent HIV infection. This study indicates potential improvement in blood safety with the implementation of a scripted donor interview and has relevance to blood safety in other sub-Saharan African countries.

Bacterial surveillance of apheresis platelets in South Africa (January 2011 to December 2016)

BackgroundGlobally, bacterial contamination of platelets remains the major transfusion‐related infectious risk. Limited data are available from low‐middle income countries. The South African National Blood Service routinely tests a percentage of apheresis platelets for bacterial contamination. We report on contamination rates from January 2011 to December 2016.MethodsA retrospective analysis of the surveillance data from apheresis platelets was performed. Two to 4 ml of each apheresis product was collected aseptically and divided equally into an aerobic and anaerobic culture bottle using the BacT/ALERT (bioMerieux) or BACTEC™ (Beckton Dickinson) systems. Bacterial identification was done using the MicroScan (Beckman Coulter) system.ResultsA total of 87 841 apheresis platelets were collected between 2011 and 2016 of which 18% were tested. The average positive culture rate was 2·7%, ranging between 0·6% (2011) and 5·22% (2015). Gram‐positive bacteria constituted 94% of all isolates (269/285), ten (4%) gram‐negative bacteria and 6 (2%) fungi were detected. The most common bacterial isolates were Cutibacterium acnes (35%), coagulase‐negative Staphylococci (26%), Bacillus spp. (8%), Corynebacteria spp. (8%). A total of nine highly pathogenic bacteria were isolated: two Acinetobacter spp, one each of Enterobacter spp., Serratia spp., Klebsiella spp., one Staphylococcus aureus and three Listeria spp. Average time to positivity for bacteria was 5·9 days. No cases of sepsis or death were reported during this time.ConclusionBacterial contamination rates, mostly due to gram‐positive bacteria, increased since 2011. Bacterial screening must be aligned with international recommendations, and novel technologies should be explored to reduce the residual risk.

Assessment of HIV transfusion transmission risk in South Africa: a 10-year analysis following implementation of individual donation nucleic acid amplification technology testing and donor demographics eligibility changes.

In 1998 we estimated that 34/million infectious window period donations were entering the blood supply at the South African National Blood Service. Selective use of donations based on donor race-ethnicity reduced this risk to 26/million donations but was deemed unethical. Consequently, in 2005 South African National Blood Service eliminated race-ethnicity-based collection policies and implemented individual-donation nucleic acid testing (ID-NAT). We describe the change in donor base demographics, human immunodeficiency virus (HIV) detection rates, and transfusion-transmissible HIV risk. In ten years 7.7 million donations were tested for anti-HIV and HIV RNA. Number of donations, HIV prevalence, ID-NAT yield rate, serology yield rate and residual transfusion-transmissible HIV risk were analyzed by donor type, race-ethnicity, age, and sex. Multiple regression analysis was performed to investigate the determinants of HIV-positive and nucleic acid testing yield donations. The combined strategy of increasing donations from black donors and implementing ID-NAT increased the proportion of donations from black donors from 6% in 2005 to 30% in 2015 (p < 0.00001), and reduced the transfusion-transmissible risk from 24 to 13 per million transfusions. ID-NAT interdicted 481 (1:16,100) seronegative window period donations, while one transfusion-transmissible case (0.13 per million) was documented. Race-ethnicity and donor type were highly significant predictors of HIV positivity, with adjusted odds ratio for first-time donors of 12.5 (95% confidence interval, 11.9-13.1) and for black race-ethnicity of 31.1 (95% confidence interval, 28.9-33.4). The proportion of serology yields among HIV-infected donors increased from 0.27% to 2.4%. ID-NAT enabled the South African National Blood Service to increase the number of donations from black donors fivefold while enhancing the safety of the blood supply.

