Global status report on blood safety and availability 2021

GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021 CONTACT World Health Organization Department of Health Products Policy and Standards 20 avenue Appia CH-1211 Geneva 27 bloodproducts@who.int https://www.who.int/bloodproducts

GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021 Global status report on blood safety and availability 2021 ISBN 978-92-4-005168-3 (electronic version) ISBN 978-92-4-005169-0 (print version) © World Health Organization 2022 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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In no event shall WHO be liable for damages arising from its use. iii CONTENTS Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Chapter 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Chapter 2. Organization and management of national blood transfusion services . . . . . . . . . . . . . . . . . . . 3 2.1 Policy and governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2.2 Finance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.3 Inspection and licensing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Chapter 3. Collection of blood and blood components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 3.1 Global overview of blood collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 3.2 Whole blood collection and apheresis collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 3.3 Types of blood donations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 3.4 Trends in whole blood collections in the world, 2008–2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.5 Blood donor profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.5.1 Donor sex and age profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.5.2 Repeat donors and first-time donors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 3.5.3 Donor deferral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Chapter 4. Processing of whole blood donations into components . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Chapter 5. Laboratory screening of blood donations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 5.1 Laboratory screening policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 5.1.1 Human immunodeficiency virus, hepatitis B virus, and hepatitis C virus . . . . . . . . . . . . . . . . . 23 5.1.2 Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 5.1.3 Chagas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 5.1.4 Human T-lymphotropic virus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 5.1.5 Malaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 5.1.6 Other transfusion-transmissible infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 5.2 Coverage and quality of laboratory screening of blood donations . . . . . . . . . . . . . . . . . . . . . . . 28 5.3 Prevalence of markers of infection in blood donations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Chapter 6. Discard of blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Chapter 7. Clinical use of blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 7.1 Assessing the need and demand for blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 7.2 Patients who received blood transfusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 7.3 Blood and blood components transfused . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021iv 7.4 Change in blood and blood components transfusion between 2013 and 2018 . . . . . . . . . . . . . . . . 40 7.5 Strategies to improve evidence-based transfusion practice and monitor safe and appropriate blood transfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 7.6 The risks of undertransfusion: unmet demand for blood in resource-limited countries . . . . . . . . . . . . 43 Chapter 8. Haemovigilance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Chapter 9. Plasma used for fractionation and the provision of plasma-derived medicinal products . . . . . . . . . 47 Chapter 10. Discussion and conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 10.1 Blood availability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 10.2 Blood safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 10.3 Clinical transfusion practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 10.4 Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 10.5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Chapter 11. Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Annex 1. Explanatory note on country data and methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Annex 2. Blood centres and data coverage, 2014/2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 Annex 3. Blood donations, 2014/2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Annex 4. Laboratory test requirements for screening donated blood for transfusion-transmissible infections, 2017/2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Annex 5. Number and proportion of donations tested positive/reactive for TTI markers, 2014/2018 . . . . . . . . . 112 Annex 6. Clinical use of blood and blood components, 2014/2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Annex 7. Provision of plasma-derived medicinal products (PDMPs) through the fractionation of plasma collected in the country, 2014/2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Annex 8. Policy, governance, quality assurance and monitoring, 2017/2018 . . . . . . . . . . . . . . . . . . . . . . . . 162 vFigures Figure 1. Governance mechanisms for blood transfusion by WHO region, 2018 . . . . . . . . . . . . . . . . . . . . 4 Figure 2. Systems of blood service financing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Figure 3. Distribution (percentage) of population and blood donations by WHO region and World Bank income group, 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Figure 4. Distribution of countries by number of whole blood donations per 1000 population, 2018 . . . . . . . . 9 Figure 5. Whole blood donations per 1000 population, 2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Figure 6. Method of collection of blood donations by WHO region and World Bank income group, 2018 . . . . . 10 Figure 7. Proportions of voluntary non-remunerated whole blood donations by WHO region and World Bank income group, 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Figure 8. Total number of apheresis donations (thousands) and distribution of donation types by WHO region. . 12 Figure 9. Proportion of voluntary non-remunerated donations (whole blood and apheresis donations combined) by country, 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Figure 10. Total whole blood collections and voluntary non-remunerated donations (millions) by WHO region, 2008–2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Figure 11. Contributions to donations by donors of different age groups in selected countries, 2018 . . . . . . . . 17 Figure 12. Contribution to donations by donors of different age groups and by World Bank income group, 2018 . 18 Figure 13. Donor deferral rate (%) by reason in countries in different income groups . . . . . . . . . . . . . . . . 19 Figure 14. Whole blood donations processed into components by WHO region and World Bank income group, 2018 (%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Figure 15. Distribution of discards of blood donations by reason, 2018 . . . . . . . . . . . . . . . . . . . . . . . . 31 Figure 16. Paradigm of need for, demand for, and use of blood . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Figure 17. Age distribution of patients who received transfusion in selected countries . . . . . . . . . . . . . . . 36 Figure 18. Distribution of blood units transfused in different clinical departments in selected countries in Africa . 37 Figure 19. Distribution of countries reporting the existence of national haemovigilance systems, 2018 . . . . . . . 45 Figure 20. Serious adverse transfusion reactions reported . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Tables Table 1. Policy and governance results: responses by countries, 2018 . . . . . . . . . . . . . . . . . . . . . . . . 3 Table 2. Funding models for responding countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Table 3. International financial and technical support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Table 4. Total funding per collection by World Bank economic group, 2018 . . . . . . . . . . . . . . . . . . . . . 6 Table 5. Inspection and licensing results for responding countries . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Table 6. Estimated blood donations by WHO region, 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Table 7. Voluntary non-remunerated donation (VNRD) and total whole blood collection in 119 countries (millions) by WHO region, 2008–2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Table 8. Annual rate of change of whole blood collections (total and voluntary non-remunerated donation, VNRD) by WHO region, 2008–2018 (median and range, %) . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table 9. Blood donations from female donors by WHO region (median and range, %) . . . . . . . . . . . . . . . 16 Table 10. Donations given by repeat voluntary non-remunerated blood donors by WHO region (median and range, %) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Table 11. Donor deferral rate by WHO region (median and interquartile range, %) . . . . . . . . . . . . . . . . . 20 Table 12. Proportion of blood donations processed into components: number of countries in each percentage grouping by WHO region, 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 13. Distribution of blood laboratory screening policies for HIV-1/2 by WHO region . . . . . . . . . . . . . . 24 Table 14. Distribution of blood laboratory screening policies for HBV by WHO region. . . . . . . . . . . . . . . . 24 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021vi Table 15. Distribution of blood laboratory screening policies for HCV by WHO region . . . . . . . . . . . . . . . 24 Table 16. Testing for Chagas disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Table 17. Testing for HTLV-1/2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 18. Malaria testing policy in 51 countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table 19. Proportion of blood screening laboratories that participate in EQAS for testing of TTIs by World Bank income group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 20. Proportions of blood donations with positive/reactive results on screening tests by income group . . . 30 Table 21. Percentage (median and interquartile range) of total whole blood donations discarded by World Bank income group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Table 22. Percentage (median and range) of donations discarded due to reactivity for markers of TTIs by World Bank income group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Table 23. Populations, blood donations and transfusion of blood products in 135 countries by World Bank income group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 24. Units of red cell products transfused per 1000 population by World Bank income group . . . . . . . . . 38 Table 25. Proportion (median and interquartile range, %) of whole blood transfusions among all red cell transfusions by World Bank income group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table 26. Units of platelet transfused per 1000 population by World Bank income group . . . . . . . . . . . . . . 39 Table 27. Units of plasma transfused per 1000 population by World Bank income group . . . . . . . . . . . . . . 40 Table 28. Units (millions) of red cell products transfused by WHO region, 2013 and 2018 . . . . . . . . . . . . . . 40 Table 29. Units (thousands) of platelets transfused by WHO region, 2013 and 2018 . . . . . . . . . . . . . . . . . 41 Table 30. Units (thousands) of plasma products transfused by WHO region, 2013 and 2018 . . . . . . . . . . . . 41 Table 31. Incidence of serious adverse reaction (per 100 000 units of components transfused) by WHO region . . 46 Table 32. Volume (litres) of plasma for fractionation by collection method and WHO region, 2018 . . . . . . . . . 48 viiPREFACE PREFACE The Global Database on Blood Safety (GDBS) reports important data from many countries on a range of indicators covering the transfusion chain from donor to recipient, as a basis for more informed discussion on the provision and governance of blood transfusion services. The GDBS reports also provide important input for formulating and updating World Health Organization (WHO) global blood safety strategies. The WHO Action Framework to Advance Universal Access to Safe, Effective and Quality-Assured Blood Products 2020–2023 aims to provide strategic direction to global efforts to address present barriers to the safety and availability of blood components and products. Recommendations included setting up effective surveillance, haemovigilance and pharmacovigilance, supported by comprehensive and accurate data collection systems, to facilitate monitoring and evaluation of national blood systems. Key data and information for each Member State were listed in annexes to the previous edition of the report, which was published in 2016. Countries, development agencies and researchers found this disaggregated country data and information useful. In this 2021 report, data from the last four years have been added and listed in the annexes. With the increased availability of data for key comparable indicators over multiple years, it is now possible to conduct trend analyses, including for global and regional trends in blood collections and transfusion. This 2021 report continues to recognize that inadequate and unsustainable financing of blood services is a major factor that impedes efforts to improve blood safety in developing countries. Governments should ensure adequate, sustainable financing for national or regional blood programmes. The financing mechanisms for blood services should be integrated within the financial structure of national health care systems. Countries with significant external donor funding support should take proactive measures to mobilize domestic sources and reduce dependence on external funding, to ensure the quality and sustainability of blood transfusion services. Access to sufficient, secure supplies of blood and blood products and safe transfusion services is an essential part of any strong health system, and is an important component of efforts towards achieving the goal of universal health coverage. Despite progress over the past decade, it is clear that the goal of universal access to safe blood and blood products has not been achieved in many countries. The sufficiency and safety of blood and blood products and their equitable access at national and global levels will thus require further scrutiny and examination. Dr Yuyun Maryuningsih Team Lead, Blood and Other Products of Human Origin Department of Health Product Policy and Standards, WHO GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021viii ACKNOWLEDGEMENTS The Blood and Other Products of Human Origin team in the WHO Department of Health Product Policy and Standards wishes to express its thanks to the following experts who contributed to the development of this report (in alphabetical order): Paul Ashford (independent consultant, United Kingdom); Fatima D. Mili (Centers for Disease Control and Prevention, United States of America); Hua Shan (Stanford University, United States of America); Simon Stanworth (National Health Service Blood and Transplant/Oxford University Hospitals NHS Trust, and University of Oxford, United Kingdom); Xun Wang (Shanghai Blood Centre); and Shimian Zou (National Heart, Lung, and Blood Institute, National Institute of Health, United States of America). The following WHO staff members contributed to the validation of data and development, editing and production of this report: Yuyun Maryuningsih (WHO headquarters); André Loua (WHO Regional Office for Africa); Mauricio Beltran Duran (WHO Regional Office for the Americas); Yetmgeta Abdella (WHO Regional Office for the Eastern Mediterranean); Aparna Singh Shah (WHO Regional Office for South-East Asia); and Paul Mainuka (WHO country office in Ethiopia). Many WHO staff members in country offices provided support for data collection and validation. Data collection, data analysis and the production of the report was coordinated by Junping Yu (WHO headquarters). The following experts (in alphabetical order) reviewed and commented on the draft report: Justina Ansah (National Blood Service, Ghana, and member of WHO Advisory Group for Blood Regulation, Availability and Safety); Peter Flanagan (New Zealand Blood Service and member of WHO Expert Advisory Panel for Transfusion Medicine); Valentina Hafner (blood transfusion expert and former WHO staff member, Romania); Joy Mammen (Department of Transfusion Medicine, Christian Medical College, Vellore, India); Guy Rautmann (member of WHO Advisory Group for Blood Regulation, Availability and Safety); Jana Rosochová (adviser on legislation and hemovigilance, National Transfusion Service, Slovakia); and Jean-Baptiste Tapko (member of WHO Advisory Group for Blood Regulation, Availability and Safety). Special thanks are due to the health ministries and national blood programmes and blood transfusion services who provided data to the WHO Global Database on Blood Safety (GDBS). National blood programme managers are acknowledged for their contribution to the WHO GDBS, which formed the basis for the preparation of this report. Development of this publication was supported by Cooperative Agreement Number GH001180 from the United States Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. ixABBREVIATIONS AND ACRONYMS LIST OF ABBREVIATIONS AND ACRONYMS Ab antibodies Ag antigens EQAS External Quality Assessment Scheme GDBS Global Database on Blood Safety HBsAg hepatitis B surface antigen HBV hepatitis B virus HCV hepatitis C virus HIV human immunodeficiency virus HTLV human T lymphotropic virus IQR interquartile range IVIg intravenous immunoglobulin NAT nucleic acid amplification testing NBTS national blood transfusion service PDMP plasma-derived medicinal product RNA ribonucleic acid SARA Service Availability and Readiness Assessment TTI transfusion-transmissible infection VNRD voluntary non-remunerated donation WHO World Health Organization 1CHAPTER 1: INTRODUCTION The Global Database on Blood Safety (GDBS) aims to provide an overview of how countries and blood transfusion services are meeting expectations of blood supply, safety and use. A safe, equitable, sustainable and secure supply of blood for transfusion remains a key need for all countries. Transfusion of blood, when available, is lifesaving supportive care, for example in patients presenting with major bleeding due to trauma or postpartum, children suffering from severe anaemia due to malaria and malnutrition, people with inherited disorders of haemoglobin, or people with bone marrow failure. However, blood for transfusion is also a potentially scarce resource with significant risks as a biological material, including transfusion-transmitted infections. The GDBS data provide a framework for exploring the balance between needs, availability, risks and use of blood for transfusion. It addresses some of the challenges of variable global access to a safe and secure supply of blood. Alongside data on blood collection, this report also presents information on the processes for establishing governance and appropriate organization for national blood supply and transfusion systems; haemovigilance to monitor risks to donors and patients; and appropriate managerial mechanisms, such as hospital transfusion committees, in hospitals. As before, the GDBS requests and analyses data from ministries of health of World Health Organization (WHO) Member States. The terminologies used in the survey questionnaire were given standardized definitions to promote consistent reporting. Where possible, efforts were made to validate the data reported to WHO with WHO regional and country offices. Countries were contacted for clarification or correction when discrepancies or unusual patterns were observed. Efforts were also made to validate GDBS data by comparing them with data available from other published sources. However, not all the data provided by all countries could be systematically verified. In particular, answers to the questions on the existence of policies, programmes or mechanisms could be affected by individual interpretation of the questions asked. The findings allow countries to understand how their own responses and targets apply alongside other countries. Core findings in the report inform the implementing of those measures of blood safety, availability and accessibility that should be within the remit of governments and ministries of health. The results should support changes required to achieve safe blood supply through various levers, such as regulation, oversight, citizen and community engagement, and adequate funding. The report also provides an opportunity for WHO and other organizations to suggest appropriate guidance. INTRODUCTION GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 20212 Prior GDBS reports have highlighted marked disparities in measures of security of supply of blood between countries, including differences between resource-rich and resource-poor country settings. Understanding the requirements for a safe and sufficient blood supply is challenging. Although overall clinical rates of blood use vary considerably between countries – whether high, medium or low resource – optimal rates for a specific country are usually not known. In some countries where there are limited supplies and concerns about blood shortages, the GDBS report provides key comparative data to assist ministries of health in planning and goal setting to enable a move towards more equitable access to a safe and sufficient blood supply. Supply and availability of blood is linked with safe and appropriate informed use at the patient level. These issues of use and transfusion risks are addressed as secondary objectives of the GDBS report in selected chapters covering blood safety, for example through haemovigilance systems, or the establishment of hospital transfusion committees to oversee transfusion activities at hospitals. Ensuring appropriate use of blood requires education and engagement with the community of health care professionals and the medical profession. It is important to recognize that we now have more understanding of the evidence base for appropriate blood transfusion through the conduct of high-quality research, including randomized trials. A recent Cochrane review of red cell transfusion thresholds identified 48 randomized trials to inform optimal transfusion practice (1). Clinicians should ensure that blood transfusion is limited to situations or cases where no appropriate transfusion alternatives are available and there is supporting evidence that the benefit of blood transfusion outweighs the risks. Patient blood management describes an evidence-informed policy for providing the best transfusion and clinical care, including the judicious use of blood components and full consideration of alternatives such as tranexamic acid (2). Potential limitations in the GDSB report are acknowledged, including varying amounts of missing data and the challenges of data verification. To an extent, these problems can be assessed by longitudinal changes in reports over time, and this new report is accompanied by an additional trend analysis for a number of measures. A further limitation is that the scope of the report is restricted to whole blood or blood components, while increasing emphasis in transfusion medicine is now being placed on alternatives to transfusion, such as appropriate use of iron or tranexamic acid, typically as part of patient blood management strategies. The way such strategies are applied in all national settings will need to be addressed in later reports. A further gap highlighted by the WHO report is a lack of good descriptive data on blood use across a broad range of transfusion-giving hospitals in all countries, and this will be proposed as an objective for WHO-sponsored activities over the next few years. 3CHAPTER 2: ORGANIZATION AND MANAGEMENT OF NATIONAL BLOOD TRANSFUSION SERVICES 2.1 Policy and governance This report is based on data that were reported by 171 of 194 Member States to the WHO GDBS. Data included for analysis were primarily for 2018, as reported by 108 countries. To give a more complete overview of the global situation, data for 2017 from 40 countries, and for 2015 from 23 countries, were used where 2018 data were not available.1 These 171 countries account for a total population of 7.2 billion, representing 98.03% of the global population. Annex 1 presents a list of the 171 responding countries to GDBS 2018 (African Region 43 of 47, Region of the Americas 33 of 35, South-East Asia Region 10 of 11, European Region 42 of 53, Eastern Mediterranean Region 18 of 21, and Western Pacific Region 25 of 27). A total of 136 countries (80%) had a unit within the ministry of health (or other government department) with responsibility for governing all activities related to provision and transfusion of blood and blood products (Table 1). In addition, 125 countries (73%) had a national blood policy, and 101 countries (59%) had a multiyear national strategic plan for blood safety. In 113 countries (66%), there was specific legislation or other legal instruments covering the safety and quality of blood and blood products for transfusion. In 100 countries (58%), a national blood committee (or equivalent) assisted the ministry of health in formulating policy and plans, setting standards and advising on key issues. In 93 countries (54%), an annual report of activities of the national blood programmes was published. Table 1. Policy and governance results: responses by countries, 2018 Provision Yes No No information Unit within the ministry of health responsible for blood transfusion 136 28 7 National blood policy 125 39 7 Multiyear strategic plan for blood safety 101 57 13 Specific legislation covering safety and quality of blood and blood products 113 45 13 National blood committee 100 62 9 Published annual report 93 58 20 ORGANIZATION AND MANAGEMENT OF NATIONAL BLOOD TRANSFUSION SERVICES 1 In the subsequent sections of this report, for the purposes of simplicity, “GDBS 2018 data” is used to describe the data from all 171 countries surveyed. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 20214 A number of responding countries did not provide answers to these fundamental policy questions. Countries that provided a “no” answer may be those with effective blood transfusion services but with different policy and governance arrangements in place, or those where there was a lack of effective policy and governance, which could have an adverse impact on transfusion capacity and safety. It is important to distinguish between these two scenarios. Follow-up of these responses may be appropriate to determine if questions or definitions should be modified in future questionnaires to ensure that all effective policy and governance models are accommodated and reported accordingly. The lack of specific legislation covering the safety and quality of blood and blood products for transfusion in many (34%) countries is of concern. Registration, licensing, regulation and inspection of blood services, all of which are essential to ensuring safety, quality and availability of blood, require an appropriate legislative framework to operate effectively. Across the WHO regions (ranked by percentage), 19 (58%) countries in the Americas, 15 (60%) in the Western Pacific, 30 (71%) in Europe, 14 (78%) in the Eastern Mediterranean, eight (80%) in South-East Asia, and 39 (91%) in Africa reported having a national blood policy. Similarly, 19 (45%) countries in Europe, 12 (48%) in the Western Pacific, 17 (52%) in the Americas, 11 (61%) in the Eastern Mediterranean, 34 (79%) in Africa, and eight (80%) in South-East Asia reported having a multiyear strategic plan for blood safety in 2018 (Figure 1). A total of 113 countries (66%) reported the existence of specific legislation covering the safety and quality of blood transfusion, compared with 92 countries (56%) in 2008. Across WHO regions (ranked by percentage), 22 (51%) countries in Africa, 17 (52%) in the Americas, 14 (56%) in the Western Pacific, seven (70%) in South-East Asia, 13 (72%) in the Eastern Mediterranean, and 40 (95%) in Europe reported having such legislation (Figure 1). Figure 1. Governance mechanisms for blood transfusion by WHO region, 2018 AFR: African Region; AMR: Region of the Americas; EMR: Eastern Mediterranean Region; EUR: European Region; SEAR: South-East Asia Region; WPR: Western Pacific Region 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% AF R AM R SE AR EU R EM R W PR AF R AM R SE AR EU R EM R W PR AF R AM R SE AR EU R EM R W PR AF R AM R SE AR EU R EM R W PR AF R AM R SE AR EU R EM R W PR Units in the ministry of health National committee National blood policy Strategic plan Specific legislation 5CHAPTER 2: ORGANIZATION AND MANAGEMENT OF NATIONAL BLOOD TRANSFUSION SERVICES 2.2 Finance A total of 116 countries (68%) reported that funding of transfusion services is provided by government budget or cost recovery. Table 2 shows more details of the funding models. Table 2. Funding models for responding countries Funding models Number % Government budget + cost recovery system 57 33.3 Government budget has a specific line item for blood transfusion services 59 34.5 Cost recovery system for blood transfusion services 25 14.6 None of these mechanisms 26 15.2 No response for both questions 4 2.4 These figures show little change from the last report, and it is of concern that 26 countries (15%) have neither a government budget nor a cost recovery system in place for the blood transfusion service. Also of concern is the number of countries that did not provide a response to these questions. Across WHO regions, 62% of countries (26 of 42) in Europe reported financing the blood services through a cost recovery scheme, either partially or entirely. In Africa, government budget allocations were the main mechanism for blood service financing: 49% of countries (21 of 43) financed the blood services solely through government budget allocation (Figure 2). Cost recovery reported might either be from the patient or from the hospital (that is, at no charge to the patient). Figure 2. Systems of blood service financing Fifty-six countries reported receiving financial support from international agencies or other organizations for blood services. Seventy-four countries reported receiving technical support from international agencies or other organizations for blood services. Further information is provided in Table 3. 21 10 4 9 6 9 5 6 1 9 1 3 14 9 3 17 7 7 3 8 2 7 4 6 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% AFR AMR SEAR EUR EMR WPR Line item in government budget Cost recovery Government budget+cost recovery No/not answered AFR: African Region; AMR: Region of the Americas; EMR: Eastern Mediterranean Region; EUR: European Region; SEAR: South-East Asia Region; WPR: Western Pacific Region GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 20216 Table 3. International financial and technical support Financial support from international agencies or other organizations for blood services Technical support from international agencies or other organizations for blood services Number Yes Yes 44 Yes No 12 No Yes 30 Countries receiving financial support included 25 (accounting for 58% of the reporting countries) in Africa, five (15%) in the Americas, six (60%) in South-East Asia, three (7%) in Europe, four (22%) in the Eastern Mediterranean, and five (20%) in the Western Pacific. Countries receiving technical support included 19 (44%) countries in Africa, 19 (58%) in the Americas, seven (70%) in South-East Asia, seven (17%) in Europe, five (28%) in the Eastern Mediterranean, and six (24%) in the Western Pacific. These figures indicate that, in comparison to 2013 data, international support and cooperation for blood safety, in particular for countries in Africa, has been reduced. International support and cooperation had played important roles in developing effective national blood systems and ensuring blood safety (3, 4). The trend of decreasing international support since the last report is of concern, as many resource-limited countries would still need such support. Eighty-four countries provided data on the total funding for the operation of the blood centres covered by the report. Looking at the relationship between total funding and total blood donations reported, varying funding levels per collection were found across the country income groups (Table 4). In general, funding per collection was higher in more economically developed countries. There were also variations among countries in the same income group. It is of concern that many low- and lower-middle-income countries reported that funding per collection was very low, or that the funding source was heavily dependent on external financial support. Table 4. Total funding per collection by World Bank economic group, 2018 Income group Total funding per collection (US$) (median, interquartile range) High (n=24) 296 (172–382) Upper middle (n=18) 102 (54–206) Lower middle (n=21) 31 (21–81) Low (n=21) 20 (12–41) 2.3 Inspection and licensing A total of 101 countries (59%) had a system of regular inspection of blood transfusion services by the national regulatory agency or another entity. Similarly, 101 countries (59%) had a system of licensing of the national blood transfusion service (NBTS) or other blood transfusion services by the national regulatory agency or another entity. Fifty-seven countries (33%) had an accreditation system for NBTS or other blood transfusion services (Table 5). 7CHAPTER 2: ORGANIZATION AND MANAGEMENT OF NATIONAL BLOOD TRANSFUSION SERVICES Table 5. Inspection and licensing results for responding countries Yes No No information Is there a system of regular inspection(s) of the NBTS/blood transfusion service(s) by the national regulatory agency or another entity? 101 61 9 Is there a system of licensing of the NBTS/blood transfusion service(s) by the national regulatory agency or another entity? 101 63 7 Are NBTS/blood transfusion service(s) accredited? 57 105 9 Effective governance depends upon mechanisms to identify and control the number of organizations permitted to act as blood transfusion services, and appropriate oversight of these organizations by an independent body reporting to the ministry of health. The WHO aide-memoire for ministries of health on “Developing a national blood system” states: “Regulatory mechanisms should be established for the control, inspection and licensing of blood transfusion services to enforce blood product standards and monitor product safety” (5). The number of countries that lack systems to license and inspect blood transfusion services continues to be a serious concern. Across the WHO regions (ranked by percentage), a system of inspection was reported in 16 (37%) countries in Africa, 12 (48%) in the Western Pacific, 18 (55%) in the Americas, 12 (67%) in the Eastern Mediterranean, seven (70%) in South- East Asia, and 36 (86%) in Europe. A system of licensing was reported in 17 (40%) countries in Africa, four (40%) in South-East Asia, 10 (40%) in the Western Pacific, nine (50%) in the Eastern Mediterranean, 25 (76%) in the Americas, and 36 (86%) in Europe. Accreditation of blood transfusion services was reported in six (14%) countries in Africa, eight (24%) in the Americas, three (30%) in South-East Asia, nine (36%) in the Western Pacific, eight (44%) in the Eastern Mediterranean, and 23 (55%) in Europe. