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Modern Blood Banking and Transfusion in Clinical Practice

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section " Hematology ".

Deadline for manuscript submissions: closed (20 February 2023) | Viewed by 9641

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Special issue editor.

Dear Colleagues,

Blood banking and transfusion practices have evolved considerably over the years. Some of the notable changes are the increasing automatization of compatibility testing and implementation of electronic systems to monitor the transfusion process from the order to the adverse effect records. Use of monoclonal antibodies such as anti-CD38 and anti-CD47 for the treatment of patients with malignancies is challenging for blood banks, since these treatments produce interferences with pre-transfusion compatibility tests delaying blood availability.

Transfusion is one of the most widely used therapies, sometimes involving inappropriate episodes. Benefits and risks have to be carefully considered when a blood transfusion is requested. During the last decade, hemovigilance systems have detected a decline in red blood cell usage that could be explained by incorporation of restrictive strategies based on current scientific evidence, among others. In fact, patient blood management programs are being progressively incorporated into the clinical practice in order to reduce unnecessary blood exposure and improve patient outcome.

The aim of this issue is to gather recent advances in blood banking laboratory and management of patients requiring a blood transfusion.

Dr. Pilar Solves Guest Editor

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website . Once you are registered, click here to go to the submission form . Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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• blood transfusion therapy
• patient blood management
• restrictive transfusion
• pre-transfusion compatibility tests

Published Papers (4 papers)

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Updated FDA Guidance for Blood Donor Eligibility for Blood Pressure and Pulse

The U.S. Food and Drug Administration (FDA) has previously provided guidance for the eligibility of blood donors with blood pressure or pulse outside of the normal range. Guidance for potential blood donors with either blood pressure or pulse outside of specified parameters have only permitted blood donations when “the responsible physician determines that their health would not be adversely affected…

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Current advances in transfusion medicine: a 2019 review of selected topics from the AABB Clinical Transfusion Medicine Committee

Affiliations.

• 1 Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington.
• 2 Department of Pathology, University of California San Diego, La Jolla, California.
• 3 Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
• 4 Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
• 5 NorthShore University Health System, Chicago, Illinois.
• 6 Transfusion Medicine Division, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
• 7 Division of Hematology/Oncology, Simmons Cancer Institute at Southern Illinois University School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA.
• 8 Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont.
• 9 Vitalant, Scottsdale, Arizona.
• 10 Department of Pathology, New York University Grossman School of Medicine, New York, New York.
• 11 Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
• 12 Clinical Pathology Division, Department of Pathology, University of Utah, Salt Lake City, Utah.
• 13 Transfusion Medicine Service, Department of Pathology, University of New Mexico, Albuquerque, New Mexico.
• 14 Transfusion Medicine & Cellular Therapy, Department of Pathology & Cell Biology, Columbia University, New York, New York.
• 15 Department of Pathology, Stanford University, Stanford, California.
• 16 Division of Pediatric Critical Care, Washington University in St Louis, St Louis, Missouri, USA.
• 17 Office of Blood Research and Review, Food and Drug Administration, Silver Spring, Maryland.
• 18 Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota.
• PMID: 32472580
• DOI: 10.1111/trf.15848

Background: The AABB Clinical Transfusion Medicine Committee (CTMC) compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine (TM) for the board of director's review. This synopsis is now made available as a manuscript published in TRANSFUSION.

Study design and methods: CTMC committee members review original manuscripts including TM-related topics published in different journals between late 2018 and 2019. The selection of topics and manuscripts are discussed at committee meetings and are chosen based on relevance and originality. After the topics and manuscripts are selected, committee members work in pairs to create a synopsis of the topics, which is then reviewed by two committee members. The first and senior authors of this manuscript assembled the final manuscript. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed.

Results: The following topics are included: infectious risks to the blood supply, iron donor studies, pre-transfusion testing interference and genotyping, cold agglutinin disease (CAD), HLA alloimmunization in platelet transfusions, patient blood management, updates to TACO and TRALI definitions, pediatric TM, and advances in apheresis medicine.

Conclusion: This synopsis provides easy access to relevant topics and may be useful as an educational tool.

© 2020 AABB.

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• Current advances in transfusion medicine 2020: A critical review of selected topics by the AABB Clinical Transfusion Medicine Committee. Allen ES, Cohn CS, Bakhtary S, Dunbar NM, Gniadek T, Hopkins CK, Jacobson J, Lokhandwala PM, Metcalf RA, Murphy C, Prochaska MT, Raval JS, Shan H, Storch EK, Pagano MB. Allen ES, et al. Transfusion. 2021 Sep;61(9):2756-2767. doi: 10.1111/trf.16625. Epub 2021 Aug 22. Transfusion. 2021. PMID: 34423446 Free PMC article. Review.
• Current advances in transfusion medicine 2021: A critical review of selected topics by the AABB Clinical Transfusion Medicine Committee. Metcalf RA, Cohn CS, Allen ES, Bakhtary S, Gniadek T, Gupta G, Harm S, Haspel R, Hess A, Jacobson J, Lokhandwala PM, Murphy C, Poston J, Prochaska MT, Raval JS, Saifee NH, Salazar E, Shan H, Zantek N, Pagano MB. Metcalf RA, et al. Transfusion. 2022 Jul;62(7):1435-1445. doi: 10.1111/trf.16944. Epub 2022 Jun 17. Transfusion. 2022. PMID: 35713186 Review.
• Current advances in 2022: A critical review of selected topics by the Association for the Advancement of Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee. Metcalf RA, Cohn CS, Bakhtary S, Gniadek T, Gupta G, Harm S, Haspel RL, Hess AS, Jacobson J, Lokhandwala PM, Murphy C, Poston JN, Prochaska MT, Raval JS, Saifee NH, Salazar E, Shan H, Zantek ND, Pagano MB. Metcalf RA, et al. Transfusion. 2023 Aug;63(8):1590-1600. doi: 10.1111/trf.17475. Epub 2023 Jul 5. Transfusion. 2023. PMID: 37403547
• Critical developments of 2018: A review of the literature from selected topics in transfusion. A committee report from the AABB's Clinical Transfusion Medicine Committee. Cohn CS, Allen ES, Cushing MM, Dunbar NM, Friedman DF, Goel R, Harm SK, Heddle N, Hopkins CK, Klapper E, Perumbeti A, Ramsey G, Raval JS, Schwartz J, Shaz BH, Spinella PC, Pagano MB. Cohn CS, et al. Transfusion. 2019 Aug;59(8):2733-2748. doi: 10.1111/trf.15348. Epub 2019 May 30. Transfusion. 2019. PMID: 31148175
• Critical developments of 2017: a review of the literature from selected topics in transfusion. A committee report from the AABB Clinical Transfusion Medicine Committee. Cushing MM, Kelley J, Klapper E, Friedman DF, Goel R, Heddle NM, Hopkins CK, Karp JK, Pagano MB, Perumbeti A, Ramsey G, Roback JD, Schwartz J, Shaz BH, Spinella PC, Cohn CS, Cohn CS, Cushing MM, Kelley J, Klapper E. Cushing MM, et al. Transfusion. 2018 Apr;58(4):1065-1075. doi: 10.1111/trf.14520. Epub 2018 Mar 9. Transfusion. 2018. PMID: 29520794 Review.
• Haass KA, Sapiano MRP, Savinkina A, et al. Transfusion-transmitted infections reported to the national healthcare safety network hemovigilance module. Transfus Med Rev 2019;33:84-91.
• Jones SA, Jones JM, Leung V, et al. Sepsis attributed to bacterial contamination of platelets associated with a potential common source - multiple states, 2018. MMWR Morb Mortal Wkly Rep 2019;68:519-23.
• [accessed 2020 May] Available from http://www.choosingwisely.org/societies/american-association-of-blood-ba... . [monograph on the internet].
• [accessed 2020 May] Available from https://www.aabb.org/programs/publications/bulletins/Documents/ab19-02.pdf .
• Learoyd P. The history of blood transfusion prior to the 20th century-part 1. Transfus Med 2012;22:308-14.

