Improving blood transfusion safety in resource-poor countries: a case study of using leucocyte reduced blood in Uganda

Background: The majority of blood transfusion safety strategies recommended by the WHO for resource-poor countries focus mainly on reducing the risk of transfusion-transmitted infections (TTIs). Other technologies such as leucocyte reduction may represent complementary strategies for improving transfusion safety.
Objective: To evaluate the role of using leucocyte reduced blood in a resource-poor country.
Methods: Pre-storage leucocyte reduced (LR) red blood cells (RBCs) were specially prepared for the Tissue Oxygenation by Transfusion in severe Anaemia and Lactic acidosis (TOTAL) study, at the Uganda Blood Transfusion Services from February 2013 through May 2015. Quality control tests were performed to evaluate the procedure, and the incremental cost of an LR–RBC unit was estimated.
Results: A total of 608 RBCs units were leucocyte reduced. Quality control tests were performed on 55 random RBCs units. The median (IQR) residual leucocyte count was 4 (0•5-10) WBC/uL, equivalent to 1•8x106> WBC per unit. The estimated incremental unit cost of leucocyte reduction was $37 USD per LR RBC unit.
Conclusion: Leucocyte reduction of blood in a resource-poor country is doable although relatively costly. As such, its value in resource-poor countries should be weighed against other transfusion safety propositions.

Keywords
Blood transfusion safety; leucocyte reduction; resource-poor countries.