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 20218 3.1 Global overview of blood collection It is estimated that 118.5 million blood donations were made in the 171 countries during the reporting period. Of these, 106.1 million were whole blood donations, and 12.4 million were apheresis donations (Table 6). These donations were collected from all types of blood donors: voluntary non-remunerated, family or replacement, and paid. This estimation has taken into consideration the partial data provided by a few countries. Annex 1 provides a note on how the estimation of global collection was performed. Table 6. Estimated blood donations by WHO region, 2018 Region Estimated whole blood donations (millions) Estimated apheresis donations (millions) Total (millions) % of global population Africa 6.1 0.03 6.1 14% Americas 21.6 2.5 24.1 13% South-East Asia 21.6 0.7 22.3 26% Europe 24.8 5.9 30.7 12% Eastern Mediterranean 8.8 0.2 9.0 9% Western Pacific 23.2 3.1 26.3 26% Global (rounded totals) 106.1 12.4 118.5 100% When the donation and population data are correlated and analysed by WHO region and World Bank income group, the level of availability of blood for transfusion is found to vary across WHO regions and World Bank income groups. For example, 43 countries in the WHO African Region collected a total of about 6.1 million blood donations; these accounted for only about 5% of global donations, although these countries are home to around 14% of the global population. In the European Region, the number of reported donations represented 26% of the global total, though the region is inhabited by only 12% of the global population. Similarly, countries in the high-income group collected 40% of the global donations, though their populations only account for 16% of the global population. Countries in the low-income and lower-middle-income groups collected 2% and 24% of the global donations, respectively, though their populations represent 8% and 40% of the global population, respectively (Figure 3). COLLECTION OF BLOOD AND BLOOD COMPONENTS 9CHAPTER 3: COLLECTION OF BLOOD AND BLOOD COMPONENTS Figure 3. Distribution (percentage) of population and blood donations by WHO region and World Bank income group, 2018 There were wide variations in blood donation rates among countries, ranging from 0.6 to 53.0 per 1000 population. The whole blood donation rate (median) was 31.5 donations per 1000 population per year (range 10.9–53.0) in high- income countries, 16.4 (range 4.6–47.6) in upper-middle-income countries, 6.6 (range 1.9–25.0) in lower-middle-income countries, and 5.0 (range 0.6–10.9) in low-income countries. Across WHO regions, the donation rates ranged as follows: 0.6 to 35.3 (median 5.4) in Africa,2 2.7 to 36.8 (median 14.6) in the Americas, 1.9 to 25.3 (median 10.6) in South-East Asia, 4.4 to 53.0 (median 32.1) in Europe, 0.6 to 25.3 (median 14.3) in the Eastern Mediterranean, and 3.4 to 47.6 (median 16.1) in the Western Pacific. Sixty countries reported collecting less than 10 whole blood donations per 1000 population per year in 2018 (Figure 4). Of these, 34 countries are in the WHO African Region, four in the Region of the Americas, five in the South-East Asia Region, four in the European Region, four in the Eastern Mediterranean Region, and nine in the Western Pacific Region (Figure 5). Given that seven countries that reported collecting less than 10 whole blood donations per 1000 population in 2013 did not respond to GDBS 2018, these figures have changed little since the last report. Figure 4. Distribution of countries by number of whole blood donations per 1000 population, 2018 2 Mauritius is an outlier in the African Region, with a donation rate of 35.3 per 1000 population. AFR: African Region; AMR: Region of the Americas; EMR: Eastern Mediterranean Region; EUR: European Region; SEAR: South-East Asia Region; WPR: Western Pacific Region 5 20 19 26 8 22 14 13 26 12 9 26 - 5 10 15 20 25 30 AFR AMR SEAR EUR EMR WPR Donation Population 27 33 32 20 12 10 37 0 5 10 15 20 25 30 35 40 <5 5 ─ <10 10 ─ <15 15 ─ <20 20 ─ <25 25 ─ <30 ≥30 N um be r o f c ou nt ri es 2 24 34 40 8 40 36 16 - 5 10 15 20 25 30 35 40 45 Low income Lower-middle income Upper-middle income High income Donation Population GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202110 Figure 5. Whole blood donations per 1000 population, 2018 3.2 Whole blood collection and apheresis collection From section 3.2 on, in analysing the types of blood donations, processing, testing, discarding, and clinical use, the data as reported by countries, including partial data reported by countries (see Annex 1 for explanatory note), rather than the estimated number based on the data coverage percentage, were directly used for aggregation and analysis. Where appropriate, analysis by WHO region and World Bank income group was also conducted. Ninety of the 171 responding countries reported collecting blood both as whole blood donations and through apheresis procedures. Of the 107 million total donations reported to the GDBS worldwide in 2018, 89% (95.2 million) were donated as whole blood, and 11% (11.9 million) were collected through apheresis procedures. In high-income countries, 22.6% of all donations were collected through apheresis, compared to 6.5% in upper-middle-income countries, and 0.5% in lower-middle-income countries. Across WHO regions, apheresis donations were mainly reported in the European Region, the Western Pacific Region, and the Region of the Americas, where 20.0%, 14.4%, and 8.7% (respectively) of the total donations were collected through apheresis procedures (Figure 6). Figure 6. Method of collection of blood donations by WHO region and World Bank income group, 2018 AFR AMR SEAR EUR EMR WPR Whole blood donations Apheresis donations AFR: African Region; AMR: Region of the Americas; EMR: Eastern Mediterranean Region; EUR: European Region; SEAR: South-East Asia Region; WPR: Western Pacific Region Low income Lower-middle income Upper-middle income High income Whole blood donations Apheresis donations 11CHAPTER 3: COLLECTION OF BLOOD AND BLOOD COMPONENTS 3.3 Types of blood donations Overall, of the total 95.2 million whole blood donations reported, 78.8 million (82.8%) were reported as voluntary non- remunerated donations, 15.1 million (15.9%) as family or replacement donations, and 164 000 (0.2%) as paid blood donations. The categories of the other 1.2% (1 167 800) of donations were unknown. In 2018, the proportion of voluntary non-remunerated whole blood donations in high-income, upper-middle-income, lower-middle-income, and low-income groups were 95.6%, 81.9%, 69.5%, and 62.8%, respectively. Higher-income groups in general had a higher proportion of blood collected from voluntary non-remunerated blood donors in surveyed countries (Figure 7). When analysed by WHO region, the proportion of voluntary non-remunerated whole blood donations varied from 49.4% in the Eastern Mediterranean Region to as high as 95.2% in the European Region and 98.7% in the Western Pacific Region. The proportion of voluntary non-remunerated whole blood donations in the African Region, Region of the Americas, and South-East Asia Region was 70.5%, 67.6%, and 79.1%, respectively (Figure 7). Figure 7. Proportions of voluntary non-remunerated whole blood donations by WHO region and World Bank income group, 2018 70.5 67.6 79.1 95.2 49.4 98.7 0 10 20 30 40 50 60 70 80 90 100 AFR AMR SEAR EUR EMR WPR % AFR: African Region; AMR: Region of the Americas; EMR: Eastern Mediterranean Region; EUR: European Region; SEAR: South-East Asia Region; WPR: Western Pacific Region Globally, 88.7% (10  542  000) of 11.9 million apheresis donations for clinical transfusion were given by voluntary non-remunerated donors, 0.6% (70 590) by family or replacement donors, and 1.0% (123 400) by paid donors. It is possible, however, that the data for some European countries may reflect the inclusion of some plasma donations for fractionation. The categories of the other 9.7% (1 151 300) of donations were unknown. In the European Region, 81.1% of the 5 739 200 apheresis donations were from voluntary non-remunerated donors, 0.3% from family or replacement donors, 1.5% from paid donors, and 17.1% with the type of donations unknown. In the Western Pacific Region, the majority of the collections reported were from voluntary non-remunerated donors, totalling 3 822 430 (98.7%). A total of 1 530 400 (91.2%) apheresis donations were collected from voluntary non-remunerated donors in the Region of the Americas, 0.4% from family or replacement donors, and 8.4% with the type of donations unknown. In the Eastern Mediterranean Region, 68.0% of the total 172 700 apheresis donations were from voluntary non-remunerated blood donors, 18.7% from family or replacement donors, 1.2% from paid donors, and 12.1% with the type of donations unknown (Figure 8). 62.8 69.5 81.9 95.6 0 10 20 30 40 50 60 70 80 90 100 Low income Lower-middle income Upper-middle income High income % GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202112 Figure 8. Total number of apheresis donations (thousands) and distribution of donation types by WHO region Figure 9 shows the geographical distribution by country of the proportion of voluntary non-remunerated blood donations (both whole blood and apheresis donations). Figure 9. Proportion of voluntary non-remunerated donations (whole blood and apheresis donations combined) by country, 2018 AFR: African Region; AMR: Region of the Americas; EMR: Eastern Mediterranean Region; EUR: European Region; SEAR: South-East Asia Region; WPR: Western Pacific Region AFR (n=7) 30 AMR (n=14) 1678 SEAR (n=4) 397 EUR (n=35) 5739 EMR (n=9) 173 WPR (n=11) 3871 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% AFR (n=7) AMR (n=14) SEAR (n=4) EUR (n=35) EMR (n=9) WPR (n=11) Voluntary non-remunerated donations Family/replacement Paid Unknown 13CHAPTER 3: COLLECTION OF BLOOD AND BLOOD COMPONENTS 3 For the method to assign values for missing data, please see the explanatory note in Annex 1. Overall, 79 countries collected more than 90% of their blood supply from voluntary non-remunerated blood donations: 31 in the European Region, 17 in the African Region, 13 in the Western Pacific Region, eight in the Region of the Americas, six in the Eastern Mediterranean Region, and four in the South-East Asia Region. Sixty-four countries reported collecting 100% or over 99% of their blood supply from voluntary non-remunerated donations. Fifty-four countries (16 in Africa, 21 in the Americas, three in South-East Asia, four in Europe, six in the Eastern Mediterranean, and four in the Western Pacific) remained considerably dependent on family or replacement and paid blood donors, with these donations accounting for more than 50% of their blood supplies in 2018. 3.4 Trends in whole blood collections in the world, 2008–2018 To assess the global trends in whole blood collections over the 10-year period, whole blood collection data from a total of 119 countries (Africa 35, Americas 27, South-East Asia six, Europe 27, Eastern Mediterranean 10, Western Pacific 14), which were either reported to the GDBS by the countries for the years 2008, 2010, 2012, 2014, 2016 and 2018 or estimated when data for specific years were missing using the data for the years immediately before or after the year with missing data,3 were compiled and analysed. Overall, an increase of 10.7 million blood donations from voluntary non-remunerated donors between 2008 and 2018 was observed in the 119 countries for which data for both years are available. An increase of 12.3 million total collections from all types of blood donors was observed between 2008 and 2018 (Table 7). By WHO region, except for Europe, in which a marginal increase was observed from 2008 to 2012 and then a marginal decrease from 2012 to 2018, all WHO regions registered trends of increases in total whole blood collections from all types of blood donors and donations collected from voluntary non-remunerated donors (Figure 10). Data from countries in North America have been excluded from the analysis in the Region of the Americas, so the results only reflect the blood collection trends in 27 Latin American and Caribbean countries. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202114 Table 7. Voluntary non-remunerated donation (VNRD) and total whole blood collection in 119 countries (millions) by WHO region, 2008–2018  Region  Donation type 2008 2010 2012 2014 2016 2018  Africa (n=35) VNRD 1.89 2.45 2.80 2.79 3.07 3.42 Total donations 2.41 3.03 3.29 3.41 3.79 4.46 Americas (n=27)a VNRD 1.28 1.43 1.73 1.94 2.17 2.32 Total donations 4.51 4.74 4.95 5.15 6.06 6.33 South-East Asia (n=6)b VNRD 2.40 2.88 3.33 4.06 4.37 5.45 Total donations 2.98 3.55 4.13 4.95 5.19 6.43 Europe (n=27) VNRD 11.53 11.95 12.48 11.79 11.73 11.79 Total donations 12.03 12.51 12.69 12.24 11.99 12.10 Eastern Mediterranean (n=10)c VNRD 2.48 2.64 2.80 2.88 2.93 3.11 Total donations 2.79 3.00 3.28 3.34 3.38 3.61 Western Pacific (n=14) VNRD 15.38 17.37 17.68 17.84 17.76 19.53 Total donations 15.52 17.42 18.23 18.38 18.32 19.63 Total (n=119) VNRD 34.96 38.73 40.82 41.30 42.03 45.62 Total donations 40.24 44.25 46.57 47.48 48.73 52.56 Notes: a The 27 countries in the Region of the Americas did not include Canada and the United States of America. b The six countries included in the South-East Asia Region did not included India, which reports collection of a very large number of blood donations every year. c Ten countries (of the 18 countries responding to GDBS 2018) in the Eastern Mediterranean Region are countries with a higher proportion of blood donations collected from voluntary non-remunerated donors. Figure 10. Total whole blood collections and voluntary non-remunerated donations (millions) by WHO region, 2008–2018 0 2 4 6 8 10 12 14 16 18 20 20 08 20 10 20 12 20 14 20 16 20 18 20 08 20 10 20 12 20 14 20 16 20 18 20 08 20 10 20 12 20 14 20 16 20 18 20 08 20 10 20 12 20 14 20 16 20 18 20 08 20 10 20 12 20 14 20 16 20 18 20 08 20 10 20 12 20 14 20 16 20 18 Africa (n=35) Americas (n=27) South-Eastern Asia (n=6) EUR (n=27) Eastern Mediterranean (n=10) Western Pacific (n=14) N um be r o f w ho le b lo od d on at oi ns c ol le ct ed (m ill io n) Donations collected from VNRD Total whole blood collections 15CHAPTER 3: COLLECTION OF BLOOD AND BLOOD COMPONENTS In addition, average annual rates of change in total whole blood collections and voluntary non-remunerated donations between 2008 and 2018 were calculated and trends for individual countries were assessed (Table 8). The median annual rate of change in total whole blood collections in the African Region was 7%, ranging from −4% to 60%, with the lower and upper quartiles at 5% and 15%. This means that in the majority (75%) of countries in the Region, total whole blood collections increased at annual rates of 5% to 60%. Similarly, the majority of countries in the Region of the Americas reported that total whole blood collections increased at annual rates of 2% to 15%. The majority of the countries in the Eastern Mediterranean Region reported that total whole blood collections increased at annual rates of 2% to 30%. In the European Region, half of the countries reported a decrease in total whole collections between 2008 and 2018, with annual rates of decrease at −7% to −1%. In contrast, 10 countries reported an increase in total whole blood collections and voluntary non-remunerated donations: Albania, Bulgaria, Croatia, Kyrgyzstan, Montenegro, North Macedonia, Poland, Romania, Slovakia and Tajikistan. In the South-East Asia Region, an increase in total whole blood collections and voluntary non-remunerated donations was reported by all six countries that were included for analysis. In the Western Pacific Region, 11 of 14 countries reported that total whole blood collections increased between 2008 and 2018 at annual rates ranging from 1% to 14%. In contrast, three countries in the Region reported a decrease. Sixty per cent (21 of 35) of countries in the African Region, 82% (23 of 28) in the Region of the Americas, and 83% (five of six) in the South-East Asia Region reported that voluntary non-remunerated donations increased at an annual rate greater than 10%, suggesting that the increase in total whole blood collections in the regions were mainly driven by an increase in the number of voluntary non-remunerated donations. However, some of the increases in rates reported could be due to zero or small baseline numbers reported in 2008, so any increase in absolute numbers would lead to the calculation of a high rate of increase. Table 8. Annual rate of change of whole blood collections (total and voluntary non-remunerated donation, VNRD) by WHO region, 2008–2018 (median and range, %) Region Type Median Range Interquartile range Min. Max. Lower Upper Africa (n=35) VNRD 16 1 251 8 42 Total 7 −4 60 5 15 Americas (n=27) VNRD 52 −2 594 15 125 Total 3 −2 15 2 6 South-East Asia (n=6) VNRD 15 6 71 12 19 Total 11 2 14 6 13 Europe (n=27) VNRD 0.3 −4 525 −2 15 Total −1 −7 17 −2 3 Eastern Mediterranean (n= 10) VNRD 9 2 37 5 15 Total 5 −3 30 2 7 Western Pacific (n=14) VNRD 7 −3 72 3 16 Total 5 −3 14 2 7 Note: Formula to calculate the average annual change rate (%) is: [(donation number in 2018 − donation number in 2008)/(donation number in 2008) x 100%]/10. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202116 3.5 Blood donor profile 3.5.1 Donor sex and age profile Data from 113 countries on the sex profile of blood donors show that, overall, 33% of blood donations were given by female donors; of these, 15 countries reported less than 10% of donations by women. Across the WHO regions, the Eastern Mediterranean had the lowest proportion of donations given by female donors (Table 9). However, substantial variations exist among countries within the region. For example, of 14 countries in the Eastern Mediterranean reporting data on the sex distribution of blood donations, 10 reported that less than 10% of donations were given by female donors. The other four countries – United Arab Emirates, Egypt, Tunisia and Oman – reported percentages of 31%, 19%, 16% and 10%, respectively. Table 9. Blood donations from female donors by WHO region (median and range, %) Region Median Range Africa (n=26) 22 8–54 Americas (n=20) 40 23–63 South-East Asia (n=7) 27 3–55 Europe (n=26) 38 9–57 Eastern Mediterranean (n= 14) 6 0.4–31 Western Pacific (n=20) 30 8–59 A total of 81 countries (Africa 21, Americas 16, South-East Asia four, Europe 16, Eastern Mediterranean 11, Western Pacific 13) reported data on the number of donations given by donors of different age groups (Figure 11). Globally, 45% of donations were given by donors aged 25 to 44 years. Donors of the age groups 45 to 64 years and 18 to 24 years contributed 24% and 25% of the total donations, respectively. Of the total donations, 4% were given by donors in the group aged 65 years and over, and 3% were given by donors aged younger than 18 years. GDBS data show that proportionally more young people donate blood in low- and middle-income countries than in high-income countries: 38% of blood donations were given by donors aged 24 years or younger in low-income countries, 47% in lower-middle- income countries, 28% in upper-middle-income countries, and 25% in high-income countries (Figure 12). This may mainly reflect the age structure of the populations in developed and developing countries: proportionally there are more young people in developing countries, and there are relatively more older people in developed countries. Demographic information about blood donors is important for formulating and monitoring donor recruitment strategies to meet blood requirements and achieve self-sufficiency. This may include strategies to address the barriers to blood donation that specific populations may face. 17CHAPTER 3: COLLECTION OF BLOOD AND BLOOD COMPONENTS Figure 11. Contributions to donations by donors of different age groups in selected countries, 2018 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Mauritius Seychelles Gabon Côte d'Ivoire South Africa Madagascar Mali Nigeria Namibia Benin Niger Central African Republic Senegal Congo Burkina Faso Burundi Zimbabwe Comoros Kenya Zambia Eswatini Trinidad and Tobago Canada Saint Vincent and the Grenadines Argentina Dominica Saint Kitts and Nevis United States of America Belize Saint Lucia Honduras Guyana Chile Brazil Bolivia (Plurinational State of) Nicaragua Colombia Indonesia Maldives Nepal Thailand Myanmar Finland Malta Iceland Croatia Bulgaria Slovenia Portugal Latvia Estonia France Republic of Moldova Kazakhstan Poland Tajikistan Turkey Slovakia Af ric a Am er ic as So ut h- Ea st A sia Eu ro pe Under 18 years 18 to 24 years 25 to 44 years 45 to 64 years 65 years or older GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202118 < 18 years 3% 18–24 years 25% 25–44 years 44% 45–64 years 24% ≥65 years 4% Figure 12. Contribution to donations by donors of different age groups and by World Bank income group, 2018 Figure 11. Contributions to donations by donors of different age groups in selected countries, 2018 (cont.) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Bahrain Qatar Iran (Islamic Republic of) Kuwait Oman Jordan Yemen Saudi Arabia Egypt Libya United Arab Emirates New Zealand Singapore Micronesia (Federated States of) Brunei Darussalam Cook Islands China Papua New Guinea Malaysia Fiji Cambodia Kiribati Republic of Korea Lao People's Democratic Republic Ea st er n M ed ite rr an ea n W es te rn P ac ifi c Under 18 years 18 to 24 years 25 to 44 years 45 to 64 years 65 years or older 3.5.2 Repeat donors and first-time donors A total of 91 countries (Africa seven, Americas 16, South-East Asia six, Europe 35, Eastern Mediterranean 9, Western Pacific 18) reported data on the number of voluntary non-remunerated whole blood donations given by first-time donors and repeat donors. Overall, the percentage of whole blood donations given by repeat voluntary non-remunerated blood donors in countries ranged widely from less than 0.1% to 100% (median 59%). Table 10 shows the proportions of donations given by repeat voluntary non-remunerated blood donors, by WHO region. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Low income Lower- middle income Upper- middle income High income ≥65 years 45–64 years 25–44 years 18–24 years < 18 years 19CHAPTER 3: COLLECTION OF BLOOD AND BLOOD COMPONENTS Table 10. Donations given by repeat voluntary non-remunerated blood donors by WHO region (median and range, %) Region Median Range Interquartile range Africa (n=7) 38 30–76 – Americas (n=16) 20 0.3–87 16–54 South-East Asia (n=6) 57 5–86 31–63 Europe (n=35) 90 0.1–100 68–93 Eastern Mediterranean (n=9) 37 1–88 18–45 Western Pacific (n=18) 56 2–96 32–83 A proxy measure for regular blood donations is the frequency of donations per donor per year. Data reported to the WHO GDBS on the number of active whole blood donors and the number of donations these donors had given in 2018 were provided by 57 countries – one low-income country, nine lower-middle-income countries, 13 upper-middle-income countries, and 34 high-income countries – accounting for 67.6 million whole blood donations. Overall, each donor donated 1.48 (median) whole blood donations on average in 2018 with the range from 1.01 to 2.12. Many countries reported exactly the same number for active donors and donations, an error probably due to the lack of an appropriate donor database that can uniquely identify donations from the same donor. It is important to have a regular donor base to ensure a sufficient and safe blood supply. It is also important to continuously recruit new donors into the donor base. 3.5.3 Donor deferral Data on deferral from blood donation were provided by 130 countries (Africa 35, Americas 25, South-East Asia seven, Europe 31, Eastern Mediterranean 13, Western Pacific 19). The total deferral rates (the percentage of deferrals among all blood donor presentations) varied widely among countries, from less than 1% to over 67%. The median rate of total deferral was 13%. Only 110 countries (low income 20, lower-middle income 30, upper-middle income 24, high income 36) provided number of deferrals by reason. Figure 13 shows the relationship between the countries’ income and the average percentage of deferrals by low weight, low haemoglobin, high-risk behaviour, and travel history. Along with increased income, the deferral rate for low weight decreased, and that for travel history increased. This may reflect different health or nutrition status and human behaviour in populations in the countries in different income groups. Figure 13. Donor deferral rate (%) by reason in countries in different income groups 0.10 4.76 0.31 1.33 0.17 4.00 2.53 0.24 0.50 1.93 0.30 0.64 1.42 0.92 0.73 0.02 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00 Low weight Low haemoglobin High-risk behaviour Travel history A ve ra ge d ef er ra l r at e by re as on (% ) High income Upper-midle income Lower-middle income Low income GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202120 Table 11 shows the median and interquartile range of the total deferral rate, by WHO region. Variations in deferral rates could be due to absence of donor selection criteria or appropriate donor selection procedures, or different donor registration practices. It is important to note, however, that there may be underreporting of the total number of deferrals or deferrals due to specific reasons, in particular by developing countries. Many countries were unable to provide information on the number of deferrals from blood donation and the underlying reasons. Collection of these data should be encouraged, as they are useful for countries in monitoring implementation of their donor selection guidelines, and in identifying needs for improvement in donor education. Table 11. Donor deferral rate by WHO region (median and interquartile range, %) Region Median Interquartile range Africa (n=35) 6.3 2.8–13.1 Americas (n=25) 20.3 15.1–27.7 South-East Asia (n=7) 11.5 4.5–11.6 Europe (n=31) 11.3 6.7–13.7 Eastern Mediterranean (n=13) 14.9 9.2–16.4 Western Pacific (n=19) 13.2 10.2–21.0 21CHAPTER 4: PROCESSING OF WHOLE BLOOD DONATIONS INTO COMPONENTS Blood collected in an anticoagulant can be stored and transfused to a patient in an unmodified state. This is known as whole blood transfusion. However, blood may be used more effectively if it is separated into components (red cell concentrates, fresh frozen plasma, cryoprecipitate, and platelet concentrates), so that it can meet the needs of more than one patient. Based on data reported to the GDBS by 157 countries, 89% of whole blood donations collected globally were processed into components: 96% in high-income countries, 96% in upper-middle-income countries, 75% in lower-middle-income countries, and 38% in low-income countries. Across the WHO regions, the percentages for processing blood into components were 62% in the African Region, 91% in the Region of the Americas, 78% in the South-East Asia Region, 99% in the European Region, 78% in the Eastern Mediterranean Region, and 98% in the Western Pacific Region (Figure 14). Figure 14. Whole blood donations processed into components by WHO region and World Bank income group, 2018 (%) PROCESSING OF WHOLE BLOOD DONATIONS INTO COMPONENTS 62 91 78 99 78 98 - 10 20 30 40 50 60 70 80 90 100 AFR AMR SEAR EUR EMR WPR AFR: African Region; AMR: Region of the Americas; EMR: Eastern Mediterranean Region; EUR: European Region; SEAR: South-East Asia Region; WPR: Western Pacific Region 38 75 96 96 0 10 20 30 40 50 60 70 80 90 100 Low income Lower-middle income Upper-middle income High income GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202122 CHAPTER 5: LABORATORY SCREENING OF BLOOD DONATIONS Table 12 shows the number of countries processing blood donations into components in different percentage groupings, by WHO region. In almost all countries in Europe (37/39), over 90% of whole blood donations were separated into components. In other WHO regions, between 42% (18/43 in Africa) and 71% (22/31 in the Americas) of countries reported that over 90% of whole blood donations were separated into components. Around 44% (19/43) of countries in Africa, 20% (2/10) of countries in South-East Asia, 15% (3/20) of countries in the Western Pacific, and 6.5% (2/31) of countries in the Americas reported that less than 50% of whole blood donations were separated into components. In comparison with previous reporting based on GDBS 2013, an increase in the proportions of whole blood processed into components was observed in the South-East Asia Region and Eastern Mediterranean Region. South-East Asia also reported that more countries were able to process a higher percentage of whole blood into components. The African Region reported a slight decrease. The other three regions (the Americas, Europe and the Western Pacific) reported high (greater than 90%) proportions of whole blood donations processed into components in both 2013 and 2018. Table 12. Proportion of blood donations processed into components: number of countries in each percentage grouping by WHO region, 2018  Region < 25% 25–49.9% 50–74.9% 75–89.9% 90–100% Africa (n=43) 15 4 3 3 18 Americas (n=31) 0 2 0 6 22 South-East Asia (n=10) 0 2 1 2 5 Europe (n=39) 0 0 0 2 37 Eastern Mediterranean (n=14) 0 2 0 4 8 Western Pacific (n=20) 1 2 0 5 12 23CHAPTER 5: LABORATORY SCREENING OF BLOOD DONATIONS 5.1 Laboratory screening policy The following subsections analyse the data on laboratory screening policy according to the target for screening. 5.1.1 Human immunodeficiency virus, hepatitis B virus, and hepatitis C virus In the WHO GDBS questionnaire, questions were asked on the policy related to the minimum requirements for laboratory screening of blood. Of the 171 responding countries, 166 reported having a policy of screening all blood donations for human immunodeficiency virus (HIV). Five countries did not answer the questions. Overall, 21 countries reported testing for HIV-1/2 antibodies (Ab), while 90 countries reported testing for HIV-1/2 antibodies and antigens (Ab+Ag). A total of 55 countries reported testing for HIV ribonucleic acid (RNA) using nucleic acid amplification testing (NAT) in addition to serological testing for all blood donations or selected donations (Table 13). Of the 171 responding countries, 166 reported having a policy of screening all blood donations for hepatitis B virus (HBV). Five countries did not answer the questions on HBV testing policy. All 166 countries reported having a policy of testing all blood donations for hepatitis B surface antigen (HBsAg). A total of 26 countries reported having a policy of testing all blood donations for anti-HBc in addition to testing for HBsAg; four countries reported selective testing for anti-HBc in addition to testing for HBsAg. Fifty-five countries reported using NAT for HBV in addition to serological testing for all blood donations or selected donations (Table 14). Of the 171 responding countries, a total of 164 countries reported having a policy of serological testing of all blood for hepatitis C virus (HCV), with 126 countries having a policy of testing all blood for HCV antibodies, and 38 countries testing for HCV Ab+Ag. Fifty-four countries reported also having a policy of NAT in addition to the serological testing for all blood donations or selected donations. Seven countries did not answer the questions in this section (Table 15). LABORATORY SCREENING OF BLOOD DONATIONS GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202124 CHAPTER 5: LABORATORY SCREENING OF BLOOD DONATIONS Table 13. Distribution of blood laboratory screening policies for HIV-1/2 by WHO region  Region Ab Ab+Ag Ab + NATa Ab+Ag + NATb Unanswered Africa (n=43)c 6 33 0 2 2 Americas (n=33) 1 24 3 4 1 South-East Asia (n=10) 4 2 0 4 0 Europe (n=42) 1 14 11 16 0 Eastern Mediterranean (n=18) 0 11 1 6 0 Western Pacific (n=25) 9 6 4 4 2 Global (n=171) 21 90 19 36 5 a Cuba reported policy of selective NAT testing. b Albania, Colombia, Indonesia, Malaysia, Myanmar, Pakistan, and Sri Lanka reported policies of selective NAT testing. c The data collection form used for the collection of the 2018 data for the African Region did not include this information. Information collected in earlier years (2015 or 2014) was used for the analysis. Table 14. Distribution of blood laboratory screening policies for HBV by WHO region Region HBsAg HBsAg + anti-HBc (routine) HBsAg + anti-HBc (selective) HBsAg + NATa HBsAg + anti-HBc (routine) + NATb HBsAg + anti-HBc (selective) + NAT Unanswered Africa (n=43)c 33 5 0 0 1 1 2 Americas (n=33) 13 9 3 1 5 1 1 South-East Asia (n=10) 4 2 0 3 1 0 0 Europe (n=42) 10 5 1 16 6 4 0 Eastern Mediterranean (n=18) 6 4 0 1 7 0 0 Western Pacific (n=25) 14 1 0 6 1 1 2 Global (n=171) 80 26 4 27 21 7 5 a Albania, Cuba, Indonesia, Malaysia, and Myanmar reported policies of selective NAT testing. b Colombia, Lebanon, Pakistan, and Sri Lanka reported policies of selective NAT testing. c The data collection form used for the collection of the 2018 data for the African Region did not include this information. Information collected in earlier years (2015 or 2014) was used for the analysis. Table 15. Distribution of blood laboratory screening policies for HCV by WHO region  Region HCV Ab HCV Ab+Ag HCV Ab + NATa HCV Ab+Ag + NATb Unanswered Africa (n=43)c 31 8 1 1 2 Americas (n=33) 17 7 5 2 2 South-East Asia (n=10) 5 1 3 1 0 Europe (n=42) 10 5 23 3 1 Eastern Mediterranean (n=18) 7 4 3 4 0 Western Pacific (n=25) 13 2 8 0 2 Global (n=171) 83 27 43 11 7 a Albania, Colombia, Cuba, Indonesia, Malaysia, Myanmar, and Pakistan reported policies of selective NAT testing. b Sri Lanka reported policy of selective NAT testing. c The data collection form used for the collection of the 2018 data for the African Region did not include this information. Information collected in earlier years (2015 or 2014) was used for the analysis. 5.1.2 Syphilis Two European countries (Denmark, Iceland) reported implementing a policy of not routinely performing syphilis testing for blood donations. Another European country (Norway) reported implementing a policy of syphilis testing 25CHAPTER 5: LABORATORY SCREENING OF BLOOD DONATIONS for selective donations, Three countries (two in Africa, one in Western Pacific) did not answer the questions on syphilis testing policy. All other 165 responding countries had a policy of performing syphilis testing for all donations. 5.1.3 Chagas Twenty countries in the Region of the Americas reported having a policy of testing all blood donations for Trypanosoma cruzi. Twelve countries reported implementing selective testing for T. cruzi for donors who had travelled to at-risk areas or who had defined risk factors (Table 16). Table 16. Testing for Chagas disease Test for all donations Selective testing Argentina Belgium Belize Canada Bolivia (Plurinational State of) Central African Republic Brazil France Chile Italy Colombia Japan Costa Rica New Zealand Ecuador Portugal El Salvador Spain Guatemala Sweden Guyana Switzerland Honduras United States of America Mexico Nicaragua Panama Paraguay Suriname Trinidad and Tobago Uruguay Venezuela (Bolivarian Republic of) 5.1.4 Human T-lymphotropic virus Thirty-five countries reported having the policy of testing all blood donations for human T-lymphotropic virus (HTLV-1/2) antibody. Fifteen countries reported implementing selective testing for donors from specific geographical locations, new donors or donors who had not been tested before (Table 17). GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202126 CHAPTER 5: LABORATORY SCREENING OF BLOOD DONATIONS Table 17. Testing for HTLV-1/2 Africa Americas Europe Eastern Mediterranean Western Pacific Seychelles Argentina France* Iran (Islamic Republic of)* Australia Benin* Bahamas Greece Kuwait China* Barbados Israel Oman Japan Brazil Luxembourg* Qatar New Zealand* Canada Netherlands* Saudi Arabia Republic of Korea* Chile Norway* United Arab Emirates Viet Nam* Colombia Portugal* Costa Rica Romania Dominica Spain* Ecuador* Sweden* Guyana United Kingdom* Haiti Honduras Jamaica Panama Paraguay Peru Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago United States of America Uruguay Venezuela (Bolivarian Republic of) * Selective testing. 5.1.5 Malaria Fifty-one countries reported having a policy of testing for malaria, of which 20 countries (five in Africa, four in the Americas, four in South-East Asia, two in Europe, three in the Eastern Mediterranean, and two in the Western Pacific) required such testing for all donations. The malaria screening policy in these 51 countries is listed in Table 18. 27CHAPTER 5: LABORATORY SCREENING OF BLOOD DONATIONS Table 18. Malaria testing policy in 51 countries Region Testing for all donations (microscopy) Selective testing (microscopy) Selective testing (antibody testing) Africa Angola Eswatinib Madagascarb Malawi Sao Tome and Principeb Botswanab Gambiaa Americas Belize Brazila Guyana Suriname Colombia Mexico South-East Asia Bangladesha Bhutan Indiaa Sri Lanka Indonesiab Myanmarb Nepala Europe Tajikistan Uzbekistan Finlanda Icelandb Norwayb Swedenb Belgium Greece Italy Luxembourg Netherlands Portugal Spain Switzerland United Kingdom Eastern Mediterranean Pakistana Saudi Arabia Yemenb Bahrain Kuwait Qatarc United Arab Emirates Western Pacific Philippinesa Vanuatu Fijia Malaysia Viet Nam Australia New Zealand Republic of Korea Singapore a Microscopy or antigen testing. b Antigen testing. c Selective testing for antigen and antibody. 5.1.6 Other transfusion-transmissible infections Fourteen countries (Austria, Canada, Cyprus, Germany, Greece, Italy, Luxembourg, Poland, Romania, Singapore, Spain, Switzerland, United Kingdom, United States of America) reported a West Nile virus testing policy. Canada and the United States of America tested all donations for West Nile virus RNA, while other countries tested selected donations. The United States of America also reported a Zika virus testing policy. Four countries (Finland, Japan, Luxembourg, Switzerland) reported a human parvovirus B19 testing policy for all donations. Switzerland indicated that the policy was implemented as required by the fractionation industry. Luxembourg and Switzerland also reported a testing policy for hepatitis A virus. France, Japan and Luxembourg reported a selective testing policy for hepatitis E virus; Switzerland reported the implementation of NAT testing for hepatitis E virus for all donations since October 2018. Three countries (Argentina, Armenia, Mexico) reported testing all donations for Brucella infection. Reports of testing under the category “other transfusion-transmissible infections” to the GDBS may not be exhaustive; countries that have implemented specific blood testing may not provide the information to WHO due to the unspecific nature of the GDBS questions. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202128 CHAPTER 5: LABORATORY SCREENING OF BLOOD DONATIONS 5.2 Coverage and quality of laboratory screening of blood donations Based on GDBS data, 10 countries (five in Africa, three in the Western Pacific, one in the Americas, and one in the Eastern Mediterranean) reported not being able to test 100% of the blood collected for one or more of the four transfusion- transmissible infections (TTIs) – HIV, HBV, HCV and syphilis – as required by the national testing policy. Three countries (two in Africa and one in the Western Pacific) reported not being able to test all donations for HIV. The percentage of donations tested in these countries ranged from 94.6% to 98.1%. Five countries (four in Africa and one in the Western Pacific) reported not being able to test all donations for HBV, with the percentage of donations tested in these countries ranging from 92.5% to 99.9%. Six countries (four in Africa and two in the Western Pacific) reported not being able to test all donations for HCV. The percentage of donations tested ranged from 88.8% to 99.7%. Two countries (one in the Americas and one in the Western Pacific) reported not testing donated blood for HCV. Seven countries (five in Africa, one in the Eastern Mediterranean, and one in the Western Pacific) reported not being able to test all donations for syphilis. The percentages of donations tested ranged from 55.5% to 98.5%. Six countries (three in the Eastern Mediterranean, three in the Western Pacific) were not able to provide data on the coverage of one or more screening tests for the four key infectious markers of HIV, HBV, HCV and syphilis. To assess whether blood screening was conducted in a quality-assured manner, data were collected on two aspects of quality assurance: use of standard operating procedures and participation in external quality assessment. Reports were received from 107 countries on the percentage of blood donations that were screened in facilities that met these quality assurance criteria. Overall, 98% of the donations reported by these countries were screened following these basic quality-assured procedures. In high-income and upper-middle-income countries, 99.8% and 99.9%, respectively, of the donations were screened following basic quality-assured procedures, compared to 82.8% and 76.2% in lower- middle-income countries and low-income countries, respectively. To supplement the assessment of the quality of testing, data on the status of the participation of blood screening laboratories in the External Quality Assessment Scheme (EQAS) for the testing of TTIs were analysed. Data on the status of EQAS participation of 4365 laboratories were reported by 126 countries (high income 37, upper-middle income 36, lower-middle income 36, low income 17). Globally, 68% of blood screening laboratories participated in EQAS for the testing of TTIs (88%, 75%, 50% and 68% in high-, upper-middle, lower-middle, and low-income countries, respectively) (Table 19). Care should be taken in interpreting the data provided for these two indicators. These results only reflect the status of countries that answered this question, rather than global status. There is evidence that countries lacking certain quality elements (for example, full participation of screening laboratories in EQAS) are more likely to skip the GDBS questions on quality-assured testing. The countries with no data or no response could be even worse with regard to quality assurance. The coverage of quality-assured testing for TTIs has been identified as a key global indicator for monitoring important global disease control programmes (6, 7). Countries are encouraged to implement all elements of the quality system in their blood screening laboratories and provide accurate information for these indicators. 29CHAPTER 5: LABORATORY SCREENING OF BLOOD DONATIONS Table 19. Proportion of blood screening laboratories that participate in EQAS for testing of TTIs by World Bank income group  Income group No. of blood screening laboratories No. of laboratories participating in EQAS Percentage Low (n=17) 491 335 68 Lower middle (n=36) 1 384 697 50 Upper middle (n=36) 2 096 1 575 75 High (n=37) 394 346 88 According to the GDBS for 2018, 40 of 140 countries4 (22 in Africa, 11 in the Western Pacific, four in South-East Asia, two in the Eastern Mediterranean and one in Europe) reported that all donations (13 countries) or a percentage of donations were tested using rapid tests. Five Pacific island nations (Cook Islands, Federated States of Micronesia, Kiribati, Samoa, Tonga) in the Western Pacific Region reported that all blood donations were tested using rapid tests. Annual numbers of blood samples in these countries are small, ranging from 300 to 3000. The use of rapid, simple, single-use devices is generally not recommended for blood screening. They may, however, be considered for use in situations, often in remote or poorly supported areas, where the blood service is not yet developed or blood is needed urgently but banked blood is not available. High-quality testing devices should be selected and the testing performed in a quality-assured manner. 5.3 Prevalence of markers of infection in blood donations Prevalence of an infection among blood donations or the proportion of blood donations with a positive result are directly related to the safety of the blood supply, because they have an impact on the residual risk of distributed blood components for transfusion, and also on the risk due to errors in blood quarantine and release (even though test-positive donations should be discarded). Prevalence of an infection in blood donations is dependent on the prevalence of an infection in the population from which blood donors are selected, and on the effectiveness of donor recruitment and selection processes. Table 20 shows the proportion of blood donations with positive or reactive5 results in screening tests for HIV, HBV, HCV, and syphilis, by income group. Globally, the proportions vary greatly, with the lowest proportions in developed countries and the highest in developing countries for all infections. 4 The GDBS survey on the use of rapid tests does not include countries in the Region of the Americas, except Canada and the United States of America. 5 See Annex 1 for an explanatory note on the issue of varying testing/confirmatory strategies in countries, on which the reported numbers of positive/reactive test donations and proportion of positive/reactive results in blood donations tested were based. The prevalence data presented in this report are a mix of both repeat reactive results in the blood centre and confirmed positive results. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202130 Table 20. Proportions of blood donations with positive/reactive results on screening tests by income group Income group Proportion of blood donations with positive/reactive results (median and interquartile range, %) HIV HBV HCV Syphilis High income 0.002 (<0.001–0.01) 0.02 (0.005–0.12) 0.007 (0.002–0.06) 0.02 (0.003–0.12) Upper-middle income 0.10 (0.03–0.23) 0.29 (0.13–0.62) 0.19 (0.07–0.36) 0.35 (0.13–1.10) Lower-middle income 0.19 (0.04–0.62) 1.70 (0.70–4.74) 0.38 (0.12–0.99) 0.69 (0.19–1.38) Low income 0.70 (0.28–1.60) 2.81 (2.00–6.02) 1.00 (0.50–1.67) 0.90 (0.60–1.81) Forty-eight countries (25 in the Americas, twelve in Europe, five in the Western Pacific, five in the Eastern Mediterranean, and one in Africa) reported HTLV-1/2 testing results. Twenty-five countries (22 in the Americas, two in Europe and one in the Western Pacific) reported testing results for Chagas disease. The testing results of HTLV-1/2 and Chagas disease in these countries, including the selective testing results in some countries, can be found in Annex 5. 31CHAPTER 6: DISCARD OF BLOOD Information on wastage or discarded blood donations was provided by 138 countries (41 high income, 36 upper- middle income, 37 lower-middle income, and 24 low income). Reactivity for markers of TTIs, outdated stock, and incomplete collection were among the main reasons for discard (Figure 15); 28% of donations were discarded with the reasons not specified. The median total discard rate was 9.6% in low-income countries, 8.0% in lower-middle-income countries, 6.7% in upper-middle-income countries, and 4.1% in high-income countries (Table 21). TTI was the most common reason for discard in low-income countries, with a median discard rate of 5.8%. Discard rates due to reactivity for markers of TTIs for lower-middle-income, upper-middle-income, and high-income countries were 4.4%, 1.9%, and 0.5%, respectively (Table 22). Figure 15. Distribution of discards of blood donations by reason, 2018 DISCARD OF BLOOD Incomplete collection 13% Transfusion- transmissible infections 26% Passed the expiry date 23%Storage problems 1% Transportation problems 0.4% Processing problems 9% Others 28% GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202132 Table 21. Percentage (median and interquartile range) of total whole blood donations discarded by World Bank income group  Income group Median Interquartile range (%) Low (n=24) 9.6 4.3–14.8 Lower middle (n=37) 8.0 5.9–11.6 Upper middle (n=36) 6.7 3.1–8.7 High (n=41) 4.1 2.9–7.4 Table 22. Percentage (median and range) of donations discarded due to reactivity for markers of TTIs by World Bank income group Income group  Median Interquartile range (%) Low income (n=24) 5.8 2.7–10.9 Lower-middle income (n=36) 4.4 2.8–6.8 Upper-middle income (n=33) 1.9 0.9–3.7 High income (n=29) 0.5 0.3–1.7 33CHAPTER 7: CLINICAL USE OF BLOOD CLINICAL USE OF BLOOD 7.1 Assessing the need and demand for blood WHO has developed the following definitions to evaluate the differences between need for, demand for, and use of blood. Need: An estimation of the amount of blood needed to meet the transfusion requirements of the patient population according to current policies, clinical guidelines and best practices. Demand: The amount of blood that would be transfused if all prescriptions for blood were met. Demand may reflect appropriate or inappropriate indications and practices. Use: The actual amount of blood currently transfused; use may be appropriate or inappropriate. These definitions, along with Figure 16, summarize current concepts on trying to measure the need for, demand for, and use of blood. Many factors influence the requirements for blood to meet the health care needs of a population, as with all other treatment modalities. These include income levels, current status and rate of development of the health care system, and accessibility of health care facilities to the public. The need for, demand for, and use of blood in a country could be affected by geography, population migration, and epidemiology of diseases for which blood is needed. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202134 Current demand Unmet demand Current use Unmet need: Health service capacity Access to health care Health-seeking behaviour Access to blood and blood products Population need Population need will vary with population size, disease burden, and the interventions avaiable to a health service Appropriate transfusions Inappropriate transfusions Figure 16. Paradigm of need for, demand for, and use of blood Source: WHO (8). In all countries, there is a need to monitor and balance the supply of blood for requirements. Even in countries with mature and developed blood transfusion services, requirements for blood are not always met, and a range of initiatives are implemented to maintain or increase blood donations. All blood transfusion services and operators, to varying degrees, invest considerable time and resources in predicting demand for blood and adjusting donations. Shortages of blood, whether real or potential, have impacted all countries at differing times, including more recently during the COVID-19 pandemic. In the early stages of the pandemic there were major concerns about lack of availability of blood for transfusion. Strategies and recommendations for responding to potential blood shortages must be incorporated into resilience planning for blood supply by countries and blood service operators (9). Blood transfusion services in developed countries may apply different approaches to assessing change in demand for blood, including use of detailed historical blood supply data to predict incremental increases in demand (time series analysis). A further approach to estimating current demand is to use real-time blood bank data on blood requests. A potential disadvantage of this approach is that the number of blood transfusion requests received by blood banks (and the amount of blood requested) may not be an accurate reflection of true demand or need. This is more likely to be the case where the blood supply has actually been, or has been perceived to be, insufficient (8). Demographic change is likely to be one of the main drivers of long-term increases in blood requirements in developed countries (10, 11). It can be modelled by describing current blood use by age, and by applying the results to predictions of future population size and structure (12). The development of new medical interventions may also impact future blood requirements in developing countries, but these are harder to predict and may in fact serve to reduce the need for blood transfusion as well as potentially increase it. There is no simple formula to provide reliable or useful estimates of the need and demand for blood in a national health system. A national assessment of blood requirements would usually be necessary for short-term or long-term national blood programme planning. For example, using a survey of a representative sample of hospitals, Drammeh et al. (13) estimated that approximately 6.2 blood donations per 1000 population are needed in the United Republic of Tanzania. This number is only slightly more than half of the 10 per 1000 population value that is used as a rough 35CHAPTER 7: CLINICAL USE OF BLOOD estimation for developing countries. Mammen et al. (14) estimated that, based on the population, 26.2 million units (95% CI 17.9–38.0) of whole blood collection would need to be collected annually. This is equivalent to a donation rate of approximately 19.4 donations per 1000 population. A different approach was used for the study, which included the determination of diseases and conditions requiring transfusion, estimation of the population at risk through a comprehensive literature review, and estimation of the percentage of people with diseases and conditions requiring transfusion and transfusion needed through the Delphi method. The study also identified a gap between need and demand (estimated at 13 million units), and highlighted the importance of addressing the multifactorial causes that lead to the existence of the gap (14). 7.2 Patients who received blood transfusion There is evidence of significant differences in patterns of blood use between high-, middle-, and low-income countries. In high-income countries, transfusion is most commonly used for supportive care in cardiovascular and transplant surgery, massive trauma, and therapy for solid and haematological malignancies. In low- and middle-income countries, on the other hand, it is more often used to treat pregnancy-related complications and severe childhood anaemia (15). Data reported to WHO indicate significant differences in the age distribution of patients transfused. In high-income countries, the most frequently transfused patient group is aged over 60 years, which accounts for up to 76 % of all transfusions. In low-income countries, up to 54% of all transfusions are for children aged under 5 years, usually followed by females aged between 15 and 45 years. Figure 17 provides examples of the age distribution of patients transfused in countries of different income groups. 2018 data on distribution of units of blood transfused in different clinical departments in hospitals or other transfusion- performing health facilities from 19 countries in the African Region revealed that among 2  248  721 blood units transfused, 466 625 (21%) were transfused to patients in paediatrics departments, and 427 289 (19%) were transfused to patients in obstetrics and gynaecology departments. In five of the 19 countries, more than 30% of blood was transfused to paediatric patients: Democratic Republic of the Congo 60%, Benin 58%, Burkina Faso 39%, Congo 33%, and Comoros 31%. Five countries reported that more than 30% of blood was transfused to gynaecological and obstetric patients: Burkina Faso 61%, Cameroon 55%, Comoros 40%, Eswatini 32%, and Burundi 32%. Blood use for trauma and major bleeding varied considerably, although generally at lower rates than for patients in paediatrics and obstetrics and gynaecology departments. The same data from the WHO African Region suggest that rates of usage in emergency and resuscitation departments in some countries approaches 23% to 34% (Madagascar 23%, Gabon 26%, Sao Tome and Principe 28%, and Cabo Verde 34%). Although these data indicate that children and women are the recipients who are most frequently transfused in low- income countries, it should be noted that these results are dependent on the accuracy of coding – for example, it is possible that blood use in emergency departments is covered by surgery departments in some countries (Figure 18). GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202136 Figure 17. Age distribution of patients who received transfusion in selected countries Note a. Based on subnational data provided by Scottish National Blood Transfusion Service. a 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Benin Burkina Faso Burundi Democratic Republic of the Congo Madagascar Bolivia (Plurinational State of) Comoros Congo Eswatini Honduras Kiribati Lao People's Democratic Republic Micronesia (Federated States of) Papua New Guinea Philippines Republic of Moldova Sao Tome and Principe Vanuatu Zimbabwe Argentina Belize Colombia Dominica Gabon Libya Maldives Saint Lucia Samoa South Africa Cook Islands France Iceland Malta New Zealand Poland Qatar Seychelles Singapore United Kingdom Lo w In co m e Lo w er -m id dl e In co m e U pp er -m id dl e In co m e H ig h in co m e Under 5 years 5 to 14 years 15 to 44 years 45 to 59 years 60 years or older 37CHAPTER 7: CLINICAL USE OF BLOOD Figure 18. Distribution of blood units transfused in different clinical departments in selected countries in Africa 6 For the purpose of simplicity, in the subsequent text, “units transfused” is used instead of “units transfused or issued”. It is assumed that blood products issued were transfused with minimal loss. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Democratic Republic of Congo Benin Burkina Faso Congo Comoros Chad Mozambique Gabon Eritrea Cabo Verde Nigeria Sao Tome and Principe Madagascar South Africa Burundi Mauritius Cameroon Eswatini Namibia Paediatrics Gynaecology and obstetrics Internal medicine Surgery Emergency and resuscitation Other 7.3 Blood and blood components transfused Not all countries responding to the GDBS were able to provide information on the units of blood and blood components transfused. Many countries provided the numbers of units that were issued to hospitals or other transfusion-performing facilities.6 A total of 144 countries (high income 43, upper-middle income 40, lower-middle income 39, low income 22) provided data to GDBS 2018 on units of blood transfused, or, when they were not available, the units of blood components issued. Nine countries provided insufficient data for the coverage percentage to be quantified. Table 23 lists the units of blood products transfused in 135 of the total 144 countries, together with the population size of these reporting countries. These data are used to estimate the rate of blood and blood component transfusion in countries in different economic groups and WHO regions. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202138 Table 23. Populations, blood donations and transfusion of blood products in 135 countries by World Bank income group Income group  Blood products (thousands) Population (millions)WB products Red cells WB-derived PLT AP-PLT FFP FP CRYO High income (n=43) 18 23 263 1 790 1 926 4 359 308 494 744 Upper-middle income (n=39) 275 26 712 1 309 2 411 6 225 71 873 2 526 Lower-middle income (n=34) 2 823 5 712 285 402 902 572 211 1 073 Low income (n=19) 1 057 756 65 0 137 1 3 395 Total (n=135) 4 173 56 443 3 449 4 739 11 623 952 1 581 4 738 WB = whole blood PLT = platelets FFP = fresh frozen plasma FP = frozen plasma AP = apheresis CRYO = cryoprecipitate A median rate of 28.8 units of red cell products (including whole blood and red cells transfused) per 1000 population (interquartile range (IQR) 21.5–37.2) was reported by high-income countries, whereas the transfusion rate was 12.7 units (IQR 8.7–19.4) in upper-middle-income countries, 5.5 units (IQR 3.2–10.3) in lower-middle-income countries, and 4.3 units (IQR 2.6–6.0) in low-income countries (Table 24). Across WHO regions, the median rate of red cell products transfused per 1000 population was 4.8 units (IQR 3.1–8.9) in Africa, 11.4 units (IQR 7.6–13.3) in the Americas, 9.7 units (IQR 5.2–12.4) in South-East Asia, 29.3 units (23.0–37.0) in Europe, 11.3 units (IQR 7.3–20.6) in the Eastern Mediterranean, and 14.0 units (IQR 6.3–20.0) in the Western Pacific. Table 24. Units of red cell products transfused per 1000 population by World Bank income group Income group  Median Interquartile range (IQR) Low income (n=19) 4.3 2.6–6.0 Lower-middle income (n=34) 5.5 3.2–10.3 Upper-middle income (n=39) 12.7 8.7–19.4 High income (n=43) 28.8 21.5–37.2 All (n=135) 12.3 5.6–24.9 Note: Seven countries in the low-income group (five in Africa) reported red cell product units (whole blood plus red cells) higher than the number of whole blood collection reported. Based on communication with the programme managers in the countries, this is because paediatric units derived from an adult unit of whole blood were counted as multiple units when reported to WHO. Paediatric units in some countries in this group are frequently supplied and transfused. The transfusion rate estimated based on these data could thus be an overestimate for countries belonging to the group. A measure of variation in clinical use is the proportion of blood that is transfused as whole blood rather than blood components, which can target specific deficiencies. GDBS data reveal great variations in the use of whole blood for transfusion among different country income groups. In high-income countries, whole blood is rarely used for transfusion, while in upper-middle-, lower-middle-, and low-income countries, 0.2%, 16%, and 47% of blood, respectively, was transfused as whole blood (Table 25). As health systems develop and become able to offer a wider range of diagnostic and treatment options, component therapy becomes increasingly important for the clinical management of patients. 39CHAPTER 7: CLINICAL USE OF BLOOD Table 25. Proportion (median and interquartile range, %) of whole blood transfusions among all red cell transfusions by World Bank income group Income group Median Interquartile range Low income (n=19) 47 3.8–94.8 Lower-middle income (n=34) 16 0.5–55.7 Upper-middle income (n=39) 0.2 0–1.7 High income (n=43) 0 0–0.04 Transfusion rates of other blood components can be calculated in a similar way. A median rate of 4.2 units of platelets transfused (in units of the dosage equivalent to adult dose ) per 1000 population (IQR 3.0–4.9) was reported by high- income countries, whereas the transfusion rate was 1.3 units (IQR 0.6–2.5) in upper-middle-income countries, 0.3 units (IQR 0.1–0.8) in lower-middle-income countries, and 0.2 units (IQR 0.1–0.3) in low-income countries (Table 26). Across WHO regions, the median rate of platelet transfusion per 1000 population was 0.2 units (IQR 0.1–0.4) in Africa, 1.1 units (IQR 0.5–2.2) in the Americas, 0.4 units (IQR 0.2–2.3) in South-East Asia, 4.2 units (2.9–4.9) in Europe, 1.7 units (IQR 1.4–2.4) in the Eastern Mediterranean, and 1.3 units (IQR 0.9–3.8) in the Western Pacific. Table 26. Units of platelet transfused per 1000 population by World Bank income group Income group  Median Interquartile range (IQR) Low income (n=12) 0.2 0.1–0.3 Lower-middle income (n=31) 0.3 0.1–0.8 Upper-middle income (n=37) 1.3 0.6–2.5 High income (n=43) 4.2 3.0–4.9 All (n=123) 1.3 0.4–3.5 Platelets can be prepared from whole blood (whole blood-derived platelets) or can be prepared through apheresis procedures (apheresis platelets). Based on the data reported by countries, globally, the ratio of whole blood-derived platelets (in units of the dosage equivalent to adult dose) to apheresis platelets was 42:58. The ratios in high-income, upper-middle-income and lower-middle-income countries was 48:52, 35:65 and 43:57, respectively, and in 12 low- income countries, the 100% of the platelets transfused are whole blood-derived. Regarding plasma transfusions, a median rate of 5.4 units of plasma (including fresh frozen plasma and frozen plasma) per 1000 population (IQR 3.4–8.1) was reported by high-income countries, whereas the transfusion rate was 4.6 units (IQR 2.4–7.7) in upper-middle-income countries, 0.5 units (IQR 0.2–2.7) in lower-middle-income countries, and 0.2 units (IQR 0.1–0.5) in low-income countries (Table 27). Across WHO regions, the median rate of plasma transfusion per 1000 population was 0.4 units (IQR 0.2–0.9) in Africa, 2.8 units (IQR 2.3–4.4) in the Americas, 0.8 units (IQR 0.5–3.4) in South-East Asia, 7.5 units (IQR 4.4–11.2) in Europe, 3.5 units (IQR 1.8–9.6) in the Eastern Mediterranean, and 3.5 units (IQR 0.5–6.1) in the Western Pacific. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202140 Table 27. Units of plasma transfused per 1000 population by World Bank income group Income group  Median (range) Interquartile range (IQR) Low income (n=15) 0.2 0.1–0.5 Lower-middle income (n=30) 0.5 0.2–2.7 Upper-middle income (n=33) 4.6 2.4–7.7 High income (n=43) 5.4 3.4–8.1 All (n=121) 3.0 0.5–7.2 Note: All units were converted to units of the dosage equivalent to adult dose if reported in individual units (individual units divided by 5). 7.4 Change in blood and blood components transfusion between 2013 and 2018 Of the 144 countries that provided blood transfusion data in 2018, 112 countries (Africa 30, Americas 16, South-East Asia nine, Europe 31, Eastern Mediterranean eight, Western Pacific 18) also provided transfusion data in 2013. The analysis of the data for both years revealed the changes in blood components transfusion between 2013 and 2018. Red cell products transfused (whole blood and red cells) in 112 countries increased by 5% between 2013 and 2018. By WHO region, the Eastern Mediterranean Region and the South-East Asia Region reported that red cell products transfused between 2013 and 2018 increased by 33% and 24%, respectively. The increase rates in Africa, the Western Pacific and the Americas were 16%, 9% and 4%, respectively. In Europe, red cell products transfused decreased by 5% during the period. In 2018, overall, the proportion of whole blood transfusions among all red cells transfused was 7.7%, a slight increase from 7.0% in 2013. By WHO region, the proportion was 28.3% in Africa, 0.3% in the Americas, 27.3% in South-East Asia, 0.4% in Europe, 27.9% in the Eastern Mediterranean, and 2.1% in the Western Pacific. South-East Asia reported a reduction in the proportion of whole blood transfusion from 32.2% in 2013 to 27.3% in 2018. The Americas and the Western Pacific reported low percentages of whole blood transfusion in both years, and a slight reduction between 2013 and 2018. In the Eastern Mediterranean, the proportion of whole blood transfusion increased from 22.3% in 2013 to 27.9% in 2018. However, this was based on data from only seven countries and might not reflect the actual regional trend. Africa reported a minimal increase in the proportion during the period (Table 28). Table 28. Units (millions) of red cell products transfused by WHO region, 2013 and 2018 Region All red cell products transfused % whole blood transfusion 2013 2018 % diff. 2013 2018 Africa (n=30) 3.32 3.85 16% 28.0% 28.3% Americas (n=16) 3.40 3.55 4% 1.2% 0.3% South-East Asia (n=9) 4.50 5.60 24% 32.2% 27.3% Europe (n=31) 20.92 19.79 –5% 0.6% 0.4% Eastern Mediterranean (n=8) 3.14 4.18 33% 22.3% 27.9% Western Pacific (n=18) 17.18 18.69 9% 2.9% 2.1% Total (n=112) 52.90 55.7 5% 7.0% 7.7% Note: Percentage change (% diff.) is calculated as (units in 2018 – units in 2013)/(units in 2013)*100%. 41CHAPTER 7: CLINICAL USE OF BLOOD Overall, in 112 countries, total platelets transfused (including both whole blood-derived platelets and apheresis platelets, both in units of the dosage equivalent to adult dose) changed little between 2013 and 2018. Across WHO regions, except for Europe, which reported a 27% decrease, all other regions reported an increase, with increase rates ranging from 15% in the Americas to 57% in Africa (Table 29). In four WHO regions (the Americas, South-East Asia, the Eastern Mediterranean, and the Western Pacific), it was observed that apheresis platelets increased at a faster rate than that of whole blood-derived platelets. Data collection in Africa did not differentiate between the two types of platelets. Europe reported that whole blood-derived platelets decreased by 43% and apheresis platelets transfused increased by 27% between 2013 and 2018. Table 29. Units (thousands) of platelets transfused by WHO region, 2013 and 2018 Region Platelets (whole blood derived) Apheresis platelets (apheresis) Platelets (total) 2013 2018 % diff. 2013 2018 % diff. 2013 2018 % diff. Africa (n=30) − − − − − − 111 174 57% Americas (n=16) 269 295 9% 123 155 26% 392 450 15% South-East Asia (n=9) 202 257 27% 31 41 32% 233 298 28% Europe (n=31) 2 812 1 590 –43% 860 1 094 27% 3 672 2 684 –27% Eastern Mediterranean (n=8) 238 275 16% 16 39 144% 254 314 24% Western Pacific (n=18) 530 576 9% 2 174 2 919 34% 2 704 3 495 29% Total (n=112) 4 051 2 993 –26% 3 204 4 248 33% 7 366 7 415 0.7% Note: All units were converted to units of the dosage equivalent to adult dosage if reported in individual units. Percentage change (% diff.) is calculated as (units in 2018 – units in 2013)/(units in 2013)*100%. − Data not available. Plasma transfused (including fresh frozen plasma and frozen plasma) in 112 countries did not change between 2013 and 2018. Across WHO regions, except Europe, which reported a 6% decrease, all other regions reported an increase at rates ranging from 2% in the Western Pacific to 20% in Africa. Cryoprecipitate transfused increased by 17% in 112 countries between 2013 and 2018. Across WHO regions, the Americas, Europe, Africa and the Eastern Mediterranean reported an increase at rates of 10%, 32%, 46% and 73%, respectively. The Western Pacific and South-East Asia reported a decrease at rates of 10% and 4%, respectively (Table 30). Table 30. Units (thousands) of plasma products transfused by WHO region, 2013 and 2018 Region Plasma Cryoprecipitate 2013 2018 % diff. 2013 2018 % diff. Africa (n=30) 351 421 20% 37 54 46% Americas (n=16) 1 023 1 109 8% 190 209 10% South-East Asia (n=9) 544 562 3% 233 224 −4% Europe (n=31) 6 400 6 021 –6% 143 189 32% Eastern Mediterranean (n=8) 1 071 1 178 10% 167 289 73% Western Pacific (n=18) 2 239 2 278 2% 233 211 −9% Total (n=112) 11 628 11 569 −0.5% 1 003 1 176 17% Note: Percentage change (% diff.) is calculated as (units in 2018 – units in 2013)/(units in 2013)*100%. Many industrialized countries have reported a decline in blood collection and transfusion in the past decade (16–20). Evidence suggests that this trend is at least in part contributable to the adoption by clinicians of restrictive transfusion policies and the implementation of patient blood management programmes (21–23). GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202142 A general increasing trend in collection and transfusion were observed in other countries, including most of the low- and middle-income countries and some high-income countries. Possible contributory factors include the expansion of health services in countries to achieve more equitable coverage (24, 25); the efforts by national governments and development partners to develop the national blood systems in priority countries (26, 27); and the growth of population. Despite progress in low- and middle-income countries, significant disparity of blood supply and transfusion among countries in the world still exists. Key collection and transfusion indicators in countries at different economic development levels reported in this and previous status reports have highlighted this ongoing disparity. 7.5 Strategies to improve evidence-based transfusion practice and monitor safe and appropriate blood transfusion Although many factors operate to explain the considerable variations in transfusion practice among countries (and within countries), one key factor is variable uptake and implementation of best practice, informed by high-quality research. There is an expanding body of literature, informed by high-quality randomized trials, to provide clearer recommendations on which patients benefit from transfusions. A 2016 update of earlier Cochrane systematic reviews on the use of red blood cell transfusions was further revised in a 2021 update (1). The 2021 review identified and reported on a total of 48 randomized trials of red cell transfusion, involving data from 21 433 participants, across a range of clinical contexts (for example, orthopaedic, cardiac, or vascular surgery; critical care; acute blood loss, including gastrointestinal bleeding; acute coronary syndrome; and cancer). Other randomized trials have evaluated both the timing of transfusion administration and transfusion volume in African children with severe anaemia (28, 29). There is now strong evidence for avoiding unnecessary transfusions with allogeneic red cells in most patients at haemoglobin thresholds between 7.0 and 8.0 grams per decilitre. Strategies to implement this research would minimize risk of exposure to unnecessary blood for transfusion, which is particularly important given variability in practices of laboratory screening for potential TTIs in many countries. Evidence-based guidelines are important tools in the education of those ordering blood components and are prerequisites for establishing systems for the appropriate clinical use of blood, such as clinical audit. In 2018, 128 countries reported the existence of national guidelines on the clinical use of blood. Across WHO regions, 32 (74%) countries in the African Region, 23 (70%) in the Region of the Americas, 9 (90%) in the South-East Asia Region, 33 (79%) in the European Region, 12 (67%) in the Eastern Mediterranean Region, and 19 (76%) in the Western Pacific Region reported the existence of national guidelines on the clinical use of blood. GDBS data reported by 92 countries (33 high-income countries, 29 upper-middle-income countries, 21 lower-middle- income countries and nine low-income countries) indicated that hospital transfusion committees were present in 48% of hospitals performing transfusion. Across World Bank economic groups, the percentage was 25% in low-income countries, 31% in lower-middle-income countries, 35% in upper-middle-income countries and 62% in high-income countries. Data reported by 90 countries indicated that systems for reporting adverse transfusion events were present in 55% of hospitals in all the countries: 74% in hospitals in high-income countries, 35% in upper-middle-income countries, 22% in lower-middle-income countries and 18% in low-income countries. 43CHAPTER 7: CLINICAL USE OF BLOOD Many countries did not answer the questions in this section, thereby limiting the ability to report on this measure. Caution must therefore be used when extrapolating the data beyond those countries that reported data to WHO. Lack of national data on the situation in both developed and developing countries reflects that this is an area of blood transfusion safety where more attention is needed, and possibly more interventions are required. In addition, operational studies in clinical use of blood are required so that more information and evidence are available. 