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Blood Banking and Transfusion Medicine

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Research output : Book/Report › Book

Ever since the discovery of blood types early in the last century, transfusion medicine has evolved at a breakneck pace. This second edition of Blood Banking and Transfusion Medicine is exactly what you need to keep up. It combines scientific foundations with todays most practical approaches to the specialty. From blood collection and storage to testing and transfusing blood components, and finally cellular engineering, youll find coverage here thats second to none. New advances in molecular genetics and the scientific mechanisms underlying the field are also covered, with an emphasis on the clinical implications for treatment. Whether youre new to the field or an old pro, this book belongs in your reference library. Integrates scientific foundations with clinical relevance to more clearly explain the science and its application to clinical practice. Highlights advances in the use of blood products and new methods of disease treatment while providing the most up-to-date information on these fast-moving topics Discusses current clinical controversies, providing an arena for the discussion of sensitive topics. Covers the constantly changing approaches to stem cell transplantation and brings you the latest information on this controversial topic.

ASJC Scopus subject areas

• General Medicine
• General Dentistry

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• 10.1016/B978-0-443-06981-9.X5001-7

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• Blood Transfusion Keyphrases 100%
• Transfusion Medicine Keyphrases 100%
• Blood Banking Keyphrases 100%
• Molecular Genetics Keyphrases 33%
• Clinical Significance Keyphrases 33%
• Clinical Practice Keyphrases 33%
• Stem Cell Transplantation Keyphrases 33%
• Blood Products Keyphrases 33%

T1 - Blood Banking and Transfusion Medicine

AU - Hillyer, Christopher D.

AU - Silberstein, Leslie E.

AU - Ness, Paul Michael

AU - Anderson, Kenneth C.

AU - Roback, John D.

N2 - Ever since the discovery of blood types early in the last century, transfusion medicine has evolved at a breakneck pace. This second edition of Blood Banking and Transfusion Medicine is exactly what you need to keep up. It combines scientific foundations with todays most practical approaches to the specialty. From blood collection and storage to testing and transfusing blood components, and finally cellular engineering, youll find coverage here thats second to none. New advances in molecular genetics and the scientific mechanisms underlying the field are also covered, with an emphasis on the clinical implications for treatment. Whether youre new to the field or an old pro, this book belongs in your reference library. Integrates scientific foundations with clinical relevance to more clearly explain the science and its application to clinical practice. Highlights advances in the use of blood products and new methods of disease treatment while providing the most up-to-date information on these fast-moving topics Discusses current clinical controversies, providing an arena for the discussion of sensitive topics. Covers the constantly changing approaches to stem cell transplantation and brings you the latest information on this controversial topic.

AB - Ever since the discovery of blood types early in the last century, transfusion medicine has evolved at a breakneck pace. This second edition of Blood Banking and Transfusion Medicine is exactly what you need to keep up. It combines scientific foundations with todays most practical approaches to the specialty. From blood collection and storage to testing and transfusing blood components, and finally cellular engineering, youll find coverage here thats second to none. New advances in molecular genetics and the scientific mechanisms underlying the field are also covered, with an emphasis on the clinical implications for treatment. Whether youre new to the field or an old pro, this book belongs in your reference library. Integrates scientific foundations with clinical relevance to more clearly explain the science and its application to clinical practice. Highlights advances in the use of blood products and new methods of disease treatment while providing the most up-to-date information on these fast-moving topics Discusses current clinical controversies, providing an arena for the discussion of sensitive topics. Covers the constantly changing approaches to stem cell transplantation and brings you the latest information on this controversial topic.

UR - http://www.scopus.com/inward/record.url?scp=85013697148&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85013697148&partnerID=8YFLogxK

U2 - 10.1016/B978-0-443-06981-9.X5001-7

DO - 10.1016/B978-0-443-06981-9.X5001-7

AN - SCOPUS:85013697148

SN - 9780443069819

BT - Blood Banking and Transfusion Medicine

PB - Elsevier Inc.

• Education Resources
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6 Educational Resources on Blood Banking & Transfusion Medicine You Can Access for Free

New York Blood Center collects an estimated 4,000 units of blood each day and distributes almost 1 million blood products annually. Throughout its 55+ year legacy, the nonprofit has also served more than 75 million patients and over 500 hospitals. Today, NYBC remains one of the largest independent, community-based blood centers in the world. However, they are much more than a blood center .

NYBC leverages the experience and expertise of New York Blood Center Enterprises (NYBCe). Comprising nine total divisions, NYBCe fulfills a four-part mission as listed on its website:

• To provide the highest quality blood and stem cell products and related medical and consultative services to hospitals and patients primarily in the greater New York metropolitan area.
• To conduct the highest quality, novel and innovative research in the fields of hematology, blood banking and transfusion medicine, and cellular therapies, thus advancing these fields and positively impacting public health.
• To develop products, technologies, and services in the fields of hematology, blood banking, and transfusion medicine and cellular therapies, with the potential to have worldwide humanitarian impact.
• To train the next generation of leaders in each of these fields.

Training the Next Generation of Leaders

While listed fourth, training and educating leaders in blood banking and transfusion medicine is just as crucial as the other facets of NYBCe’s mission.

“Our resources give our customers and the blood banking and transfusion medicine communities a chance to learn from some of the best and brightest experts in the field,” says Lynsi Rahorst , MHPE, MT(ASCP) SBBCM, NYBCe’s Manager of Education and Training for the Immunohematology Reference and Genomics Laboratories.

These initiatives go beyond individual professional development, though. By sharing its resources and knowledge, NYBCe shapes the landscape of global healthcare and scientific discovery. As a result, NYBCe and other life science organizations are able to develop the next generation of therapeutic agents in areas of high unmet need and pave the way for new blood products, techniques, and more.

Professional education is just one way NYBCe is fighting for a healthier future .

6 Educational Resources to Access Through NYBCe

Let’s take a look at some of the specific resources on blood banking and transfusion medicine you can access through NYBCe’s Education Resources website right now.

1.    Experience in Blood Banking (EBB)

Now that the live, weekly webinars of the Essentials of Transfusion Medicine Webinar Series (ETMWS) are coming to a close, do you find yourself hungry for more blood banking educational content? NYBCe Education Resources website has you covered.

Not only is there a link to the ETMWS recordings (that you may view for P.A.C.E. credit), the NYBCe Education Resources web page offers so much more educational content in transfusion medicine and blood banking, at various levels of instruction. One of the resources available on the NYBCe Education Resources website  is Community Blood Center’s (CBC) Experience in Blood Banking courses.

For decades, the Immunohematology Reference Laboratory at Community Blood Center has hosted annual Experience in Blood Banking (EBB) courses for the local blood banking community, including medical laboratory science students, blood bank and generalist technologists, transfusion services managers, supervisors, residents, and fellows.

These courses provide information on blood banking with an emphasis on immunohematology testing, methods, and case studies. The format of the courses has evolved over the years, but currently two different EBB courses are offered: EBB:101, which covers the fundamentals of blood banking; and EBB: Advanced, focusing on advanced serologic and genomic testing. Attendees of EBB courses can earn free P.A.C.E. credits with submission of a course evaluation.