The validation and implementation of donor screening for hepatitis B virus, hepatitis C virus, human immunodeficiency virus 1/2 and syphilis by ultrio elite assay (Panther system) and chemiluminescence assay (Abbott Architect i2000SR system) in Namibia

Infectious disease screening of Namibia blood donations for infectious diseases was contracted to the South African National Blood Service (SANBS) since 2004 and needed to be relocated back to Namibia. A cost analysis conducted showed that by introducing certain strategies, it was cost‐effective to implement ID‐NAT in Namibia. NAMBTS chose Ultrio Elite assay/Panther System (Gen‐Probe and Novartis, USA) for ID‐NAT for HIV 1/2 RNA, HBV DNA and HCV RNA and Chemiluminescent immunoassay done on the Architect i2000SR system (Abbott, Delkenheim, Germany) for HIV 1/2 Ag/Ab, anti‐HCV, HBsAg and Syphilis. For performance evaluation, the Panther System was compared with the Procleix TIGRIS system—Ultrio Plus assay (Gen‐Probe and Novartis, USA) while the Architect system was compared with the Abbott PRISM. The results of this evaluation demonstrated a 100% sensitivity and 100% specificity of the Ultrio Elite assay while the Architect also demonstrated 100% sensitivity and specificity of above 99% for detecting viral markers for HBV, HIV and HCV, and 97% sensitivity and 99·7% specificity for detecting syphilis. We found both the Procleix Panther and Architect systems to be flexible, robust and effective in screening blood for transfusion in our setting. Donor screening for HIV 1/2, HBV, HCV and syphilis for ID‐NAT and serology using the Procleix Panther and Architect systems was successfully relocated from South Africa and implemented in February 2014 in Namibia.

Hepatitis C genotype distribution in patient and blood donor samples in South Africa for the period 2008-2012.

There are limited molecular epidemiological studies of hepatitis C at a national level in South Africa. The introduction of newer treatment modalities for hepatitis C requires knowledge of the genotypes as these may have different prognostic and therapeutic implications. This retrospective study describes genotype distributions of patients attending specialist clinics and a blood donor group studied during the period 2008-2012 in South Africa. Residual samples from diagnostic viral load testing from specialist clinics in South Africa (n=941) and from the South African National Blood Service (n=294) were analysed quantitatively by real-time PCR and genotyped using the Versant line probe assay or sequencing. Genotype 1 was predominant in blood donors (34%), whilst genotype 5a was prevalent in patients (36%). In the blood donor group, genotype 4 was detected for the first time. Genotype 2 was rare in the patient group and not detected in blood donors. Genotype 1 was the predominant genotype in the younger age groups (less than 30years), whereas genotype 5a was found at higher proportions in the older age groups for both the patient and blood donor groups, comprising more than 60% of genotypes in those older than 50years. Genotypes 1 and 5 were at highest proportions across all provinces compared to other genotypes. In blood donors, genotype 1 was predominant among Caucasians (43%) and genotype 5a among Blacks (54%). Such information is required for planning the impact on the health sector with regard to newly emerging therapies for hepatitis C and burden of disease.

Delay and poor diagnosis of Down syndrome in KwaZulu-Natal, South Africa: A retrospective review of postnatal cytogenetic testing.

Down syndrome (DS) is the most common chromosomal disorder in newborns. Until 20 years ago DS was considered rare in black African children in South Africa (SA). Lack of awareness of DS on the part of medical staff in SA, and difficulty in diagnosing it, appear to persist. To establish an epidemiological profile of DS and investigate the ability of clinicians in KwaZulu-Natal Province (KZN), SA, to make accurate clinical diagnoses of DS. Records at the South African National Blood Service cytogenetic laboratory in Pinetown, KZN, were examined for all tests for clinically suspected DS undertaken during January 2009 - December 2013 and all cytogenetically proven DS test results. Age at diagnosis, the hospital from where the test was sent and type of chromosomal pattern for each confirmed DS test result were recorded. Of a total of 1 578 tests requested, 875 confirmed DS, indicating that clinicians correctly clinically diagnosed DS 55.4% of the time. The average age of cytogenetic diagnosis of DS was 1 year and 20 days.The minimum population prevalence of DS was 0.8/1 000. The diagnosis of DS is a challenge in KZN, potentiating missed opportunities for early intervention. The relatively low population prevalence of DS may be attributable to a lack of confirmatory cytogenetic tests or missed clinical diagnoses. It may also be attributable to a high mortality rate for children with DS in the province.