7.6 The risks of undertransfusion: unmet demand for blood in resource-limited countries The above discussion has focused on appropriate transfusions, and the need to avoid unnecessary transfusions. It is critical, however, to recognize the risks of undertransfusion or delayed transfusion. A number of studies have highlighted the burden of severe anaemia in young children, often due to malaria. Mortality rates are significant, and deaths may occur within a few hours of arrival in hospital, indicating the importance of access to timely blood transfusion support, which is often not available (30–32). Failure to recognize the presence of severe anaemia resulted in lack of transfusion in some cases (33). The prevention and treatment of postpartum haemorrhage requires a multiplicity of interventions, including timely blood transfusion (34). The WOMAN trial report published by Picetti et al. (35) assessed the clinical and contextual factors surrounding the deaths of 483 women (of the 20 060 patients assessed in the trial) following postpartum haemorrhage in developing countries. It found that lack of timely transfusion or insufficient transfusion are still factors that lead to maternal deaths (35). An earlier review by Bates et al. (36) estimated that that overall 26% (ranging from 16% to 71%) of maternal haemorrhage deaths were due to lack of blood for transfusion. Both the WHO Thirteenth General Programme of Work and specific global programmes, such as the Human Reproduction Programme based at WHO headquarters, identify the need to ensure universal health coverage as a key strategy (37). Universal health coverage requires ensuring access to essential health services. It is important that countries and development partners agree to collect data on indicators to monitor progress towards achieving universal health coverage and to evaluate the quality and effectiveness of their care processes (38, 39). One of these monitoring systems is the WHO annual monitoring system for Service Availability and Readiness Assessment (SARA). The system has been implemented in many low- and middle-income countries to regularly assess basic and comprehensive service availability and readiness, including uninterrupted safe blood supply, at the facility level (40–42). Currently, there are very limited data or studies available on unmet need for blood transfusion in low- and middle- income countries. More publications on the clinical impact of lack of available blood for transfusion in low- and middle- income countries are needed. It is also important to establish data collection mechanisms to systematically monitor and eventually correct the situation. The expansion of the scope of haemovigilance should be considered to include monitoring unmet need through a structured reporting system (43). GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202144 HAEMOVIGILANCE An important component of a blood safety system is the establishment of haemovigilance, which is a set of surveillance procedures covering the entire transfusion chain. It includes efforts to monitor and evaluate adverse events associated with the blood supply and transfusion service, and to use the findings to improve blood safety and transfusion outcomes. Haemovigilance programmes have drawn attention to the importance of many poorly documented and potentially preventable adverse events, including incorrect blood component transfused, transfusion-related acute lung injury and bacterial contamination of platelets. Well functioning haemovigilance systems indicate how safety should be improved, and also document the success of the various measures put in place to improve transfusion safety. In many developed countries, such as the countries of the European Union, there is a legal requirement to report serious adverse reactions and events to the regulatory agency. More recently, the scope of haemovigilance has been expanded to include adverse events in blood donors, thus helping to improve safety for the donor as well as the patient. There is growing recognition of the need to identify and document adverse events associated with lack of availability of, or access to, blood transfusion to meet appropriate demand. Mechanisms need to be developed to facilitate the capture of information on such events, particularly as they are likely to have a disproportionate impact in low-income countries. GDBS 2018 indicates that 49% (84 of 171) countries reported having a national haemovigilance system. Across WHO regions, Europe had the highest percentage, with 81% (34 of 42) of reporting countries having such a system. The percentages of countries that reported having national haemovigilance systems in other WHO regions were 52% (13 of 25) for the Western Pacific, 50% (nine of 18) for the Eastern Mediterranean, 40% (four of 10) for South-East Asia, 40% (17 of 43) for Africa, and 21% (seven7 of 33) for the Americas (Figure 19). 7 This does not include four countries in the Region of the Americas that answered the question as “partial”. 45CHAPTER 8: HAEMOVIGILANCE Figure 19. Distribution of countries reporting the existence of national haemovigilance systems, 2018 A total of 62 countries (five in Africa, seven in the Americas, three in South-East Asia, 31 in Europe, four in the Eastern Mediterranean, and 12 in the Western Pacific) reported haemovigilance data from clinical transfusion. Of those 62 countries, 37 were high-income countries, and there were no low-income countries. Haemovigilance data are important to low-income countries in order to guide distribution of their limited resources. However, qualified data are nearly always absent in these low-income countries. The cases of serious adverse reaction reported are shown in Figure 20, by category. Anaphylaxis and hypersensitivity (3256 cases), other serious adverse reaction (1491), and transfusion-associated circulatory overload (679 cases) were the three main causes of serious adverse reaction, accounting for 50%, 23% and 10% of the total cases of serious adverse reaction reported, respectively. A total of 1491 cases were reported in the serious adverse reaction category “other”. Many countries indicated that the main cases in this category were febrile non-haemolytic transfusion reactions. Since cases of febrile non-haemolytic transfusion reactions are not always serious, the “other” category may represent overreporting of serious adverse reaction cases. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202146 Figure 20. Serious adverse transfusion reactions reported Given that the total number of blood components issued or transfused in the 62 reporting countries was 53 034 608 units, the incidence of serious adverse reaction relative to the total number of blood components (whole blood + red blood cells + plasma + platelets + cryoprecipitate) issued (or transfused) can be calculated as 12.2 per 100 000 distributed blood components. The incidence of serious adverse reaction in these 62 countries by WHO region is presented in Table 31. The incidence of serious adverse reaction per 100 000 units of blood components transfused in the European Region, which reported both the largest number of case and denominator (components transfused or issued), was 9.7 per 100 000 units of distributed blood components. The incidence rates in the African Region, the Region of the Americas, the South-East Asia Region, the Eastern Mediterranean Region, and the Western Pacific Region were 14.7, 18.5, 51.2, 10.0, and 6.7 per 100 000 units of distributed blood components, respectively. Some of the reported adverse transfusion reactions might include both serious and non-serious transfusion reactions, accounting for higher serious adverse reaction rates in some countries. It may also be possible that not all countries followed the internationally recognized definitions promoted by WHO (44). Countries should establish haemovigilance programmes to improve the reporting of adverse events so that recommendations can be made to minimize them at national level. Internationally, the existence of comparable haemovigilance data from more countries will help countries to benchmark transfusion safety with each other and make continual improvement. Table 31. Incidence of serious adverse reaction (per 100 000 units of components transfused) by WHO region Serious adverse reaction Total number of components transfused/issued Incidence Africa (n=5) 214 1 457 280 14.7 Americas (n=7) 1 045 5 654 075 18.5 South-East Asia (n=3) 1 395 2 722 070 51.2 Europe (n=31) 2 634 27 238 559 9.7 Eastern Mediterranean (n=4) 409 4 070 358 10.0 Western Pacific (n=12) 795 11 892 266 6.7 Total (n=62) 6492 53 034 608 12.2 0 0 0 5 11 16 22 33 76 176 198 200 329 679 1491 3256 0 500 1000 1500 2000 2500 3000 3500 Graft versus host disease Other transfusion-associated parasitical infection Transfusion-associated malaria infection Transfusion-associated HIV-1/2 infection Other transfusion-associated viral infection Post-transfusion purpura Transfusion-associated HBV infection Transfusion-associated HCV infection Sepsis due to bacterial contamination of the donor unit Non-immunological haemolysis Transfusion-related acute lung injury (TRALI) Immunological haemolysis due to ABO incompatibility Immunological haemolysis due to other allo-antibody Transfusion-associated circulatory overload Other serious adverse transfusion reaction Anaphylaxis/hypersensitivity 47CHAPTER 9: PLASMA USED FOR FRACTIONATIONAND THE PROVISION OF PLASMA-DERIVED MEDICINAL PRODUCTS PLASMA USED FOR FRACTIONATION AND THE PROVISION OF PLASMA-DERIVED MEDICINAL PRODUCTS Plasma-derived medicinal products (PDMPs) are critical in the prevention and treatment of major morbidities associated with a wide range of inherited and acquired medical conditions and diseases. Nevertheless, supplies of essential PDMPs are inadequate in many low- and middle-income countries, leaving many patients with severe congenital and acquired disorders without adequate treatment (45). Globally, large volumes of the plasma used for the manufacturing of PDMPs are collected from compensated or paid donors in plasma collection centres operated by commercial plasma fractionators (46). Ensuring a safe, secure, sufficient and ethically obtained supply of PDMPs is an important public health responsibility of every national government. World Health Assembly resolution WHA63.12 urges Member States to establish, implement, and support nationally coordinated, efficiently managed and sustainable blood and plasma programmes according to the availability of resources, with the aim of achieving self-sufficiency. A major factor limiting the global availability of PDMPs is an inadequate supply of plasma meeting internationally recognized standards for fractionation. The WHO guidance on “Increasing supplies of plasma-derived medicinal products in low- and middle-income countries through fractionation of domestic plasma” provides a strategic framework to assist Member States in increasing their volume of quality plasma for fractionation (47). This global status report continues providing information on progress in countries in making quality-assured plasma available for fractionation of PDMPs to meet the treatment needs of patients. Of 171 responding countries, 163 reported on the status of PDMPs in their countries. Fifty-six countries reported various arrangements for utilizing plasma collected in the country for fractionation. Of those, 34 countries reported that the plasma was fractionated through domestic or contract fractionation, 10 countries reported selling the plasma to the fractionator and purchasing PDMPs from the market (not necessarily produced through manufacture of the plasma originating in the countries), and 12 countries reported using both of those options. Of 163 countries reporting the status of PDMPs in their countries, 91 reported that all PDMPs were imported, while 16 countries reported that no PDMPs were used during the reporting period. Eight countries did not answer the question. Data on the volume of plasma sent for fractionation by the blood services in 2018 were obtained from 45 countries, which reported the collection of a total of around 18.8 million litres of plasma for fractionation. A review of modern plasma fractionation by Burnouf (48) indicated that between 42 million and 45 million litres of human plasma are GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202148 fractionated annually in the world. The lower volume, derived from the WHO GDBS, arises from the fact that the GDBS questionnaire does not cover collection of information on global collection of source plasma from plasma collection centres operated by commercial plasma fractionators. An analysis by collection method (recovered from whole blood or by apheresis) showed that 31% of the plasma sent for fractionation by blood establishments was from recovered plasma. In Europe, 3.5 million litres of recovered plasma were fractionated, accounting for 52% of the fractionated plasma in the region. In the Western Pacific Region, around 1.3 million litres of recovered plasma were fractionated, accounting for 12% of the total volume of fractionated plasma reported in the region, with the remaining 88% (9.6 million litres) collected through apheresis (Table 32). In comparison with the previous report based on 2013 data (49), two countries from the Eastern Mediterranean Region reported a total volume of 346 319 litres, an increase from the total volume of 245 381 litres reported for 2013. Seven countries in the Region of the Americas reported a total volume of 482 036 litres, an increase from 303 000 for 2013. Table 32. Volume (litres) of plasma for fractionation by collection method and WHO region, 2018  Region Recovered plasma Apheresis plasma Total % of recovered plasma Africa (n=2) 306 186 5 760 311 946 98 Americas (n=7) 474 004 8 032 482036 98 South-East Asia (n=2) 126 600 6 819 133 419 95 Europe (n=25) 3 469 402 3 160 695 6 629 997 52 Eastern Mediterranean (n=2) 186 277 160 042 346 319 54 Western Pacific (n=7) 1 279 552 9 588 860 10 868 412 12 Total (n=45) 5 842 021 12 930 108 18 772 129 31 The volume of plasma for fractionation (and processing for PDMPs) per 1000 population varied considerably between countries, ranging from 0.1 to 52.6 litres, with a median of 5.2 litres (IQR 1.4–9.6). Forty-two countries responded that at least one of four products – albumin, intravenous immunoglobulin (IVIg), factor VIII (excluding recombinant products), and factor IX – were manufactured by fractionation within the country or through contract fractionation. Twenty-three countries reported that all four products were manufactured by fractionation within the country or through contract fractionation, while seven countries reported that three products – albumin, IVIg and factor VIII – and seven countries reported that two products – albumin and IVIg – were thus manufactured. Four countries reported that only albumin and one country reported that only IVIg were manufactured in such a way. Twenty-four countries provided information on the proportion of products supplied through fractionation (domestic or contract fractionation) of plasma collected in the country (self-reliance rate). Six countries – Australia, Czechia, Denmark, Latvia, New Zealand, and Republic of Moldova – reported that 100% of albumin was provided by fractionation of the plasma collected in the countries, while another eight countries reported that more than 60% of albumin was provided in such a way – Argentina (90%), Mexico (85%), South Africa (80%), Singapore (74%), Italy (72%), Spain (70%), Republic of Korea (69%), and Japan (63%). Five countries – Czechia, Denmark, Latvia, Morocco, and Singapore – reported that 100% of plasma-derived factor VIII products were provided by fractionation of the plasma collected in the countries, while Japan, New Zealand and South Africa reported 95%, 88% and 80% of factor VIII products were provided in such a way, respectively. Six countries – Czechia, Japan, Latvia, Republic of Korea, Slovenia and South Africa – reported 100% of IVIg was provided by fractionation of the plasma collected in the countries. Annex 7 provides information on the proportion of supplies of different PDMPs manufactured through fractionation (domestic or contract fractionation) of the plasma collected in the country. 49CHAPTER 10: DISCUSSION AND CONCLUSIONS DISCUSSION AND CONCLUSIONS This document is primarily based on data collected for 2018, as reported by 171 of 194 Member States of the WHO GDBS. This database provides information on the current global status of major aspects of blood banking and transfusion practices, namely blood availability, blood safety and, to a lesser extent, clinical transfusion practice. Data have been analysed according to reporting countries’ geographical location (region) as well as the level of economic development as defined by the World Bank. Although encouraging progress has been seen compared with survey data from earlier time periods in some areas, significant challenges still remain, especially for resource-poor countries. One area that deserves special attention is the lingering lack of specific legislation covering the safety and quality of blood and blood products for transfusion in many countries. While 95% of European countries reported having such legislation, the proportions were only 51% in Africa, 52% in the Americas, and 56% in the Western Pacific. Governance through a system of inspection and licensing is important for national blood availability and safety. Only 59% of countries had a system of regular inspection and licensing by the national regulatory agency, and only 33% of countries had an accreditation system for blood transfusion services. Building up a system for inspection and licensing should be a priority for countries that do not currently have such programmes. Committed government support in funding, legislation and regulation of national blood services will be fundamental for achieving the progress needed to reach the goal of providing safe and sufficient blood to all patients who need blood transfusion. In this aspect, useful lessons could be learned from the experience in the European Union in ensuring sufficiency and access to safe blood products through implementing a harmonized legislative and regulatory framework across all Member States (50). In addition to the above overall concerns, specific challenges related to blood availability, blood safety and clinical transfusion practice are discussed in the following subsections. 10.1 Blood availability The true need for blood products is difficult to measure directly and can be influenced by many factors. Using population blood donation rate as a proxy measure for blood availability, higher-income countries clearly have more blood products available for transfusion. The blood donation rate per 1000 population varies from 0.6 to 53. High-income countries collected 40% of the global donations while their population made up 16% of the global population. However, population-based rates do not take into account availability and accessibility of blood products throughout the country GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202150 and significant variability may exist, for example between urban and rural settings. Despite progress that has been made, the transfusion rates of blood components in developing countries are much lower than in developed countries. Correlated with the disparity of blood availability is the funding level for blood centres. In general, funding per collection was higher in more economically developed countries. Strategies to improve blood collection and distribution in less economically developed countries need to be developed and effectively implemented. 10.2 Blood safety The starting point of a safe blood supply is a stable population of regular voluntary non-remunerated blood donors. Globally, 82.8% of whole blood donations were collected from voluntary non-remunerated blood donors. This proportion was 95.6% for high-income countries and 62.8% for low-income countries. Repeat donations carry the least risk of infection. While the whole blood donation from repeat donors ranged from less than 0.1% to 100%, the median rate was 90% for European countries versus 20% to 56% for countries in the other five WHO regions. Although estimates of residual risk levels for TTIs are not readily available, prevalence rates of TTI markers are correlated with the level of residual risk. For HIV, HBV, HCV and syphilis markers, the prevalence rates for all four infections were lowest in high-income countries and highest in low-income countries. The higher prevalence rates of TTI markers in low-income countries should be reduced through greater efforts to increase blood collections from more repeat voluntary non-remunerated donors in order to reduce the reliance on family or replacement and paid blood donations. Systematic screening and testing of donations for TTI markers is an important step in reducing the risk of TTIs. The majority of countries have national policies for screening for major TTIs (HIV, HBV, HCV and syphilis), though there are variations in details of screening policy and screening for additional TTIs (such as Chagas disease, HTLV, malaria and West Nile fever), with a major reason being regional differences in infectious disease epidemiology. The effectiveness of TTI screening can only be guaranteed with well designed and implemented quality assurance systems. Two major components of a basic quality system are the consistent use of standard operating procedures and participation in external quality assessment. In low-income countries, only 76.2% of donations were screened following basic quality-assured procedures. Investing in establishing quality assurance programmes will be key to improving blood safety globally. 10.3 Clinical transfusion practice Differences in clinical transfusion patterns between resource-rich and resource-poor countries were reflected in many aspects of transfusion practice. Most blood transfusions in low-income countries are still used for childbirth- related complications and severe childhood anaemia, while in high-income countries transfusions are mostly given to support patients for surgery, critical illness and cancer treatment. The use of fresh frozen plasma is significantly less common in low-income countries than in high-income countries; the same applies to the use of platelet transfusions. Comprehensive data on patterns of blood use in all countries, but specifically low-income countries, is needed to understand issues of demand and supply. One major setting of uncertainty is blood use in acute injury and trauma in low- and middle-income countries, as highlighted in a recent systematic review (51). 51CHAPTER 10: DISCUSSION AND CONCLUSIONS Safe and effective clinical transfusion practices can be improved by hospital transfusion committees, providing critical local oversight of the transfusion process. GDBS data reported by 92 countries indicated that 48% of hospitals where transfusion was performed reported having a transfusion committee (62% in high-income countries and 25% in low- income countries). The proportion of hospitals that have a reporting system for adverse transfusion reactions was higher for resource-rich countries and lower for resource-poor countries. National haemovigilance programmes have increasingly been implemented, first for systematically monitoring the safety of the entire transfusion process and more recently also for measuring transfusion outcome. In 2018, 81% of countries in Europe had such a system, while the percentage rates were lower for all other regions. More research to improve the implementation of appropriate evidence-based utilization of blood and the use of alternatives to transfusion will benefit the entire global transfusion community. Even though many resource-poor countries are still focusing on fundamental challenges, including blood availability and safety, security of blood supply remains an important issue for all blood services and operators. Appropriate utilization of blood supported by patient blood management programmes will help to decrease unnecessary blood transfusions and reduce transfusion risk, and improve patient care and outcomes (52). Strategies must address fundamental concerns about lack of availability of blood, for example to treat severe life-threatening anaemia in children with malaria or to manage major blood loss in trauma and postpartum bleeding. This applies for all countries and especially low-resource country settings. 10.4 Data The existence of a data collection and reporting system is an important element of a well managed, nationally coordinated blood transfusion programme. Having adequate national data on blood availability and safety allows a country to set priorities and to further strengthen the national blood system. There is a need to establish systems of surveillance on the incidence and prevalence of HIV, HBV, HCV and other infections in blood donors and vigilance on the transfusion outcomes of recipients, including post-transfusion risk of infection. Information on clinical transfusion, including patterns of use by indication and department, forms the basis for monitoring clinical transfusion practice and provides critical performance measures to influence desirable changes in the prescription and administration of blood and to reduce variations in transfusion practice. Information on lack of availability of blood to meet clinically justified need is not routinely collected but is an important measure of the effectiveness of the blood transfusion service. Countries providing partial data should consider instituting standardized systems for data collection and management at national level. National blood transfusion services need to provide greater structure and support for information management systems. Hospitals need to establish mechanisms for improving data collection for the traceability and utilization of blood and for haemovigilance. 10.5 Conclusions The issue of adequate blood availability lies at the centre of the various challenges faced by the global blood bank community. With economic development, the currently low- and middle-income countries are expected to experience growth of their national health care systems. Advances in health care – including increased accessibility to health GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202152 care for the population and greater availability of treatment options – is likely to bring increased demand for blood transfusion support. An inadequate blood supply can impede the progress of national health care. Different factors will be relevant to explain potential or actual shortages of blood donations in countries, for example due to lack of repeat donations from voluntary non-remunerated donors. In many resource-poor countries, inadequacy of blood supply often coexists with inadequate funding and less vigorous government legislation and regulation. Safe blood chains depend on an effective TTI screening system with strong quality systems, and effective clinical adverse reaction monitoring mechanisms or national haemovigilance systems. The goal of achieving an adequate and secure blood supply chain is of great significance, not only for the blood banking and transfusion medicine community but also for the overall public health of a nation. In conclusion, the WHO survey continues to show significant variations in the availability, safety and use of blood and blood components between resource-rich and resource-poor countries. Despite progress in some areas there are still challenges, especially for resource-poor countries, in reaching the goal of providing sufficient, secure and safe blood for all people who need blood transfusion. The following measures will be vital to achieving that aim. Improving funding support for blood services, establishing specific legislation, and developing national programmes for providing effective governance of blood collection services will be critical in order to continuously improve global blood availability and safety. Building quality assurance programmes for TTI screening of donations will help to reduce residual TTI risks. Improving the safety and efficacy of clinical transfusions through the work of national haemovigilance systems and hospital transfusion committees should be a priority for all countries, especially resource-poor countries. Investing in improved systems for collecting data on hospital-based blood transfusion, on transfusion safety and on blood utilization will in turn establish the foundations for building an evidence-based approach to safe transfusion medicine practices in the future. 53CHAPTER 6: DISCARD OF BLOOD LIMITATIONS While best attempts have been made to obtain accurate data from countries, the data submitted by national health authorities have not been independently verified. Data accuracy therefore depends on the data collection systems in countries, and this report can only reflect the information provided by WHO Member States. While many countries report comprehensive national data on blood availability and safety, others provide limited information on the activities of a subset of blood centres in the country. Incomplete data and potentially different interpretations of some indicators affected our ability to analyse some of the information received from countries. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202154 REFERENCES 1. Carson JL, Stanworth SJ, Dennis JA, Trivella M, Roubinian N, Fergusson DA et al. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database of Systematic Reviews. 2021;12:CD002042. doi:10.1002/14651858. CD002042.pub5. 2. Mueller MM, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger R et al. Patient blood management: recommendations from the 2018 Frankfurt Consensus Conference. JAMA. 2019;321(10):983–97. doi:10.1001/ jama.2019.0554. 3. Kanagasabai U, Chevalier MS, Drammeh B, Mili FD, Qualls ML, Bock N et al. Trends and gaps in national blood transfusion services: 14 sub-Saharan African countries, 2014–2016. MMWR. 2018;67:1392–6. doi:10.15585/mmwr. mm6750a4external icon. 4. Mili FD, Teng Y, Shiraishi RW, Yu J, Bock N, Drammeh B et al. New HIV infections from blood transfusions averted in 28 countries supported by PEPFAR blood safety programs, 2004–2015. Transfusion. 2021;61(3):851–61. doi:10.1111/ trf.16256. 5. Aide-mémoire: developing a national blood system. Geneva: World Health Organization; 2011 (https://apps.who. int/iris/handle/10665/330045, accessed 13 January 2022). 6. Global Health Sector Strategy on Viral Hepatitis 2016–2021: towards ending viral hepatitis. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf, accessed 17 January 2022). 7. Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/331697, accessed 17 January 2022). 8. WHO Experts’ Consultation on Estimation of Blood Requirements, 3–5 February 2010, WHO headquarters, Geneva: meeting report. Geneva: World Health Organization; 2010 (http://www.who.int/bloodsafety/transfusion_services/ estimation_meeting-report.pdf?ua=1, accessed 17 January 2022). 9. Stanworth SJ, New HV, Apelseth TO, Brunskill S, Cardigan R, Doree C et al. Effects of the COVID-19 pandemic on supply and use of blood for transfusion. Lancet Haematology. 2020;7(10):e756-e764. 10. Ehling M, Pötzsch O. Demographic changes in Germany up to 2060: consequences for blood donation. Transfusion Medicine and Hemotherapy. 2010;37:131–9. 11. Greinacher A, Fendrich K, Alpen U, Hoffmann W. Impact of demographic changes on the blood supply: Mecklenburg- West Pomerania as a model region for Europe. Transfusion. 2007;47:395–401. 12. Volken T, Buser A, Castelli D, Fontana S, Beat M, Frey BM et al. Red blood cell use in Switzerland: trends and demographic challenges. Blood Transfusion. 2018;16:73–82. doi:10.2450/2016.0079-16. 13. Drammeh B, De A, Bock N, Pathak S, Juma A, Kutaga R et al. Estimating Tanzania’s national met and unmet blood demand from a survey of a representative sample of hospitals. Transfusion Medicine Reviews. 2018;32(1):36–42. doi:10.1016/j.tmrv.2017.07.004. 14. Mammen JJ, Asirvatham ES, Lakshmanan J, Sarman CJ, Mani T, Charles B et al. National level estimation of population need for blood in India. Transfusion. 2021;61(6):1809 –21. doi:10.1111/trf.16369. 15. Mafirakureva N, Khoza S, Hassall O, Faragher BE, Kajja I, Mvere DA et al. Profiles of blood and blood component transfusion recipients in Zimbabwe. Blood Transfusion. 2015;13(4):600–9. doi:10.2450/2015.0019-15. 16. Janssen MP, van Hoeven LR, Rautmann G. Trends and observations on the collection, testing and use of blood and blood components in Europe: 2001–2011 report. Strasbourg: Directorate for the Quality of Medicines and Healthcare of the Council of Europe (EDQM); 2014 (https://www.edqm.eu/sites/default/files/trends_and_observations_on_ the_collection_testing_and_use_of_blood_and_blood_components_in_europe_20.pdf, accessed 17 January 2022). 17. Ellingson KD, Sapiano MR, Haass KA, Savinkina AA, Baker ML, Chung KW et al. Continued decline in blood collection and transfusion in the United States – 2015. Transfusion. 2017;57(Suppl. 2):1588–98. doi:10.1111/trf.14165. 55REFERENCES 18. 18. Jones JM, Sapiano MR, Savinkina AA, Haass KA, Baker ML, Henry RA et al. Slowing decline in blood collection and transfusion in the United States – 2017. Transfusion. 2020;60(Suppl. 2):S1–S9. doi:10.1111/trf.15604. 19. Jones JM, Sapiano MR, Mowla S, Bota D, Berger JJ, Basavaraju SV. Has the trend of declining blood transfusions in the United States ended? Findings of the 2019 National Blood Collection and Utilization Survey. Transfusion. 2021;61:S1–S10. 20. Annual report 2017–2018. Auckland, New Zealand: New Zealand Blood Service; 2018. 21. Gross I, Seifert B, Hofmann A, Spahn DR. Patient blood management in cardiac surgery results in fewer transfusions and better outcome. Transfusion. 2015;55:1075–81. 22. Xydas S, Magovern CJ, Slater JP, Brown JM, Bustami R, Parr GV et al. Implementation of a comprehensive blood conservation program can reduce blood use in a community cardiac surgery program. Journal of Thoracic and Cardiovascular Surgery. 2012;143:926–35. 23. National Blood Authority annual report 2017–2018. Canberra, Australia: National Blood Authority; 2018. 24. Pitman JP, Wilkinson R, Basavaraju SV, von Finckenstein B, Sibinga CS, Marfin AA et al. Investments in blood safety improve the availability of blood to underserved areas in a sub-Saharan African country. ISBT Science Series. 2014;9(2):325–33. doi:10.1111/voxs.12107. 25. Loua A, Nikiema JB, Sougou K, Kasilo OJM. Transfusion in the WHO African Region. Transfusion Clinique et Biologique. 2019;26:155–9. 26. Chevalier MS, Kuehnert M, Basavaraju SV, Bjork A, Pitman JP. Progress toward strengthening national blood transfusion services: 14 countries, 2011–2014. MMWR. 2016;65(5):115–9. doi:10.15585/mmwr.mm6505a4. 27. Global report: World Blood Donor Day 2016. Sanquin (the Netherlands); 2017 (https://www.who.int/campaigns/ world-blood-donor-day/2016/2016-report.pdf, accessed 17 January 2022). 28. Maitland K, Kiguli S, Olupot-Olupot P, Engoru C, Mallewa M, Goncalves PS et al. Immediate transfusion in African children with uncomplicated severe anemia. New England Journal of Medicine. 2019;381(5):407–19. 29. Maitland K, Olupot-Olupot P, Kiguli S, Chagaluka G, Alaroker F, Opoka RO et al. Transfusion volume for children with severe anemia in Africa. New England Journal of Medicine. 2019;381(5):420–31. 30. Kiguli S, Maitland K, George EC, Olupot-Olupot P, Opoka RO, Engoru C et al. Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness. BMC Medicine. 2015;13:21. 31. Thomas J, Ayieko P, Ogero M, Gachau S, Makone B, Nyachiro W et al. Blood transfusion delay and outcome in county hospitals in Kenya. American Journal of Tropical Medicine and Hygiene. 2017;96(2):511–7. doi:10.4269/ ajtmh.16-0735. 32. Cheema B, Molyneux EM, Emmanuel JC, M’baya B, Esan M, Kamwendo H et al. Development and evaluation of a new paediatric protocol for Africa. Transfusion Medicine. 2010;20:140–51. 33. Educational modules on clinical use of blood. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/ handle/10665/350246, accessed 18 January 2022). 34. WHO recommendations for the prevention of postpartum haemorrhage. Geneva: World Health Organization; 2012 (http://apps.who.int/iris/bitstream/handle/10665/75411/9789241548502_eng.pdf, accessed 18 January 2022). 35. Picetti R, Miller L, Shakur-Still H, Pepple T, Beaumont D, Balogun E et al. The WOMAN trial: clinical and contextual factors surrounding the deaths of 483 women following post-partum haemorrhage in developing countries. BMC Pregnancy and Childbirth. 2020;20:409. doi:10.1186/s12884-020-03091-8. 36. Bates I, Chapotera GK, McKew S, van den Broek N. Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services. BJOG. 2008;115(11):1331–9. doi:10.1111/j.1471-0528.2008.01866.x. 37. UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. 38. Universal health coverage (UHC). Geneva: World Health Organization; 2021 (https://www.who.int/news-room/ fact-sheets/detail/universal-health-coverage-(uhc), accessed 18 January 2022). 39. Strategies towards ending preventable maternal mortality (‎EPMM)‎. Geneva: World Health Organization; 2015 (https://apps.who.int/iris/handle/10665/153544, accessed 18 January 2022). 40. Service availability and readiness assessment (‎SARA)‎: an annual monitoring system for service delivery: reference manual, version 2.2, Revised July 2015. Geneva: World Health Organization; 2014 (https://apps.who.int/iris/ handle/10665/149025, accessed 18 January 2022). GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202156 41. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva: World Health Organization; 2010 (https://apps.who.int/iris/handle/10665/258734, accessed 18 January 2022). 42. Service availability and readiness assessment (SARA): reports. Geneva: World Health Organization (https://www. who.int/data/data-collection-tools/service-availability-and-readiness-assessment-(sara)/service-availability-and- readiness-assessment-(sara)-reports, accessed 18 January 2022). 43. User guide for navigating resources on stepwise implementation of haemovigilance systems. Geneva: World Health Organization; 2021. 44. A guide to establishing a national haemovigilance system. Geneva: World Health Organization; 2016 (https://apps. who.int/iris/handle/10665/250233, accessed 18 January 2022). 45. Report on the annual global survey 2018. Montreal, Canada: World Federation of Hemophilia; 2019 (http://www1. wfh.org/publications/files/pdf-1731.pdf, accessed 18 January 2022). 46. Blood and other medical products of human origin: report by the Secretariat. In: Executive Board, 136th session, December 2014. Geneva: World Health Organization; 2015 (https://apps.who.int/iris/handle/10665/251809, accessed 18 January 2022). 47. Guidance on increasing supplies of plasma-derived medicinal products in low- and middle-income countries through fractionation of domestic plasma. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/ handle/10665/340171, accessed 18 January 2022). 48. Burnouf T. An overview of plasma fractionation. Annals of Blood 2018;3:33. doi:10.21037/aob.2018.05.03. 49. Global status report on blood safety and availability. Geneva: World Health Organization; 2016 (https://apps.who. int/iris/bitstream/handle/10665/254987/9789241565431-eng.pdf?sequence=1&isAllowed=y, accessed 18 January 2022). 