In August of 2020, Community Blood Center offered its first virtual EBB: Advanced due to COVID restrictions. In the Spring of 2021, virtual EBB:101 was offered. Both of these courses consisted of a series of weekly webinars, and are still available for viewing for P.A.C.E. credit.

Experience in Blood Banking: Advanced (Recorded in August 2020)

This course consists of four 1.5-hour webinars and offers attendees up to six P.A.C.E. contact hours. The intended audience for EBB: Advanced is blood bank technologists, supervisors, and managers, though anyone wishing to dive deeply into the world of immunohematology and genomics will benefit from this course.

Speakers at EBB: Advanced are experts from CBC’s Immunohematology Reference Laboratory, the National Center for Blood Group Genomics, and New York Blood Center’s Laboratory of Immunohematology. Topics covered include antibodies to high and low prevalence antigens, ABO genotyping when A1 lectin testing is inconclusive, warm autoimmune hemolytic anemia following stem cell transplant, and platelet antibody testing. Presentations often include case studies to emphasize key points and engage the audience.

The 2020 EBB:Advanced course will be available to view for P.A.C.E. credit only until July 31, 2021.

Experience in Blood Banking: 101 (Recorded in March-April 2021)

This course consists of eight 1.5 hour webinars, and offers a total of 12 P.A.C.E. contact hours. Medical laboratory science students and generalist technologists wishing to brush up on their blood banking knowledge are two groups who will benefit from EBB:101, though anyone hoping for an entry-level approach to blood banking will find the information in this course useful.

General blood banking topics such as infectious disease testing, component utilization, visual inspection of blood products and transfusion reactions are included. In addition, the course covers fundamental immunohematology topics such as antibody identification, DATs and eluates, serologic case studies. and hemolytic disease of the fetus/newborn.

While the Experience in Blood Banking courses are free for everyone, they will only be available for a limited time.

2.    eLearning in Transfusion Medicine

Not everyone learns the same. Rather than listen passively to a lecture, some people prefer to have a more interactive experience. New York Blood Center Enterprises is proud to offer eLearning in Transfusion Medicine .

eLearning courses are distinctive in that they are interactive and require learner participation as educational content is presented. Several eLearning courses are currently available, and new courses are added regularly. These courses are designed to take the learner 30-60 minutes to complete, and are worth 0.5-1.0 P.A.C.E. contact hours. The intended audience for eLearning courses is medical laboratory scientists, though anyone interested in the topics may access and complete the courses.

Topics covered by eLearning courses span blood banking and transfusion medicine. Transfusion reactions, Babesia testing, autoimmune hemolytic, and warfarin reversal are just some of the topics currently available.

If you are interested in these courses, we recommend checking back often, as content is rotated and new courses are added regularly. Also, while the eLearning courses are free for everyone, they will only be available for a limited time.

3.    Quick Lessons in Immunohematology

New York Blood Center Enterprises is proud to offer “Quick Lessons” in Immunohematology , which provide information on a variety of immunohematology topics in an easy-to-digest format.

Each “Quick Lesson” is a brief, downloadable PDF that thoroughly explains an immunhematologic concept, provides examples, reinforces learning with case studies, and concludes with a short assessment based on the learning objectives.

“Quick Lessons” are ideal educational material for individuals who are learning the fundamentals of blood banking, but may also be beneficial to anyone wishing to refresh knowledge of a specific subject.

Laboratory science students, blood bank technologists, residents, or fellows will find valuable information on several topics. Fundamental topics like “Elution and Eluates” and “Titration” describe commonly used methods and discuss routine applications, whereas “Anti-CD38” and “Antibody to a High Prevalence Antigen” dive into contemporary issues in blood bank testing and complex serologic investigations.

Whether you are new to blood banking or just wish to have a deeper understanding of immunohematologic concepts, you are sure to find valuable information in the form of “Quick Lessons” in Immunohematology.

4.    Resident Rotation: Immunohematology Reference Laboratory

The Resident Rotation: Immunohematology Reference Laboratory web page was originally designed to provide a comprehensive immunohematology reference laboratory (IRL) experience to pathology residents while minimizing time actually spent in the laboratory due to social distancing guidelines.

The Resident Rotation: IRL consists of seven consecutive modules that increase in complexity. The rotation begins with fundamentals, like hemagglutination, and works up to complex serologic methods like elution and adsorption. A handbook is available for download to accompany the instruction provided in each module.

Modules contain explanations, case study examples, interactive quizzes to assess understanding, and videos of how to perform blood bank methods. Topics covered include ABO/Rh testing, antibody screens, antibody identification and interpreting antibody panels. As complexity increases, antigen typing, DATs and eluates, and differential adsorptions are explained in depth.

Although these modules were originally designed for pathology residents, because they start at the most basic of immunohematology concepts and build on knowledge until finally discussing highly complex serologic methods, the modules can serve as excellent educational material for a variety of learners.

5.    Immunohematology Method Videos

A picture may be worth a thousand words, and a video of a laboratory method provides explanation and insight that surpass that offered by reading a procedure or a package insert.

The New York Blood Center Enterprises Education Resources website contains a link to several Immunohematology Method Videos , including standard testing like ABO/Rh; antibody screen in tube, gel, and solid phase; and direct antiglobulin testing (DAT). In addition, more esoteric testing such as acid elution and differential adsorption, is included.

These videos may be helpful to medical laboratory science students just learning the fundamentals of blood bank testing. New technologists training in the blood bank may also benefit, along with residents or fellows who are just being introduced to immunohematology concepts. These videos can be a valuable resource to technologists who may not perform some of these methods at their institution, but would like to better understand the testing.

6.    Laboratory Science Student Resources

New York Blood Center Enterprises is proud to support the development of new blood bankers!

In the Laboratory Science Student Resources section of the New York Blood Center Enterprises Education Resources website, you will find learning modules and presentations designed for MLS/MLT students who are learning blood banking principles. Laboratory science students may review these modules to strengthen their understanding, while MLS/MLT Programs may choose to incorporate the modules into their routine instruction.

An interactive module on ABO discrepancies walks through the steps of identifying and resolving ABO discrepancies using a case-based approach. Resolution of ABO discrepancies can be a difficult concept to learn because appropriate samples may be challenging to procure, and appropriate reagents may not be available. This module provides examples, demonstrates methods, and encourages learner engagement.

A module comparing blood bank methodologies is also available. After explaining the three methodologies utilized in blood bank testing (tube, gel, and solid phase), this module incorporates videos that demonstrate how to perform testing using each method. A chart is provided to help students compare and contrast the different methodologies. Often, laboratory science students don’t have access to all three methods at their training site, so this module offers beneficial information that prepares students for a future as a blood banker.

Ready Student videos are presentations specifically geared toward laboratory science students. The Ready Student One video introduces the Immunohematology Reference Laboratory (IRL) and explains how an IRL differs from a transfusion service. In addition, it provides a behind-the-scenes look at an IRL and the resources available that are used to resolve the most complex serologic investigations.

The Ready Student 2 video includes a case study approach to antibody identification using specialized reference laboratory methods like red blood cell phenotyping, testing a selected cell panel and testing enzyme-modified cells. In addition, this video covers strategies for acquiring rare blood for patients who need it. Learners may actively participate with periodic quiz questions and can follow along by downloading the provided case panels.

Support Professional Education at NYBCe

Visit NYBCe’s Education Resources to stay up to date with the Enterprise’s professional education opportunities. New resources and programs are posted here regularly!

If you’d like to help NYBCe continue to offer convenient, high-quality educational content and support their mission to train the next generation of blood banking and transfusion medicine leaders, please consider making a financial contribution online today.

