Promoting national blood systems in developing countries.

PURPOSE OF REVIEW: Over the last decade, there has been increased global attention dedicated to improving the availability, safety and use of blood in low-income and middle-income countries. These efforts have focused on a number of common objectives, such as establishing a 100% voluntary nonremunerated blood donor base and implementing component therapy. Recently, some of these objectives have been challenged. This article reviews many recent findings of the experts leading these international projects.

RECENT FINDINGS: The majority of current research is focused on blood donation and patient blood management in sub-Saharan Africa, with contributions to other fields of blood safety in Latin America, the Caribbean and Asia. Countries collecting blood from the replacement donors are challenging the notion that replacement donors are inherently a higher risk group than voluntary donors. Simultaneously, many countries are considering how best to improve the management of their blood inventories and to optimize their national standards, guidelines and protocols - all with the goal of improving patient outcomes.

SUMMARY: There still exist many questions in the areas of blood donation and clinical use that are either unanswered or merit further investigation. Given the variable circumstances observed between different countries and geographic regions, it sometimes may be advisable to limit global recommendations in favor of the regionally focused ones.