50. Evaluation of the Union legislation on blood, tissues and cells. Document SWD(2019) 375 final. Brussels: European Commission; 2019 (https://ec.europa.eu/health/sites/default/files/blood_tissues_organs/docs/swd_2019_376_ en.pdf, accessed 19 January 2022). 51. Yang L, Slate-Romano J, Marqués CG, Uwamahoro C, Twagirumukiza FR, Naganathan S et al. Evaluation of blood product transfusion therapies in acute injury care in low- and middle-income countries: a systematic review. Injury. 2020;51(7):1468–76. doi:10.1016/j.injury.2020.05.007. 52. The urgent need to implement patient blood management: policy brief. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/handle/10665/346655, accessed 19 January 2022). 57ANNEXES ANNEXES Annex 1. Explanatory note on country data and methodology Annex 2. Blood centres and data coverage, 2014−2018 Annex 3. Blood donations, 2014−2018 Annex 4. Laboratory test requirements for screening donated blood for transfusion-transmissible infections, 2017/2018 Annex 5. Number and proportion of donations tested positive/reactive for TTI markers, 2014−2018 Annex 6. Clinical use of blood and blood components, 2014−2018 Annex 7. Provision of plasma-derived medicinal products (PDMPs) through the fractionation of plasma collected in the country, 2014−2018 Annex 8. Policy, governance, quality assurance and monitoring, 2017/2018 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202158 Annex 1. Explanatory note on country data and methodology Country data sources Data from the following countries were used as sources for this report. WHO African Region (43/47) Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cabo Verde, Cameroon, Central African Republic, Chad, Comoros, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Eritrea, Eswatini, Ethiopia, Gabon, Gambia, Ghana, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, South Africa, South Sudan, Togo, Uganda, United Republic of Tanzania, Zambia, Zimbabwe. Data for Equatorial Guinea, Guinea, Guinea-Bissau and Sierra Leone were not included. WHO Region of the Americas (33/35) Argentina, Bahamas, Barbados, Belize, Bolivia (Plurinational State of ), Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, United States of America, Uruguay, Venezuela (Bolivarian Republic of ). Data for Antigua and Barbuda, and Grenada were not included. Data provided by the territories of Aruba, Bermuda, British Virgin Islands, Cayman Islands, Curaçao, French Territories, Montserrat, and Turks and Caicos Islands were not included in this report. The information can be found in the following WHO/PAHO report: Supply of blood for transfusion in Latin American and Caribbean countries 2016–2017 (available at https://iris.paho.org/bitstream/handle/10665.2/52966/9789275121719_eng.pdf). WHO South-East Asia Region (10/11) Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, Timor-Leste. Data for Democratic People’s Republic of Korea were not included. WHO European Region (42/53) Albania, Armenia, Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Iceland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Luxembourg, Malta, Montenegro, Netherlands, North Macedonia, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, Turkey, United Kingdom of Great Britain and Northern Ireland, Uzbekistan. Data for Andorra, Azerbaijan, Belarus, Georgia, Hungary, Ireland, Lithuania, Monaco, San Marino, Turkmenistan and Ukraine were not included. WHO Eastern Mediterranean Region (18/21) Afghanistan, Bahrain, Egypt, Iran (Islamic Republic of ), Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Saudi Arabia, Qatar, Sudan, Tunisia, United Arab Emirates, Yemen. Data for Djibouti, Somalia and Syrian Arab Republic were not included. 59ANNEX 1. EXPLANATORY NOTE ON COUNTRY DATA AND METHODOLOGY WHO Western Pacific Region (25/27) Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Lao People’s Democratic Republic, Malaysia, Marshall Islands, Micronesia (Federated States of ), Mongolia, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tonga, Vanuatu, Viet Nam. Data for Nauru and Tuvalu were not included. Population data and income group classifications Data reported for population were extracted from World population prospects: the 2019 revision. New York: Population Division, Department of Economic and Social Affairs, United Nations Secretariat; 2019. Age-specific population data from the same source were used to calculate the age-specific donation rate per 1000 population for countries that provided donations by donors of different age groups. Income group classification is based on World Bank list of economies (2019). Washington (DC): World Bank; 2019. Partial data Thirty-nine countries provided partial data with estimated percentages of the national number of donations covered by the report ranging from 15% to 99%. Of those 39 countries, 19 reported more than 90% of national collections. Eight countries reported data less than 50%. In generating the global overview, the percentages were used to calculate adjusted numbers. The percentages were also used to calculate the donations per 1000 population. Some countries reported coverage percentage but did not provide any sampling frame or basis. Decisions had to be made as to whether to apply the estimated percentage to obtain an adjusted total collections and donations rate. In some cases, in order to provide aggregate data, it has been necessary to assume that this partial information is representative of the whole country. It is recognized that this may present a more favourable picture than in reality, particularly for low- and middle-income countries where, when partial data are provided, the data often relate to major cities; these tend to have better facilities, equipment and management, and have wider coverage, leaving other areas with a poorer situation unreported. Caution should be taken not to generalize these data. Updated indicators Due to slight differences in the availability of country data and the adjustment of data submitted by a small number of countries as the result of validation, some indicators in this report may differ from WHO Fact Sheet: Blood safety and availability (updated June 2020) and the published regional reports. Confirmatory testing It should be noted that a higher proportion of middle- and low-income countries only reported reactive results for testing of transfusion-transmissible infection. Countries that did not provide confirmatory test results may also have higher percentages of positive results among donations than those included. In addition, it should be noted that the strategies and protocols for conducting screening and confirmatory tests may differ between countries. In some countries, a sample was considered as positive when found twice repeatedly reactive. The samples were not confirmed with additional tests. Explanatory note for Table 7, Table 8 and Figure 10 Data from the following countries were included in the trend analysis as shown in Table 7, Table 8 and Figure 10. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202160 Africa (35 countries): Algeria, Benin, Botswana, Burkina Faso, Burundi, Cabo Verde, Cameroon, Central African Republic, Comoros, Congo, Côte d’Ivoire, Eritrea, Ethiopia, Gabon, Ghana, Kenya, Lesotho, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, South Africa, Togo, Uganda, United Republic of Tanzania, Zambia, Zimbabwe. Americas (27 countries and excluding countries in North America): Argentina, Bahamas, Barbados, Belize, Bolivia (Plurinational State of ), Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago. South-East Asia (six countries): Bangladesh, Bhutan, Indonesia, Nepal, Sri Lanka, Thailand. Europe (27 countries): Albania, Armenia, Bosnia and Herzegovina, Bulgaria, Croatia, Czechia, Denmark, Estonia, Finland, France, Iceland, Italy, Kyrgyzstan, Luxembourg, Montenegro, North Macedonia, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, Slovakia, Slovenia, Sweden, Switzerland, Tajikistan. Eastern Mediterranean (10 countries): Afghanistan, Bahrain, Egypt, Iran (Islamic Republic of ), Jordan, Morocco, Oman, Qatar, Tunisia, United Arab Emirates. Western Pacific (14 countries): Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Lao People’s Democratic Republic, Micronesia (Federated States of ), Mongolia, New Zealand, Papua New Guinea, Republic of Korea, Singapore. Assigning values for missing data for trend analysis When data in specific years were missing but data immediately before or after the year were available, the following methods were used to assign a value to the missing data (in sequence of preference): (1) the average of the numbers reported in the years immediately before and after the specific year; (2) data immediately before the specific year; or (3) data immediately after the specific year. However, data available in one specific year should not be used to assign values for both immediately before and after that year. In such a case, the country should be excluded in the trend analysis. 61ANNEX 2: BLOOD CENTRES AND DATA COVERAGE 2014–2018 Annex 2. Blood centres and data coverage 2014–20181 … Not reported/not available. — No response. * Blank cell (in the last column): 100%. Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Afghanistan 2014 1 50 51 1 253 254 2015 1 50 51 1 50 51 2017 1 101 102 1 288 289 2018 1 288 289 1 101 102   Albania 2014 1 30 31 1 30 31 2015 1 31 32 1 31 32 2017 — — — — — — — 2018 1 31 32 1 31 32 Algeria 2014 7 199 206 7 199 206 2015 7 199 206 7 199 206 2017 — — — — — — — 2018       20 209 229   Andorra 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Angola 2014 — — — — — — 2015 — — — — — — 2017 — — — — — — — 2018 0 164 164 Antigua and Barbuda 2014 — — — — — — — 2015 — — — — — — 2017 — — — — — — — 2018 — — — — — — — Argentina 2014 45 209 254 38 175 213 95 2015 45 209 254 38 175 213 95 2016 45 209 254 38 175 213 95 2017 38 149 187 34 129 163 95 Armenia 2014 6 15 21 6 15 21 2015 6 15 21 6 15 21 2017 — — — — — — — 2018 — — — — — — — Australia 20142 82 0  82 82 0  82 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — 1 The surveys to collect Global Database on Blood Safety (GDBS) data from Latin America and Caribbean Countries and from countries in other WHO Regions were administered separately. In this report, available key GDBS data from the last four years reported by each Member State were listed in the annexes. Due to the different schedules to administer the surveys, these four years were slightly different for countries covered by the two surveys: 2014, 2015, 2016 and 2017 for Latin America and Caribbean Countries; 2014, 2015, 2017 and 2018 for other countries. Important notes provided by the Member States were kept in the annexes as footnotes. These notes provided further information on how blood transfusion services/the supply of PDMP were organized and managed in the Member States. They sometimes also provided comments on the coverage of the data that was reported to GDBS. 2 2013 data. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202162 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Austria 2014 23 8 31 23 7 30 97 2015 23 8 31 23 8 31 2017 23 8 31 22 8 29 93.6 2018 23 8 31 23 8 31 Azerbaijan 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Bahamas 2014 0 3 3 0 3 3 2015 — — — — — — — 2016 0 3 3 0 3 3 2017 0 3 3 0 3 3 Bahrain 2014 0 3 3 0 1 1 94 2015 0 3 3 0 1 1 94 2017 3 3 3 1 1 1 93 2018 0 3 3   1 1 90 Bangladesh 2014 108 219 327 25 219 244 84 2015 108 219 327 25 219 244 84 2017 39 198 237 3 69 72 88 2018 54 288 342 3 87 90 90 Barbados 2014 0 1 1 0 1 1 2015 — — — — — — — 2016 0 1 1 0 1 1 2017 0 1 1 0 1 1 Belarus 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Belgium 2014 4 2 6 4 2 6 2015 4 2 6 4 2 6 2017 — — — — — — — 2018 — — — — — — — Belize 2014 1 6 7 1 6 7 2015 1 6 7 1 6 7 2016 1 6 7 1 6 7 2017 1 6 7 1 6 7 Benin 2014 6 34 40 6 34 40 — 2015 6 40 46 6 40 46 — 2017 — — — — — — — 2018       6 34 40 Bhutan 2014 0 27 27 0 27 27 2015 0 27 27 0 27 27 2017 0 27 27 0 27 27 2018 0 27 27 0 15 15 90 63ANNEX 2: BLOOD CENTRES AND DATA COVERAGE 2014–2018 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Bolivia 2014 11 7 18 11 7 18 2015 11 7 18 11 7 18 2016 11 7 18 11 7 18 2017 12 5 17 12 5 17 Bosnia and Herzegovina 2014 1 17 18 1 17 18 2015 1 17 18 1 17 18 2017 — — — — — — — 2018 1 17 18 1 17 18 Botswana3 2014 2 0 2 2 0 2 2015 2 0 2 2 0 2 2017 2 0 2 2 0 2 2018 2 0 2 Brazil 2014 — — — — — — — 2015 … … 544 … … 544 2016 … … 3 328 … … .. 2017 … … 3 071 … … … Brunei Darussalam4 2014 0 5 5 0 4 4 80 2015 0 5 5 0 4 4 80 2017 0 5 5 0 4 4 90 2018 0 5 5 0 4 4 90 Bulgaria 2014 6 23 29 6 23 29 2015 5 24 29 5 24 29 2017 — — — — — — — 2018 6 23 29 6 23 29 Burkina Faso 2014 4 39 43 4 39 43 2015 4 58 62 4 58 62 2017 4 39 43 4 39 43 2018 4 39 43 Burundi 2014 — — — — — — — 2015 5 2 7 5 2 7 2017 — — — — — — — 2018       5 3 8 Cabo Verde 2014 0 6 6 0 6 2015 0 6 6 0 6 6 2017 — — — — — — — 2018 0 6 6 Cambodia 2014 1 21 22 1 21 22 80 2015 1 21 22 1 21 22 80 2017 — — — — — — — 2018 — — — — — — — Cameroon 2014 0 … … 0 15 15 2015 … … … 0 37 37 2017 … … … 0 49 49 2018       0 58 58 3 There are two blood centres. Each of the two centres are linked to two collection sites (four blood collection sites in total). 4 Reported data did not include the data of one hospital-based blood centre (which is a private hospital). GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202164 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Canada5 2014 2 0 2 1 0 1 80 2015 2 0 2 1 0 1 80 2017 2 0 2 1 0 1 80 2018 — — — — — — — Central African Republic 2014 1 32 33 1 0 1 80 2015 1 34 35 1 0 1 80 2017 — — — — — — — 2018       1 0 1 Chad 2014 1 58 59 1 58 59 2015 1 64 65 1 64 65 2017 — — — — — — — 2018       1 76 77   Chile 2014 — — — — — — — 2015 4 74 78 4 74 78 806 2016 4 74 78 4 74 78 80 2017 4 74 78 4 74 78 80 China 2014 452 0 452 452 0 452 2015 452 0 452 452 0 452 2017 452 0  452 452 0  452   2018 452 0  452 452 0  452 Colombia 2014 … … … … … … 2015 24 59 83 24 59 83 92.4 2016 25 57 82 25 57 82 98.5 2017 23 58 81 23 58 81 99.2 Comoros 2014 0 5 5 0 5 5 2015 0 5 5 0 5 5 2017 — — — — — — — 2018       1 5 6   Congo 2014 4 28 32 4 28 32 90 2015 4 34 38 4 34 38 92 2017 0 29 29 0 29 29 2018       2 34 36   Cook Islands 2014 0 1 1 0 1 1 2015 — — — — — — — 2017 0 1 1 0 1 1 2018 — — — — — — — Costa Rica 2014 2 32 34 2 31 33 2015 2 32 34 2 32 34 2016 2 33 35 2 33 35 2017 2 33 35 2 33 35 Côte D’Ivoire 2014 27 0 27 27 0 27 2015 27 0 27 27 0 27 2017 22 0 22 22 0 22 2018       27 24 51   5 Canada has two blood suppliers. Hema-Quebec is responsible for the province of Quebec. Canadian Blood Services is responsible for all other provinces and territories. 6 This report covers 80% of blood donations in Chile; the remaining 20% of collections were performed in private practices. 65ANNEX 2: BLOOD CENTRES AND DATA COVERAGE 2014–2018 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Croatia 2014 1 7 8 1 7 8 2015 1 7 8 1 7 8 2017 1 6 7 1 6 7 2018 1 6 7 1 6 7 Cuba 2014 — — — — — — — 2015 — — — — — — — 2016 … … … … … 2017 … … … … … Cyprus 2014 1 0 1 1 0 1 52.2 2015 1 0 1 1 0 1 51.57 2017 — — — — — — — 2018 4 0  4  4 0  4  Czechia 2014 8 65 73 8 65 73 2015 8 65 73 8 65 73 2017 — — — — — — — 2018 2 66 68 2 66 68 8 Democratic People's Republic of Korea 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Democratic Republic of the Congo 2014 15 875 890 15 875 890 83.7 2015 — — — — — — — 2017 — — — — — — — 2018       26 850 876   Denmark 2014 — — — — — — — 2015 — — — — — — — 2017 0 5 5 0 5 5 9 2018 0 5 5 0 5 5 Djibouti 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Dominica 2014 0 1 1 0 1 1 2015 0 1 1 0 1 1 2016 0 1 1 0 1 1 2017 0 1 1 0 1 1 Dominican Republic 2014 25 17 42 25 17 42 2015 37 34 71 25 17 42 2016 37 34 71 26 15 41 2017 37 34 71 10 18 28 7 This report covers data from only 1 centre (The Cyprus Blood Establishment), which until 2016 served only the Nicosia District. The other districts (Limassol, Larnaca, Paphos and Famagusta) were served by Blood Banks that belong to the corresponding public hospitals. 8 Stand-alone blood centres that only collect plasma for fractionation are not included. There are 9 such centres. 9 The Danish health care system is organised in 5 regions and each region has its own blood centre. The blood centres are characterized by a high level of collaboration. Blood centres are obliged to report to the Danish Patient Safety Authority annually on their activities. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202166 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Ecuador 2014 … … … … … … …. 2015 7 15 22 7 15 22 2016 8 13 21 8 13 21 2017 8 12 20 8 12 20 Egypt 2014 — — — — — — — 2015 24 268 292 24 0 24 35 201710 24 …  …  24 0  24 33 2018 28 … … 28 0 28 33 El Salvador 2014 1 28 29 1 28 29 2015 1 28 29 1 28 29 92.9 2016 1 18 19 1 18 19 2017 1 18 19 1 18 19 Equatorial Guinea 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Eritrea 2014 1 0 1 1 0 1 95 2015 1 0 1 1 0 1 95 2017 — — — — — — — 2018       1 0 1 Estonia 2014 0 4 4 0 4 4 2015 0 4 4 0 4 4 2017 0 4 4 0 4 4 2018 0 4 4 0 4 4 Eswatini 2014 — — — — — — — 2015 — — — — — — — 2017 1 0 1 1 0 1 2018       1 0 1 Ethiopia 2014 25 0 25 25 0 25 2015 25 0 25 25 0 25 2017 25 0 25  25 0 25 2018       42 0 42 Fiji 2014 0 3 3 0 3 3 2015 — — — — — — — 2017 — — — — — — — 2018 0 3 3 0 3 3 Finland 2014 1 0 1 1 0 1 2015 1 0 1 1 0 1 2017 1 0 1 1 0 1 2018 1 0 1 1 0 1 France11 2014 18 0 18 18 0 18 2015 18 0 18 18 0 18 2017 — — — — — — — 2018 18 0 18 18 0 18 10 The Egyptian blood transfusion system is composed of many stakeholders who provide blood and blood components throughout Egypt. The data included in this report are those of the National Blood Transfusion Services only, with its 24 regional blood banks covering most of the Egyptian governorates. 11 The French Blood Establishment is composed of 17 regional facilities. There is also an army blood centre (CTSA). 67ANNEX 2: BLOOD CENTRES AND DATA COVERAGE 2014–2018 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Gabon 2014 2 2 2 0 0 0 60 2015 1 1 0 1 1 2 81 2017 1 8 9 1   1 7012 2018       1 0 1 Gambia 2014 0 12 12 0 11 11 2015 — — — — — — 2017 — — — — — — 2018       0 10 10 Georgia 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Germany 2014 19 51 70 19 51 70 2015 19 51 70 19 51 70 2017 — — — — — — — 2018 — — — — — — — Ghana 2014 1 103 104 1 103 104 9213 2015 1 103 104 1 103 104 96 2017 1 159 160 1 159 160 97 2018 1 2 3 Greece 2014 4 97 101 4 97 101 2015 4 97 101 4 97 101 2017 — — — — — — — 2018 — — — — — — — Grenada 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Guatemala 2014 13 48 61 13 48 61 89 2015 13 57 70 13 57 70 95 2016 14 58 72 14 48 62 97 2017 16 58 74 16 48 64 97.9 Guinea 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Guinea-Bissau 2014 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Guyana 2014 — — — — — — — 2015 1 0 1 1 0 1 2016 1 0 1 1 0 1 2017 1 0 1 1 0 1 12 Data only cover the capital. 13 Some hospital-based blood centres did not provide complete data. It is estimated the collections in this centres account for 8% of the national collection. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202168 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Haiti 2014 9 6 15 9 6 15 95 2015 1 0 1 1 0 1 95 2016 1 0 1 1 0 1 9514 2017 1 0 1 1 0 1 95 Honduras 2014 — — — — — — — 2015 2 15 17 2 12 17 97 2016 2 14 16 2 14 16 2017 2 16 18 2 16 18 Hungary 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Iceland 2014 0 1 1 0 1 1 2015 0 1 1 0 1 1 2017 0 1 1 0 1 1 2018 0 1 1 0 1 1 India 2014 … … 2 760 … … 2 760 2015 … … … … … … … 2017 … … … … … … … 2018 … … … … … … … Indonesia 2014 297 172 379 183 117 300 92 2015 221 193 414 180 124 304 79.7 2017 222 198 420 201 113 314 63.7 2018 222 198 420 212 159 371 78.2 Iran (Islamic Republic of) 2014 91 0 91 91 0 91 2015 91 0 91 91 0 91 2017 91 0 91 91 0 91 2018 91 0 91 91 0 91 Iraq 2014 — — — — — — — 2015 18 21 39 18 21 39 2017 — — — — — — — 2018 — — — — — — — Ireland 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — Israel 2014 1 7 8 1 0 1 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Italy 2014 0 287 287 0 287 287 2015 0 288 288 0 288 288 2017 0 278 278 0 278 278   2018 0  278 278 0  278 278 14 Some blood units screened by National Blood Centre are collected by MSF. 69ANNEX 2: BLOOD CENTRES AND DATA COVERAGE 2014–2018 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Jamaica 2014 — — — — — — — 2015 1 9 10 1 9 10 2016 2 8 10 2 8 10 2017 1 15 16 1 15 16 Japan 2014 54 0 54 54 0 54 2015 54 0 54 54 0 54 2017 54 0 54 54 0 54 2018 — — — — — — — Jordan 2014 17 25 42 4 25 29 58 2015 17 26 43 4 26 30 56 2017 13 31 44 2 0 2 5515 2018 4 37 41 1 0 1 …15 Kazakhstan 2014 18 0 18 18 0 18 2015 18 0 18 18 0 18 2017 — — — — — — — 2018 18 0 18 18 0 18 Kenya 2014 6 12 18 6 12 18 45.9 2015 6 12 18 6 12 18 38.8 2017 33 0 33 33 0  33 70 2018       27 0  27   Kiribati 2014 0 3 3 0 3 3 75 2015 0 3 3 0 1 1 75 2017 0 3 3 0 3 3 2018 0 3 3 0 1 1 75 Kuwait 2014 — — — — — — — 2015 1 0 1 1 0 1 2017 1 0 1 1 0 1 2018 1 0 1 1 0 1 Kyrgyzstan 2014 6 39 45 6 39 45 2015 6 39 45 6 39 45 2017 — — — — — — — 2018 6 39 45 6 39 45 Lao People’s Democratic Republic 2014 13 3 16 14 3 17 2015 13 3 16 13 3 16 2017 15 3 18 15 3 18 2018 18 0 18 18 0 18 Latvia 2014 — — — — — — — 2015 — — — — — — — 2017 1 7 8 1 7 8 2018 1 6 7 1 6 7 Lebanon 2014 13 100 113 — — — — 2015 13 100 113 13 100 113 2017 — — — — — — — 2018 — — — — — — — 15 Data only cover the blood bank directorate. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202170 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Lesotho 2014 3 0 3 3 0 3 2015 3 0 3 3 0 3 2017 4 0 4 4 0 4 2018 2 2 4 Liberia 2014 2 38 40 2 38 40 85 2015 — — — — — — — 2017 — — — — — — — 2018 2 38 40 Libya 2014 — — — — — — — 2015 — — — — — — — 2017 10 53 63 10 53 63 93.6 2018 10 48 58 10 48 58 92 Lithuania 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Luxembourg 2014 1 0 1 1 0 1 2015 1 0 1 1 0 1 2017 — — — — — — — 2018 1 0 1 1 0 1 Madagascar 2014 1 47 48 0 47 47 95 2015 1 48 49 0 44 44 91.7 2017 3 61 64 0 50 50 82 2018       5 70 75 Malawi 2014 4 67 71 4 67 71 … 2015 4 60 64 4 60 64 7016 2017 4 0 4 4 0 4 69.917 2018       4 67 71 Malaysia 2014 1 114 115 1 114 115 90 2015 1 116 117 1 116 117 9018 2017 — — — — — — — 2018 — — — — — — — Maldives 2014 1 75 76 1 11 12 8719 2015 1 21 22 1 20 21 95 2017 — — — — — — — 2018 1 21 22 1 20 21 95 Mali 2014 1 6 7 1 6 7 98 2015 1 7 8 1 7 8 98 2017 1 0 1 1 0 1 20  2018       1 13 14 16 Malawi Blood Transfusion Service provide about 70% of blood supplies. The remainder is provided by hospitals. 17 The total number of blood units collected in the Malawi is reported in the Quarterly Integrated HIV Program Reports published by the Ministry of Health. A total of 87,166 units of blood were collected nationally, of which 60,938 units were collected by the Malawi Blood Transfusion Service. 18 Excluding collection of blood donation in two public hospital universities, private health care blood bank and army hospital blood bank. This report covers 100% of blood donation facilities under Ministry of Health (MOH). 19 Approximately 10651 blood units were collected in the main blood centres across the country and approximately 1500 blood units were collected in small blood transfusion centres. 20 Mali has a National Blood Transfusion Center (CNTS) based in Bamako (capital). Blood collection, processing and distribution activities are carried out through seven regional hospitals. CNTS does not have all the data on blood transfusion activities for the whole country. The data reported only covers the CNTS in Bamako. 71ANNEX 2: BLOOD CENTRES AND DATA COVERAGE 2014–2018 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Malta 2014 1 0 1 1 0 0 — 2015 1 0 1 1 0 1 2017 1 0 1 1 0 1 2018 — — — — — — — Marshall Islands 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 0 2 2 0 1 1 8021 Mauritania 2014 1 13 14 1 13 14 2015 1 13 14 1 0 1 85 2017 — — — — — — — 2018       1 13 14 Mauritius 2014 1 0 1 1 0 1 2015 1 0 1 1 0 1 2017 — — — — — — — 2018       1 0 1 Mexico 2014 — — — — — — — 2015 44 528 572 44 528 572 2016 163 353 516 163 353 516 2017 163 353 516 163 353 516 Micronesia (Federated States of) 2014 0 5 5 0 4 4 95 2015 0 5 5 0 4 4 95 2017 0 5 5 0 4 4 90 2018 5 5 5 4 4 4 95 Monaco 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Mongolia 2014 1 25 26 1 25 26 2015 1 25 26 1 25 26 2017 1 26 27 1 26 27 2018 1 26 27 1 26 27 Montenegro 2014 9 0 9 9 0 9 2015 9 0 9 9 0 9 2017 — — — — — — — 2018 1 0  1 1 0  1 Morocco 2014 2 17 19 2 17 19 2015 2 14 16 2 14 16 2017 — — — — — — — 2018 6 11 17 6 11 17 Mozambique 2014 1 154 155 1 154 155 2015 1 154 155 1 154 155 2017 3 160 163 3 160 163 2018       1 162 163   21 There are 2 hospital-based blood banks: 1 in Ebey and 1 in Majuro (capital). It is estimated that blood collections in Majuro account for 80% of the national collections. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202172 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Myanmar 2014 1 333 334 1 144 145 82 2015 1 333 334 1 153 154 83 2017 1 386 387 1 150 151 9522 2018 1 391 392 1 155 156 95 Namibia 2014 — — — — — — — 2015 1 0 1 1 0 1 2017 1 0 1 1 0 1 2018       1 0 1 Nauru 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Nepal 2014 64 36 100 64 36 100 2015 27 73 100 27 73 100 2017 70 38 108 70 38 108 2018 70 38 108 70 38 108 Netherlands 2014 — — — — — — — 2015 1 0 1 1 0 1 2017 — — — — — — — 2018 — — — — — — — New Zealand 2014 6 0 6 6 0 6 2015 6 0 6 6 0 6 2017 6 0 6 6 0 6 2018 6 0 6 6 0 6 Nicaragua 2014 — — — — — — — 2015 2 0 2 2 0 2 2016 2 0 2 2 0 2 2017 2 0 2 2 0 2 Niger 2014 5 0 5 5 0 5 2015 5 1 6 5 1 6 2017 — — — — — — — 2018       5 1 6 Nigeria 2014 …  …  ..  18 25 43 5 2015 …  …  …  18 25 43 10 2017 …  …  ..  18 25 43 5 2018 …  …  …  18 46 64 Niue 2014 0 1 1 0 1 1 2015 0 1 1 0 1 1 2017 — — — — — — — 2018 0 1 1 0 1 1 North Macedonia 2014 1 0 1 1 0 1 2015 21 0 21 21 0 21 99 2017 0 0 21 0 0 21 …23 2018 21 21 100 22 The services that are not covered by the report are small, which use less than 20 units per year. 23 Institute of Transfusion Medicine is the only blood transfusion service in the country which includes 1 national institute, 3 regional Centres and 17 hospital units called Blood Transfusion Services. The data reported cover 100% for some activities (such as testing) but only 30-50% for other activities. 73ANNEX 2: BLOOD CENTRES AND DATA COVERAGE 2014–2018 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Norway 2014 — — — — — — — 2015 — — — — — — — 2017 0 22 22 0 22 22 2018 0 22 22 0 22 22   Oman 2014 1 16 17 1 13 14 82 2015 1 16 17 1 13 14 82 2017 — — — — — — — 2018 1 15 16 1 12 13 81.2 Pakistan 2014 — — — — — — — 2015 — — 1830 59 97 156 40 2017 … … … 120 486 606 2018 … … … 120 486 606 95 Palau 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 0 1 1 0 1 1 Panama 2014 0 31 31 0 31 31 2015 0 29 29 0 29 29 2016 0 30 30 0 30 30 2017 0 30 30 0 28 28 94 Papua New Guinea 2014 0 35 35 0 23 23 61.4 2015 0 35 35 0 23 23 59 2017 0 35 35 0 23 23 59 2018 — — — — — — — Paraguay 2014 — — — — — — — 2015 1 7 8 1 7 8 2016 1 7 8 1 7 8 99.5 2017 1 9 10 1 7 8 99 Peru 2014 — — — — — — — 2015 — — — — — — — 2016 … … … … … … 2017 2 93 95 2 93 95 Philippines 2014 — — — — — — — 2015 14 33 47 13 14 27 21.4 2017 — — — — — — — 2018 — — — — — — — Poland 2014 23 0 23 23 0 23 2015 23 0 23 23 0 23 2017 23 0  23 23 0  23   2018 23 0 23 23 0 23 Portugal 2014 3 31 34 3 31 34 2015 3 32 35 3 32 35 2017 4 29 33 4 29 33 2018 4 29 33 4 29 33 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202174 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Qatar 2014 1 0 1 1 0 1 2015 1 0 1 1 0 1 78 2017 1 0 1 1 0 1 2018 1 0 1 1 0 1 Republic of Korea 2014 18 93 111 18 93 111 2015 18 92 110 18 92 110 2017 18 87 105 18 86 104 9924 2018 18 97 105 18 97 104 99 Republic of Moldova 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 1 16 17 1 16 17 Romania 2014 — — — — — — — 2015 — — — — — — — 2017 42 0 42 42 0 42 2018 42 0 42 42 0 42 Russian Federation 2014 114 327 441 114 327 441 99 2015 112 294 406 112 294 406 99 2017 101 253 354 101 253 354 99 2018 101 231 332 101 231 332 99 Rwanda 2014 5 0 5 5 0 5 2015 5 0 5 5 0 5 2017 — — — — — — — 2018 5 0 5 Saint Kitts and Nevis 2014 — — — — — — — 2015 0 1 1 0 1 1 2016 0 1 1 0 1 1 2017 0 1 1 0 1 1 Saint Lucia 2014 … … …. … … … … 2015 0 2 2 0 2 2 2016 0 2 2 0 2 2 2017 0 2 2 0 2 2 Saint Vincent and the Grenadines 2014 — — — — — — 2015 0 1 1 0 1 1 2016 0 1 1 0 1 1 2017 0 1 1 0 1 1 Samoa 2014 0 2 2 0 1 1 98.1 2015 0 2 2 0 1 1 97.6 2017 — — — — — — — 2018 San Marino 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — 24 One hospital-based blood centre was closed and unable to report. 75ANNEX 2: BLOOD CENTRES AND DATA COVERAGE 2014–2018 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Sao Tome and Principe 2014 0 2 2 0 2 2 2015 0 2 2 0 1 1 2017 — — — — — — — 2018 0 3 3 Saudi Arabia 2014 11 320 331 11 320 331 2015 11 320 331 11 320 331 2017 — — — — — — — 2018 — — — — — — — Senegal 2014 2 21 23 2 21 23 2015 2 19 21 2 19 21 2017 1 25 26 1 25 26 2018 2 25 27 Serbia 2014 3 44 47 3 44 47 2015 3 44 47 3 44 47 2017 — — — — — — — 2018 — — — — — — — Seychelles 2014 0 1 1 1 1 2015 0 1 1 0 1 1 2017 — — — — — — — 2018 — — — — — — — Sierra Leone 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Singapore 2014 1 1 2 1 0 1 97.625 2015 1 1 2 1 0 1 98.2 2017 1 1 2 1 0 1 98.8 2018 1 0 1 1 0 1 Slovakia 2014 12 33 45 12 33 45 2015 12 33 45 12 33 45 2017 14 30 44 14 30 44 2018 14 30 44 14 30 44 Slovenia 2014 3 0 3 3 0 3 2015 3 0 3 3 0 3 2017 3 0 3 3 0 3 2018 — — — — — — — Solomon Islands 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 0 9 9 0 1 1 9026 Somalia 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — 25 97.6% of blood donations in Singapore are collected by the Blood Services Group. 26 Stock of blood is only kept in the national referral hospital in Honiara. In other smaller hospitals, blood is collected from family replace blood donors only when there is a need. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202176 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total South Africa27 2014 11 0 11 11 0 11 2015 11 0 11 11 0 11 2017 11 0 11 11 0 11 2018 11 0 11 South Sudan 2014 2 13 15 … … … 6.7 2015 — — — — — — — 2017 — — — — — — — 2018       3 12 15 Spain 2014 21 0 21 21 0 21 2015 21 0 21 21 0 21 2017 — — — — — — — 2018 20 0 20 20 0 20 Sri Lanka 2014 2 90 92 2 90 92 2015 2 96 98 2 96 98 2017 2 98 100 2 98 100 2018 2 101 103 2 101 103 Sudan 2014 18 334 352 18 334 352 … 2015 20 352 372 20 352 372 2017 — — — — — — — 2018 — — — — — — — Suriname 2014 — — — — — — 2015 1 0 1 1 0 1 2016 1 0 1 1 0 1 2017 1 0 1 1 0 1 Sweden 2014 0 30 30 0 30 30 2015 0 30 30 0 30 30 2017 0 26 26 0 26 26 2018 0 26 26 0 26 26 Switzerland 2014 12 1 13 12 1 13 2015 11 1 12 11 1 12 2017 11 0 11 11 0 11 2018 11 0 11 11 9 11 Syrian Arab Republic 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Tajikistan 2014 — — — — — — — 2015 4 0 4 4 0 4 2017 5 0  5 5 0  5 2018 4 0  4 4 0  4 27 Blood services in South Africa are delivered by two independent blood services – SANBS (South African National Blood Service) and WPBTS (Western Province Blood Transfusion Service). This report is a national summary covering activities of both services. 77ANNEX 2: BLOOD CENTRES AND DATA COVERAGE 2014–2018 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Thailand 2014 13 157 170 1 0 1 28.128 2015 13 157 170 1 0 1 27.8 2017 13 160 170 13 0 13 40.629 2018 13 160 173 13 0 13 41.9 Timor-Leste 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 0 6 6 0 1 1 7530 Togo 2014 2 0 2 2 0 2 2015 2 0 2 2 0 2 2017 2 0 2 2 0 2 2018       2 0 231 Tonga 2014 0 1 1 0 1 1 2015 0 1 1 0 1 1 2017 0 1 1 0 1 1 2018 0 1 1 0 1 1   Trinidad and Tobago 2014 — — — — — — — 2015 1 5 6 1 5 6 2016 0 7 7 0 7 7 2017 0 7 7 0 7 7 Tunisia 2014 7 25 32 6 0 6 2015 7 25 32 6 0 6 2017 7 25 32 7 25 32 2018 7 25 32 7 25 32 Turkey 2014 17 25 42 17 25 17 80 2015 17 25 42 17 0 17 80 2017 18 13 31 18 0 18 82 2018 — — — — — — — Turkmenistan 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Tuvalu 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Uganda 2014 7 0 7 7 0 7 2015 7 0 7 7 0 7 2017 7 0 7 7 0 7 2018       7 0 7 28 Total blood collection in whole country is 2,274,788 units. National Blood Centre collected 639,919 units 29 Data reported cover National Blood Centre and 12 Regional Blood Centres excluding Hospital-based blood centres. 30 Data only cover the National Blood Bank. 31 Blood system consists of 1 national centre (CNTS), 1 regional centre (CRTS) and 6 collection and distribution stations. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202178 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Ukraine 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — United Arab Emirates 2014 4 9 13 4 9 13 2015 4 9 13 4 9 13 25 2017 — — — — — — — 2018 5 7 12 4 7 11 9332 United Kingdom of Great Britain and Northern Ireland33 2014 4 6 10 4 6 10 2015 4 6 10 4 6 10 2017 — — — — — — — 2018 — — — — — — — United Republic of Tanzania 2014 7 0 7 7 0 7 4634 2015 7 0 7 7 0 7 24 2017 7 0 7 7 0 7 2018       7 0 7 United States of America 2014 136 115 251 48 — 48 60 2015 … … … 48 0 48 60 2017 65 0 65 4 0 4 5235 2018 65 0  65 5 0  5 6236 Uruguay 2014 — — — — — — — 2015 3 71 74 3 71 74 72 2016 3 71 74 3 71 74 94 2017 3 71 74 3 71 74 96 Uzbekistan 2014 16 189 205 16 189 205 2015 16 189 205 16 189 205 2017 — — — — — — — 2018 — — — — — — — Vanuatu 2014 — — — — — — — 2015 0 4 4 0 4 4 2017 — — — — — — — 2018 — — — — — — — Venezuela (Bolivarian Republic of) 2014 — — — — — — — 2015 4 335 339 4 335 339 80.9 2016 — — — — — — — 2017 — — — — — — — Viet Nam 2014 0 63 63 0 63 63 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — 32 The stand-alone centre (Military Blood Bank) that was not included in the report is estimated to contribute approximately 7% of the national blood collection. 33 Subnational data provided by Scottish National Blood Transfusion Service and Welsh Blood Service. 34 The estimation is based on Blood Need Assessment study conducted in 2014. The study indicated the need of blood units in Tanzania is 278,000 per year. 35 This report includes data from 4 of the largest blood collection centres in the Unites States of America. 36 This report includes data from 5 of the largest blood collection centres in the Unites States of America. 79ANNEX 2: BLOOD CENTRES AND DATA COVERAGE 2014–2018 Country Data year Number of blood centres in the country Number of blood centres covered by this report Estimated % of blood donations covered by this report* Stand-alone Hospital-based Total Stand-alone Hospital-based Total Yemen 2014 — — — — — — — 2015 … … … … … 9 30 2017 — — — — — — — 2018 8 271 279 3 0 3 … Zambia 2014 9 0 9 9 0 9 0 2015 10 0 10 10 0 10 2017 — — — — — — — 2018 — — — — — — — Zimbabwe 2014 5 0 5 5 0 5 2015 5 0 6 5 0 5 2017 5 0 5 5 0 5 2018       5 0 5 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202180 Annex 3. Blood donations 2014–2018 … Not reported/not available. Blank cell: Not required/not applicable. — No response. VNRD: Voluntary non-remunerated donations. Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Afghanistan 2014 55 203 … … 67 492 0 0 122 695 2015 69 272 … … 86 443 0 0 155 715 2017 77 923 … … 101 858 0 0 179 781 2018 82 904 … … 127 723 0 0 210 627 Albania 2014 — — — — — — — 2015 7 404 111 7 293 20 309 1 960 15 29 688 2017 — — — — — — — 2018 9 282 … … 23 144 650 11 33 087 Algeria 2014 364 445 … … 166 350 0 530 795 2015 … … … … … 502 924 2017 — — — — — — — 2018 397 097 … … 195 583 0 592 680 Andorra 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Angola 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 9 463 … … 97 030 0 0 106 493 Antigua and Barbuda 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Argentina 2014 417 368 166 947 250 421 436 465 0 853 833 2015 468 361 … … 557 318 0 1 025 679 2016 401 384 60 208 341 176 520 911 0 924 804 2017 495 000 297 000 198 000 609 532 0 1 104 532 Armenia 2014 819 799 20 4 435 8 111 0 13 365 2015 740 721 19 5 047 7 824 0 13 611 2017 — — — — — — — 2018 — — — — — — — Australia1 2014 — — — — — — — 2015 — — — — — — — 2017 701 136 701 136 2018 690 759 690 759 1 Data source: Australia Red Cross Blood Service Annual report 2016-2017; Australian Red Cross Blood Service Annual Report 2017-2018. Available at: https://www.lifeblood.com.au/about/our-strategy/annual-reports. 81ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Austria 2014 — — — — — — 212 717 2015 — — — — — — 422 786 2017 … … … … … … 352 7982 2018 … … … … … … 422 7862 Azerbaijan 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Bahamas 2014 1 859 … … 2 699 0 4 558 2015 — — — — — — — 2016 1 610 914 696 4 129 0 5 739 2017 1 293 341 919 4 303 0 5 596 Bahrain 2014 19 347 2 500 16 847 65 0 0 19 412 2015 19 152 2 410 16 742 0 0 0 19 152 2017 18 837 …. … 0 0 0 18 837 2018 19 546 … … 0 0 19 546 Bangladesh 2014 185 797 … … 465 921 0 651 718 2015 200 906 … … 478 775 0 679 681 2017 152 984 … … 550 440 0 703 424 2018 171 000 … … 590 115 0 761 115 Barbados 2014 529 — — 4 052 0 4 581 2015 — — — — — — — 2016 623 … … 4 549 5 172 2017 556 … … 4 687 0 5 243 Belarus 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Belgium 2014 469 164 52 497 416 667 0 0 0 469 164 2015 465 463 53 868 411 595 — — — 465 463 2017 — — — — — — — 2018 — — — — — — — Belize 2014 1 116 … … 3 213 0 4 329 2015 783 … … 4 781 0 5 564 2016 795 … … 5 031 0 5 826 2017 680 … … 5 412 0 6 092 Benin 2014 70 744 30 229 43 782 3 267 0 74 011 2015 68 498 27 940 40 558 3 146 0 71 644 2017 — — — — — — — 2018 81 500 … … 1 703 0 0 83 203 Bhutan 2014 6 667 4 000 2 667 2 708 0 0 9 375 2015 6 797 3 943 2 854 1 997 0 0 8 794 2017 7 989 …  …  2 008 0 0  9 997 2018 5 496 … … 2 274 0 0 7 770 2 Partial data. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202182 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Bolivia 2014 40 435 29 351 11 084 60 669 0 101 104 2015 44 188 — — 63 884 0 108 072 2016 39 746 28 281 11 465 72 725 0 112 571 2017 42 698 31 353 11 345 76 965 0 119 663 Bosnia and Herzegovina 2014 16 410 7 776 13 004 220 0 0 16 410 2015 15 240 6 521 12 267 51 0 0 15 240 2017 — — — — — — — 2018 — — — — — — — Botswana 2014 25 510 … … 0 0 0 25 510 20153 27 444 … … 0 0 0 27444 2017 … … … … … … … 2018 24 088 … … 0 0 0 24 088 Brazil 2014 — — — — — — — 2015 1 892 114 … … 1 197 008 0 3 087 399 2016 2 454 117 … … 1 502 708 0 3 956 825 2017 2 395 417 1 447 387 948 030 1 465 433 0 3 860 850 Brunei Darussalam 2014 15 130 4 197 9 384 0 0 15 130 2015 15 183 3 556 10 079 0 0 15 183 2017 16 104 3 404 10 129 0 0   16 104 2018 15 537 2 825 9 864 0 0 15 537 Bulgaria 2014 33 434 6 687 26 747 133 736 2 311 169 481 2015 57 058 12 643 44 415 10 7963 1 860 166 881 2017 — — — — — — — 2018 167 424 36 115 45 332 130 551 2 209 300 184 Burkina Faso 2014 80 284 50 243 30 041 32 830 0 113 114 2015 86 694 52 599 34 095 29 602 0 116 296 2017 88 270 50 954 37 316 27 604 0   115 874 2018 94 223 … … 12 012 0 106 235 Burundi 2014 — — — — — — — 2015 60 084 19 757 40 327 0 0 0 60 084 2017 — — — — — — — 2018 82 524 … … 0 0 0 82 524 Cabo Verde 2014 2 760 … … 495 0 3 255 2015 2 819 1277 1542 498 0 3 317 2017 — — — — — — — 2018 2 292 1 060 0 3 352 Cambodia 2014 17 790 15 655 2 135 35 074 0 0 52 864 2015 17 034 16 182 852 37 795 0 0 54 829 2017 — — — — — — — 2018 — — — — — — — Cameroon 2014 5 966 … … 43 117 — — 49 083 2015 8 848 … … 53 004 1 638 9 572 73 096 2017 9 533 … … 79 067 2 447 91 047 2018 6 312 … … 88 561 0 0 94 873 3 2016 data 83ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Canada4 2014 863 567 97 208 766 359 0 0 0 863 567 2015 807 001 82 096 724 905 0 0 0 807 001 2017 794 471 103 750 690 921 0 0 0 794 471 2018 — — — — — — — Central African Republic 2014 12 078 5 799 6 416 137 0 0 12 215 2015 15 480 7 493 8 131 0 0 0 15 480 2017 — — — — — — — 2018 21 000 … … 0 0 0 21 000 Chad 2014 5 734 4 874 860 71 736 0 77 470 2015 4 143 3 315 828 19 569 0 23 712 2017 — — — — — — — 2018 831 … … 73 637 0 0 74 468 Chile 2014 59 722 181189 0 240 911 2015 68 176 44 023 24 153 171 373 0 239 549 2016 80 225 44 648 35 577 172 306 0 252 531 2017 90 531 48 167 42 364 175 122 0 265 653 China 2014 11 682 449 … … 481 495 0 12 163 944 2015 11 819 408 … … 493 115 0 12 312 523 2017 13 328 648 … … 243 974 0 13 572 622 2018 13 661 423 … … 39 196 0 13 700 619 Colombia 2014 647 269 382 132 265 137 85 855 0 733 124 2015 725 209 569 780 155 429 70 479 0 795 688 2016 757 788 583 201 171 926 58 664 0 816 452 2017 782 964 599 611 183 353 47 327 0 830 291 Comoros 2014 120 15 105 2 200 0 2 320 2015 70 10 60 2 321 0 2 391 2017 — — — — — — — 2018 168 … … 1 512 0 0 1 680 Congo 2014 20 173 9 836 10 337 34 121 0 0 54 294 2015 25 648 15 914 9 734 34 489 0 0 60 137 2017 56 111 14 515 8 020 33 576 0 56 122 2018 36 028 … … 52 304 0 0 88 332 Cook Islands 2014 193 37 113 0 0 0 193 2015 — — — — — — — 2017 262 10 252 0 0 262 2018 — — — — — — — Costa Rica 2014 46 188 … … 26 863 0 73 051 2015 45 769 … … 29 999 0 75 768 2016 47 061 … … 30 541 0 77 602 2017 47 204 … … 30 185 0 77 389 Côte d’Ivoire 2014 92 115 51 364 40 751 0 0 0 92 115 2015 155 534 63 024 92 510 0 0 0 155 534 2017 153 754 59 894 93 860 0 0 0 153 754 2018 158 539 … … 0 0 0 158 539 4 Subnational data provided by Canadian Blood Service. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202184 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Croatia 2014 180 005 14 076 165 929 0 0 180 005 2015 191 442 19 125 172 317 0 0 191 442 2017 194 702 14 895 179 807 0 0 194 702 2018 190 447 12 912 177 535 0 0 190 447 Cuba 2014 415 902 … … 0 0 415 902 2015 416 923 … … 0 0 416 923 2016 — — — — — — — 2017 411 979 164 971 247 008 0 0 411 979 Cyprus 2014 31 444 2 834 28 610 0 0 31 444 2015 30 711 3 019 27 692 0 0 30 711 2017 — — — — — — — 2018 63 008 0 63 008 0 0 63 008 Czechia 2014 403 500 27 000 376 500 403 500 2015 403 200 25 600 377 600 0 0 403 200 2017 — — — — — — — 2018 417 251 27 262 389 989 0 0 0 417 251 Democratic People’s Republic of Korea 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Democratic Republic of the Congo 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 141 603 … … 246 523 32 021 0 420 147 Denmark 2014 — — — — — — — 2015 — — — — — — — 2017 207 462 15 455 192 007 207 462 2018 206 990 16 773 190 217 0 0 0 206 990 Djibouti 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Dominica 2014 66 … … 940 0 1 006 2015 — — — — — — — 2016 101 19 82 1 064 0 1 165 2017 171 17 77 790 0 961 Dominican Republic 2014 9 379 … … 84 177 335 93 891 2015 9 126 … … 69 330 59 78 515 2016 7 284 … … 100 297 0 107 581 2017 7 383 … … 97 721 0 105 104 Ecuador 2014 139 571 92 566 232 137 2015 168 464 163 082 83 805 78 305 246 769 2016 166 392 … … 69 876 236 268 2017 179 823 … … 69 530 0 249 353 85ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Egypt 2014 — — — — — — — 2015 402 600 480 390 59 430 50 000 0 732 442 616 2017 466 741 456 800 9 941 469 117 2018 305 718 300 000 5 718 121 142 426 860 El Salvador 2014 14 665 … … 83 423 98 090 2015 15 810 11 299 4 511 77 009 0 92 819 2016 23 059 17 603 5 456 81 554 0 104 613 2017 24 159 13 201 10 953 77 650 0 101 809 Equatorial Guinea 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Eritrea 2014 7 285 6 467 818 784 0 0 8 069 2015 6 264 5 696 568 758 0 0 7 022 2017 — — — — — — — 2018 9 057 … … 218 0 0 9 275 Estonia 2014 60 531 6 951 53 580 0 0 0 60 531 2015 59 013 5 960 53 053 0 0 0 59 013 2017 55 057 5 084 49 973 0 0 0 55 057 2018 50 142 5 099 45 043 0 0 0 50 142 Eswatini 2014 — — — — — — — 2015 — — — — — — — 2017 14 675 14 675 0 0 0 0 14 675 2018 15 203 … … 0 0 0 15 203 Ethiopia 2014 61 385 … … 26 300 87 685 2015 121 968 … … 6 185 0 0 128 153 2017 183 338 172 288 11 050 3 515 0 0 186 853 2018 182 767 … … 3 730 0 0 186 497 Fiji 2014 11 655 4 429 7 226 1 767 0 0 13 432 2015 — — — — — — — 2017 — — — — — — — 2018 17 814 6 923 10 891 443 0 0 18 257 Finland 2014 208 380 14 312 194 068 0 0 0 208 380 2015 209 408 13 622 195 786 0 0 0 209 408 2017 204 948 14 343 190 605 0 0 0 204 948 2018 206 610 14 735 191 875 0 0 0 206 610 France 2014 2 532 137 … … 0 0 2 532 137 2015 2 979 964 … … 0 0 0 2 979 964 2017 — — — — — — — 2018 2 512 870 387 109 2 125 761 0 0 2 512 870 Gabon 2014 6 589 … … 14 905 0 0 21 494 2015 7 844 … … 17 236 0 0 25 080 2017 4 697 … … 10 994 0 25 549 2018 6 900 … … 16 100 0 0 23 000 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202186 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Gambia 2014 2 356 … … 8 861 0 0 11 217 2015 — — — — — — — 2017 — — — — — — — 2018 1 330 … … 10 659 0 0 11 989 Georgia 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Germany 2014 4 496 589 390 665 4 105 924 0 0 4 496 589 2015 4 193 478 339 505 3 853 973 0 0 4 193 478 2017 — — — — — — — 2018 — — — — — — — Ghana 2014 45 459 27 730 17 729 104 863 150 322 2015 52 785 33 255 19 530 102 465 0 155 250 2017 … … … … … … … 2018 57 594 … … 104 632 0 162 226 Greece 2014 276 248 28 106 248 142 265 414 0 541 662 2015 274 705 … … 229 855 0 504 560 2017 — — — — — — — 2018 — — — — — — — Grenada 2014 509 55 454 757 0 1 266 2015 — — — — — — — 2016 — — — — — — — 2017 — — — — — — — Guatemala 2014 7 622 … … 106 766 0 114 388 2015 6 870 … … 119 352 0 126 222 2016 6 868 … … 128 624 0 135 492 2017 6 888 … … 129 930 0 136 818 Guinea 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Guinea-Bissau 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Guyana 2014 — — — — — — — 2015 9 696 2 482 7 208 6 0 9 702 2016 4 193 …  …  6 002 0 10 195 2017 9 755 3 013 6 712 0 9 755 Haiti 2014 15 505 …  …  13 362 0 28 867 2015 13 239 …  …  14 513 0 27 752 2016 10 203 …  …  15 496 0 25 699 2017 11 571 …  …  16 447 0 28 018 87ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Honduras 2014 10 111 …  …  48 107 393 58 611 2015 13 326 …  …  57 624 687 71 637 2016 16 922 …  …  62 854 47 79 823 2017 13 959 …  …  66 861 24 80 844 Hungary 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Iceland 2014 11 393 0 11 393 0 0 0 11 393 2015 10 689 0 10 689 0 0 0 10 689 2017 10 734 0 10 734 0 0 0 10 734 2018 — — — — — — — India 2014 8 427 714 … … 2 410 669 0 10838383 2015 8 532 000 … … 2 268 000 0 10 800 000 2017 8 931 000 … … 2 519 000 0 11 450 000 2018 9 424 000 … … 2 976 000 0 12 400 000 Indonesia 2014 2 633 334 …  …  414 333 7 070 3 054 747 2015 3 034 904 …  …  330 913 5 118 3 370 935 2017 3 209 506 …  …  256 099 8 520 3 474 125 2018 3 480 051 989 612 2 490 439 327 097 14 567 3 821 715 Iran (Islamic Republic of) 2014 2 052 549 432 687 1 619 862 0 0 0 2 052 549 2015 2 066 849 404 323 1 662 526 0 0 0 2 066 849 2017 2 072 370 265 716 1 806 654 0 0 0 2 072 370 2018 2 069 273 245 412 1 823 861 0 0 0 2 069 273 Iraq 2014 — — — — — — — 2015 … … … … … … 550 000 2017 — — — — — — — 2018 — — — — — — — Ireland 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Israel 2014 263 797 50 464 212 109 0 0 263 797 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Italy 2014 2 587 869 365 037 2 222 832 0 0 0 2 587 869 2015 2 576 473 386 125 2 190 348 0 0 0 2 576 473 2017 2 579 438 385 411 2 194 027 0 0 0 2 579 438 2018 2 569 275 371 093 2 198 182 0 0 0 2 569 275 Jamaica 2014 6 412 …  …  20 716 0 29 390 2015 8 291 …  …  20 125 0 28 416 2016 5 346 …  …  19 915 0 25 351 2017 5 612 …  …  26 417 0 32 029 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202188 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Japan 2014 3 604 721 389 161 3 215 560 0 0 0 3 604 721 2015 3 547 726 352 654 3 195 072 0 0 0 3 547 726 2017 3 420 645 337 778 3 082 867 0 0 0 3 420 645 2018 — — — — — — — Jordan 2014 63 817 19 145 44 672 58 907 0 122 724 2015 63 657 21 430 42 227 54 227 0 117 884 20175 36 953 24 389 12 564 26 759 0 0 63 713 2018 35 652 24 244 11 408 29 171 0 0 64 823 Kazakhstan 2014 151 480 151 480 40 523 103 832 7 746 246 282 2015 157 016 75 368 81 648 97 065 31 403 285 484 2017 — — — — — — — 2018 147 092 55 340 91 752 39 209 2 419 190 782 Kenya 2014 183 406 127 731 55 675 0 0 0 183 406 2015 155 081 108 557 46 524 0 0 0 155 081 2017 — — — — — — — 2018 164 275 …  …  0 0 0 164 275 Kiribati 2014 196 …  …  1 653 0 1 849 2015 229 …  …  1 942 0 2 171 2017 105 95 10 2 823 0 2 932 2018 229 …  …  1 942 0 2 171 Kuwait 2014 — — — — — — — 2015 39 522 17 014 22 511 27 626 0 5 67 156 2017 47 408 14 794 32 614 26 511 0 73 919 2018 43 467 14 278 29 189 34 564 0 0 78 031 Kyrgyzstan 2014 … … … … … … 39 884 2015 5 288 2 602 640 33 996 3 826 43 110 2017 — — — — — — — 2018 … … … … … … … Lao People’s Democratic Republic 2014 31 750 … … 3 297 0   35 047 2015 31 386 18 825 1 256 5 277 0 36 740 2017 42 173 19 382 22 791 3 562 45 735 2018 45 982 19 242 17 471 2 998 0 49 070 Latvia 2014 — — — — — — — 2015 — — — — — — — 2017 49 725 6 158 43 567 0 0 49 725 2018 52 174 6 675 45 499 0 0 52 174 Lebanon 2014 … … … … … … 150 000 2015 … … … … … … 150 000 2017 — — — — — — — 2018 — — — — — — — Lesotho 2014 8 063 5 623 2 440 310 0 0 8 373 2015 7 666 5 084 2 582 213 0 0 7 879 2017 3 836 1 421 2 415 1 602 5 438 2018 3 900 … … 2 518 0 0 6 418 5 Partial data. 89ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Liberia 2014 500 131 12 3 471 0 0 4 114 2015 — — — — — — — 2017 — — — — — — — 2018 6 362 … … 4 661 0 0 11 023 Libya 2014 — — — — — — — 2015 — — — — — — — 2017 18 534 3 706 14 828 124 038 0 142 572 2018 17 057 1 405 15 652 131 273 0 148 330 Lithuania 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Luxembourg 2014 23 937 1 402 22 535 0 0 23 937 2015 20 358 904 19 454 0 0 20 358 2017 — — — — — — — 2018 19 724 1 125 18 599 0 0 19 724 Madagascar 2014 6 564 2 704 3 860 24 406 0 30 970 2015 7 044 2 760 4 284 26 118 0 0 33 162 2017 8 523 … … 30 831 0 0 39 210 2018 9 821 … … 39 102 0 0 48 923 Malawi 2014 52 065 27 062 25 003 26 000 0 0 78 065 2015 52 160 28 162 29 858 26 000 0 0 84 020 2017 60 938 … … 0 0 0 60 938 2018 52 494 … … 10 506 0 0 63 000 Malaysia 2014 657 367 230 467 426 900 49 0 657 416 2015 707 328 237 362 469 966 76 0 707 404 2017 — — — — — — — 2018 — — — — — — — Maldives 2014 2 081 … … 7 288 0 9 369 2015 1 209 324 750 864 127 2 200 2017 — — — — — — — 2018 2 335 852 1 483 4 131 0 6 466 Mali 2014 … … … … … … … 2015 12 282 4 524 7 758 32 752 0 0 45 034 2017 12 764 5 378 7 386 35 744 0 48 508 2018 15 025 … … 40 981 0 0 56 006 Malta 2014 — — — — — — — 2015 17 014 2 163 14 851 0 0 0 17 014 2017 15 917 1 065 14 852 0 0 0 15 917 2018 — — — — — — — Marshall Islands 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 … … … … … … 288 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202190 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Mauritania 2014 … … … … 0 0 15 490 2015 4 689 — — 10 040 0 0 14 729 2017 — — — — — — — 2018 6 346 … … 12 047 0 0 18 393 Mauritius 2014 41 390 … … 4 201 0 45 591 2015 43 011 11 745 28 266 3 525 0 46 536 2017 — — — — — — — 2018 41 063 … … 3 508 0 160 44 731 Mexico 2014 49 794 … … 1 889 266 0 1 939 060 2015 84 634 82 040 326 2 085 368 0 2 170 002 2016 113 052 … … 2 240 804 2 353 857 2017 124 325 … … 2 270 511 0 2 394 836 Micronesia (Federated States of) 2014 160 15 145 1 477 0 0 1 637 2015 172 50 122 1 549 0 0 1 721 2017 306 145 161 1 361 0 0 1 667 2018 302 157 145 1 434 0 0 1 736 Monaco 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Mongolia 2014 26 097 13 301 12 273 523 0 0 26 097 2015 30 202 15 504 14 698 194 0 0 30 396 2017 33 407 15 033 18 374 0 0 0 33 407 2018 31 072 14 679 16 393 0 0 0 31 072 Montenegro 2014 5 994 1 776 4 218 10 657 0 0 16 651 2015 6 961 2 287 3 134 10 198 0 17 159 2017 — — — — — — — 2018 7 608 1 663 5 945 11 045 0 0 18 653 Morocco 2014 237 457 … … 59 489 0 0 296 946 2015 204 979 164 395 59 414 32 678 0 0 297 073 2017 — — — — — — — 2018 298 842 … … 22 494 0 0 321 336 Mozambique 2014 47 582 … … 73 509 0 0 121 091 2015 … … … … 0 0 126 068 2017 61 996 … … 70 061 132 057 2018 66 459 … … 69 632 0 0 136 091 Myanmar 2014 47 057 18 844 28 213 3 941 0 0 50 998 2015 61 037 26 943 34 094 1 886 0 0 62 923 2017 71 620 28 434 43 186 2 313 0 0 73 933 2018 96 018 41 305 54 713 921 0 0 96 939 Namibia 2014 — — — — — — — 20156 32 968 6 441 26 527 0 0 0 32 968 2017 37 785 7 524 30 261 0 0 0 37 785 2018 37 672 … … 0 0 0 37 672 6 2016 data. 91ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Nauru 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Nepal 2014 217 160 54 290 162 870 34 744 0 0 217 160 20157 98 000 49 000 49 000 17 000 0 0 115 000 2017 215 200 53 800 161 400 47 240 0 0 262 440 2018 225 696 67 708 157 988 46 226 0 0 271 922 Netherlands 2014 — — — — — — — 2015 435 405 … … … … … 435 405 2017 — — — — — — — 2018 — — — — — — — New Zealand 2014 120 668 15 246 105 422 0 0 0 120 668 2015 119 554 15 452 104 102 0 0 0 119 554 2017 111 189 15 556 95 633 0 0 0 111 189 2018 112 162 16 249 95 913 0 0 0 112 162 Nicaragua 2014 75 035 … … … … 75 035 2015 74 955 28 982 44 937 0 0 74 955 2016 76 697 29 357 47 346 76 697 2017 84 682 40 215 44 467 0 0 84 682 Niger 2014 22 913 7 637 15 276 55 444 0 78 357 2015 28 199 12 049 16 150 59 589 0 87 788 2017 — — — — — — — 2018 38 625 … … 99 090 0 0 137 715 Nigeria8 2014 49 111 33 827 15 284 14 243 0 16 689 80 043 2015 58 363 43 057 15 306 40 622 0 0 98 985 2017 31 553 21 336 10 217 42 687 0 0 74 240 2018 30 229 … … 84 800 53 432 240 168 701 Niue 2014 0 0 0 17 0 0 17 2015 — — — — — — — 2017 — — — — — — — 2018 … … … … … … … North Macedonia 2014 51 276 7 356 43 920 724 0 52 000 2015 48 349 5 908 42 441 0 0 48 694 2017 ... ... ... ... ... ... ... 2018 53 915 5 451 48 465 271 0 0 54 186 Norway 2014 — — — — — — — 2015 — — — — — — — 2017 177 719 10 000 167 719 0 0 0 177 719 2018 174 454 10 000 164 454 0 0 0 174 454 Oman 2014 48 526 23 780 24 847 8 703 0 57 330 2015 47 155 22 674 20 863 8 988 0 56 143 2017 — — — — — — — 2018 51 615 25 625 25 990 5 792 0 57 407 7 Partial data. 8 Partial data. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202192 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Pakistan 2014 — — — — — — — 2015 220 847 — — 1 159 439 0 1 380 286 2017 … … … … … … … 2018 410 599 … … 1 903 709     2 314 308 Palau 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 603 250 0 853 Panama 2014 3 352 … … 47 407 5 079 55 838 2015 3 970 … … 49 340 0 56 205 2016 3 802 … … 50 833 2 319 56 954 2017 2 801 … … 48 822 2 443 54 066 Papua New Guinea 2014 15 916 8 379 7 537 12 451 0 28 367 2015 18 615 10 561 8 046 14 582 0 33 197 2017 20 847 10 012 10 692 17 647 0 38 544 2018 — — — — — — — Paraguay 2014 8 022 … … 79 866 0 87 888 2015 8 819 … … 77 178 0 85 997 2016 10 090 … … 83 410 93 500 2017 12 673 … … 76 061 0 88 734 Peru 2014 — — — — — — — 2015 — — — — — — — 2016 31 444 30 815 629 308 140 0 339 594 2017 34 718 33 643 1 075 324 740 0 359 458 Philippines 2014 — — — — — — — 2015 713 366 280 031 433 335 148 289 324 861 979 2017 — — — — — — — 2018 — — — — — — — Poland 2014 1 118 846 193 401 925 445 51 741 446 1 172 361 2015 1 157 092 112 832 1 044 260 184 347 1 157 623 2017 1 160 746 199 099 9 61 647 48 677 358 1 210 706 2018 1 172 572 181913 9 86 166 50 180 367 1 223 209 Portugal 2014 353 459 36 172 190 710 0 0 353 459 2015 337 580 37 603 186 321 0 0 337 580 2017 318 839 25 823 293 016 0 0 318 839 2018 309 231 24 645 284 586 0 0 309 231 Qatar 2014 25 242 … … … … … 25 242 2015 27 032 11 849 15 183 5 0 0 27 039 2017 27 095 12 289 14 806 13 0 0 27 108 2018 30 209 12 952 17 257 26 0 0 30 235 Republic of Korea 2014 3 048 488 522 917 2 525 571 0 0 0 3 048 488 2015 3 077 553 478 260 2 599 293 0 0 0 3 077 553 2017 2 133 219 368 393 1 764 826 0 0 0 2 133 219 2018 2 114 925 330 586 1 784 339 0 0 0 2 114 925 93ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Republic of Moldova 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 59 336 … … 3 857 63 193 Romania 2014 — — — — — — — 2015 — — — — — — — 2017 417 114 118 986 298 128 0 0 0 417 114 2018 416 769 122 348 294 421 0 0 0 416 769 Russian Federation 2014 2 212 349 … … 0 90 079 2 302 468 2015 2 247 891 … … 0 43 596 2 291 487 2017 2 175 625 … … 0 24 010 2 199 635 2018 2 203 748 … … 0 20 463 2 224 211 Rwanda 2014 42 789 10 697 32 092 0 0 0 42 789 2015 53 436 10 687 42 749 0 0 0 53 436 2017 — — — — — — — 2018 65 512 … … 0 0 0 65 512 Saint Kitts and Nevis 2014 — — — — — — 2015 42 30 6 366 0 408 2016 32 13 19 509 0 541 2017 25 … … 545 0 570 Saint Lucia 2014 1 402 … … 1038 0 2 440 2015 1 563 634 929 898 0 2 461 2016 1 310 481 829 1 248 0 2 558 2017 1 561 587 974 1 215 0 2 776 Saint Vincent and the Grenadines 2014 77 … … 987 0 1 064 2015 144 … … 884 0 1 028 2016 122 … … 981 0 1 103 2017 110 … … 1 197 0 1 307 Samoa 2014 264 … … 1 448 0 0 1 712 2015 257 51 206 2 222 0 0 2 479 2017 — — — — — — — 2018 — — — — — — — San Marino 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Sao Tome and Principe 2014 562 … … 296 0 11 869 2015 825 650 175 185 0 0 1 010 2017 — — — — — — — 2018 853 … … 341 0 0 1 194 Saudi Arabia 2014 176 600 52 500 124 100 267 450 0 444 050 2015 188 900 63 400 125 500 295 700 0 0 484 600 2017 — — — — — — — 2018 — — — — — — — GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202194 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Senegal 2014 75 438 44 927 30 511 3 110 0 0 78 548 2015 51 506 35 368 16 138 17 789 0 0 69 295 2017 80 900 50 967 29 933 8 005 0 0 88 905 2018 87 183 … … 10 775 0 0 97 958 Serbia 2014 237 755 … … 0 0 0 237 755 2015 243 473 … … 0 0 0 243 473 2017 — — — — — — — 2018 — — — — — — — Seychelles 2014 452 119 396 813 0 0 1 822 2015 634 305 300 724 0 0 1 863 2017 — — — — — — — 2018 — — — — — — — Sierra Leone 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Singapore 2014 108 058 23 880 84 178 0 0 0 108 058 2015 112 713 24 736 87 977 0 0 0 112 713 2017 116 128 24 842 91 286 0 0 0 116 128 2018 115 826 24 349 91 477 0 0 0 115 826 Slovakia 2014 218 439 … … 0 0 218 439 2015 222 286 27 905 194 381 0 0 222 286 2017 215 786 18 363 197 423 0 0 215 786 2018 22 1936 17 865 204 071 0 0 221 936 Slovenia 2014 89 395 9 596 79 799 0 0 0 89 395 2015 88 394 8 654 56 521 0 0 0 88 394 2017 90 927 9 514 81 413 0 0 0 90 927 2018 50 142 5 099 81 413 0 0 0 50 142 Solomon Islands 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 … … … … … … … Somalia 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — South Africa 2014 956 931 117 612 839 319 0 0 189 819 120 2015 981 673 122 344 859 329 0 0 981 673 2017 964 588 111 319 853 269 0 0 0 964 588 2018 982 010 … … 0 0 0 982 010 South Sudan 20149 323 300 23 190 0 0 323 2015 — — — — — — — 2017 — — — — — — — 2018 1 754 … … 4 779 0 0 6 533 9 Partial data. 95ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Spain 2014 1 621 707 … … — — — 1 621 707 2015 1 651 074 … … 0 0 0 1 651 074 2017 1 686 463 … … 0 0 0 1 686 463 2018 — — — — — — — Sri Lanka 2014 380 367 82 136 298 321 0 0 380 367 2015 395 500 85 403 310 097 0 0 395 500 2017 423 668 … … 0 0 0 423 668 2018 450 640 … … 0 0 0 450 640 Sudan 2014 46 013 … … 295 207 341 220 2015 26 192 … … 289 568 0 0 315 764 2017 — — — — — — — 2018 — — — — — — — Suriname 2014 10 521 … … … … 10 521 2015 10 290 … … 0 0 10 290 2016 10 429 … … 10 429 2017 10 270 … … 0 0 10 270 Sweden 2014 462 629 0 462 629 0 0 462 629 2015 456 295 … … 0 0 456 295 2017 418 040 28 244 389 796 418 040 2018 409 187 29 146 409 187 0 0 409 187 Switzerland 2014 310 216 25279 284 937 0 0 310 216 2015 292 625 28170 264 455 0 0 292 625 2017 265 409 … … 0 0 265 409 2018 260 011 … … 0 0 260 011 Syrian Arab Republic 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Tajikistan 2014 21 487 6 431 8 224 2 084 5 271 0 36 142 2015 33 489 10 419 23 070 2 833 6 613 0 42 935 2017 28 097 6 725 21 372 3 481 8 641 0 40 219 2018 31 326 9 789 15 662 6 574 7 935 0 48 523 Thailand 201410 639 919 92 650 547 269 0 0 0 639 919 201510 650 107 96 229 553 878 0 0 0 650 107 201711 1 067 896 154 678 913 218 0 0 1 067 896 201811 1 112 497 152 536 959 961 0 0 0 1 112 497 Timor-Leste 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 800 600 200 3 138 0 0 3 938 Togo 2014 48 408 14 334 34074 0 0 0 48408 2015 44 751 11 446 33305 0 0 0 44751 2017 42 906 10 106 32 800 0 0 0 42 906 2018 50 023 ... ... 0 0 0 50 023 10 Numbers of donations reported in this section only cover the National Blood Centre, Bangkok, accounting for approximately 30% of the total national collections. 11 Partial data. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202196 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total Tonga 2014 — — — — — — — 2015 — — — — — — — 2017 ... ... ... ... ... ... 1 675 2018 ... ... ... ... ... ... 3 322 Trinidad and Tobago 2014 3 753 ... ... 17 419 0 21 172 2015 3 866 564 302 17 132 0 20 998 2016 4 444 1 092 3 352 17 431 0 21 875 2017 4 737 1 180 3 557 16 746 0 21 483 Tunisia 2014 52 998 44 630 8 368 86 470 0 0 139 468 2015 ... ... ... ... ... ... ... 2017 67 908 56 940 10 968 160 496 0 0 228 404 2018 56 795 ... ... 164 009 0 0 220 804 Turkey 2014 1 729 935 623 912 1 206 023 0 0 0 1 829 935 2015 1 904 585 60 279 1 301 828 0 0 0 1 904 585 2017 2 357 582 678 261 1 679 321 0 0 0 2 357 582 2018 — — — — — — — Turkmenistan 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Tuvalu 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Uganda 2014 217 945 98 075 59 934 0 0 0 217 945 2015 230 995 87 778 143 217 0 0 0 230 995 2017 209 633 ... ... 0 0 0 209 633 2018 254 750 ... ... 0 0 0 254 750 Ukraine 2014 — — — — — — — 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — United Arab Emirates 2014 81 183 … … 26 4 239 7 85 455 201512 24 050 … … 142 0 24 192 2017 — — — — — — — 2018 120 320 73 070 47 250 2 565 4 361 0 127 246 United Kingdom of Great Britain and Northern Ireland13 2014 257 845 25 110 232 735 0 0 257 845 2015 238 706 23 463 229 565 0 0 0 245 867 2017 — — — — — — — 2018 — — — — — — — United Republic of Tanzania 2014 115 960 100 901 15 059 12 955 0 0 128 915 2015 58 462 10 197 48 265 9 518 0 0 67 980 2017 156 749 147 344 9 405 77 204 0 0 233 953 2018 173 922 … … 133 913 0 0 307 835 12 Partial data. 13 Subnational data provided by Scottish National Blood Transfusion Service and Welsh Blood Service. 97ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year No. whole blood donations collected (excluding autologous donations) VNRD VNRD from first time donors VNRD from repeat donor Family/ replacement donations Paid donations Others Total United States of America 201414 5 504 977 1 030 095 4 554 485 454 0 0 5 505 431 201515 5 166 495 910 176 425 638 301 0 0 5 166 795 201716 4 961 320 1 069 626 3 679 691 270 0 833 4 962 423 201817 5 934 137 1 235 853 4 468 618 1 113 0 0 5 935 250 Uruguay 2014 47 927 … … 48 331 0 96 258 2015 46 534 … … 43 937 0 90 471 2016 46 050 … … 41 790 0 87 840 2017 40 118 … … 51 263 0 91 381 Uzbekistan 2014 66 598 66 109 489 46 618 0 135 859 2015 76 514 76 256 258 53 560 0 142 723 2017 — — — — — — — 2018 — — — — — — — Vanuatu 2014 — — — — — — — 2015 927 235 550 395 0 0 1 322 2017 — — — — — — — 2018 — — — — — — — Venezuela (Bolivarian Republic of) 2014 312 048 — — 0 0 312 048 2015 299 878 — — 0 0 299 878 2017 — — — — — — — 2018 — — — — — — — Viet Nam 2014 963 358 529 846 197 050 26 255 11 323 1 001 013 2015 — — — — — — — 2017 — — — — — — — 2018 — — — — — — — Yemen 2014 — — — — — — — 2015 2 715 — — 6 972 0 9 687 2017 — — — — — — — 2018 … … … … … … 17 913 Zambia 2014 109 269 54 634 54 635 0 0 0 109 269 2015 100 110 53 058 47 052 0 0 0 100 110 2017 — — — — — — — 2018 — — — — — — — Zimbabwe 2014 58 603 19 978 38 625 0 0 58 603 2015 59 947 20 970 38 977 0 0 59 947 2017 65 164 … … 0 0 65 164 2018 82 257 … … 0 0 82 257 14 It was estimated that the number of blood donations reported covered 60% of the national data. 15 It was estimated that the number of blood donations reported covered 60% of the national data. 16 This report includes data from 4 of the largest blood collection centres in the United States of America. It was estimated that the number of blood donations reported covered 52% of the national data. 17 This report includes data from 5 of the largest blood collection centres in the United States of America. It was estimated that the number of blood donations reported covered 64% of the national data. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 202198 Annex 3. Blood donations 2014–2018 (continued) … Not reported/not available. Blank cell: Not required/not applicable. — No response. VNRD: Voluntary non-remunerated donors. Country Data year Blood donations collected through apheresis procedures No. apheresis donations collected VNRD VNRD from first-time donors VNRD from repeat donors Family/ replacement donations Paid donations Others Total no. of donations Argentina 2014 Yes … … … … … … … 2015 Yes … … … … … … 8 169 2016 Yes 20 383 4 246 1 6137 849 0 21 232 2017 Yes 64 250 12 850 51 400 0 0 64 250 Armenia 2014 Yes 0 0 0 0 330 0 330 2015 Yes 0 0 0 0 105 0 105 2017 — — — — — — — — 2018 — — — — — — — — Australia1 2014 — — — — — — — — 2015 — — — — — — — — 2017 Yes 571 915 — — 0 0 0 571 915 2018 Yes 639 090 … — 0 0 0 639 090 Austria 2014 Yes … … … … … … 721 933 2015 Yes … … … … … … 714 878 2017 Yes … … … … … … 527 172 2018 Yes … … … … … … 714 878 Bangladesh 2014 Yes … … … … … … … 2015 Yes … … … … … … … 2017 Yes 20 30 0 50 2018 Yes 20 20 0 0 0 20 Barbados 2014 Yes … … … … … … 98 2015 — — — — — — — — 2016 … … … … … … … … 2017 … … … … … … … … Belgium 2014 Yes 126 846 7 029 119 817 0 0 0 126 846 2015 Yes … … … … … … … 2017 — — — — — — — — 2018 — — — — — — — — Bolivia 2014 … … … … … … … … 2015 … … … … … … … … 2016 Yes 202 136 66 104 306 2017 Yes 223 139 84 128 351 Bosnia and Herzegovina 2014 Yes … … … … … … 486 2015 Yes 481 … … … … … 481 2017 — — — — — — — — 2018 — — — — — — — — 1 Data source: Australia Red Cross Blood Service Annual report 2016-2017; Australian Red Cross Blood Service Annual Report 2017-18. Available at: https://www.lifeblood.com.au/about/our-strategy/annual-reports. 99ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year Blood donations collected through apheresis procedures No. apheresis donations collected VNRD VNRD from first-time donors VNRD from repeat donors Family/ replacement donations Paid donations Others Total no. of donations Botswana 2014 Yes 119 … … 0 0 119 2015 Yes 3 … … 0 0 3 2017 Yes 22 0 22 0 0 22 2018 Yes 22 0 22 0 0 22 Brazil 2014 — — — — — — — — 2015 Yes … … … … … … 67 987 2016 Yes … … … … … … 8 279 2017 Yes … … … … … … 79 860 Brunei Darussalam 2014 Yes 392 … … 0 0 392 2015 Yes 485 … … 0 0 485 2017 Yes 535 … … 0 0 535 2018 Yes 451 … … 0 0 451 Bulgaria 2014 Yes 0 0 0 0 2 311 0 2 311 2015 Yes 0 0 0 0 1 511 1 511 2017 — — — — — — — — 2018 Yes 1 082 1 082 Canada 2014 Yes 59 657 48 59 609 0 0 0 59 657 2015 Yes 57 172 32 57 140 0 0 0 57 172 2017 Yes 56 114 43 56 071 0 0 0 56 114 2018 — — — — — — — — Chile 2014 … … … … … … … … 2015 Yes … … … … … … … 2016 Yes … … … … … … 1866 2017 Yes … … … … … … 2172 China 2014 Yes 760 415 … … 61 396 821 811 2015 Yes 819 682 … … 66 168 0 885 850 2017 Yes 952 459 … … 64 919 1 017 378 2018 Yes 1 075 750 … … 11 097 1 086 847 Colombia 2014 Yes 32 844 11 258 21 588 4 502 37 346 2015 Yes 34 811 17 987 16 824 6 614 0 41 425 2016 Yes 38 308 17 450 20 858 5 638 0 43 943 2017 Yes 42 672 19 647 23 025 3 347 0 46 019 Costa Rica 2014 Yes … … … … … … … 2015 Yes 726 … … … … … 726 2016 Yes 3 867 966 122 30 3 897 2017 Yes 130 32 98 8 138 Croatia 2014 Yes 3 711 0 3 711 0 0 0 3 711 2015 Yes 4 157 0 4 157 0 0 4 157 2017 Yes 194 702 14 895 179 807 0 0 194 702 2018 Yes 5 206 0 5 206 0 0 5 206 Cuba 2014 … … … … … … … … 2015 … … … … … … … … 2016 yes 13 711 …  …  0 0 13 711 2017 … … … … … … … … GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021100 Country Data year Blood donations collected through apheresis procedures No. apheresis donations collected VNRD VNRD from first-time donors VNRD from repeat donors Family/ replacement donations Paid donations Others Total no. of donations Cyprus 2014 Yes 90 0 90 0 0 90 2015 Yes 111 0 111 0 0 111 2017 — — — — — — — — 2018 Yes 335 … … 0 0 335 Czechia 2014 Yes 704 900 23 200 681 700 0 0 704 900 2015 Yes … … … … … … 689 200 2017 — — — — — — — — 2018 Yes … … … … … … 218 632 Denmark 2014 — — — — — — — — 2015 — — — — — — — — 2017 Yes 64 262 0 0 0 64 262 2018 Yes 71 786 0 0 0 71 786 Ecuador 2014 … … … … … … … … 2015 Yes — — — — 0 — 4 914 2016 Yes … … … … … … 4 511 2017 Yes … … … … … … 6 444 Egypt 2014 — — — — — — — — 2015 Yes 1 453 … … 0 0 1 453 2017 … … … … … … … … 2018 Yes … … … … … … 20183 El Salvador 2014 … … … … … … … … 2015 Yes … … … … … … … 2016 Yes 1 431 …  …  0 0 1 431 2017 Yes 1 231 …  …  0 0 1 231 Estonia 2014 Yes 2 115 0 2 115 0 0 0 2 115 2015 Yes 2 612 0 2 612 0 0 0 2 612 2017 Yes 3 447 0 3 447 0 0 3 447 2018 Yes 3 344 0 3 344 0 0 0 3 344 Finland 2014 Yes 4 417 0 4 417 0 0 0 4 417 2015 Yes 2 128 0 2 128 0 0 0 2 128 2017 Yes 2 585 0 2 585 0 0 0 2 585 2018 Yes 2 585 0 2 585 0 0 0 2 585 France 2014 Yes 294 575 … … 0 0 294 575 2015 Yes 399 743 … … 0 0 399 743 2017 — — — — — — — — 2018 Yes 453 392 87 498 365 894 0 0 453 392 Germany 2014 Yes 2 705 397 2 594 2 702 803 0 0 2 705 397 2015 Yes 2 569 486 2 233 2 567 253 0 0 2 569 486 2017 — — — — — — — — 2018 — — — — — — — — Greece 2014 Yes 9 520 207 6 843 7 050 0 16 570 2015 Yes 11 794 …  …  6 351 0 18 145 2017 — — — — — — — — 2018 — — — — — — — — 101ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year Blood donations collected through apheresis procedures No. apheresis donations collected VNRD VNRD from first-time donors VNRD from repeat donors Family/ replacement donations Paid donations Others Total no. of donations Guatemala 2014 Yes … … … … … 1 996 2015 Yes 0 … … 2 301 0 2 301 2016 Yes 0 2 421 0 2 421 2017 Yes 0 2 950 0 2 950 Honduras 2014 Yes … … … … … ... … 2015 … … … … … ... … … 2016 Yes … … … … … ... … 2017 … … … … … ... … … Iceland 2014 Yes 935 0 935 0 0 0 935 2015 Yes 919 0 919 0 0 0 919 2017 Yes 786 0 786 0 0 0 786 2018 — — — — — — — — India 2014 Yes  …  …  …  …  …  …  …  2015 Yes …  …  …  …  …  …  …  2017 … … … … … … … … 2018 … … … … … … … … Indonesia 2014 Yes … … … … … … … 2015 Yes … … … … … … … 2017 Yes 7 719 … … 418 0 8 173 2018 Yes 14 093 10 933 3 160 2 555 185 16 833 Iran (Islamic Republic of) 2014 Yes 6 681 442 6 239 0 0 0 6 681 2015 Yes 6 418 889 5 529 0 0 0 6 418 2017 Yes 394 582 50 054 344 528 0 0 0 394 582 2018 Yes 82 929 36 472 46 457 0 0 0 82 929 Israel 2014 Yes 1 727 0 1 727 0 0 1 727 2015 — — — — — — — — 2017 — — — — — — — — 2018 — — — — — — — — Italy 2014 Yes 493 908 … … 0 0 2015 Yes 485 006 … … 0 0 485006 2017 Yes 427 288 … … 0 0 427288 2018 Yes 421 807 … … 0 0 421807 Japan 2014 Yes 1 394 406 6 532 1 387 874 0 0 1 394 406 2015 Yes 1 361 430 5 637 1 355 793 0 0 0 1 361 430 2017 Yes 1 355 003 6 573 1 348 430 1 355 003 2018 — — — — — — — — Jordan 2014 Yes 40 0 40 25 0 65 2015 Yes 45 0 45 30 0 75 2017 Yes 13 0 13 0 0 0 13 2018 Yes 13 0 13 0 0 0 13 Kazakhstan 2014 Yes 16 776 1 677 15 099 104 352 29 133 … … 2015 Yes 11 411 5 477 5 934 9 337 24 927 … 45 675 2017 — — — — — — — — 2018 Yes 16 329 2 699 13 630 2 594 5 990 24 913 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021102 Country Data year Blood donations collected through apheresis procedures No. apheresis donations collected VNRD VNRD from first-time donors VNRD from repeat donors Family/ replacement donations Paid donations Others Total no. of donations Kuwait 2014 — — — — — — — — 2015 Yes 837 121 716 0 0 837 2017 Yes 8 271 207 8 064 454 8 725 2018 Yes 7 285 174 7 111 473 0 0 7 758 Kyrgyzstan 2014 Yes … … … … … … … 2015 Yes 0 6 619 1 207 7 828 2017 — — — — — — — — 2018 … … … … … … … … Lebanon 2014 Yes … … … … … … … 2015 Yes … … … … … … … 2017 — — — — — — — — 2018 — — — — — — — — Libya 2014 — — — — — — — — 2015 — — — — — — — — 2017 Yes 3 226 1 107 2 119 22 430 0 25 656 2018 Yes 3 760 1 217 2 543 29 008 0 32 768 Luxembourg 2014 Yes 3 767 0 3 767 0 0 0 3 767 2015 Yes 3 299 0 3 299 0 0 0 3 299 2017 — — — — — — — — 2018 Yes 2 757 0 2 757 0 0 0 2 757 Malaysia 2014 Yes 17 899 0 17 899 0 0 17 899 2015 Yes 23 354 0 23 354 0 0 23 354 2017 — — — — — — — — 2018 — — — — — — — — Maldives 2014 No 2015 Yes … … … … … … … 2017 — — — — — — — — 2018 Yes 13 1 12 83 0 96 Malta 2014 — — — — — — — — 2015 … … … … … … … … 2017 Yes 374 0 374 0 0 0 374 2018 — — — — — — — — Mauritius 2014 Yes 76 … … 28 0 104 2015 Yes 88 … … 0 0 88 2017 — — — — — — — — 2018 Yes … … … … … … … Mexico 2014 … … … … … … … … 2015 Yes 75 951 75 951 0 0 0 75 951 2016 Yes … … … … … … … 2017 Yes … … … … … … 88 737 Mongolia 2014 Yes 2 674 12 2 662 0 0 0 2 674 2015 Yes 3 348 40 3 308 0 0 0 3 348 2017 Yes 3 644 18 3 626 0 0 0 3 644 2018 Yes 3 224 22 3 202 0 0 0 3 224 103ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year Blood donations collected through apheresis procedures No. apheresis donations collected VNRD VNRD from first-time donors VNRD from repeat donors Family/ replacement donations Paid donations Others Total no. of donations Morocco 2014 Yes 0 … … 100 0 0 100 2015 Yes 0 … … 100 0 0 100 2017 — — — — — — — — 2018 Yes … … … … 0 … 661 Myanmar2 2014 Yes 44 0 44 0 0 0 44 2015 Yes 35 0 35 0 0 0 35 2017 Yes 15 0 15 0 0 0 15 2018 Yes 8 0 8 0 0 0 8 Namibia 2014 — — — — — — — — 2015 Yes 1 007 0 1 007 0 0 0 1 007 2017 Yes 1 228 0 1 228 0 0 0 1 228 2018 … … … … … … … … Nepal 2014 No … … … … … … … 2015 Yes 20 10 10 80 0 0 100 2017 … … … … … … … … 2018 … … … … … … … … New Zealand 2014 Yes 41 669 0 41 669 0 0 0 41 669 2015 Yes 50 360 6 50 354 0 0 0 50 360 2017 Yes 56 891 1 56 890 0 0 0 56 891 2018 Yes 62 543 1 62 542 0 0 0 62 543 North Macedonia 2014 Yes 150 80 70 0 0 150 2015 Yes 190 … … 120 0 310 2017 Yes 208 … … 0 0 208 2018 Yes … … … … … … … Norway 2014 — — — — — — — — 2015 — — — — — — — — 2017 Yes 16 001 0 16 001 0 0 0 16 001 2018 Yes 15 954 0 15 954 0 0 0 15 954 Oman 2014 Yes 305 0 305 0 0 305 2015 Yes 497 3 494 0 0 497 2017 — — — — — — — — 2018 Yes 919 3 916 16 0 935 Panama 2014 — — — — — — — — 2015 Yes 3 982 … … 49 392 2 980 0 56 373 2016 Yes 4 603 … … … … … 4 603 2017 Yes … … … … … … 3 935 Paraguay 2014 … … … … … … … … 2015 Yes … … … … … … … 2016 Yes … … … … … … … 2017 … … … … … … … … Peru 2014 … … … … … … … … 2015 … … … … … … … … 2016 Yes …  …  …  …  …  …  2 784 2017 Yes …  …  …  …  …  …  48 612 2 Data cover the National Blood Centre only. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021104 Country Data year Blood donations collected through apheresis procedures No. apheresis donations collected VNRD VNRD from first-time donors VNRD from repeat donors Family/ replacement donations Paid donations Others Total no. of donations Philippines 2014 — — — — — — — — 2015 Yes 11 351 … … 91 3 677 15 119 2017 — — — — — — — — 2018 — — — — — — — — Poland 2014 Yes 51 147 … … 440 1 774 0 53 361 2015 Yes 48 992 … … 1 011 1 580 0 51 583 2017 Yes 22 298 … … 277 22 1 22 598 2018 Yes … … … … … … 50 3603 Portugal 2014 Yes 6 312 … … 0 0 6 312 2015 Yes 6 631 … … 0 0 6 631 2017 Yes 5 214 1 5 213 0 0 5 214 2018 Yes 4 860 1 4 859 0 0 4 860 Qatar 2014 No 2015 Yes 678 0 678 0 0 678 2017 Yes 756 3 759 0 0 0 756 2018 Yes 973 7 966 0 0 0 973 Republic of Korea 2014 Yes 915 161 … … … … 915 161 2015 Yes 901 413 … … … … 901 413 2017 Yes 787 847 13 061 774 786 … … 787 847 2018 Yes 761 534 11 038 750 496 0 0 0 761 534 Republic of Moldova 2014 — — — — — — — — 2015 — — — — — — — — 2017 — — — — — — — — 2018 Yes 11 397 … … 634 129 12 160 Romania 2014 — — — — — — — — 2015 — — — — — — — — 2017 Yes 6 813 7 6 806 0 0 0 6 813 2018 Yes 6 718 0 6 718 1 0 0 6 718 Russian Federation 2014 Yes 681 074 … … 120 807 801 881 2015 Yes 612 040 … … 0 77 948 689 988 2017 Yes 480 109 … … 0 70 558 550 667 2018 Yes 463 800 … … 0 75 206 539 006 Rwanda 2014 No 2015 Yes 100 0 100 0 0 0 100 2017 — — — — — — — — 2018 … … … … … … … … Saudi Arabia 2014 Yes 12 300 8 400 3 900 14 250 0 26 550 2015 Yes 16 600 3 800 12 800 1 600 0 0 18 200 2017 — — — — — — — — 2018 — — — — — — — — Serbia 2014 Yes … … … … … … … 2015 Yes … … … … … … … 2017 — — — — — — — — 2018 — — — — — — — — 3 This number is the units of apheresis platelets that was collected during the year. In addition, 143258 units of apheresis plasma and 92 units of apheresis red cells were also reported. 