Browse NYBCe’s Education Resources

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Topics in blood transfusion

Today marks World Blood Donor Day and so we asked Deputy Editor for Journal of Intensive Care , Hiroshi Morisaki, to explain more about the importance of blood transfusion, and how research in this area is progressing.

Hiroshi Morisaki 14 Jun 2016

To date, humans have uncovered a number of natural principles and issues such as the origin and mysteries of the universe, the earth and even life. We have simultaneously developed innumerable non-natural products for human use.

However, we have not yet succeeded in creating a man-made, cost-effective alternative to red blood cells (RBCs) despite the performance of extensive research and numerous clinical trials.

A life-saving intervention

The cellular health of the host requires an oxygen (O 2 ) supply that matches the O 2 requirements of its tissue. An insufficient O 2 supply results in ischemia, subsequently inducing tissue and/or organ injury, frequently observed in critically ill patients.

RBC transfusion, first performed over 300 years ago, remains a fundamental life-saving intervention in medicine.

Hemoglobin, which is enclosed in RBCs as an O 2 carrier, plays the most important role in supplying O 2 to the tissues. Accordingly, RBC transfusion, first performed over 300 years ago, remains a fundamental life-saving intervention in medicine.

Until the early 1980s, RBC transfusion was considered to be practically risk-free and a truly effective intervention in patients with active bleeding or anemia due to a variety of reasons in the intensive care field.

However, the threat of potentially-fatal transfusion-related infections, i.e., human immunodeficiency virus, has led physicians throughout the world to obviate this conventional intervention to the extent that is possible.

Research in the literature

In 1999, Canadian investigators examined the effects of a restrictive RBC transfusion strategy in comparison to a liberal strategy in critically ill patients. They indicated that a restrictive strategy was at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients with some exceptions.

Although several debates are currently ongoing, most physicians now agree that a restrictive strategy to limit RBC transfusion is a valuable approach in the treatment of stable patients with anemia.

However, we need to be cautious when interpreting the results of the Canadian study as it indicated some exceptions.

Even though we have seen extraordinary advances in medical science and related technology over the last several decades, clinical practices have been determined based on the balance between the benefits and related risks of intervention.

They found that a restrictive transfusion strategy was significantly associated with reduced mortality in younger patients and in those with less severe conditions. In other words, a liberal RBC transfusion strategy might be more effective for older patients and patients with more severe conditions.

RBC transfusion by itself is not an exception. The level of hemoglobin that works in some patients may not work in others. Indeed, a previous cohort study of intensive care unit patients suggests that restrictive RBC transfusion policies may not be uniformly applicable in the clinical setting.

World Blood Donor Day

In 2012, the World Health Organization (WHO) released a document entitled, “ Blood donor selection – Guideline on assessing donor suitability for blood donation ”. In this guideline, the authors noted that a careful process to assess the suitability of donors is essential for protecting the safety and sufficiency of the blood supply, and safeguarding the health of both ‘recipients’ and ‘donors’. We should therefore understand that blood transfusion not only improves the recipients’ conditions but also affects the donors’ health.

Away from the discussion of whether restrictive or liberal RBC transfusion strategies should be applied, natural human blood is needed to save the lives in emergency and long-term treatment settings, even in the 21 st century.

If you believe yourself to be in good health, you should donate your blood to prove it and to save lives at the same time.

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Blood Banking

What is blood banking.

Blood banking is the process that takes place in the lab to make sure that donated blood, or blood products, are safe before they are used in blood transfusions and other medical procedures. Blood banking includes typing the blood for transfusion and testing for infectious diseases.

Facts about blood banking

According to the American Association of Blood Banks as of 2013:

About 36,000 units of blood are needed every day.

The number of blood units donated is about 13.6 million a year.

About 6.8 million volunteers are blood donors each year.

Each unit of blood is broken down into components, such as red blood cells, plasma, cryoprecipitated AHF, and platelets. One unit of whole blood, once it's separated, may be transfused to several patients, each with different needs.

Annually, more than 21 million blood components are transfused.

Who are the blood donors?

Most blood donors are volunteers. However, sometimes, a patient may want to donate blood a couple of weeks before undergoing surgery, so that his or her blood is available in case of a blood transfusion. Donating blood for yourself is called an autologous donation . Volunteer blood donors must pass certain criteria, including the following:

Must be at least 16 years of age, or in accordance with state law   

Must be in good health

Must weigh at least 110 pounds

Must pass the physical and health history exam given before donation

Some states permit people younger than 16 or 17 years to donate blood, with parental consent.

What tests are done in blood banking?

A certain set of standard tests are done in the lab once blood is donated, including, but not limited to, the following:

Typing: ABO group (blood type)

Rh typing (positive or negative antigen)

Screening for any unexpected red blood cell antibodies that may cause problems in the recipient

Screening for current or past infections, including:

Hepatitis viruses B and C

Human immunodeficiency virus (HIV)

Human T-lymphotropic viruses (HTLV) I and II

West Nile virus

Chagas disease 

Irradiation to blood cells is performed to disable any T-lymphocytes present in the donated blood. (T-lymphocytes can cause a reaction when transfused, but can also cause graft-versus-host problems with repeated exposure to foreign cells.)

Leukocyte-reduced blood has been filtered to remove the white blood cells that contain antibodies that can cause fevers in the recipient of the transfusion. (These antibodies, with repeated transfusions, may also increase a recipient's risk of reactions to subsequent transfusions.)

What are the blood types?

According to the American Association of Blood Banks, distribution of blood types in the U.S. includes the following:

O Rh-positive - 39%

A Rh-positive - 31%

B Rh-positive - 9%

O Rh-negative - 9%

A Rh-negative - 6%

AB Rh-positive - 3%

B Rh-negative - 2%

AB Rh-negative - 1%

What are the components of blood?

While blood, or one of its components, may be transferred, each component serves many functions, including the following:

Red blood cells. These cells carry oxygen to the tissues in the body and are commonly used in the treatment of anemia.

Platelets. They help the blood to clot and are used in the treatment of leukemia and other forms of cancer.

White blood cells. These cells help to fight infection, and aid in the immune process.

Plasma. The watery, liquid part of the blood in which the red blood cells, white blood cells, and platelets are suspended. Plasma is needed to carry the many parts of the blood through the bloodstream. Plasma serves many functions, including the following:

Helps to maintain blood pressure

Provides proteins for blood clotting

Balances the levels of sodium and potassium

Cryoprecipitate AHF.  The portion of the plasma that contains clotting factors that help to control bleeding.

Albumin, immune globulins, and clotting factor concentrates may also be separated and processed for transfusions.

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Promised Cures, Tainted Cells: How Cord Blood Banks Mislead Parents

Families pay thousands of dollars to store their children’s stem cells with the hope of a healthier future. But the cells are rarely useful, and sometimes contaminated.

Anna Lazos with her son and their dog. After spending thousands of dollars on cord blood storage, Ms. Lazos asked to withdraw a sample to enroll him in an autism clinical trial. The company told her that the cells were contaminated with E. coli. Credit... Hannah Yoon for The New York Times

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By Sarah Kliff and Azeen Ghorayshi

The reporters talked to more than 60 doctors, parents, executives, former sales representatives and quality control managers for this article.

• Published July 15, 2024 Updated July 18, 2024

Millions of pregnant women get the pitch through their OB-GYN: Put a bit of your newborn’s umbilical cord on ice, as a biological insurance policy. If your child one day faces cancer, diabetes or even autism, the precious stem cells in the cord blood could become a tailor-made cure.

