The impact of HIV-associated anaemia on the incidence of red blood cell transfusion: Implications for blood services in HIV-endemic countries

Abstract

Cytopaenias, especially anaemia, are common in the HIV-infected population. The causes of HIV related cytopaenias are multi-factorial and often overlapping. In addition, many of the drugs used in the management of HIV-positive individuals are myelosuppresive and can both cause and exacerbate anaemia. Even though blood and blood products are still the cornerstone in the management of severe cytopaenias, how HIV may affect blood utilisation is not well understood. The impact of HIV/AIDS on blood collections has been well documented. As the threat posed by HIV on the safety of the blood supply became clearer, South Africa introduced progressively more stringent donor selection criteria, based on the HIV risk profile of the donor cohort from which the blood collected. The implementation of new testing technology in 2008 which significantly improved the safety of the blood supply enabled the removal of what was perceived by many as a racially based donor risk model. However, this new technology had a significant and sustained impact on the cost of blood and blood products in South Africa. In contrast, it would appear little is known of how HIV influences the utilisation of blood and blood products. Considering the high prevalence of HIV among hospitalised patients and the significant risk for anaemia among this group, there would be an expectation that the transfusion requirements of an HIV-infected patient would be higher than that of an HIV-negative patient. However, very little published data is available on this topic which emphasises the need for further large-scale studies to evaluate the impact of HIV/AIDS on the utilisation of blood and blood products and how the large-scale roll-out of ARV programs may in future play a role in determining the country’s blood needs.

Addressing gaps in international blood availability and transfusion safety in low‐ and middle‐income countries: a NHLBI workshop

“…51 High burdens of HIV infection may influence the appropriate use of blood because of anemia and other HIV-related complications. 52 Social and cultural factors could also play a role in adherence to suboptimal transfusion practices. Chronic blood shortage has a major influence on blood product prescription.…”

“…Inappropriate transfusion of blood products exists in many LMICs, which could be due to limited training in transfusion medicine and either a lack of clinical transfusion guidelines or their effective implementation . High burdens of HIV infection may influence the appropriate use of blood because of anemia and other HIV‐related complications . Social and cultural factors could also play a role in adherence to suboptimal transfusion practices.…”

Risk factors for peripartum blood transfusion in South Africa: a case‐control study

“…Research on transfusion in HIV positive obstetric patient is particularly relevant, given the association of HIV with anemia and other complications, but such data are limited 10 . The few published studies evaluating the association between HIV and increased blood use have yielded somewhat different results 10–12 . While HIV may be a driver of transfusion 11,12 , the strength of that association dissipates after controlling for potential confounders 10 .…”

Anemia, Blood Transfusion Requirements and Mortality Risk in Human Immunodeficiency Virus-Infected Adults Requiring Acute Medical Admission to Hospital in South Africa

“…Thus, increased ART coverage may contribute towards decreased patient morbidity, the increased availability of blood products, and decreased healthcare costs. Prescription of blood transfusions should be based on best practice guidelines where available [ 12 ], and further studies are needed to evaluate the impact of ART on blood product use (especially large ART cohort studies), as well as additional strategies for reducing blood transfusion requirements among both HIV-infected and uninfected patients in sub-Saharan Africa [ 15 , 41 ].…”

“…This may include administration of blood transfusions when considered clinically appropriate. Although it may be expected that HIV-infected hospitalized patients in sub-Saharan Africa have high transfusion requirements, few data have been published data on this topic [ 15 – 17 ]. In addition, some evidence suggests that blood transfusions are associated with modest increases in plasma HIV-1 RNA levels and increased mortality risk [ 11 , 18 – 20 ].…”