105ANNEX 3. BLOOD DONATIONS 2014–2018 Country Data year Blood donations collected through apheresis procedures No. apheresis donations collected VNRD VNRD from first-time donors VNRD from repeat donors Family/ replacement donations Paid donations Others Total no. of donations Singapore 2014 Yes 9 337 10 9 327 0 0 0 9 337 2015 Yes 9 335 15 9 320 0 0 0 9 335 2017 Yes 9 041 58 8 983 0 0 0 9 041 2018 Yes 8 382 20 8 362 0 0 0 8 382 Slovakia 2014 Yes 5 156 … … … … … … 2015 Yes 5 298 0 5 298 0 0 0 5 298 2017 Yes 5 511 0 5 511 0 0 0 5 511 2018 Yes 5 624 0 5 624 0 0 0 5 624 Slovenia 2014 Yes 1 160 … … 0 0 0 1 160 2015 Yes 3 048 … … 0 0 0 3 048 2017 Yes 4 647 0 4 647 0 0 0 4 647 2018 Yes 3 344 0 3 344 0 0 0 3 344 South Africa 2014 Yes 23 610 108 23 502 0 0 0 23 610 2015 Yes 23 809 84 23 725 0 0 0 23 809 2017 Yes 19 205 67 18 790 0 0 0 19 205 2018 … … … … … … … … Spain 2014 Yes 54 601 … … … … 54 601 2015 Yes 55 899 … … … … 55 899 2017 Yes 70 798 … … 0 0 70 798 2018 — — — — — — — — Sri Lanka 2014 Yes 1 318 0 1 318 0 0 1 318 2015 Yes 1 534 0 1 534 0 0 0 1 534 2017 Yes 1 958 0 1 958 0 0 0 1 958 2018 Yes 1 598 0 1 598 0 0 0 1 598 Sweden 2014 Yes 45 403 0 45 403 0 0 45 403 2015 Yes 45 435 0 45 435 0 0 45 435 2017 Yes 40 108 0 40 108 0 0 40 108 2018 Yes 37 882 0 37 882 0 0 37 882 Switzerland 2014 Yes 19 659 0 19 659 0 0 19 659 2015 Yes 18 425 0 18 425 0 0 18 425 2017 Yes 17 098 … … 0 0 17 098 2018 Yes 17 797 … … 0 0 17 797 Tajikistan 2014 Yes … … … … … … … 2015 Yes 4 327 2 456 1 871 150 7 049 11 526 2017 … … … … … … … … 2018 Yes 0 0 0 0 425 0 425 Thailand 2014 Yes 15 865 0 15 865 0 0 0 15 865 2015 Yes 17 773 0 17 773 0 0 0 17 773 2017 Yes 31 579 0 31 579 0 0 0 31 579 2018 Yes 378 479 0 378 479 0 0 0 378 479 Tunisia 2014 Yes … … … … … … … 2015 No 2017 Yes 210 190 20 742 0 0 952 2018 Yes 59 … … 963 0 1 022 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021106 Country Data year Blood donations collected through apheresis procedures No. apheresis donations collected VNRD VNRD from first-time donors VNRD from repeat donors Family/ replacement donations Paid donations Others Total no. of donations Turkey 2014 Yes 30 323 7 642 22 681 0 0 0 30 323 2015 Yes 33 347 4 609 28 738 0 0 0 33 347 2017 Yes … … … … … … … 2018 — — — — — — — — United Arab Emirates 2014 Yes 40 … … … 0 10 2414 2015 Yes 24 050 … … 142 0 24 192 2017 — — — — — — — — 2018 Yes 4 863 491 4 231 251 2 144 7 258 United Kingdom of Great Britain and Northern Ireland5 2014 Yes 14 384 104 14 280 0 0 0 14 384 2015 Yes 13 917 78 13 845 0 0 0 13 917 2017 — — — — — — — — 2018 — — — — — — — — United States of America 2014 Yes 1 069 936 53 115 1 016 821 157 0 0 1 070 093 2015 Yes 1 093 319 55 268 1 038 051 146 0 0 1 093 465 2017 Yes 1 025 451 51 810 910 940 149 0 18 1 025 618 2018 Yes 1 353 287 72 136 414 095 384 0 0 1 353 784 Uruguay 2014 … … … … … … … … 2015 Yes … … … … … … … 2016 Yes … … … … … … 1 706 2017 Yes 2 118 … … … … … 2 118 Venezuela (Bolivarian Republic of) 2014 — — — — — — — — 2015 Yes 10 384 — — 0 0 10 384 2017 — — — — — — — — 2018 — — — — — — — — Viet Nam 2014 Yes 2 258 2 082 176 592 33 291 0 36 141 2015 — — — — — — — — 2017 — — — — — — — — 2018 — — — — — — — — Zimbabwe 2014 Yes 71 0 71 0 0 0 71 2015 Yes 111 0 111 0 0 0 111 2017 Yes 250 0 0 0 250 2018 … … … … … … … … 4 Units of apheresis platelets issued. 5 Subnational data provided by Scottish National Blood Transfusion Service and Welsh Blood Service. 107ANNEX 4. LABORATORY TEST REQUIREMENTS FOR SCREENING DONATED BLOOD FOR T TIS, 2007/2018 Annex 4. Laboratory test requirements for screening donated blood for transfusion-transmissible infections (TTIs), 2007/2018 Y: Required for all donations. S: Required for selected donations. Blank cell: Not required. … Not reported/not available. — No response. * Data of 2017/2018 was not available. Data of earlier years were listed in the table. Country HIV1+2 Hepatitis B Hepatitis C Syphilis Chagas disease Malaria HTLV-1/2 Ab Ag NAT HBsAg Anti- HBc Ab NAT Anti- HCV Ab Ag NAT Serological testing Others Ab Others Smear microscopy Ag Others Ab Others Afghanistan Y Y Y Y Y Albania Y Y S Y S Y S Y Algeria* Y Y Y Y Y Andorra — — — — — — — — — — — — — — — — — — Angola* Y Y Y Y Y Y Antigua and Barbuda — — — — — — — — — — — — — — — — — — Argentina Y Y Y Y Y Y Y Y Y Armenia* Y Y Y Y Y Y Australia* Y Y Y S Y Y Y Y S1 Y Austria Y Y Y Y Y Y Azerbaijan — — — — — — — — — — — — — — — — — — Bahamas Y Y Y Y Y Y Y Bahrain Y Y Y Y Y Y Y Bangladesh Y Y Y Y Y Barbados Y Y Y Y Y Y Belarus — — — — — — — — — — — — — — — — — — Belgium* Y Y Y S Y Y Y Y S S Belize Y Y Y Y Y Y Y Benin* Y Y Y Y Y Y S Bhutan Y Y Y Y Y Y Y Bolivia Y Y Y Y Y Y Y Bosnia and Herzegovina Y Y Y Y Botswana Y Y Y Y S Brazil Y Y Y Y Y Y Y Y Y Y2 Y Brunei Darussalam Y Y Y Y Y Bulgaria Y Y Y Y Y Y Burkina Faso Y Y Y Y Y Burundi* Y Y Y Y Y Y Cabo Verde* Y Y Y Y Y Y Cambodia Y Y Y Y Cameroon Y Y Y Y Canada Y . Y Y Y Y Y Y Y S Y Central African Republic* Y Y Y Y Y S Chad* Y Y Y Y Y 1 Antibody screening. 2 Or antigen test. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021108 Country HIV1+2 Hepatitis B Hepatitis C Syphilis Chagas disease Malaria HTLV-1/2 Ab Ag NAT HBsAg Anti- HBc Ab NAT Anti- HCV Ab Ag NAT Serological testing Others Ab Others Smear microscopy Ag Others Ab Others Chile Y Y Y Y Y Y Y Y Y China Y Y Y Y Y Y Y Y S Colombia Y Y S Y Y S Y S Y Y S Y Comoros* Y Y Y Y Congo Y Y Y Y Y Y Cook Islands Y Y Y Y Costa Rica Y Y Y Y Y Y Y Y Côte d’Ivoire Y Y Y Y Y Croatia Y Y Y Y Y Y Y Y Cuba Y S Y S Y S Y Cyprus Y Y Y Y Y Y Y Y Czechia Y Y Y Y Y Democratic People’s Republic of Korea — — — — — — — — — — — — — — — — — — Democratic Republic of the Congo* Y S Y Y Y S Denmark Y Y Y Y S Y Y Y S3 Djibouti — — — — — — — — — — — — — — — — — — Dominica Y Y Y Y Dominican Republic … … … … … … … … … … … … … … … … … … Ecuador Y Y Y Y Y Y Y Y Y Y Y S Egypt Y Y Y Y Y Y Y Y El Salvador Y Y Y S Y Y Y Equatorial Guinea — — — — — — — — — — — — — — — — — — Eritrea* Y Y Y Y Y Estonia Y Y Y Y Y Y Y Eswatini Y Y Y Y Y Y Y Y Y Ethiopia Y Y Y Y Y Fiji Y Y Y Y Y Y S4 Finland Y Y Y Y Y Y Y S5 France Y Y Y Y Y Y Y Y S S Gabon Y Y Y Y Y Y Y Gambia* Y Y Y Y Y S6 Georgia — — — — — — — — — — — — — — — — — — Germany* Y Y Y Y S Y Y Y Ghana Y Y Y Y Y Greece Y Y Y Y S Y Y S Y Y S Y Grenada — — — — — — — — — — — — — — — — — — Guatemala Y Y Y Y Y Y Y Guinea — — — — — — — — — — — — — — — — — — Guinea-Bissau — — — — — — — — — — — — — — — — — — Guyana Y Y Y Y Y Y Y Y Haiti Y Y Y Y Y Y Honduras Y Y Y Y Y Y Y Y Y Y Y Y 3 Indirect fluorescent antibody test (IFAT). 4 Or antigen test. 5 Or antigen test. 6 Or antigen test. 109ANNEX 4. LABORATORY TEST REQUIREMENTS FOR SCREENING DONATED BLOOD FOR T TIS, 2007/2018 Country HIV1+2 Hepatitis B Hepatitis C Syphilis Chagas disease Malaria HTLV-1/2 Ab Ag NAT HBsAg Anti- HBc Ab NAT Anti- HCV Ab Ag NAT Serological testing Others Ab Others Smear microscopy Ag Others Ab Others Hungary — — — — — — — — — — — — — — — — — — Iceland Y Y Y Y S India* Y Y Y Y Y Y7 Indonesia Y Y S Y S Y S Y S Iran (Islamic Republic of) Y Y Y Y Y S Iraq* Y Y Y Y Y Y Ireland — — — — — — — — — — — — — — — — — — Israel* Y Y Y Y Y Y Y Y Italy Y Y Y Y Y Y Y Y S8 Jamaica Y Y Y Y Y Y Japan Y Y Y Y Y Y Y Y S Y Jordan Y Y Y Y Y Y Kazakhstan Y Y Y Y Y Y Y Y Kenya* Y Y Y Y Y Kiribati Y Y Y Y Kuwait Y Y Y Y Y Y Y Y Y S9 Y Kyrgyzstan Y Y Y Y Y Y Y Lao People’s Democratic Republic Y Y Y Y Y Latvia Y Y Y Y Y Y Y Y Lebanon Y Y Y Y S Y Y Lesotho Y Y Y Y Y Liberia* … … … … … … … … … … … … … … … … … … Libya Y Y Y Y Y Y Lithuania — — — — — — — — — — — — — — — — — — Luxembourg Y Y Y Y S Y Y Y Y S S10 S Madagascar Y Y Y Y Y Malawi Y Y Y Y Y Y Malaysia Y Y S Y S Y S Y S Maldives Y Y Y Y Mali Y Y Y Y Y Y Malta Y Y Y Y Y Y Marshall Islands Y Y Y Y Mauritania* Y Y Y Y Mauritius* Y Y Y Y Y Mexico Y Y Y Y Y Y S Micronesia (Federated States of) Y Y Y Y Monaco — — — — — — — — — — — — — — — — — — Mongolia Y Y Y Y Y Y Y Y Montenegro Y Y Y Y Y Morocco Y Y Y Y Y Y Mozambique Y Y Y Y Y Myanmar Y Y S Y S Y S Y S 7 Or antigen test. 8 Antibody test. 9 Antibody test. 10 Antibody test. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021110 Country HIV1+2 Hepatitis B Hepatitis C Syphilis Chagas disease Malaria HTLV-1/2 Ab Ag NAT HBsAg Anti- HBc Ab NAT Anti- HCV Ab Ag NAT Serological testing Others Ab Others Smear microscopy Ag Others Ab Others Namibia Y Y Y Y Y Y Y Nauru — — — — — — — — — — — — — — — — — — Nepal Y Y Y Y S11 Netherlands* Y Y Y Y Y Y Y Y S12 S New Zealand Y Y Y Y Y Y Y Y S S13 S Nicaragua Y Y Y S Y Y Y Y Niger* Y Y Y Y Y Nigeria Y Y Y Y Y Y Y Niue Y Y Y Y North Macedonia Y Y Y Y Y Norway Y Y Y S Y S S S Oman Y Y Y Y Y Y Y Y Y Y Y Pakistan Y Y S Y Y S Y Y S Y Y14 Palau Y Y Y Y Panama Y Y Y Y Y Y Y Y Papua New Guinea Y Y Y Paraguay Y Y Y Y Y Y Y Y Peru Y S Y Y Y Y S15 Y Philippines* Y Y Y Y Y Y Y16 Poland Y Y Y Y Y Y Y Portugal Y Y Y Y Y Y Y Y S S S Qatar Y Y Y Y Y Y Y Y Y S S Y Republic of Korea Y Y Y Y Y Y Y S17 S Republic of Moldova Y Y Y Y Y Y Y Y Romania Y Y Y Y Y Y Y Russian Federation Y Y Y Y Y Y Y Y Rwanda* Y Y Y Y Y Saint Kitts and Nevis Y Y Y Y Y Y Saint Lucia Y Y Y Y Y Y Saint Vincent and the Grenadines Y Y Y Y Y Y Samoa Y Y Y Y San Marino — — — — — — — — — — — — — — — — — — Sao Tome and Principe* Y Y Y Y Y Saudi Arabia* Y Y Y Y Y Y Y Y Y Y Y18 Y Senegal Y Y Y Y Y Serbia* Y Y Y Y Y Seychelles* Y Y Y Y Y Y Y Sierra Leone — — — — — — — — — — — — — — — — — — Singapore Y Y Y Y Y Y Y S 11 Or antigen test. 12 Antibody test. 13 Antibody test. 14 Or antigen test. 15 Or antigen test. 16 Or antien test. 17 Antibody test. 18 Or antigen test. 111ANNEX 4. LABORATORY TEST REQUIREMENTS FOR SCREENING DONATED BLOOD FOR T TIS, 2007/2018 Country HIV1+2 Hepatitis B Hepatitis C Syphilis Chagas disease Malaria HTLV-1/2 Ab Ag NAT HBsAg Anti- HBc Ab NAT Anti- HCV Ab Ag NAT Serological testing Others Ab Others Smear microscopy Ag Others Ab Others Slovakia Y Y Y Y Y Y Slovenia Y Y Y Y Y Y Y Y Solomon Islands Y Y Y Y Somalia — — — — — — — — — — — — — — — — — — South Africa Y Y Y Y S Y Y S Y Y South Sudan Y Y Y Y Y Spain Y Y Y Y Y Y Y S S19 S Sri Lanka Y Y S Y Y S Y Y S Y Y Sudan* Y Y Y Y Y Suriname Y Y Y Y Y Y Y Y Sweden Y Y Y Y Y Y Y S S S Switzerland Y Y Y Y Y Y Y S S20 Syrian Arab Republic — — — — — — — — — — — — — — — — — — Tajikistan Y Y Y Y Y Y Y Y Y Y Thailand Y Y Y Y Y Y Y Y Timor-Leste Y Y Y Y Y Y Y Y Y Y Y Togo Y Y Y Y y Y Tonga Y Y Y Y Y Y Trinidad and Tobago Y Y Y Y Y Y Y Tunisia Y Y Y Y Y Y Turkey Y Y Y Y Y Y Y Y Turkmenistan — — — — — — — — — — — — — — — — — — Tuvalu — — — — — — — — — — — — — — — — — — Uganda Y Y Y Y Y Ukraine — — — — — — — — — — — — — — — — — — United Arab Emirates Y Y Y Y Y Y Y Y Y S Y United Kingdom of Great Britain and Northern Ireland* Y Y Y Y Y Y Y Y S21 S United Republic of Tanzania Y Y Y Y Y Y United States of America Y Y Y Y Y Y Y Y S Y Uruguay Y Y Y Y Y Y Y Y Y Uzbekistan* Y Y Y Y Y Y Vanuatu Y Y Y Y Y Venezuela (Bolivarian Republic of)* Y Y Y Y Y Y Y Y Y Viet Nam* Y Y Y Y Y S S Yemen Y Y Y Y Y Y Y Y Zambia* Y Y Y Y Y Zimbabwe Y Y Y Y Y 19 Antibody test. 20 Antibody test. 21 Antibody test. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021112 Annex 5. Number and proportion of donations tested positive/reactive for TTI markers 2014–2018 … Not reported/not available. Blank cell: Not required/not applicable. — No response. * Proportion, expressed as positive/reactive per 100 donations tested. Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Afghanistan 2014 75 122 695 0.06 3 878 122 695 3.16 733 122 695 0.59 449 122 695 0.36 2015 105 155 715 0.07 4 752 155 715 3.05 949 155 715 0.60 610 155 715 0.39 2017 89 198 274 0.04 8 733 257 695 3.38 2 541 257 695 0.98 … 257 696 … 2018 88 230 777 0.04 5 657 247 608 2.28 2 058 247 608 0.83 1 486 247 608 0.60 Albania 2014 — — — — — — — — — — — — 2015 13 29 688 0.04 1 527 29 688 5.14 218 29 688 0.73 54 29 688 0.18 2017 — — — — — — — — — — — — 2018 5 23 312 0.02 1 060 23 312 4.54 132 23 312 0.59 18 23 312 0.08 Algeria 2014 262 517 775 0.05 1 297 517 775 0.25 590 517 775 0.11 975 517 775 0.19 2015 266 488 850 0.05 1 424 488 850 0.28 706 488 850 0.14 1 514 477 459 0.32 2017 — — — — — — — — — — — — 2018 237 592 680 0.04 1 007 592 680 0.17 534 592 680 0.09 1 067 592 680 0.18 Andorra 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Angola 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 852 106 493 0.80 6 603 106 493 6.20 852 106 493 0.80 1 065 106 493 1.00 Antigua and Barbuda 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2016 — — — — — — — — — — — — 2017 — — — — — — — — — — — — Argentina 2014 1 727 959 233 0.18 1 918 959 233 0.20 3 837 959 233 0.40 9 592 959 233 1.00 2015 2 067 980 988 0.21 5 016 980 988 0.51 3 345 980 988 0.34 10 202 980 988 1.04 2016 1 664 917 868 0.18 1 757 917 868 0.19 2 496 917 868 0.27 8 600 917 868 0.94 2017 1 654 1 102 875 0.15 2 206 1 102 875 0.20 3 529 1 102 875 0.32 13 786 1 102 875 1.25 Armenia 2014 10 13 695 0.07 279 13 695 2.04 56 13 695 0.41 14 13 695 0.10 2015 4 13 716 0.03 274 13 716 1.99 31 13 716 0.23 18 13 716 0.13 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Australia1 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 3 1 273 051 <0.001 75 1 273 051 0.006 48 1 273 051 0.004 … … … 2018 7 1 329 849 <0.001 79 1 329 849 0.006 53 1 329 849 0.004 … … … 1 Data source: Transfusion-transmissible infections in Australia: 2019 Surveillance Report. Kirby Institute, UNSW Sydney, and the Australian Red Cross Lifeblood; 2018; Transfusion-transmissible infections in Australia: 2019 Surveillance Report. Kirby Institute, UNSW Sydney, and the Australian Red Cross Lifeblood; 2019. Available at: http://www.kirby.unsw.edu.au. Number of total donations was used as denominator to calculate the proportion. 113ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Austria2 2014 4 251 126 0.002 15 251 126 0.006 4 251 126 0.002 15 251 126 0.006 2015 1 258 488 <0.001 13 258 488 0.005 11 258 488 0.004 25 258 488 0.01 2017 … … … … … … … … … … … … 2018 … … … … … … … … … … … … Azerbaijan 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Bahamas 2014 0 4 563 0 6 4 563 0.13 2 4 563 0.04 16 4 563 0.35 2015 … … … … … … … … … … … … 2016 8 5 759 0.13 29 5 759 0.50 16 5 759 0.27 45 5 759 0.78 2017 8 5 619 0.14 30 5 619 0.53 15 5 619 0.27 45 5 619 0.80 Bahrain 2014 0 19 412 0 15 19 412 0.07 19 19 412 0.09 20 19 412 0.10 2015 0 19 152 0 13 19 152 0.06 15 19 152 0.07 20 19 152 0.10 2017 4 18 837 0.02 10 18 837 0.05 8 18 837 0.04 19 18 837 0.10 2018 1 19 546 0.005 7 19 546 0.03 5 19 546 0.02 20 19 546 0.10 Bangladesh 2014 74 651 718 0.01 5 529 651 718 0.84 462 651 718 0.07 754 651 718 0.11 2015 46 679 681 0.01 5 428 679 681 0.80 752 679 681 0.11 605 679 681 0.09 2017 66 703 424 0.009 5 033 703 424 0.71 240 703 424 0.03 954 703 424 0.14 2018 77 761 115 0.01 5 797 761 115 0.76 246 761 115 0.03 1 179 761 115 0.15 Barbados 2014 7 4 686 0.15 15 4 686 0.32 24 4 686 0.51 57 4 686 1.22 2015 — — — — — — — — — — — — 2016 12 5 238 0.23 16 5 238 0.31 17 5 238 0.33 85 5 238 1.62 2017 7 5 243 0.13 10 5 243 0.19 21 5 243 0.40 69 5 243 1.32 Belarus 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Belgium 2014 4 596 054 0.0006 47 596 054 0.007 16 596 054 0.002 38 596 054 0.006 20153 4 282 465 0.001 35 282 465 0.01 10 282 465 0.004 29 282 465 0.01 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Belize 2014 7 4 329 0.16 22 4 329 0.50 10 4 329 0.23 29 4 329 0.67 2015 11 5 564 0.19 14 5 564 0.25 5 5 564 0.09 25 5 564 0.44 2016 8 5 826 0.14 27 5 826 0.46 15 5 826 0.26 5 5 826 0.09 2017 6 6 092 0.10 10 6 092 0.16 3 6 092 0.05 12 6 092 0.20 Benin 2014 1 233 74 011 1.67 5 155 74 011 6.97 1 518 74 011 2.05 574 74 011 0.77 2015 1 129 71 644 1.58 5 409 71 644 7.55 1 477 71 644 2.06 566 71 644 0.79 2017 — — — — — — — — — — — — 2018 1 523 83 203 1.83 5 009 83 203 6.02 1 290 83 203 1.55 1 257 83 203 1.51 Bhutan 2014 7 9 375 0.07 71 9 375 0.75 27 9 375 0.29 117 9 375 1.25 2015 3 8 794 0.03 66 8 794 0.75 7 8 794 0.08 138 8 794 1.57 2017 5 9 997 0.05 67 9 997 0.67 0 9 997 0 170 9 997 1.70 2018 0 7 770 0 64 7 770 0.82 0 7 770 0 144 7 770 1.85 2 The denominators are the total numbers of donors tested. 3 The denominators are the total number of donors that were tested. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021114 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Bolivia 2014 251 101 166 0.25 248 101 166 0.25 365 101 166 0.36 760 101 166 0.75 2015 263 108 132 0.24 245 108 132 0.22 409 108 132 0.37 832 108 132 0.76 2016 357 112 536 0.32 267 112 536 0.24 480 112 536 0.43 1 121 112 536 1.00 2017 348 119 663 0.29 284 119 663 0.24 358 119 663 0.30 911 119 663 0.76 Bosnia and Herzegovina 2014 … … … … … … … … … … … … 2015 1 15 209 0.007 24 15 209 0.16 7 15 209 0.05 2 15 209 0.01 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Botswana 2014 314 25 510 1.23 261 25 510 1.02 68 25 510 0.26 475 25 510 1.86 2015 521 27 444 1.89 213 27 444 0.77 219 27 444 0.70 505 27 444 1.84 2017 344 … 1.43 245 … 1.02 106 … 0.44 360 … 1.49 2018 352 24 088 1.46 289 24 088 1.20 108 24 088 0.45 368 24 088 1.53 Brazil 2014 — — — — — — — — — — — — 2015 5 336 2 356 414 0.22 4 939 2 356 414 0.21 7 795 2 356 414 0.33 25 467 2 356 414 1.08 2016 7 294 3 463 353 0.21 6 976 3 463 353 0.20 10 898 3 463 353 0.32 34 863 3 463 353 1.01 2017 8 636 3 143 417 0.28 7 179 3 143 417 0.23 10 289 3 143 417 0.33 33 738 3 143 417 1.07 Brunei Darussalam 2014 1 15 522 0.006 49 15 522 0.31 16 15 522 0.10 64 15 522 0.41 2015 3 15 668 0.02 39 15 668 0.24 9 15 668 0.06 54 15 668 0.34 2017 4 16 639 0.02 38 16 639 0.23 6 16 639 0.04 35 16 639 0.21 2018 7 15 988 0.04 28 15 988 0.18 8 15 988 0.05 45 15 988 0.28 Bulgaria 2014 5 169 481 0.003 1 085 169 481 0.64 119 169 481 0.07 220 169 481 0.13 2015 12 168 334 0.007 718 168 334 0.43 89 168 334 0.05 137 168 334 0.08 2017 — — — — — — — — — — — — 2018 143 169 633 0.08 962 169 633 0.57 380 169 633 0.22 504 169 633 0.30 Burkina Faso 2014 2 702 113 114 2.38 11 021 113114 9.74 5 969 113 114 5.27 2 149 113 114 1.89 2015 2 314 119 366 1.93 10 575 119366 8.85 5 363 119 366 4.49 2 553 119 366 2.14 2017 3 660 115 874 3.16 10 810 115874 9.33 5 467 115 874 4.72 1 946 115 874 1.68 2018 1 434 106 235 1.34 6 672 106,235 6.28 2 877 106 235 2.71 791 106 235 0.74 Burundi 2014 — — — — — — — — — — — — 2015 517 60 084 0.86 1 743 60 084 2.9 2 992 60 084 4.97 100 60 084 0.16 2017 — — — — — — — — — — — — 2018 330 82 524 0.40 1 733 82 524 2.20 2 475 82 524 3.00 495 82 524 0.60 Cabo Verde 2014 4 3 255 0.12 65 3 255 1.99 2 3 255 0.06 4 3 255 0.12 2015 3 3 317 0.09 45 3 317 1.35 1 3 317 0.03 3 3 317 0.09 2017 — — — — — — — — — — — — 2018 1 3 352 0.03 53 3 352 1.58 2 3 352 0.06 6 3 352 0.18 Cambodia 2014 78 52 864 0.15 2 744 52 864 5.19 297 52 864 0.56 293 52 864 0.55 2015 83 54 829 0.15 2 668 54 829 4.87 265 54 829 0.48 292 54 829 0.51 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Cameroon 2014 2 373 49 083 4.83 3 111 49 083 6.33 1 843 49 083 3.75 1 663 49 083 3.38 2015 2 199 73 062 3.01 3 128 73 062 4.28 971 73 062 1.32 1 336 73 062 1.82 2017 2 085 91 047 2.29 4 478 91 047 4.92 2 102 91 047 2.31 2 187 91 047 2.40 2018 1 277 94 873 1.35 3 783 94 873 3.99 2 776 94 873 2.93 1 862 94 873 1.96 115ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Canada 2014 3 864 173 <0.001 38 864 173 0.004 50 864 173 0.006 31 864 173 0.004 2015 4 923 224 <0.001 54 923 224 0.006 56 923 224 0.006 32 923 224 0.003 2017 2 850 585 <0.001 59 850 585 0.007 52 850 585 0.006 46 850 585 0.005 2018 — — — — — — — — — — — — Central African Republic 2014 635 12 215 5.20 1 390 12 215 11.38 573 12 215 4.69 901 12 215 7.38 2015 733 15 480 4.74 1 566 15 480 10.12 322 15 480 2.08 781 15 480 5.04 2017 — — — — — — — — — — — — 2018 868 21 000 4.13 2 132 21 000 10.15 341 21 000 1.62 418 21 000 1.99 Chad 2014 1 775 77 490 2.29 7 310 77 490 9.43 2 387 77 490 3.08 1 766 77 490 2.28 2015 1 948 79 535 2.44 7 154 79 535 8.99 1 671 79 535 2.10 2 750 79 535 3.45 2017 — — — — — — — — — — — — 2018 1 664 74 468 2.23 6 673 74 447 8.96 1 656 74 229 2.23 2 691 73 322 3.67 Chile 2014 275 235 323 0.11 18 235 283 0.008 26 235 789 0.01 2 208 235 533 0.93 2015 103 246 900 0.04 29 246 900 0.01 57 246 900 0.02 782 246 900 0.32 2016 … … 0.04 … … 0.19 … … 0.01 … … 0.40 2017 110 265 653 0.04 37 265 653 0.01 70 265 653 0.03 … … … China 2014 … … … … … … … … … … … … 2015 18 909 13 312 002 0.14 69 873 13 312 002 0.42 41 831 13 312 002 0.31 63 734 13 312 002 0.48 2017 … … … … … … … … … … … … 2018 … … … … … … … … … … … … Colombia 2014 1 711 756 370 0.22 1 092 756 370 0.14 2 956 756 370 0.39 11 420 756 370 1.51 2015 1 568 795 792 0.20 1 176 795 792 0.15 2 771 795 792 0.35 11 378 795 792 1.43 2016 1 726 817 004 0.21 971 817 004 0.12 3 016 817 004 0.37 10 714 817 004 1.31 2017 1 746 830 291 0.21 994 830 291 0.12 3 058 830 291 0.37 9 870 830 291 1.19 Comoros 2014 0 2 320 0 90 2 320 3.88 54 2 320 2.33 22 2 320 0.95 2015 0 2 391 0 48 2 391 2.01 8 2 391 0.33 10 2 391 0.42 2017 — — — — — — — — — — — — 2018 0 1 680 0 53 1 680 3.15 15 1 512 0.99 27 1 370 1.97 Congo 2014 1 552 54 294 2.86 3 896 54 294 7.18 1 361 54 294 2.51 111 54 294 0.20 2015 1 589 60 137 2.64 3 960 60 137 6.58 975 60 137 1.62 94 60 137 0.16 2017 1 394 56 111 2.48 3 220 56 112 5.74 628 56 111 1.12 72 56 111 0.13 2018 2 216 88 332 2.51 5 164 88 332 5.85 1 352 88 332 1.53 138 88 332 0.16 Cook Islands 2014 0 193 0 0 193 0 193 193 0 0 193 0 2015 — — — — — — — — — — — — 2017 0 262 0 0 262 0 0 262 0 0 262 0 2018 — — — — — — — — — — — — Costa Rica 2014 55 73 057 0.07 303 73 057 0.41 155 73 057 0.21 403 73 057 0.62 2015 82 75 733 0.10 87 75 733 0.11 168 75 733 0.22 332 75 733 0.43 2016 55 77 607 0.07 54 77 607 0.07 131 77 607 0.17 636 77 607 0.82 2017 60 77 389 0.08 204 77 389 0.26 138 77 389 0.18 372 77 389 0.48 Côte d’Ivoire 2014 334 168 025 0.20 11 396 168 025 6.78 2 995 168 025 1.78 522 168 025 0.31 2015 62 155 534 0.04 10 873 155 534 6.99 2 456 155 534 1.58 623 155 534 0.4 2017 84 153 754 0.05 7 572 153 754 4.92 2 082 153 754 1.35 375 153 754 0.24 2018 … 158 539 … 11 010 158 539 6.94 3 473 158 539 2.19 312 158 539 0.20 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021116 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Croatia 2014 2 180 005 0.001 33 180 005 0.01 7 180 005 0.003 7 180 005 0.004 2015 4 191 442 0.002 22 191 442 0.01 7 191 442 0.003 10 191 442 0.005 2017 2 199 725 0.001 17 199 725 0.009 5 199 725 0.003 6 199 725 0.003 2018 2 195 563 0.001 7 195 563 0.004 1 195 563 0.0005 5 195 563 0.003 Cuba 2014 99 415 902 0.02 1 714 415 902 0.41 3 837 415 902 0.92 2 123 415 902 0.51 2015 81 416 923 0.01 2 457 416 923 0.58 4 960 416 923 1.19 2 207 416 923 0.52 2016 — — — — — — — — — — — — 2017 2 269 411 979 0.55 1 669 411 979 0.41 3 799 411 979 0.92 1 424 411 979 0.35 Cyprus 2014 19 31 444 0.06 15 31 444 0.04 75 31 444 0.24 15 31 444 0.04 2015 21 30 711 0.06 18 30 711 0.05 41 30 711 0.13 17 30 711 0.05 2017 — — — — — — — — — — — — 2018 2 63 008 0.003 24 63 008 0.04 5 63 008 0.008 19 63 008 0.03 Czechia 2014 6 1 095 000 <0.001 37 1 095 000 0.003 138 1 095 000 0.01 35 1 095 000 0.003 2015 9 1 092 400 <0.001 27 1 092 400 0.002 149 1 092 400 0.01 26 1 092 400 0.002 2017 — — — — — — — — — — — — 2018 0 635 883 0 10 635 883 0.002 15 635 883 0.002 9 635 883 0.001 Democratic People’s Republic of Korea 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Democratic Republic of the Congo 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 8 403 397 530 2.11 10 924 388 735 2.81 9 663 373 277 2.59 6 722 370 670 1.81 Denmark 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 1 272 593 <0.001 11 272 593 0.004 3 272 593 0.001 2018 0 278 975 0 4 278 975 0.001 2 278 975 <0.001 Djibouti 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Dominica 2014 0 1 006 0 2 1 006 0.19 19 1 006 1.88 2015 — — — — — — — — — 2016 1 1 165 0.09 2 1 165 0.17 13 1 165 1.12 2017 2 893 0.22 0 893 0 6 893 0.67 Dominican Republic 2014 256 92 621 0.27 945 92 622 1.02 194 92 623 0.21 653 92 624 0.70 2015 134 77 840 0.17 742 78 533 0.94 116 78 533 0.14 462 78 533 0.58 2016 191 107 943 0.18 1 666 107 943 1.54 191 107 943 0.18 759 107 943 0.70 2017 159 105 134 0.15 723 105 134 0.69 174 105 134 0.17 542 105 134 0.52 Ecuador 2014 687 232 215 0.29 524 232 215 0.22 587 232 215 0.25 2 912 232 215 0.25 2015 905 246 887 0.36 572 246 887 0.23 608 246 887 0.24 3 499 246 887 1.41 2016 842 236 370 0.36 491 236 370 0.21 570 236 370 0.24 3 309 236 370 1.40 2017 783 249 363 0.31 377 249 363 0.15 643 249 363 0.26 3 010 249 363 1.21 117ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Egypt 2014 — — — — — — — — — — — — 2015 534 55 673 0.95 3 086 55 673 5.54 … 55 673 … 373 55 673 0.66 2017 1 017 469 958 0.22 3 863 469 958 0.82 11 730 469 958 2.49 1 594 469 958 0.34 2018 985 428 759 0.23 3 269 428 759 0.76 9 978 428 759 2.33 1 038 428 759 0.24 El Salvador 2014 89 98 090 0.09 115 98 090 0.11 220 98 090 0.22 1 166 98 090 1.18 2015 118 92 882 0.13 116 92 882 0.12 840 92 882 0.10 498 92 882 1.5 2016 98 104 616 0.09 108 104 616 0.10 128 104 616 0.12 1 551 104 616 1.48 2017 342 101 605 0.34 172 101 605 0.17 153 101 605 0.15 1 266 101 605 1.25 Equatorial Guinea 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Eritrea 2014 21 8 069 0.26 192 8 069 2.38 67 8 069 0.83 13 8 069 0.16 2015 16 7 022 0.23 171 7 022 2.43 45 7 022 0.64 25 7 022 0.36 2017 — — — — — — — — — — — — 2018 26 9 275 0.28 110 9 275 1.19 24 9 275 0.26 45 9 275 0.49 Estonia 2014 3 60 531 0.004 5 60 531 0.008 32 60 531 0.05 13 60 531 0.02 2015 5 59 013 0.008 8 59 013 0.01 22 59 013 0.03 17 59 013 0.02 2017 1 55 057 0.002 7 55 057 0.01 24 55 057 0.04 13 55 057 0.02 2018 3 53 486 0.006 5 53 486 0.009 21 53 486 0.04 14 53 486 0.03 Eswatini 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 149 14 675 1.02 340 14 675 2.32 69 14 675 0.47 101 14 675 0.69 2014 — — — — — — — — — — — — Ethiopia 2014 692 87 685 0.78 3 055 87 685 3.48 619 87 685 0.71 192 87 685 0.21 2015 659 128 153 0.51 3 771 128 153 2.94 865 128 153 0.67 730 128 153 0.57 2017 655 186 853 0.35 2 875 186 853 1.54 385 186 853 0.21 1 792 186 853 0.96 2018 653 186 497 0.35 1 754 186 497 0.94 386 186 497 0.21 1 788 186 497 0.96 Fiji 2014 12 13 432 0.09 164 13 432 1.22 0 13 432 0 445 13 432 3.31 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 …  … … … … … … … … … … … Finland 2014 2 214 713 0 3 214 713 0 5 214 713 0 5 214 713 0 2015 1 211 536 <0.001 7 211 536 0.003 7 211 536 0.003 4 211 536 0.001 2017 1 204 024 <0.001 3 204 024 0.001 4 204 024 0.002 6 204 024 0.003 2018 2 206 610 0.001 0 206 610 0 1 206 610 <0.001 7 205 391 0.003 France 2014 36 2 826 712 0.001 256 2 826 712 0.009 127 2 826 712 0.004 369 2 826 712 0.01 2015 24 2 958 120 <0.001 225 2 958 120 0.007 110 2 958 120 0.003 410 2 958 120 0.01 2017 — — — — — — — — — — — — 2018 25 2 926 942 <0.001 139 2 926 942 0.005 75 2 926 942 0.003 336 2 926 942 0.01 Gabon 2014 918 20 897 4.39 2015 … … … … … … … … … … … … 2017 300 20 293 1.48 688 21 347 3.22 102 21 624 0.47 384 21 457 1.79 2018 303 23 000 1.32 762 23 000 3.31 155 23 000 0.67 388 23 000 1.69 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021118 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Gambia 2014 71 10 686 0.66 511 8 029 6.36 18 6 556 0.27 2 3 560 0.05 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 15 11 989 0.13 423 11 378 3.71 13 11 161 0.12 5 6 641 0.08 Georgia 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Germany 2014 67 7 201 986 <0.001 362 7 201 986 0.005 233 7 201 986 0.003 354 7 201 986 0.005 2015 58 6 762 964 <0.001 303 6 762 964 0.004 221 6 762 964 0.003 265 6 762 964 0.003 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Ghana 2014 3 157 150 322 2.10 4 059 150 322 2.70 3 006 150 322 1.90 7 516 150 322 4.99 2015 1 863 155 250 1.20 4 580 155 250 2.95 1 856 155 250 1.19 4 658 155 250 3.00 2017 1 987 162 226 1.22 4 150 162 226 2.56 3 105 162 226 1.91 3 871 162 226 2.39 2018 479 55 315 0.87 1 537 55 315 2.78 768 55 315 1.39 1 897 55 315 3.43 Greece 2014 38 541 662 0.007 430 541 662 0.08 107 541 662 0.02 137 541 662 0.02 20154 39 367 261 0.01 426 367 261 0.12 108 367 261 0.03 145 367 261 0.04 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Grenada 2014 4 1 267 0.31 9 1 267 0.71 3 1 267 0.23 3 1 267 0.23 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Guatemala 2014 174 114 404 0.15 396 114 404 0.34 649 114 404 0.56 1 789 114 404 0.56 2015 299 126 244 0.24 474 126 244 0.38 683 126 244 0.54 1 782 126 244 1.14 2016 364 135 396 0.27 584 135 396 0.43 764 135 396 0.56 1 682 135 396 1.24 2017 234 136 241 0.17 500 136 241 0.37 768 136 241 0.56 1 560 136 241 1.15 Guinea 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Guinea-Bissau 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Guyana 2014 — — — — — — — — — — — — 2015 95 9 696 0.98 137 9 696 1.41 104 9 696 1.07 82 9 696 0.84 2016 87 10 200 0.85 156 10 200 1.52 118 10 200 1.15 61 10 200 0.59 2017 61 9 755 0.63 183 9 755 1.88 103 9 755 1.06 109 9 755 1.12 Haiti 2014 282 28 867 0.98 987 28 867 3.42 247 28 867 0.86 743 28 867 2.57 2015 220 27 752 0.79 1 020 27 752 3.67 235 27 752 0.84 972 27 752 3.50 2016 157 25 699 0.61 838 25 699 3.26 175 25 699 0.68 656 25 699 2.55 2017 148 28 018 0.53 656 28 018 2.34 155 28 018 0.55 440 28 018 1.57 4 The denominators are the total number of donors that were tested. 119ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Honduras 2014 162 58 108 0.28 150 58 126 0.26 260 58 167 0.45 463 58 148 0.80 2015 67 71 660 0.09 130 71 660 0.18 269 71 660 0.37 499 71 660 0.69 2016 88 79 830 0.11 147 79 793 0.18 301 79 797 0.38 719 79 830 0.90 2017 96 80 850 0.12 192 80 850 0.24 310 80 850 0.38 589 80 850 0.73 Hungary 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Iceland 2014 0 12 328 0 0 12 328 0 0 12 328 0 2015 0 11 608 0 0 11 608 0 0 11 608 0 2017 0 11 520 0 0 11 520 0 0 11 520 0 2018 — — — — — — — — — — — — India 2014 … … 0.14 … … 0.85 … … 0.33 … … 0.18 2015 … … 0.14 … … 0.86 … … 0.34 … … 0.15 2017 … … 0.13 … … 0.89 … … 0.29 … … 0.18 2018 … … 0.14 … … 0.78 … … 0.33 … … 0.23 Indonesia 2014 8 028 3 043 194 0.26 46 161 3 045 103 1.51 12 113 3 042 770 0.39 26 287 3 044 167 0.86 2015 7 601 2 860 082 0.26 40 116 2 860 994 1.40 11 442 2 860 141 0.40 23 808 2 860 767 0.83 2017 8 473 3 474 125 0.24 42 437 3 474 125 1.22 11 536 3 474 125 0.33 22 056 3 474 125 0.63 2018 11 791 3 813 871 0.31 41 642 3 816 122 1.09 11 710 3 812 617 0.31 24 368 3 814 533 0.64 Iran (Islamic Republic of) 2014 68 2 052 549 0.003 2 728 2 052 549 0.13 899 2 052 549 0.04 16 2 052 549 <0.001 2015 69 2 066 849 0.003 2 425 2 066 849 0.11 847 2 066 849 0.04 10 2 066 849 <0.001 2017 51 20 72 370 0.002 1 107 2 072 370 0.53 543 2 072 370 0.03 6 2 072 370 <0.001 2018 51 2 069 273 0.002 937 2 069 273 0.05 360 2 069 273 0.02 5 2 069 273 <0.001 Iraq 2014 — — — — — — — — — — — — 2015 … … … … … … … … … … … … 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Ireland 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Israel 2014 3 262 605 0.001 96 262 605 0.03 117 262 605 0.04 19 262 605 0.007 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Italy 2014 128 3 081 777 0.004 731 3 081 777 0.02 309 3 081 777 0.01 535 3 081 777 0.02 2015 105 3 061 479 0.003 501 3 061 479 0.01 180 3 061 479 0.005 456 3 061 479 0.01 2017 80 3 006 726 0.003 599 3 006 726 0.02 232 3 006 726 0.008 499 3 006 726 0.02 2018 83 2 991 082 0.003 521 2 991 082 0.02 163 2 991 082 0.005 548 2 991 082 0.02 Jamaica 2014 129 29 390 0.44 221 29 390 0.75 78 29 390 0.27 507 29 390 1.23 2015 87 28 869 0.30 186 28 869 0.64 144 28 869 0.49 581 28 869 2.01 2016 … … … … … … … … … … … … 2017 … … 0.30 … … 0.65 … … 0.44 … … 1.25 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021120 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Japan 2014 2 765 4 999 127 0.06 22 436 4 999 127 0.45 1 358 4 999 127 0.03 4 662 4 999 127 0.09 2015 2 966 4 909 156 0.06 20 243 4 909 156 0.41 1 351 4 909 156 0.03 4 553 4 909 156 0.09 2017 3 020 4 775 648 0.06 14 023 4 775 648 0.29 1 335 4 775 648 0.03 4 670 4 775 648 0.10 2018 — — — — — — — — — — — — Jordan 2014 3 122 789 0.002 3 142 122 789 2.56 135 122 789 0.11 3 122 789 0.002 2015 … 117 884 … 2 947 117 884 2.50 153 117 884 0.13 15 117 884 0.01 2017 … … … … … … … … … … … … 2018 1 64 823 0.002 87 64 823 0.13 55 64 823 0.08 13 64 823 0.02 Kazakhstan 2014 73 291 574 0.02 3 513 291 574 1.20 2 123 291 574 0.72 2 599 291 574 0.89 2015 83 284 012 0.02 3 208 284 012 1.12 1 857 284 012 0.65 2 458 284 012 0.86 2017 — — — — — — — — — — — — 2018 62 211 469 0.03 1 287 211 469 0.61 631 211 469 0.30 1 120 211 469 0.53 Kenya 2014 1 217 183 406 0.66 2 796 183 406 1.52 1 429 183 406 0.78 987 183 406 0.54 2015 1 320 155 081 0.85 3 800 155 081 2.45 1 817 155 081 1.17 1 080 155 081 0.69 2017 — — — — — — — — — — — — 2018 1 029 164 275 0.63 2 048 164 275 1.25 893 164 275 0.54 510 164 275 0.31 Kiribati 2014 2 1 849 0.11 286 1 849 15.46 0 1 849 0 231 1 849 12.49 2015 0 2 171 0 146 2 171 6.72 0 2 171 0 50 2 171 2.30 2017 0 1 436 0 150 1 443 10.39 0 1 430 0 28 1 408 1.99 2018 0 2 171 0 146 2 171 6.73 0 2 171 0 50 2 171 2.30 Kuwait 2014 — — — — — — — — — — — — 2015 11 77 700 0.01 77 77 700 0.10 173 77 700 0.22 127 77 700 0.16 2017 85 82 937 0.10 44 82 937 0.05 124 82 937 0.15 136 82 937 0.16 2018 90 85 847 0.10 66 85 847 0.08 168 85 847 0.20 93 85 847 0.11 Kyrgyzstan 2014 157 41 156 0.38 1 818 41 156 4.41 750 41 156 1.82 479 41 156 1.16 2015 152 41 946 0.36 1 860 41 946 4.43 825 41 946 1.97 691 41 946 1.65 2017 — — — — — — — — — — — — 2018 … … … … … … … … … … … … Lao People’s Democratic Republic 2014 31 35 047 0.08 1 544 35 047 4.40 64 35 047 0.18 1 35 047 0.002 2015 28 36 740 0.08 1 572 35 740 5.28 42 36 740 0.11 4 36 740 0.01 2017 97 45 735 0.21 1 916 45 735 4.19 59 45 735 0.13 37 45 735 0.08 2018 129 49 070 0.26 1 855 49 070 3.78 61 49 070 0.12 40 49 070 0.08 Latvia 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 3 52 250 0.006 14 52 250 0.03 33 52 250 0.06 10 52 250 0.02 2018 9 56 960 0.02 16 56 960 0.28 28 56 960 0.05 17 56 960 0.03 Lebanon 2014 … … … … … … … … … … … … 2015 … … … … … … … … … … … … 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Lesotho 2014 219 8 373 2.61 65 8 373 0.77 29 8 373 0.34 205 8 373 2.44 2015 191 7 879 2.42 68 7 879 0.86 37 7 879 0.47 192 7 879 2.43 2017 108 5 439 1.99 54 5 439 0.99 29 5 439 0.53 234 5 439 4.30 2018 199 6 418 3.10 71 6 418 1.11 32 6 418 0.50 232 6 418 3.61 121ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Liberia 2014 5 578 0.86 59 578 10.20 2 578 0.35 2 578 0.35 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 256 11 023 2.32 1 510 11 023 13.70 44 11 023 0.40 143 11 023 1.30 Libya 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 58 142 572 0.04 233 142 572 0.23 255 142 572 0.18 22 142 572 0.02 2018 75 148 330 0.05 281 148 330 0.19 200 148 330 0.13 31 148 330 0.02 Lithuania 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Luxembourg 2014 0 23 937 0 1 23 937 0.004 0 23 937 0 72 23 937 0.30 2015 0 23 713 0 0 23 713 0 3 23 713 0.001 37 23 713 0.16 2017 — — — — — — — — — — — — 2018 0 22 603 0 0 22 603 0 1 22 603 0.004 6 22 603 0.03 Madagascar 2014 90 30 970 0.29 1 081 30 970 3.49 280 30 970 0.90 445 30 970 1.43 2015 69 33 162 0.21 1 094 33 162 3.29 201 33 162 0.60 395 33 162 1.19 2017 167 39 210 0.43 1 542 39 210 5.93 376 39 210 0.96 375 39 210 0.96 2018 225 48 923 0.46 2 163 48 923 4.42 507 48 923 1.04 507 48 923 1.04 Malawi 2014 1 530 52 065 2.94 1 625 52 065 3.12 436 52 065 0.84 1 191 52 065 2.29 2015 1 204 52 160 2.31 1 666 52 160 3.19 505 52 160 0.97 1 230 52 160 2.36 2017 1 046 60 938 1.72 1 295 60 938 2.13 825 60 938 1.36 1 405 60 938 2.31 2018 1 008 63 000 1.60 1 512 63 000 2.40 1 890 63 000 3.00 1 449 63 000 2.30 Malaysia 2014 196 675 315 0.03 1 545 675 315 0.22 392 675 315 0.05 374 675 315 0.05 2015 235 707 419 0.03 1 302 707 419 0.18 353 707 419 0.05 374 707 419 0.05 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Maldives 2014 6 10 651 0.05 44 10 651 0.41 60 10 651 0.56 30 10 651 0.28 2015 … … … … … … … … … … … … 2017 — — — — — — — — — — — — 2018 5 6 562 0.08 9 6 562 0.14 26 6 562 0.40 3 6 562 0.05 Mali 2014 … … … … … … … … … … … … 2015 1 279 45 034 2.84 7 014 45 034 15.57 1 561 45 034 3.47 56 45 034 0.12 2017 1 136 48 508 2.34 5 200 48 508 10.72 743 48 508 1.53 0 48 508 0 2018 829 56 006 1.48 5 634 56 006 10.06 935 56 006 1.67 22 56 006 0.04 Malta 2014 — — — — — — — — — — — — 2015 0 17 014 0 2 17 014 0.01 1 17 014 0.005 2 17 014 0.01 2017 0 15 917 0 2 15 917 0.01 0 15 917 0 0 15 917 0 2018 — — — — — — — — — — — — Marshall Islands 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 … … … … … … … … … … … … GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021122 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Mauritania 2014 … … … … … … … … … … … … 2015 … … … … … … … … … … … … 2017 — — — — — — — — — — — — 2018 34 18 393 0.18 2 301 18 393 12.51 1 18 393 0.005 79 18 393 0.43 Mauritius 2014 21 45 695 0.04 19 45 695 0.04 118 45 695 0.25 164 45 695 0.35 2015 15 46 536 0.03 41 46 536 0.08 116 46 536 0.25 131 46 536 0.28 2017 — — — — — — — — — — — — 2018 27 44 731 0.06 42 44 731 0.09 110 44 731 0.25 171 44 731 0.38 Mexico 2014 4 955 1 939 060 0.26 3 173 1 939 060 0.16 11 542 1 939 060 0.60 11 188 1 939 060 0.58 2015 5 214 2 170 002 0.24 3 247 2 170 002 0.15 10 414 2 170 002 0.48 12 245 2 170 002 0.56 2016 6 614 2 356 388 0.28 5 602 2 356 388 0.24 12 231 2 356 388 0.52 31 779 2 356 388 1.35 2017 6 487 2 394 836 0.27 6 258 2 394 836 0.26 12 899 2 394 836 0.54 21 077 2 394 836 0.88 Micronesia (Federated States of) 2014 — — — — — — — — — — — — 2015 2 1 721 0.12 14 1 721 0.81 3 1 721 0.17 31 1 721 1.80 2017 0 1 667 0 14 1 667 0.84 0 1 