Listen to this article with reporter commentary

Many families are happy to pay for the assurance of a healthy future. More than two million umbilical cord samples sit in a handful of suburban warehouses across the country. It’s a lucrative business, with companies charging several thousand dollars upfront plus hundreds more every year thereafter. The industry has grown rapidly, bolstered by investments from medical device companies, hospital partnerships and endorsements from celebrities like Drew Barrymore and Chrissy Teigen.

But the leading banks have consistently misled customers and doctors about the technology’s promise, an investigation by The New York Times found. Doctors rarely use cord blood anymore, thanks to advances that have made it easier to transplant adult stem cells. And the few parents who try to withdraw cord blood samples often find that they are unusable — either because their volume is too low or they have been contaminated with microbes.

When the first cord blood banks opened three decades ago, doctors were optimistic about turning the stem cells, otherwise discarded as medical waste, into a powerful new treatment for patients with leukemia and other blood disorders. Private banks promised peace of mind for anxious parents-to-be, knowing the cells would be ready and waiting if their child ever got sick.

That potential has not materialized. Just 19 stem-cell transplants using a child’s own cord blood have been reported since 2010, according to the Center for International Blood and Marrow Transplant Research. Newer research has led many doctors to abandon cord blood in favor of adult stem cells.

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• Cord blood banking:...

Cord blood banking: Experts raise concern over claims made for stem cell applications

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• Jacklin Kwan , freelance journalist
• kwan.jacklin{at}gmail.com

Marketing by some private biobanks may be misleading expectant parents about the procedure’s value, writes Jacklin Kwan

Umbilical cord blood banking has gained prominence in the past decade as an option for expectant parents worried about their child’s future health. 1 Parents pay private biobank companies up to £3000 (excluding annual storage fees) to freeze their baby’s cord blood, which contains stem cells, in case the infant develops a condition that could be treated with stem cell therapy.

Umbilical cord blood banking: overinflated claims of stem cells’ application?

Cells4Life, which claims to be the UK’s largest private biobank for cord blood banking, says that its particular method delivers more stem cells from umbilical cord blood than its competitors’ processes. For this marketing message it relies on research published in the Journal of Stem Cells Research, Development & Therapy . Publication of this research took place just 17 days after receipt of the manuscript, a timescale far shorter than is typical for peer reviewed journals. Two editors listed on the journal’s editorial board say they did not in fact hold these roles, The BMJ discovered ( box 1 ).

Claim of superior technology by UK’s largest private biobank raises questions

Cells4Life says it is the UK’s largest provider of cord blood banking services. The firm markets its proprietary technology TotiCyte—a “precise, low concentration mixture of two solutions,” the cryoprotectants dimethyl sulfoxide (DMSO) and dextran—as the reason why, after collection, processing, and freezing, its samples have three times as many stem cells as competitors that use other processing methods (assuming that freezing and collection are kept the same across all methods).

Patricia Murray, professor of stem cells and regenerative medicine at the University of Liverpool, says that there is no clear scientific reason why TotiCyte should outperform market alternatives. “All they’ve got in TotiCyte is DMSO and dextran, which are well established cryoprotectants,” she said, “There may just be a slight difference in the percentages of DMSO and dextran, but you wouldn’t expect it to have such a dramatic effect on cell survival.”

Responding to this, Cells4Life’s chief executive, Claudia Rees, says that TotiCyte is used as a blood separation reagent to sediment red blood cells so they can be removed before freezing, not as a cryoprotectant.

Murray points to a written opinion by an international searching authority (ISA or patent office) in 2014 when Cells4Life applied for a patent under the World Intellectual Property Organisation. The ISA examined TotiCyte’s application to sediment red blood cells as well as its role as a cryoprotectant and concluded: “It follows that the addition of DMSO to the dextran composition does not add any technical effect in the use and method for white blood cell enrichment and appears merely to serve as a patent strategical means to establish novelty over the art.”

Rees told The BMJ that Cells4Life has been granted patents in the US and China for TotiCyte as proof of its novelty.

Published research claims

The evidence for Cell4Life’s TotiCyte claim is given in a “peer reviewed publication,” the Journal of Stem Cells Research, Development & Therapy , published by Herald Scholarly Open Access. The research article referenced by Cells4Life was received on 14 May 2021 and published only 17 days later. 2 When asked by The BMJ , the journal in question claims to maintain a double blind process of peer review.

However, a 2017 study of journal response times suggests that journals typically take 12-14 weeks to handle accepted medicine and public health papers. 3 This is the time in which the paper is under the responsibility of the journal—in other words, the time it takes for the journal to evaluate the manuscripts, find reviewers, have time for the reviewers to complete their work, and for editors to evaluate manuscripts on the basis of reviewers’ reports. It does not include the time taken for authors to revise and resubmit their work.

The BMJ contacted two editors who were listed on the journal’s editorial board. One said that they had “never held an active role in the journal nor received any articles or communications from them for review or any other purpose.” The other said that they “never accepted the position of editor to this journal.”

After being contacted by The BMJ , both researchers have asked the Journal of Stem Cells Research, Development & Therapy to remove their names. The BMJ was unable to make contact with the journal about this matter.

Rees says, “The Journal of Stem Cells Research, Development & Therapy has its own independent editorial board, provides an NLM [National Library of Medicine] identifier [and] an impact factor, and operates under the COPE guidelines.” COPE is the Committee of Publication Ethics, a non-profit organisation that promotes and defines best practices in scholarly publishing.

Experts in regenerative medicine have criticised Cell4Life’s marketing directed at expectant parents, which they say contains misleading statements. Charles Murry, director of the Institute for Stem Cell and Regenerative Medicine at the University of Washington, Seattle, says claims that stem cells can develop into almost any type of cell in the body have been “very rigorously disproven.”

“Routinely used” and promising—or “rigorously disproven”?

Depending on the specific company and on whether parents choose also to bank cord tissue, private umbilical cord blood banking services range from £550 to around £3000, excluding annual storage fees of over £100 to keep samples frozen. Those financial costs are often marketed as an investment, given that there have been promising reports of successful use of stem cell based therapies to treat a wide range of potentially life threatening diseases, from cerebral palsy to leukaemia. 4 5

The Cells4Life website claims that “umbilical cord blood is routinely used in treatments for over 80 different conditions and diseases,” including cancers, blood disorders, immune disorders, and autism. It says, “Umbilical cord blood stem cells are pure and plastic, meaning that they can become almost any cell in the human body,” and, “They can become almost any tissue type in the body and may even be used to regrow entire organs.”

But Murry says this list of applications is unrealistic. “There were people making these claims in the late 1990s—that these cells have the plasticity to become other things—but that’s been very rigorously disproven.” 6 7 8 He tells The BMJ that the haematopoietic stem cells (HSCs) and mesenchymal stem or stromal cells (MSCs) harvested from cord blood ( box 2 ) are a form of adult stem cell and that there is a “restricted repertoire” of what they’re able to develop into—namely, blood cells for HSCs and connective tissue cells for MSCs.

What is cord blood banking?

Blood in the umbilical cord contains haematopoietic stem cells, which can be used to develop into different kinds of blood cells (such as red blood cells), and mesenchymal stem cells (stromal cells), which are important for repairing some body tissues. After birth, the umbilical cord can be clamped and the blood within it and the placenta cryogenically stored. According to the Human Tissue Authority, 376 843 units of cord blood were stored with the UK’s private cord blood biobanks at the end of 2022, representing over 90% of the country’s total stores of cord blood supply. The remainder is stored in philanthropic umbilical cord blood banks, such as the independent charity Anthony Nolan, 9 to which parents can choose to donate cord blood for other patients or research.

