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© 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
GD
P /
capi
ta
Healthcare spending / capita
$100
$1,000
$10,000
$100,000
$10 $100 $1,000 $10,000
GD
P/Ca
pita
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
HIV
Pre
vale
nce
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
Perc
ent o
f Pop
ulat
ion
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
Recommended