Organizing a national blood service with limited resources – developments in the South African National Blood Service

BackgroundSouth Africa has a population of 52 million people and is classified as a Middle Human Development Index (HDI) Country. Up until 1994, the majority Black population lived under discriminatory apartheid laws with resulting in significant socio‐economic disparities between the various population groups. The health system is two tier with Government funding health care in the public sector and medical insurance schemes funding health care in the private sector for those who can afford it. Fiscal allocation for health care in the public sector has been averaging at about 8·5% of the country's gross domestic product (GDP) and is utilized by 84% of the population as the majority of the population cannot afford medical insurance. There is inadequate value contribution due to high disease burden, increasing demand for services from previously disadvantaged groups and inefficiencies in service delivery. The blood services operate on a fee‐for‐service basis supplying about 60% of blood to public sector hospitals and about 40% to private health facilities. The South African National blood service (SANBS) supplies blood and blood products to 88% of the population in eight of the nine provinces and the Western Province Blood Transfusion Service (WPBTS) which operates independently in the Western Cape Province supplies the remaining 12%. Both blood services operate on a ‘vein to vein’ basis managing blood collections from 100% voluntary non‐remunerated donors, processing whole blood into various components, testing for viral markers and cross matching and issuing blood products to doctors on request. SANBS was formed as a National Blood Service in 2001 as a result of the amalgamation of 6 regional blood service organizations. The mission of SANBS is ‘to provide all patients with sufficient, safe, quality blood products and related medical services in a sustainable manner’. Blood safety and sufficiency are the most critical objectives of both blood establishments (BEs).AimTo present historical developments and achievements of SANBS in pursuit of its mandate over the last 12 years. The objective is to share outcomes of various strategies that enabled and strengthened delivery in the South African resource‐constrained environment and challenging socio‐economic context.MethodsA review of the strategic plans, governance framework, operational service delivery and efficiency, human resource management, financial efficiency and stakeholder management was performed to highlight the strategy, challenges and successes of organizing a national blood service.ResultsDespite significant socio‐economic challenges and limited resources SANBS has managed to effectively provide a low risk and sustainable blood supply to the patients that it serves.

Are there alternatives to the shortage of blood in South Africa?

From time to time, the South African National Blood Service disseminates messages that the country’s blood stock levels are running very low. The average blood stock level varies from 4.6 days for group B to 10.7 days for group AB blood in nonemergency situations. 1 However, with the December festive period approaching, these blood stock levels usually drop significantly as the demand for blood transfusion increases because of fatalities from motor vehicle accidents, traumatic injuries and obstetric haemorrhage. The solution to blood shortage is not simple in South Africa as potential blood donors dwindle, safety fears increase with regard to contracting bloodborne infections and healthcare workers constantly deal with the ethical dilemma of Jehovah’s Witnesses whose doctrine forbids them from accepting blood transfusions. Globally, the safety of blood transfusion has improved substantially since the 1980s, when human immunodeficiency virus (HIV) was discovered to be blood transmissible. 2 However, one of the biggest challenges to blood safety in sub-Saharan Africa is being able to access safe and adequate quantities of blood and blood products. 3

Intra-operative cell salvage in South Africa: Feasible, beneficial and economical

Healthcare services in KwaZulu-Natal (KZN) frequently experience shortages of blood products. Alternatives to traditional blood sources are needed. One possibility is cell salvage and autologous blood transfusion. Few data exist relating to their use in the South African context. To ascertain whether cell salvage (CS) is beneficial, feasible and economical in our setting, with the anticipation that results would excite further studies and potentially change current practice and improve existing protocols. Methods. This study reviewed current intraoperative Cell Saver use at Grey's and Edendale hospitals in Pietermaritzburg, KZN. Current practices were observed and compared with the costs of the equivalent amount of red cell concentrate (RCC) purchased from the South African National Blood Service (SANBS). All cases of Cell Saver usage over a 1-year period from July 2012 to June 2013 were analysed. The total volume of blood transfused from CS was 55 735 ml, approximately equivalent to 186 RCC units. The comparative cost of equivalent units of RCC from SANBS was R258 445. The total cost of Cell Saver disposables during the study period was R206 047, or R263 478 when Cell Saver machine depreciation costs were included. More than one CS blood unit was available for transfusion in 66% of cases. No additional staff were required to operate the Cell Saver, which was successfully used by medical officers. This study showed that intraoperative CS use is feasible, has potential patient benefit by reducing blood bank blood transfusion, and is financially comparable to purchasing the equivalent number of SANBS RCC.