Stem cell therapies are showing promise in treating some conditions that diminish quality of life, such as cerebral palsy. 4 Finding a stem cell match through public banks or within families can be a challenge.

Responding to this criticism, Cells4Life says, “Any cursory search of published literature on future applications of perinatal stem cells demonstrates the huge potential that cord blood holds for use in regenerative medicine in the future.” It references papers in which MSCs are used to reduce inflammatory immune responses after organ transplantations and adds: “MSCs can be transformed into inducible pluripotent stem cells (iPSCs). This technology allows a cell to mimic an embryonic stem cell … capable of forming any tissue with [the] exception of germ cells.”

Potentially misleading claims

But Murry considers the claims of pluripotency and the ability to develop into any tissue potentially misleading, because they do not give parents the whole picture. He says that transforming stem cells into iPSCs requires highly trained stem cell scientists to reprogramme the cell. “The biobanks store the starting material in a 1000 step journey,” he says, “They don’t provide you with a route to a scientist in a lab.”

“Also, you can make iPSCs from your blood or from your skin as an adult,” Murry adds, meaning that cord blood banking is unnecessary for this process.

Many other private biobanks make similar claims about the therapeutic potential of cord blood. SmartCells, a competing cord blood bank, claims on its website: “As the body’s building blocks, the possibilities for using stem cells are endless. These potent cells are unique because they have the ability to repair, replace, and regenerate cells of almost any kind.”

Future Health Biobank, another private cord blood bank service, lists “treatment possibilities” on its website, naming over 75 genetic, immune, and blood disorders that can be treated with HSCs.

Pietro Merli is a paediatrician at the Bambino Gesù paediatric hospital in Rome, Italy, where he uses HSCs and other cell products to treat his patients. He also believes that the lists of diseases and disorders claimed by the biobanks to be treatable with MSCs and HSCs are unrealistic.

He explains that many of the disorders and diseases he treats with HSCs do not require autologous stem cells, harvested from the patients, and can instead use allogeneic stem cells from donors who are HLA (human leucocyte antigen) matched to patients. “There are many conditions that can be treated with haematopoietic stem cell transplants, but these are allogeneic stem cell transplants, not autologous,” he says.

Merli says that the few instances in which doctors might use autologous HSC transplants are in treating lymphomas. “But you can use your own stem cells from bone marrow, which are harvested during your treatment,” he said, adding that there is no benefit to harvesting and storing stem cells from cord blood.

Merli says that in Italy, where he practises, such advertising by stem cell therapy companies is illegal. He also says that no cord blood bank he has seen details how patients would hypothetically be able to use their preserved stem cells.

Neither SmartCells nor Future Health responded to The BMJ ’s request for comment.

The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives do not recommend commercially harvesting umbilical cord blood, unless there’s a specific medical reason to do so. 10

Murry says the decision whether to bank their infant’s cord blood ultimately lies with parents: “If the cost is not a big deal for you, and it brings you peace of mind, go for it.”

Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.

Commissioning and peer review: Commissioned; externally peer reviewed.

This feature has been funded by the BMJ Investigations Unit. For details see bmj.com/investigations . Got a story? Contact us: [email protected]

• ↵ Saving and storing your baby’s cord blood and tissue: is this a growing trend? Louisa Ghevaert Associates. 2020. https://louisaghevaertassociates.co.uk/saving-and-storing-your-babys-cord-blood-and-tissue-is-this-a-growing-trend
• Martin L-A ,
• Slaughter R ,
• Klimentov A ,
• Huisman J ,
• Eggenberger S ,
• Boucard C ,
• Schoeberlein A ,
• Zakrzewski W ,
• Dobrzyński M ,
• Szymonowicz M ,
• Wagers AJ ,
• Sherwood RI ,
• Christensen JL ,
• Weissman IL
• ↵ Anthony Nolan. Cord blood programme. https://www.anthonynolan.org/clinicians-researchers-hub/healthcare-professionals/cord-blood-programme
• ↵ Royal College of Obstetricians and Gynaecologists, Royal College of Midwives. RCOG/RCM statement on umbilical cord blood collection and banking. 2011. https://www.rcm.org.uk/media/2309/rcog-rcm-statement-on-umbilical-cord-blood-collection-and-banking.pdf

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July 24, 2024

This article has been reviewed according to Science X's editorial process and policies . Editors have highlighted the following attributes while ensuring the content's credibility:

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Some companies are overinflating value of umbilical cord blood banking to expectant parents, experts warn

by British Medical Journal

Some private UK biobanks may be misleading expectant parents about the value of storing umbilical cord blood to treat life-threatening diseases that may arise in their child in the future, reveals an investigation by The BMJ .

Over the past decade, growing numbers of parents have chosen to store blood from the umbilical cord, which contains stem cells , in case their infant develops a condition that could be treated with stem cell therapy .

Parents must use a private biobank, which charges between £550 and £3,000 for freezing a baby's umbilical cord blood. On top of this, parents must pay an annual storage fee of over £100 to keep samples frozen.

Private biobanks market their umbilical cord blood banking services to expectant parents as an investment in protecting their child's future health alongside claims that stem-cell based therapies have been used successfully to treat a wide range of potentially life-threatening diseases, from cerebral palsy to leukemia.

But experts in regenerative medicine say many of these companies' marketing claims are misleading.

For example, Cells4Life, which describes itself as the UK's largest provider of cord blood banking services, claims that "umbilical cord blood is routinely used in treatments for over 80 different conditions and diseases," including cancers, blood disorders, immune disorders, and autism. It adds that umbilical cord blood stem cells are "pure and plastic," meaning that "they can become almost any tissue type in the body and may even be used to regrow entire organs."

The investigation also found that Cells4Life markets its services on questionable evidence published in the Journal of Stem Cells Research, Development & Therapy . Although the journal claims to operate a peer-review process, the research article referenced by Cells4Life was published in the journal just 17 days after receipt—a timescale far shorter than the 12-14 weeks typical for peer-reviewed journals. The BMJ contacted two editors listed on the journal's editorial board who said that they did not in fact hold these roles.

SmartCells, another private cord blood bank service, claims on their website that the possibilities for using stem cells are endless, as these cells "have the ability to repair, replace, and regenerate cells of almost any kind." The website of another service, Future Health, lists more than 75 genetic, immune and blood disorders that can be treated.

Charles Murry, director of the Institute for Stem Cell and Regenerative Medicine at the University of Washington, Seattle, and Pietro Merli, a pediatrician at the Bambino Gesù Pediatric Hospital in Italy, said the list of applications is unrealistic.

Murry says the list is based on claims by people in the late 1990s that these cells have the plasticity to become almost any type of cell in the body—claims that have been "very rigorously disproven."

He said that umbilical cord blood contains adult stem cells , which limits the types of cells they can become— hematopoietic stem cells (HSCs) can become blood cells, and mesenchymal stem or stromal cells (MSCs) can build connective tissue such as bone, cartilage, tendons, ligaments, muscles, and bone marrow.

Cells4Life said, "Any cursory search of published literature on future applications of perinatal stem cells demonstrates the huge potential that cord blood holds for use in regenerative medicine in the future."

It pointed to research suggesting that MSCs can be transformed into inducible pluripotent stem cells (iPSCs), which can mimic embryonic stem cells and are therefore capable of forming any tissue except germ cells (precursors of egg and sperm cells).

Murry highlighted that transforming stem cells into iPSCs requires highly trained stem cell scientists and that iPSCs can also be created from adult blood or skin cells, meaning that cord blood banking is unnecessary.

Merli, who uses stem cell therapy to treat his patients, says many of the conditions he treats do not require autologous stem cells (harvested from the patient) and that allogeneic stem cells (from matched donors) can be used instead.

He said that leukemia was one of the few conditions where doctors might use stem cells harvested from the patient, but that these could be taken from the patient's bone marrow, so there was no benefit to harvesting and storing stem cells from cord blood.

He added that in Italy it is illegal for stem cell therapy companies to make such claims in their advertising.

Neither SmartCells nor Future Health responded to The BMJ 's request for comment.

Both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives do not recommend commercially harvesting umbilical cord blood , unless there's a specific medical reason to do so.

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Original research

Knowledge of blood donation and associated factors in ethiopia: a systematic review and meta-analysis, addisu getie.

1 Nursing, Woldia University, Woldia, Ethiopia

Adam Wondmieneh

Melaku bimerew, getnet gedefaw.

2 Midwifery, Woldia University, Woldia, Ethiopia

Asmamaw Demis

Associated data.

bmjopen-2020-044343supp001.pdf

All data relevant to the study are included in the article or uploaded as supplementary information.

To assess the level of knowledge about blood donation and associated factors in Ethiopia.

Systematic review and meta-analysis.

Both published and unpublished cross-sectional studies on the level of knowledge about blood donation in Ethiopia were included. Articles from different databases such as PubMed/MEDLINE, HINARI, EMBASE, Scopus, Google Scholar and African Journals Online were searched. Cochrane I 2 statistics were used to check for heterogeneity. Subgroup and sensitivity analyses of evidence of heterogeneity were carried out. Egger’s test with funnel plot was conducted to investigate publication bias.

Twenty cross-sectional studies with a total of 8338 study participants (4712 men and 3626 women) were included. The overall nationwide level of knowledge about blood donation was 56.57% (95% CI 50.30 to 62.84). Being in secondary school and above (adjusted OR=3.12; 95% CI 2.34 to 4.16) and being male (adjusted OR=1.81; 95% CI 1.44 to 2.28) were the factors associated with level of knowledge about blood donation.

More than half of the study participants were knowledgeable about blood donation. Sex and educational status were the factors significantly associated with level of knowledge about blood donation in Ethiopia. Therefore, there is a need for education and dissemination of information about blood donation among the general population to build adequate knowledge and maintain regular blood supply.

Strengths and limitations of this study

• This study highlights the nationwide level of knowledge about blood donation in Ethiopia.
• This study covers a wide area and investigates different articles, making the review more accurate.
• Subgroup and sensitivity analyses were carried out to investigate the heterogeneity of the included studies.
• All included studies were cross-sectional in design, which may limit investigation of the cause–effect relationship.

Introduction

Blood donation is life-saving for people in different emergency conditions, such as road traffic accidents, surgical procedures, pregnancy and delivery complications, chemotherapy, and diseases such as malaria, anaemia and intestinal parasites. 1 Blood donation is a noble practice of saving the life of millions of people. Donating safe and adequet blood can safe up to three lives of a patient who need blood. 2

Although the demand for adequate and safe blood is significantly increasing, there is a serious and critical shortage of blood stocks in low-income and middle-income countries. In low-income and middle-income countries, family replacement and paid blood donors are the most common sources of blood transfusion. 3 The availability of blood for transfusion in low-income countries is very limited due to the low level of knowledge, unwillingness to donate blood and poor blood donation practices. Meanwhile, patients suffer from lack of blood transfusion due to increased need from different medical and surgical conditions 4

While every blood donor is considered a hero, the amount of blood collected from donors and the average rate of blood collection in low-income countries including Ethiopia are low compared with the demand for blood. 5 The act of family replacement therapy is a common blood donation practice than collecting from volunteer blood donors, which is a common predisposing factor for misconception towards blood donation practice. 6

As different studies have shown, the prevalence of level of knowledge regarding blood donation ranged from 32.4% to 40.45%. 7 4 8 Education, sensitisation of blood donation, increasing public awareness, and campaign through the internet and media are recommended strategies to increase awareness, attitude and motivational practice of blood donation. 9–11 Fear of the different health risks after blood donation and lack of information on where, when and how to donate blood are the most common factors that hinder blood donation. 12 Even though beliefs, attitudes and behaviours regarding blood donation differ, adequate knowledge is needed among non-donors. There is a gap between willingness to donate blood and the number of donors in most populations around the world, which affects the practice of blood donation. 13 There is a need to spread awareness on blood donation among the general population to maintain an adequate and safe blood supply, which can be done through well-designed communication strategies to overcome the problem. 7

While there is a very high need for blood supply in Ethiopia, there is a serious shortage of blood stocks in the country. Thus, identifying the different factors that hinder knowledge about the practice of blood donation is essential. This systematic review and meta-analysis aims to review the different studies conducted so far on the level of knowledge about blood donation and associated factors in Ethiopia.

Methods and materials

Study protocol.

In this meta-analysis, the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines for reporting of findings were used 14 ( online supplemental table S1 ).

Supplementary data

Databases and search strategy.

Different databases such as PubMed/MEDLINE, Hinari, EMBASE, Google Scholar and African Journals Online were used to search for available articles. Both published and unpublished articles from the repository of Ethiopian universities were also searched. The search date was from 1 January 2000 up to 1 May 2021. Articles reporting on knowledge about blood donation and associated factors in Ethiopia were included in the final analysis. The search items were “knowledge” OR “awareness” AND “blood donation” OR “volunteer blood donation” AND “associated factors” OR “determinant factors” AND “Ethiopia”. These search strings were developed using “AND” and “OR” Boolean operators ( table 1 ).

Search of different databases for studies about level of knowledge and associated factors regarding blood donation in Ethiopia

Search and eligibility of studies

All retrieved articles were exported to EndNote reference software V.8 citation manager (Thomson, Stamford, Connecticut, USA) to sort and delete duplicates. Two investigators (AG and AD) independently evaluated each article by title and abstract, assessed the eligibility of the articles, and critically reviewed the selected articles. Extraction was done by author name, publication year, region where the study was conducted, study subjects, sampling method, method of survey, study period, sample size, study design, level of education, level of knowledge regarding blood donation and factors associated with level of knowledge about blood donation.

Eligibility criteria

Both published and unpublished cross-sectional studies conducted on the level of knowledge about blood donation among populations in Ethiopia were included, whereas qualitative studies, different trials, case reports, review articles, updates and news were excluded from the analysis. Furthermore, articles not reporting on the outcome of the study and those without full texts were excluded.

Outcome measurement of the study

There are two main outcomes, namely level of knowledge about blood donation and the factors associated with it. Level of knowledge was measured using the mean score on the knowledge assessment questions. Study participants who scored with a mean score and above on the knowledge assessment items were considered knowledgeable about blood donation, whereas those who scored below the mean score were considered not knowledgeable.

Quality assessment

Two authors (AG and AD) independently assessed the quality of the studies using the Newcastle-Ottawa Scale for cross-sectional studies. 15 Methodological quality, comparability, outcome and statistical analysis of the studies were the main assessment tools used to determine quality. Studies that scored ≥7 out of 10 were considered to be of high quality. During quality appraisal of the articles, any discrepancies between the two authors were resolved. All authors independently assessed the eligibility of the articles to be considered in the final analysis.

Data processing and analysis

In this systematic review and meta-analysis, a weighted inverse variance random-effects model at 95% CI was used to calculate the pooled prevalence of level of knowledge about blood donation and the associated factors. 16 After extraction and cleaning using Microsoft Excel spreadsheets, the data were exported to STATA V.11 statistical software for analysis. The heterogeneity of the studies was assessed using the Cochrane Q-test and I 2 with the corresponding p value. I 2 values of 25%, 50% and 75% represent low, moderate and high heterogeneity, respectively. 17 The source of heterogeneity was examined through subgroup analysis based on region, study subjects, study setting and sample size. Sensitivity analysis was also carried out to confirm the presence or absence of influential studies. The presence of publication bias was evaluated using Egger’s test and presented with funnel plots. 18 For associated factors, log OR was used to decide on the association between the associated factors and the level of knowledge about blood donation. A statistical test with a p value of less than 0.05 was considered statistically significant. 19

Patient and public involvement

It was not appropriate or possible to involve the patients or the public in the design, conduct, reporting or dissemination plans of our research.

Six hundred and ninety-four articles were retrieved. Of these retrieved articles, 284 were excluded due to duplication. Three hundred and sixty-eight articles were further excluded after reviewing the titles and abstracts. Furthermore, 22 articles which did not fulfil the inclusion criteria were excluded. Finally, 20 articles were used in the analysis ( figure 1 ).

Flow chart of selection of studies for the systematic review and meta-analysis of the level of knowledge about blood donation and associated factors in Ethiopia.

Characteristics of the studies and study participants

Twenty cross-sectional studies with a total of 8338 study participants (4712 men and 3626 women) were involved. Of the included articles, eight were from the Amhara region, 1 12 20–25 five from the Oromia region, 4 26–29 two from the Addis Ababa city administration, 5 30 two from Southern Nations, Nationalities and Peoples Region, 31 32 two from Tigri region, 33 34 and the remaining was from the Afar region. 35 The sample size of the included studies ranged from 218 to 845 ( table 2 ).

Characteristics of studies included in the review and meta-analysis of knowledge about blood donation and associated factors in Ethiopia

SNNPR, South Nations, Nationalities and Peoples Region.

Knowledge about blood donation

The overall pooled prevalence of level of knowledge about blood donation in Ethiopia was 56.57% (95% CI 50.30 to 62.84) ( figure 2 ).

Forest plot of the pooled prevalence of knowledge about blood donation and associated factors in Ethiopia. ES, Effect Size.

Heterogeneity and publication bias

In this systematic review and meta-analysis, heterogeneity was identified within the studies (I 2 =97.3%, p<0.001). The funnel plot showed an asymmetrical distribution of studies included in the review and a statistically significant Egger’s test (p=0.02), suggesting the presence of publication bias ( figure 3 ).

Funnel plot with 95% confidence limits of the pooled prevalence of knowledge about blood donation and associated factors in Ethiopia. sep; standared error of prevalence.

Subgroup analysis

Subgroup analysis was done by region, study subjects, study setting and sample size. The highest pooled prevalence of level of knowledge about blood donation was reported by healthcare workers (65.28%, 95% CI 55.16 to 75.40). Similarly, the level of knowledge about blood donation was higher among studies done in institutions (institution-based) (60.45%, 95% CI 51.05 to 69.83) than studies conducted in the community ( table 3 ).

Subgroup analysis of the level of knowledge about blood donation and associated factors in Ethiopia (n=20)

Other: Addis Ababa, Eastern Ethiopia.

Sensitivity analysis

As shown in table 4 , all of the point’s estimates are within the overall 95% CI, which confirms that omission of any of the studies included in this systematic review and meta-analysis does not affect the overall prevalence of the level of knowledge about blood donation.

Sensitivity analysis of knowledge about blood donation and associated factors in Ethiopia

Factors associated with knowledge about blood donation

In this study, participants’ sex and level of education were significant factors associated with level of knowledge about blood donation. The odds of level of knowledge were 1.81 times more likely among men than women (adjusted OR (AOR)=1.81; 95% CI 1.44 to 2.28) ( figure 4 ). Similarly, the odds of level of knowledge were 3.12 times more likely among participants whose educational status was above secondary school than those who did not attend any formal education (AOR=3.12; 95% CI 2.34 to 4.16) ( figure 5 ).

Overall pooled OR of the association between sex and level of knowledge about blood donation in Ethiopia. AOR, adjusted OR.

Overall pooled OR of the association between educational status and level of knowledge about blood donation in Ethiopia. AOR, adjusted OR.

In this systematic review and meta-analysis, the pooled prevalence of good knowledge about blood donation is 56.57% (95% CI 50.30 to 62.84), which indicates that there is a lack of adequate knowledge about blood donation in the country. This might be due to the absence of regular blood donation programmes, less media coverage, limited campaign and limited educational access with regard to blood donation in the country.

The level of knowledge in this study is lower than the studies conducted in Malaysia (98%), 2 Barabanki, India (90%), 36 and Benin City, Nigeria (92.65 %). 37 This variation might be due to differences in study participants. In Malaysia, the study participants were nursing students; in Benin City, Nigeria the study participants were healthcare workers; and in Barabanki, India the study participants were undergraduate medical students. In contrast, this study targeted all populations in the country. This variation might also be due to the status and level of media coverage and the educational status of people in Ethiopia; Ethiopia is one of the low-income countries with very limited education coverage and media accessibility. There is an almost similar finding with regard to knowledge about blood donation with a study done among students of a tertiary institution in Nigeria. 9 However, the finding of this study is higher than the studies conducted in Kerala, India (35%) 7 and in Nepal (32%), 8 which may be due to time variations, where the previous studies were conducted before 7 and 5 years, respectively.

In the subgroup analysis, there was no significant variation with regard to the prevalence of knowledge about blood donation within the region where the studies were done. However, there were variations with regard to knowledge prevalence within study participants, study setting and sample size categories. Accordingly, the highest prevalence of knowledge was reported among healthcare workers. This is because healthcare workers have formal education on blood donation and know more about human physiology than others. Healthcare workers may also have experience with blood donation. This agreed with a study conducted in developing countries where regular donors had good knowledge compared with non-donors. 13 Studies conducted in institutions (institution-based) showed a higher prevalence of knowledge than studies conducted in the community (community-based). This is due to the populations in institutions having more access to information. 7

In this systematic review and meta-analysis, the odds of knowledge about blood donation were 1.81 times more likely among men than women. This might be due to women being more prone to different physiological conditions such as menstruation and bleeding during pregnancy and delivery, which deter them from donating blood. As a result they have poor blood donation practices when compared with men. This poor practice may indirectly affect women’s knowledge about blood donation. 3 Educational status also had a significant association with knowledge about blood donation. The odds of knowledge about blood donation were 3.12 times more likely among participants who had a level of education above secondary school compared with illiterates. 11 This is because formal education is the cornerstone of acquiring knowledge. Therefore, participants who reached secondary school and above have more access to information than participants who did not have any formal education.

Limitations of the study

All studies included in this systematic review and meta-analysis were cross-sectional studies, which may limit the generation of a cause–effect link between independent and dependent variables.

More than half of the study participants were knowledgeable about blood donation. Sex and educational status were significantly associated with level of knowledge about blood donation in Ethiopia. Therefore, there is a need for education and dissemination of information about blood donation among the general population to build adequate knowledge and maintain regular blood supply.

Supplementary Material

Contributors: AG and MB designed the study, as well as designed and run the literature search. AG, AW, MB, GG and AD acquired the data, screened the records, extracted the data and assessed the risk of bias. AG and AD did the statistical analyses and wrote the report. All authors provided critical conceptual input, analysed and interpreted the data, and critically revised the report. All authors read and approved the final manuscript.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Data availability statement

Ethics statements, patient consent for publication.

Not required.

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