667 0 17 1 667 1.02 2018 0 1 736 0 14 1 736 0.81 0 1 736 0 18 1 736 1.04 Monaco 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Mongolia 2014 3 26 097 0.01 955 26 097 3.6 638 26 097 2.4 736 26 097 2.80 2015 1 30 396 0.003 691 30 396 2.27 771 30 396 2.5 763 30 396 2.50 2017 0 33 407 0 519 33 407 1.55 405 33 407 1.21 675 33 407 2.02 2018 0 34 296 0 230 34 296 0.67 170 34 296 0.50 363 34 296 1.06 Montenegro 2014 0 16 651 0 11 16 651 0.17 2 16 651 0.03 9 16 651 0.14 2015 1 17 159 0.006 9 17 159 0.05 6 17 159 0.03 9 17 159 0.05 2017 — — — — — — — — — — — — 2018 2 18 653 0.01 10 18 653 0.05 3 18 653 0.02 23 18 653 0.12 Morocco 2014 56 296 946 0.02 2 698 296 946 0.90 118 296 946 0.04 3 810 296 946 1.28 2015 94 297 073 0.01 2 859 297 073 0.96 630 297 073 0.04 3 689 297 073 1.24 2017 — — — — — — — — — — — — 2018 49 321 336 0.02 2 909 321 336 0.91 37 321 336 0.01 5 115 321 336 1.59 Mozambique 2014 6 374 121 091 5.27 5 055 121 091 4.18 790 121 091 0.66 4 054 121 091 3.35 2015 6 161 126 068 4.89 5 313 126 068 4.21 842 126 068 0.67 4 884 126 068 3.87 2017 4 084 132 057 3.09 5 088 132 057 3.85 1 316 132 057 0.99 3 137 132 057 2.38 2018 5 171 136 091 3.80 5 022 136 091 3.69 1 606 136 091 1.18 4 260 136 091 3.13 Myanmar 2014 565 313 662 0.18 7 497 313 662 2.39 1 569 313 662 0.5 2 509 313 662 0.79 2015 798 379 088 0.21 8 719 379 088 2.30 1 895 379 088 0.50 3 411 379 088 0.90 2017 848 421 659 0.20 8 186 421 659 1.94 1 546 421 659 0.37 3 165 421 659 0.75 2018 879 457 657 0.19 7 779 457 657 1.70 1 473 457 657 0.32 3 221 457 657 0.70 Namibia 2014 — — — — — — — — — — — — 20155 75 33 975 0.22 229 33 975 0.67 149 33 975 0.44 135 33 975 0.40 2017 66 37 785 0.17 251 37 785 0.66 … 37 785 … 89 37 785 0.24 2018 105 37 672 0.28 354 37 672 0.94 72 37 672 0.19 127 37 672 0.34 5 2016 data. 123ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Nauru 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Nepal 2014 68 217 160 0.03 617 217 160 0.31 422 217 160 0.21 760 217 160 0.38 2015 77 231 000 0.03 703 231 000 0.30 518 231 000 0.22 972 231 000 0.42 2017 66 262 440 0.03 466 262 440 0.18 351 262 440 0.13 714 262 440 0.27 2018 113 271 922 0.04 700 271 922 0.26 424 271 922 0.16 1 229 271 922 0.45 Netherlands 2014 — — — — — — — — — — — — 2015 … … … … … … … … … … … … 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — New Zealand 2014 1 162 337 <0.001 10 162 337 0.006 5 162 337 0.003 7 162 337 0.004 2015 0 169 914 0 28 169 914 0.02 8 169 914 0.005 5 169 914 0.003 2017 1 168 080 <0.001 19 168 080 0.01 6 168 080 0.004 16 168 080 0.01 2018 0 174 705 0 13 174 705 0.007 5 174 705 0.003 8 174 705 0.005 Nicaragua 2014 53 75 035 0.07 158 75 035 0.21 226 75 035 0.30 222 75 035 0.29 2015 68 74 955 0.09 136 74 955 0.18 254 74 955 0.33 236 74 955 0.31 2016 65 76 697 0.09 175 76 697 0.23 210 76 697 0.27 440 76 697 0.57 2017 49 84 682 0.06 164 84 682 0.19 225 84 682 0.27 251 84 682 0.30 Niger 2014 1 245 78 357 1.58 6 735 78 357 8.59 812 78 357 1.03 550 78 357 0.70 2015 983 87 788 1.12 6 838 87 788 7.78 750 87 788 0.85 427 87 788 0.48 2017 — — — — — — — — — — — — 2018 2 142 137 715 1.56 11 001 137 715 7.99 1 999 137 715 1.45 1 153 137 715 0.84 Nigeria 2014 1 088 80 043 1.35 4 600 80 043 5.74 1 428 80 043 1.78 829 80 043 1.03 2015 1 318 98 985 1.33 6 409 98 985 6.47 1 689 98 985 1.70 1 253 98 985 1.26 2017 971 74 240 1.31 4 110 74 240 5.54 1 826 74 240 2.46 823 74 240 1.11 2018 1 972 165 605 1.19 6 102 165 605 3.68 3 689 165 605 2.23 1 522 165 605 0.92 Niue 2014 0 17 0 0 17 0 0 17 0 0 17 0 2015 …  …  …  …  …  …  …  …  …  …  …  …   2017 — — — — — — — — — — — — 2018 …  …  …  …  …  …  …  …  …  …  …  …   North Macedonia 2014 3 33 000 0.004 119 33 000 0.37 15 33 000 0.05 61 33 000 0.19 2015 30 30 000 0.1 161 30 000 0.43 77 30 000 0.26 40 30 000 0.13 2017 0  29 900 0  71  29 900 0.23  45 29 900 0.15 21 29 900  0.07  2018 0 20 771 0 51 20 771 0.25 7 20 771 0.03 … … … Norway 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 0 193 720 0 2 193 720 0.001 3 193 720 0.002 2 19 032 0.01 2018 0 190 408 0 0 190 408 0 1 190 408 0.0005 0 11 5797 0 Oman 2014 9 57 635 0.01 699 57 635 1.21 203 57 635 0.35 50 57 635 0.08 2015 9 56 640 0.02 976 56 640 1.70 170 56 640 0.30 70 56 640 0.12 2017 — — — — — — — — — — — — 2018 8 58 342 0.01 326 58 342 0.56 213 58 342 0.37 91 58 342 0.16 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021124 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Pakistan 2014 — — — — — — — — — — — — 2015 276 1 380 285 0.02 23 465 1 380 285 1.70 38 648 1 380 285 2.80 7 584 697 275 1.09 2017 …  …  …  …  …  …  …  …  …  …  …  …   2018 1 999 2 004 007 0,10 39 800 2 031 244 1.96 50 478 2 030 079 2.49 12 872 1 872 687 0.69 Palau 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 0 879 0 9 879 1.02 2 879 0.23 15 879 1.70 Panama 2014 — — — — — — — — — — — — 2015 87 55 764 0.16 120 55 764 0.21 202 55 764 0.36 491 55 764 0.88 2016 98 57 102 0.17 126 57 102 0.22 224 57 102 0.39 559 57 102 0.98 2017 84 54 066 0.16 125 54 066 0.23 176 54 066 0.33 460 54 066 0.85 Papua New Guinea 2014 336 28 367 1.18 3 355 28 367 11.82 3 602 28 367 12.69 2015 353 33 196 1.06 4 112 33 196 12.4 13 33 196 0.03 2017 579 38 544 1.50 4 325 38 544 11.22 4 211 38 544 10.93 2018 — — — — — — — — — — — — Paraguay 2014 295 87 888 0.33 296 87 888 0.33 323 87 888 0.36 5 778 87 888 6.57 2015 288 98 945 0.29 294 98 945 0.29 333 98 945 0.33 5 934 98 945 5.99 2016 291 94 666 0.31 286 94 666 0.30 463 94 666 0.49 5 522 94 666 5.83 2017 196 89 007 0.22 331 89 007 0.37 476 89 007 0.54 4 744 89 007 5.33 Peru 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2016 929 343 608 0.27 1 142 343 608 0.33 1 469 343 608 0.43 3 192 343 608 0.93 2017 794 359 458 0.22 1 478 359 458 0.41 2 162 359 458 0.60 3 536 359 458 0.98 Philippines 2014 — — — — — — — — — — — — 2015 1 183 866 295 0.13 20 787 868 289 2.39 2 291 867 551 0.26 4 373 867 865 0.50 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Poland 2014 41 1 235 400 0.003 394 1 235 400 0.03 457 1 235 400 0.03 158 1 235 400 0.01 2015 46 1 276 284 0.003 337 1 276 284 0.02 305 1 276 284 0.02 151 1 276 284 0.01 2017 35 1 305 998 0.003 220 1 305 998 0.02 203 1 305 998 0.02 164 1 305 998 0.01 2018 34 1 293 424 0.003 204 1 293 424 0.02 187 1 293 424 0.01 134 1 293 424 0.01 Portugal 2014 26 353 459 0.01 41 353 459 0.01 22 353 459 0.01 … … … 2015 28 337 580 0.01 37 337 580 0.01 21 337 580 0.01 … … … 2017 13 325 043 0.004 30 325 043 0.009 22 325 043 0.007 108 325 043 0.03 2018 10 314 091 0.003 16 314 091 0.005 9 314 091 0.003 90 314 091 0.03 Qatar 2014 7 25 099 0.02 63 25 099 0.25 60 25 099 0.23 57 25 099 0.22 2015 4 27 038 0.02 77 27 038 0.28 59 27 038 0.21 54 27 038 0.192 2017 9 27 389 0.03 61 27 389 0.22 164 27 389 0.60 101 27 389 0.37 2018 4 30 125 0.01 38 30 125 0.13 59 30 125 0.20 62 30 125 0.21 Republic of Korea 2014 2 041 3 044 274 0.06 1 738 3 044 274 0.05 3 635 3 044 274 0.11 759 3 044 274 0.02 2015 1 691 3 074 278 0.05 1 036 3 074 278 0.03 3 722 3 074 278 0.12 626 3 074 278 0.02 2017 4 018 2 835 639 0.14 1 105 2 835 639 0.04 196 2 835 639 0.007 362 2 835 639 0.01 2018 3 611 2 876 459 0.13 1 003 2 876 459 0.03 302 2 876 459 0.01 322 2 876 459 0.01 125ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Republic of Moldova 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 115 75 421 0.15 558 75 421 0.74 745 75 421 0.99 807 75 421 1.07 Romania 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 49 417 114 0.01 1 676 417 114 0.40 301 417 114 0.07 1 136 417 114 0.27 2018 41 423 487 0.01 1 651 423 487 0.39 262 423 487 0.06 1 043 423 487 0.25 Russian Federation 2014 1 669 3 104 349 0.05 5 522 3 104 349 0.17 13 150 3 104 349 0.42 6 614 3 104 349 0.21 2015 1 814 2 981 475 0.06 7 103 2 981 475 0.23 10 169 2 981 475 0.34 6 267 2 981 475 0.21 2017 1 416 2 750 302 0.05 3 740 2 750 302 0.14 6 262 2 750 302 0.23 4 492 2 750 302 0.16 2018 1 209 2 763 217 0.04 2 334 2 763 217 0.08 5 049 2 763 217 0.18 3 907 2 763 217 0.14 Rwanda 2014 168 42 789 0.39 475 42 789 1.11 466 42 789 1.09 265 42 789 0.62 2015 208 53 436 0.39 593 53 436 1.11 582 53 436 1.09 331 53 436 0.62 2017 — — — — — — — — — — — — 2018 43 65 512 0.07 549 65 512 0.84 328 65 512 0.50 254 65 512 0.39 Saint Kitts and Nevis 2014 — — — — — — — — — — — — 2015 0 408 0 12 408 2.94 1 408 0.24 7 408 1.71 2016 0 542 0 14 542 2.58 4 542 0.74 10 542 1.85 2017 0 571 0 22 571 3.85 1 571 0.18 3 571 0.52 Saint Lucia 2014 2 2 456 0.08 31 2 456 1.26 3 2 456 0.12 43 2 456 1.75 2015 4 2 463 0.16 22 2 463 0.89 1 2 463 0.04 34 2 463 1.38 2016 4 2 563 0.16 13 2 563 0.51 2 2 563 0.08 23 2 563 0.90 2017 4 2 773 0.14 12 2 773 0.43 2 2 773 0.07 26 2 773 0.94 Saint Vincent and the Grenadines 2014 1 995 0.10 8 995 0.80 3 995 0.30 27 995 2.71 2015 1 1 028 0.09 5 1 028 0.48 2 1 028 0.19 23 1 028 2.23 2016 1 1 103 0.09 9 1 103 0.81 2 1 103 0.18 10 1103 0.91 2017 2 1 295 0.15 11 1 295 0.85 2 1 295 0.15 12 1 295 0.93 Samoa 2014 0 0 0 78 1 712 4.55 12 1 712 0.70 0 0 0 2015 10 2 479 0.40 84 2 479 3.39 1 2 479 0.04 7 2 479 0.28 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — San Marino 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Sao Tome and Principe 2014 3 869 0.35 116 869 13.35 1 424 0.24 1 869 0.12 2015 7 1 010 0.69 88 1 010 8.71 4 908 0.44 8 1 010 0.79 2017 — — — — — — — — — — — — 2018 5 1 194 0.42 93 1 194 7.79 6 1 194 0.50 18 1 194 1.50 Saudi Arabia 2014 …  …  …  …  …  …  …  …  …  …  …  …   2015 …  …  …  …  …  …  …  …  …  …  …  …   2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021126 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Senegal 2014 186 78 548 0.24 7 763 78 548 9.88 370 78 548 0.47 143 78 548 0.18 2015 171 69 295 0.24 6 758 69 295 9.75 452 69 295 0.65 128 69 295 0.18 2017 196 88 905 0.22 8 757 88 905 9.85 585 88 905 0.66 172 88 905 0.19 2018 161 97 958 0.16 8 458 97 958 8.63 326 97 958 0.33 124 97 958 0.13 Serbia 2014 5 64 846 0.007 26 64 846 0.04 30 64 846 0.04 17 64 846 0.02 2015 6 63 440 0.09 37 63 440 0.05 26 63 440 0.04 13 63 440 0.02 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Seychelles 2014 8 1 822 0.44 4 1 822 0.22 2 1 822 0.11 8 1 822 0.44 2015 10 1 863 0.53 1 1 863 0.05 2 1 863 0.11 8 1 863 0.42 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Sierra Leone 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Singapore 2014 6 117 491 0.005 115 117 491 0.09 15 117 491 0.01 39 117 491 0.03 2015 3 122 111 0.002 114 122 111 0.09 10 122 111 0.008 29 122 111 0.02 2017 9 125 207 0.007 109 125 207 0.09 14 125 207 0.01 29 125 207 0.02 2018 6 124 229 0.004 128 124 229 0.10 7 124 229 0.006 38 124 229 0.03 Slovakia 20146 2 134 179 0.001 22 134 179 0.02 3 134 179 0.002 24 134 179 0.02 2015 1 227 584 <0.001 18 227 584 0.007 14 227 584 0.006 28 227 584 0.01 2017 1 221 297 <0.001 28 221 297 0.01 7 221 297 0.003 15 221 297 0.007 2018 4 227 560 0.002 24 227 560 0.01 9 227 560 0.004 23 227 560 0.01 Slovenia 2014 3 87 826 0.003 9 87 826 0.01 4 87 826 0.004 4 87 826 0.004 2015 0 87 697 0 9 87 697 0.01 4 87 697 0.004 4 87 697 0.004 2017 0 89 580 0 5 89 580 0.005 1 89 580 0.001 5 89 580 0.005 2018 — — — — — — — — — — — — Solomon Islands 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 … … … … … … … … … … … … Somalia 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — South Africa 2014 1 884 977 904 0.19 827 977 904 0.08 70 977 904 0.007 1 712 977 904 0.17 2015 1 872 1 005 516 0.18 810 1 005 516 0.08 73 1 005 516 0.007 1 779 1 005 516 0.17 2017 1 529 983 793 0.16 731 983 793 0.07 75 983 793 0.008 2 617 983 793 0.27 2018 1 536 982 010 0.16 729 982 010 0.07 112 982 010 0.01 2 846 982 010 0.29 South Sudan 2014 … … … … … … … … … … … … 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 9 6 533 0.14 51 6 533 0.78 37 6 533 0.57 41 6 533 0.63 6 The denominators are the total number of donors tested. 127ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Spain 2014 131 1 671 325 0.007 408 1 671 325 0.02 188 1 671 325 0.01 633 1 671 325 0.03 2015 119 1 699 817 0.007 355 1 699 817 0.02 184 1 699 817 0.01 793 1 699 817 0.04 2017 98 1 681 793 0.006 283 1 681 793 0.02 140 1 681 793 0.008 660 1 681 793 0.04 2018 — — — — — — — — — — — — Sri Lanka 2014 26 381 685 0.006 394 381 685 0.10 654 381 685 0.17 152 381 685 0.04 2015 21 397 034 0.005 409 397 034 0.10 800 397 034 0.2 175 397 034 0.04 2017 28 423 668 0.007 618 423 668 0.15 905 423 668 0.21 152 423 668 0.04 2018 29 450 640 0.006 513 450 640 0.11 898 450 640 0.20 107 450 640 0.02 Sudan 2014 2 014 257 107 0.78 10 344 238 679 4.33 4 909 241 470 2.03 7 309 249 485 2.92 2015 …  …  0.70 …  …  4.30 …  …  1.15 …  …  3.26 2017 — — — — — — — — — — — — 2018 …  …  …  …  …  …  …  …  …  …  …  …  Suriname 2014 1 10 521 0.01 9 10 521 0.09 3 10 521 0.03 3 10 521 0.03 2015 0 10 296 0 5 10 296 0.06 9 10 296 0.01 11 10 296 0.02 2016 3 10 432 0.03 4 10 432 0.04 4 10 432 0.04 5 10 432 0.05 2017 …  …  0.07 …  …  0.05 …  …  0.07 …  …  0.24 Sweden 2014 0 498 004 0 1 498 004 <0.001 1 498 004 <0.001 1 498 004 <0.001 2015 1 525 569 <0.001 2 525 569 <0.001 1 525 569 <0.001 1 525 569 <0.001 2017 1 499 944 <0.001 2 499 944 <0.001 2 499 944 <0.001 2 499 944 <0.001 2018 0 491 036 0 0 491 036 0 2 491 036 0.0004 2 491 036 <0.001 Switzerland 2014 6 329 875 0.001 17 329 875 0.005 13 329 875 0.003 16 329 875 0.004 2015 2 311 050 <0.001 34 311 050 0.01 8 311 050 0.002 21 311 050 0.006 2017 2 282 507 <0.001 39 282 507 0.01 12 282 507 0.004 13 282 507 0.005 2018 3 277 808 0.001 33 277 808 0.01 6 277 808 0.002 16 277 808 0.006 Syrian Arab Republic 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Tajikistan 2014 …  …  …  …  …  …  …  …  …  …  …  …  2015 89 42 935 0.21 1 027 42 935 2.39 460 42 935 0.37 546 42 935 1.27 2017 46 40 219 0.11 1 506 40 219 3.74 1 296 40 219 3.22 1 741 40 219 4.33 2018 …  …  …  …  …  …  …  …  …  …  …  …  Thailand 2014 599 638 117 0.09 1 810 638 117 0.28 1 010 638 117 0.16 626 638 117 0.10 2015 670 665 920 0.10 1 716 665 920 0.25 1 049 665 920 0.15 557 665 920 0.08 2017 921 1 065 275 0.09 3 151 1 065 275 0.29 1 623 1 065 275 0.15 1 114 1 065 275 0.10 2018 821 1 122 497 0.07 821 1 122 497 0.32 821 1 122 497 0.12 821 1 122 497 0.09 Timor-Leste 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 12 4 460 0.27 267 4 460 5.99 22 4 460 0.49 196 4 460 4.40 Togo 2014 320 48 408 0.66 1 152 48 408 2.37 684 48 408 1.41 … 48 408 … 2015 295 44 751 0.65 1 521 44 751 3.39 538 44 751 1.20 239 31 585 0.75 2017 190 42 906 0.44 1 051 42 906 2.45 343 42 906 0.80 151 42 906 0.35 2018 251 50 023 0.50 1 385 50 023 2.77 285 50 023 0.57 149 50 023 0.30 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021128 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Tonga 2014 … … … … … … … … … … … … 2015 … … … … … … … … … … … … 2017 … … … … … … … … … … … … 2018 … … … … … … … … … … … … Trinidad and Tobago 2014 … … … … … … … … … … … … 2015 … … … … … … … … … … … … 2016 42 21 870 0.19 37 21 870 0.17 23 21 870 0.11 242 21 870 1.11 2017 49 21 645 0.23 199 21 645 0.92 91 21 645 0.42 243 21 645 1.12 Tunisia 2014 17 216 752 0.008 3 201 217 217 1.47 799 216 941 0.37 168 216 907 0.07 2015 …  …  …  …  …  …  …  …   …  …  …  …  2017 …  …  …  …  …  …  …  …   …  …  …  …  2018 …  …  …  …  …  …  …  …   …  …  …  …  Turkey 2014 2 379 1 860 258 0.13 8 545 1 860 258 0.46 2 141 1 860 258 0.12 2 421 1 860 258 0.13 2015 123 1 937 932 0.006 6 597 1 937 932 0.33 284 1 937 932 0.01 1 175 1 937 932 0.06 2017 218 2 391 573 0.009 6 370 2 391 573 0.27 320 2 391 573 0.01 1 166 2 391 573 0.05 2018 — — — — — — — — — — — — Turkmenistan 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Tuvalu 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Uganda 2014 2 371 217 945 1.08 5 019 217 945 2.30 3 467 217 945 1.59 291 217 945 0.13 2015 1 470 230 995 0.63 5 426 230 995 2.34 3 572 230 995 1.54 656 230 995 0.28 2017 …  …  …  …  …  …  …  …   …  …  …  …  2018 1 783 254 750 0.70 11 464 254 750 4.50 9 681 254 750 3.80 1 774 254 750 0.70 Ukraine 2014 — — — — — — — — — — — — 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — United Arab Emirates 2014 10 101 849 0.01 86 101 849 0.08 181 101 849 0.18 200 101 849 0.20 2015 …  …  …  …  …  …  …  …   …  …  …  …  2017 — — — — — — — — — — — — 2018 12 132 849 0.009 97 80 896 0.12 201 132 849 0.15 151 80 896 0.19 United Kingdom of Great Britain and Northern Ireland7 2014 0 285 381 0 10 285 381 0.004 14 285 381 0.005 9 285 381 0.003 2015 1 271 327 <0.001 8 271 327 0.002 14 271 327 0.005 12 271 327 0.004 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — United Republic of Tanzania 2014 1 876 128 915 1.46 6 304 128 915 4.89 2 017 128 915 1.56 1 656 128 915 1.28 2015 1 087 67 980 1.60 3 467 67 980 5.10 1 395 67 980 2.05 1 367 67 980 2.01 2017 3 509 233 953 1.50 11 464 233 953 4.90 1 170 233 953 0.50 4 445 233 953 1.90 2018 3 227 307 835 1.05 13 613 307 835 4.42 1 092 307 835 0.35 6 801 307 835 2.21 7 Subnational data provided by Scottish National Blood Transfusion Service and Welsh Blood Service. 129ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year HIV 1+2 HBV HCV Syphilis Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* Positive/ reactive, no. No. donations tested %* United States of America 2014 158 6 566 047 0.002 549 6 566 147 0.008 1 102 6 566 135 0.02 1 611 6 564 758 0.02 2015 109 6 243 465 0.001 433 6 243 488 0.006 1 084 6 243 479 0.02 1 246 6 242 194 0.01 2017 428 5 998 504 0.007 1 776 5 998 753 0.03 2 552 5 998 914 0.04 1 767 5 997 133 0.03 2018 855 6 951 668 0.01 1 950 6 951 952 0.03 3 184 6 951 892 0.05 3 032 6 949 911 0.04 Uruguay 2014 90 100 164 0.09 102 100 164 0.10 320 100 164 0.31 510 100 164 0.50 2015 103 96 304 0.11 102 96 304 0.10 295 96 304 0.30 399 96 304 0.41 2016 108 90 064 0.12 105 90 064 0.12 266 90 064 0.30 366 90 064 0.41 2017 90 92 674 0.10 145 92 674 0.16 314 92 674 0.34 451 92 674 0.49 Uzbekistan 2014 921 135 859 0.67 6 876 135 859 5.06 4 135 135 859 3.04 1 860 135 859 1.36 2015 852 142 723 0.59 6 580 142 723 4.61 3 832 142 723 2.68 2 255 142 723 1.57 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Vanuatu 2014 — — — — — — — — — — — — 2015 0 1 322 0 17 1 322 1.29 3 1 322 0.23 12 1 322 0.91 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Venezuela (Bolivarian Republic of) 2014 775 312 048 0.24 1 145 312 048 0.36 881 312 048 0.28 5 209 312 048 1.66 2015 737 299 879 0.24 1 154 299 879 0.38 1 016 299 879 0.33 4 644 299 879 1.54 2016 — — — — — — — — — — — — 2017 — — — — — — — — — — — — Viet Nam 2014 3 242 1 037 154 0.31 25 583 1 037 154 2.47 6 313 1 037 154 0.61 3 421 1 037 154 0.33 2015 — — — — — — — — — — — — 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — — Yemen 2014 — — — — — — — — — — — — 2015 32 9 687 0.33 1 468 9 687 15.3 77 9 687 0.80 25 9 687 0.25 2017 — — — — — — — — — — — — 2018 131 17 913 0.73 341 17 913 1.90 138 17 913 0.77 158 17 913 0.88 Zambia 2014 3 824 109 269 3.49 6 009 109 269 5.49 1 529 109 269 1.40 1 311 109 269 1.20 2015 3 003 100 110 3.00 5 305 100 110 5.30 900 100 110 0.90 900 100 110 0.90 2017 — — — — — — — — — — — — 2018 — — — — — — — — — — — Zimbabwe 2014 304 58 603 0.51 334 58 603 0.56 0 58 603 0 34 58 603 0.06 2015 259 59 947 0.43 207 59 947 0.34 1 59 947 0.001 34 59 947 0.05 2017 199 65 164 0.31 147 65 164 0.23 1 65 164 0.002 40 65 164 0.06 2018 317 82 257 0.39 169 82 257 0.21 4 82 257 0.005 42 82 257 0.05 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021130 Annex 5. Number and proportion of donations tested positive/reactive for TTI markers 2014–2018 (continued) … Not reported/not available. Blank cell: Not required/not applicable. — No response. * Proportion, expressed as positive/reactive per 100 donations tested. Country Data year Chagas disease Malaria HTLV-1/2 Positive/ reactive, no. No. donations screened %* Positive/ reactive, no. No. screened %* Positive/ reactive, no. No. screened %* Angola 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 … … … Argentina 2014 21 103 959 233 2.46 1 535 959 233 0.18 2015 14 711 980 988 1.50 1 348 980 988 0.14 2016 18 126 917 868 1.98 1 387 917 868 0.15 2017 16 653 1 102 875 1.51 2 426 1 102 875 0.22 Australia 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — 3 1 273 051 <0.001 2018 — — — — — — 3 1 329 849 <0.001 Bahamas 2014 4 4 563 0.09 2015 … … … 2016 19 5 759 0.33 2017 29 5 619 0.52 Bangladesh 2014 48 651 718 0.007 2015 72 679 681 0.01 2017 77 703 424 0.009 2018 120 761 115 0.02 Barbados 2014 20 4 686 0.42 2015 — — — — — — — — — 2016 25 5 238 0.48 2017 17 5 243 0.32 Belize 2014 8 4 329 0.18 2015 7 5 564 0.12 2016 14 5 826 0.24 2017 7 6 092 0.12 Bhutan 2014 0 9 375 0 2015 0 2 066 0 2017 0 9 997 0 2018 0 7 770 0 Bolivia 2014 3 948 101 166 3.90 2015 2 717 108 132 2.51 2016 2 428 112 536 2.16 2017 2 462 119 663 2.06 131ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year Chagas disease Malaria HTLV-1/2 Positive/ reactive, no. No. donations screened %* Positive/ reactive, no. No. screened %* Positive/ reactive, no. No. screened %* Brazil 2014 — — — — — — — — — 2015 5 096 2 356 414 0.22 5 581 2 356 414 0.24 2016 5 721 3 463 353 0.17 7 924 3 463 353 0.23 2017 8 088 3 143 417 0.26 9 631 3 143 417 0.31 Cambodia 2014 6 52 864 0.01 2015 … … … 2017 — — — — — — — — — 2018 — — — — — — — — — Canada 2014 5 15 026 0.03 11 923 224 0.001 2015 1 15 265 0.006 9 864 173 0.001 2017 0 18 600 0 13 850 585 0.002 2018 — — — — — — Chile 2014 280 235 897 0.11 184 235 735 0.07 2015 310 246 900 0.13 276 246 900 0.11 2016 … … 0.08 … … 0.05 2017 235 265 653 0.09 147 265 653 0.06 Colombia 2014 3 088 756 370 0.40 2 136 704 280 0.30 2015 3 015 795 792 0.38 2 551 795 792 0.32 2016 2 194 817 004 0.27 2 035 817 004 0.25 2017 1 577 830 291 0.19 1 818 830 291 0.22 Costa Rica 2014 107 73 057 0.15 57 73 057 0.08 2015 101 75 733 0.13 95 75 733 0.13 2016 110 77 607 0.14 62 77 607 0.08 2017 187 77 389 0.24 78 77 389 0.10 Dominica 2014 8 1 006 0.79 2015 6 1 037 0.57 2016 8 1 165 0.69 2017 9 893 1.01 Dominican Republic 2014 151 92 626 0.16 2015 159 77 563 0.21 2016 223 107 943 0.21 2017 296 105 134 0.28 Ecuador 2014 576 232 215 0.25 2 15 342 0.01 2015 843 246 887 0.34 10 16 848 0.06 2016 962 236 370 0.41 76 19 381 0.39 2017 1 333 249 363 0.53 157 23 883 0.661 El Salvador 2014 2 260 98 090 2.30 2015 2 458 92 882 2.65 2016 4 043 104 616 3.86 2017 2 104 101 605 2.07 Finland 2014 2015 2017 0 686 0 0 7 0 2018 38 694 5.48 0 5 0 1 HTLV-1/2 screening was performed in 9.58% of the units GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021132 Country Data year Chagas disease Malaria HTLV-1/2 Positive/ reactive, no. No. donations screened %* Positive/ reactive, no. No. screened %* Positive/ reactive, no. No. screened %* France 2014 30 2 826 712 0.001 2015 17 2 958 120 <0.001 2017 — — — — — — — — — 2018 1 68 805 0.001 1 332 229 662 0.58 23 2 926 942 <0.001 Greece 2014 1 541 662 <0.001 2015 3 3672612 <0.001 2017 — — — — — — — — — 2018 — — — — — — — — — Guatemala 2014 1 187 114 404 1.04 2015 1 173 126 244 0.93 2016 1 126 135 396 0.83 2017 985 136 241 0.72 Guyana 2014 — — — — — — 2015 32 9 698 0.33 98 9 696 1.01 2016 46 10 200 0.45 84 10 200 0.82 2017 155 9 755 1.59 99 9 755 1.02 Haiti 2014 198 28 867 2015 215 27 752 0.78 2016 197 25 699 0.77 2017 151 28 018 0.54 Honduras 2014 550 58 172 0.96 104 57 820 0.18 2015 531 71 660 0.74 107 71 555 0.15 2016 567 79 830 0.71 138 79 830 0.17 2017 626 80 850 0.77 147 80 850 0.18 India 2014 … … 0.8 2015 … … 0.7 2017 … … 0.07 2018 … … 0.05 Indonesia 2014 907 140 258 0.64 2015 287 107 198 0.26 2017 218 74 056 0.29 2018 175 129 902 0.13 Iran (Islamic Republic of) 2014 308 411 444 0.07 2015 245 410 687 0.05 2017 191 435 784 0.04 2018 146 450 613 0.03 Israel 2014 0 262 605 0 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Jamaica 2014 444 29 390 1.51 2015 440 28 869 1.52 2016 … … … 2017 455 32 092 1.42 2 Total number of donors tested. 133ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year Chagas disease Malaria HTLV-1/2 Positive/ reactive, no. No. donations screened %* Positive/ reactive, no. No. screened %* Positive/ reactive, no. No. screened %* Japan 2014 2 590 4 999 127 0.05 2015 2 477 4 909 156 0.05 2017 5 381 4 775 648 0.11 2018 — — — Kuwait 2014 — — — — — — — — — 2015 637 12 679 5.02 21 77 700 0.02 2017 497 9 858 5.04 28 82 937 0.03 2018 1 218 11 442 10.65 38 85 847 0.04 Luxembourg 2014 0 17 0 0 1 774 0 0 933 0 2015 0 37 0 0 1 730 0 0 804 0 2017 — — — — — — — — — 2018 17 2 350 0.72 1 1 259 0.03 Madagasgar 2014 … … … 2015 … … … 2017 — — — 2018 28 39 210 0.07 Malawi 2014 452 52 065 0.87 2015 … … … 2017 … … … 2018 … … 0.54 Mexico 2014 8 910 1 870 303 0.48 2015 7 961 2 168 737 0.37 2016 8 830 2 356 388 0.38 2017 8 767 2 394 836 0.37 New Zealand 2014 1 161 0.62 356 6 737 5.28 2 15 746 0.01 2015 0 183 0 344 7 498 4.59 1 16 044 0.006 2017 0 194 0 2 8 171 0.02 0 16 164 0 2018 0 255 0 1 8 998 0.01 1 16 876 0.006 Nicaragua 2014 230 75 035 0.30 2015 256 74 955 0.34 2016 382 76 697 0.50 2017 188 84 682 0.22 Norway 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 15 1 358 1.10 2018 12 3 655 0.33 Oman 2014 2015 2017 2018 69 58 342 0.12 Pakistan 2014 — — — — — — — — — 2015 1 086 613 674 0.18 2017 … … … 2018 14 800 1 751 296 0.85 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021134 Country Data year Chagas disease Malaria HTLV-1/2 Positive/ reactive, no. No. donations screened %* Positive/ reactive, no. No. screened %* Positive/ reactive, no. No. screened %* Panama 2014 209 56 426 0.37 183 56 426 0.32 2015 292 55 764 0.52 244 55 764 0.44 2016 136 57 102 0.24 227 57 102 0.40 2017 103 54 066 0.19 180 54 066 0.33 Paraguay 2014 2 050 87 888 2.33 182 87 888 0.21 2015 2 343 98 945 2.37 317 98 945 0.32 2016 1 971 94 666 2.08 270 94 666 0.29 2017 1 560 89 007 1.75 239 89 007 0.27 Peru 2014 — — — — — — — — — 2015 — — — — — — — — — 2016 1 227 343 608 0.36 2 623 343 608 0.76 2017 1 627 359 458 0.45 2 809 359 458 0.78 Philippines 2014 588 865 283 0.06 2015 588 865 283 0.06 2017 — — — — — — — — — 2018 — — — — — — — — — Portugal 2014 … … … … … … 2015 … … … … … … 2017 1 4 448 0.02 3 43 480 0.007 2018 8 4 835 0.17 4 40 315 0.01 Qatar 2014 0 25 099 0 10 25 099 0.03 2015 0 15 555 0 9 27 038 0.03 2017       0 15 444 0 46 27 389 0.17 2018 0 17 457 0 4 30 125 0.01 Republic of Korea 2014 1 280 1 377 253 0.09 309 2 324 443 0.01 2015 569 3 318 313 0.01 409 2 377 726 0.01 2017 981 1 224 636 0.08 385 2 311 258 0.02 2018 1 614 1 275 356 0.13 304 1 244 660 0.02 Republic of Moldova 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 115 58 821 0.20 558 58 821 0.95 Romania 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 30 417 114 0.007 2018 15 423 487 0.004 Saint Kitts and Nevis 2014 — — — 2015 6 408 1.47 2016 14 542 2.58 2017 5 571 0.88 Saint Lucia 2014 15 2 456 0.61 2015 21 2 463 0.85 2016 20 2 563 0.78 2017 7 2 773 0.25 135ANNEX 5. NUMBER AND PROPORTION OF DONATIONS TESTED POSITIVE/REACTIVE FOR T TI MARKERS 2014–2018 Country Data year Chagas disease Malaria HTLV-1/2 Positive/ reactive, no. No. donations screened %* Positive/ reactive, no. No. screened %* Positive/ reactive, no. No. screened %* Saint Vincent and the Grenadines 2014 22 995 2.22 2015 22 1 028 2.14 2016 21 1 103 1.90 2017 27 1 295 2.08 Seychelles 2014 7 1 822 0.38 2015 10 1 863 0.54 2017 — — — 2018 — — — Singapore 2014 230 10 176 2.26 2015 221 10 458 2.11 2017 148 10 133 1.46 2018 135 9 916 1.36 Spain 2014 77 98 554 0.08 109 14 033 0.78 16 512 757 0.003 2015 70 74 536 0.09 96 28 577 0.34 20 486 957 0.004 2017 38 70 738 0.05 217 26 716 0.81 18 453 679 0.004 2018 — — — — — — — — — Sri Lanka 2014 0 381 685 0 2015 0 397 034 0 2017 0 423 668 0 2018 0 450 640 0 Suriname 2014 2 10 521 0.02 2015 0 10 296 0 0 10 432 0 2016 0 10 4323 0 0 10 4324 0 2017 … … 0.01 … … 0.08 Sweden 2014 … … … 2015 … … … 2017 1 258 8235 <0.001 2018 0 491 036 0 Trinidad and Tobago 2014 … … … … … … 2015 … … … … … … 2016 13 21 870 0.06 91 21 870 0.42 2017 53 21 645 0.24 237 21 645 1.09 United Arab Emirates 2014 20 101 849 0.02 2015 23 … … 2017 — — — 2018 40 132 849 0.03 United Kingdom of Great Britain and Northern Ireland 2014 20 2 752 0.73 0 28 531 0 2015 22 3 337 0.65 0 271 327 0 2017 — — — — — — — — — 2018 — — — — — — — — — United States of America 2014 79 2 072 704 0.003 163 6 566 129 0.002 2015 72 1 880 849 0.003 2017 135 1 429 411 0.009 270 5 998 695 0.005 2018 349 2 482 711 0.01 729 6 951 685 0.01 3 Inconclusive: 3. 4 Inconclusive: 3. 5 Total number of blood donors tested. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021136 Country Data year Chagas disease Malaria HTLV-1/2 Positive/ reactive, no. No. donations screened %* Positive/ reactive, no. No. screened %* Positive/ reactive, no. No. screened %* Uruguay 2014 206 100 164 0.20 98 100 164 0.10 2015 188 96 304 0.19 214 96 304 0.22 2016 157 90 064 0.17 114 90 064 0.13 2017 139 92 674 0.15 148 92 674 0.16 Venezuela (Bolivarian Republic of) 2014 1 077 312 048 0.34 442 312 048 0.14 2015 946 299 879 0.31 543 299 879 0.18 2016 … … 0.35 … … 0.14 2017 — — — — — — Viet Nam 2014 80 597 602 0.013 181 242 015 0.07 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Yemen 2014 — — — — — — — — — 2015 121 9 687 1.3 2017 — — — — — — — — — 2018 554 17 913 3.1 137ANNEX 6. CLINICAL USE OF BLOOD AND BLOOD COMPONENTS 2014–2018 Annex 6. Clinical use of blood and blood components 2014–2018 … Not reported/not available. Blank: Not required/not applicable. — No response. * Except stated/explained otherwise, 1 unit of blood component is defined as the preparation from whole blood donations of 450 ml. ** 1 unit of apheresis platelets usually contains 200–450 x 109 platelets. ∆ In adult therapeutic doses. Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Afghanistan 2014 … 101 049 3 898 15 0 1 297 0 0 2015 … 142 336 6 343 5 213 0 1 783 0 40 2017 … 159 198 10 376 8 457 0 1 728 0 22 2018 … 179 878 14 340 12 959 0 3 381 0 69 Albania 2014 — — — — — — — — — 2015 32 … … … … … … … 2017 — — — — — — — — — 2018 32 391 22 452 4 217 … 14 508 7 643 466 Units issued Algeria 2014 494 14 154 445 352 87 823 11 419 94 782 0 0 Units issued 2015 494 13 588 434 122 98 678 7 989 80 046 0 0 Units issued 2017 — — — — — — — — — 2018 494 8 544 508 765 103 292 …  82 796   0 Andorra 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Angola 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 159 97 568 12 399 9 154 0  4 879 0  18 Antigua and Barbuda 2014 — — — — — — — — — 2015 — — — — — — — — — 2016 — — — — — — — — — 2017 — — — — — — — — — Argentina 2014 2 723 12 000 731 000 385 400 … 84 000 110 000 24 168 2015 2 365 1 120 524 136 445 676 3 692 226 922 31 769 86 230 2016 1 135 6 448 665 802 319 441 15 152 163 982 10 553 20 927 2017 1 135 7 335 1 016 808 491 700 59 197 291 240 12 281 23 000 Armenia 2014 … 0 12 207 2 730 70 12 067 … 575 Units issued 2015 127 0 12 341 3 035 50 11 452 0 739 Units issued 2017 — — — — — — — — — 2018 — — — — — — — — — Australia 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021138 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Austria 2014 163 … 291 593 6 748∆ 24 700 …1 12 Units transfused 2015 181 … 329 841 11 219∆ 26 397 …2 26 Units transfused 2017 179 0 319 935 … … 6 677 … 2018 179 0  334 240 … … 4 832    … Azerbaijan 2014 — — — — — — — — — 2015 — — — — — — — — — 2016 — — — — — — — — — 2017 — — — — — — — — — Bahamas 2014 … … … … … … … … 2015 … … … … … … … … 2016 … … … … … … … … 2017 3 … … … … … … … Bahrain 2014 20 … 18 237 15 659 108 … … … Units transfused 2015 193 100 14 831 18 522 85 … … … Units transfused 2017 16 … … … … … … … 2018 17 … … … … … … … Bangladesh 2014 244 … … … … … … … 2015 244 … … … … … … … 2017 198 652 924 50 500 300 50 32 000 300   Units issued 2018 342 761 115 84 465 34 495 20 59 481 10 113 Units issued Barbados 2014 3 3 565 4 293 532 82 967 0 0 2015 — — — — — — — — — 2016 3 0 5 060 626 98 802 0 0 2017 3 0  4 700 195 121 763 0  0    Belarus 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Belgium 2014 112 0 447 567 31 461∆ 36 096 62 359 0 0 Units transfused 2015 … 0 434 145 31 503∆ 33 979 73 152 0 0 Units transfused 2017 — — — — — — — — — 2018 — — — — — — — — — Belize 2014 … 1 978 1 863 222 0 651 170 30 2015 14 1 764 1 629 227 0 452 174 6 2016 14 1 764 1 291 … 0 452 174 6 2017 14 2 217 2 075 139 0  714 63 8 Benin 2014 50 72 769 16 061 477 0 3 581 0 0 Units issued 2015 40 57 080 16 913 185 0 3 500 0 0 Units issued 2017 — — — — — — — — — 2018 40 25 012 100 083 21 0  3 416   0 Units issued Bhutan 2014 29 854 5 936 912 0 936 11 Units issued 2015 29 3 142 4 808 1 391 0 1 265 0 0 Units issued 2017 23 3 062 5 955 2 016 0  1 560     Units issued 2018 27 1 446 5 019 2 208  0 1 528     Units issued 1 Fresh frozen Plasma (quarantine): 7036 units. Fresh frozen Plasma (virus-inactivated): 4751 units. 2 Fresh frozen Plasma (quarantine): 3695 units. 139ANNEX 6. CLINICAL USE OF BLOOD AND BLOOD COMPONENTS 2014–2018 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Bolivia 2014 … … … … … … … … 2015 … … … … … … … … 2017 — — — — — — — — — 2018 95 495 78 100 28 409 265 44 573 490 5 628   Bosnia and Herzegovina 2014 18 243 8 250 … … 7 067 0 0 Units issued 2015 18 97 12 815 7 314 785 10 165 0 0 Units issued 2017 — — — — — — — — — 2018 — — — — — — — — — Botswana 2014 33 0 2 158 302 119 536 Units issued 2015 33 … … … … … … … 2017 27 … … … … … … … 2018 27 … … … … … … …   Brazil 2014 — — — — — — — — — 2015 … 2 666 1 871 862 720 618 0 471 960 8 607 91 421 2016 … 1 818 658 723 27 525 95 199 705 0 8 885 2017 … 937 1 329 853 491 640   291 710 9 899 63 391 Brunei Darussalam 2014 4 0 12 832 2 606 333 1 989 0 206 Units transfused 2015 4 0 13 621 2 679 418 2 828 0 431 Units transfused 2017 4 0  14 933 2 493 430 2 907 0  431 Units transfused 2018 4 0 15 995 2 080 563 2 555 0  86 Units transfused Bulgaria 2014 190 61 169 417 22 747 2 525 119 887 0 0 Units issued 2015 249 200 168 521 26 175 2 390 93 409 0 0 Units issued 2017 — — — — — — — — — 2018 172 92 155 525 26 712 2 145 100 310 100   Units issued Burkina Faso 2014 48 27 775 74 795 2 071 0 2 435 0 0 Units issued 2015 104 26 644 72 692 2 074 0 2 461 0 0 Units issued 2017 62 27 604 73 219 2 035 0  2 503 0  0  Units issued 2018 116 …  85 234 2 834 0  4730 0  0 Units issued Burundi 2014 52 … … … … … … … 2015 91 … … … … … … … 2017 — — — — — — — — — 2018 65 75 589 1 902 0 0  0   0   Cabo Verde 2014 6 0 2 897 193 0 400 0 184 Units transfused 2015 6 3 3 093 165 0 403 0 87 Units transfused 2017 6 0 2 897 193 0 400 0 184 Units transfused 2018 6 32 3 093 165 0 403 0 87 Units transfused Cambodia 2014 45 23 318 21 984 1 286 0 1 712 0 426 Units issued 2015 45 27 937 22 156 1 729 0 1 706 0 151 Units issued 2017 — — — — — — — — — 2018 — — — — — — — — — Cameroon 2014 15 18 262 0 0 0 0 0 0 Units transfused 2015 37 56 902 0 0 0 0 0 0 Units transfused 2017 49 74 189 0 0 0 0 0 0 Units transfused 2018 58 73 113 5 290 591 0  1 325 0  0 Units transfused GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021140 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Canada 2014 460 0 736 086 62 683∆ 30 229 18 507 85 8103 59 159 Units issued 2015 460 0 780 405 76 898∆ 37 865 0 129 010 61 531 Units transfused 2017 460 0 714 996 69 808∆ 29 747 15 953 68 755 59 741 Units transfused 2018 — — — — — — — — — Central African Republic 2014 44 9 767 2 880 236 0 247 0 32 Units issued 2015 44 12 859 0 0 0 0 0 0 Units issued 2017 — — — — — — — — — 2018 23 16 316 0 0 0  0 0  0 Units issued  Chad 2014 69 60 127 2 040 172 0 1 974 0 0 Units issued 2015 77 62 974 1 615 371 0 1 615 0 0 Units issued 2017 — — — — — — — — — 2018 77 44 220 65 0 0  25   0 Units issued Chile 2014 — — — — — — — — — 2015 74 0 220 252 93 087 3 342 79 962 0 12 416 2016 74 0 234 894 140 116 1 850 77 434 0 18 285 2017 74 0  231 708 96 674 2 172 81 642 0  15 940   China4 2014 … 73 955 19 814 868 405 815 1 254 774 … … … Units issued 2015 … 55 983 19 988 596 364 984 1 381 951 17 580 496 … … Units issued 2017 …  30 662 22 002 222 390 864 1 614 378 18 966 728 …  …  Units issued 2018 …  41 745 22 607 300 523 970 1 778 523 …  …  …  Units issued Colombia 2014 414 8 250 664 457 162 495 128 445 201 360 0 44 396 2015 517 1 338 662 721 177 547 121 854 211 723 0 48 836 2016 581 1 818 658 723 181 133 153 745 199 705 0 50 612 2017 588 445 835 367 216 918 206 604 216 561 0  70 367   Comoros 2014 5 1 913 0 0 0 0 0 0 Units issued 2015 6 2 290 0 0 0 0 0 0 Units issued 2017 — — — — — — — — — 2018 8 1 525 0 0 0  0 0  0 Units issued  Congo 2014 16 10 038 41 782 114 0 819 0 2 Units issued 2015 34 14 539 29 761 97 0 391 0 0 Units issued 2017 52 15 812 34 388 798 0 2 060 0  5 Units issued 2018 52 9 380 68 714 262 0  888 0  2 Units issued  Cook Islands 2014 … … … … … … … … 2015 … … … … … … … … 2017 2 0 97 0 0 9 0 0 Units transfused 2018 — — — — — — — — — Costa Rica 2014 34 … … … … … … … 2015 32 … … … … … … … 2016 33 0 65 454 27 525 95 14 048 0 8 885 2017 33 0  64 044 32 048 111 17 436 0  11 552   Côte d’Ivoire 2014 … 12 239 201 112 3 855 0 1 486 0 0 Units issued 2015 … 3 441 179 734 3 495 0 2 300 0 8 Units issued 2017 121 2 752 175 443 3 472 0 10 543 0 0 Units issued 2018 162 3 373 166 583 3 509 0  9 623 0  0 Units issued 3 Plasma data include apheresis plasma, cryosupernatant, frozen plasma. 4 1 unit of red cell products: preparation from 200 ml whole blood donations. 141ANNEX 6. CLINICAL USE OF BLOOD AND BLOOD COMPONENTS 2014–2018 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Croatia5 2014 38 0 175 113 23 344∆ 0 49 132 0 6 770 Units issued 2015 36 0 185 190 30 074∆ 0 56 681 0 975 Units issued 2017 34 0  182 811 27 067∆ 0  49 625 0  1 300 Units issued 2018 35 0  188 184 30 281∆ 0  51 029 0  1 324 Units issued Cuba 2014 … … … … … … … … 2015 … 0 241 071 49 254 0 39 139 5 917 12 071 2016 — — — — — — — — — 2017 … 0 219 808 40 847 1 019 60 999 1 886 9 875 Cyprus 2014 9 0 33 382 1 997∆ 1 54 6 605 Units issued 2015 9 0 32 492 2 502∆ 176 0 7 388 0 Units transfused 2017 — — — — — — — — — 2018 65 0  61 574 5 208∆ 335 12 004   113 Units transfused Czechia 2014 188 130 372 588 37 200 27 957 157 664 Units issued 2015 188 79 386 700 10 400 30 400 154 500 0 0 Units issued 2017 — — — — — — — — — 2018 188 1 577 404 501 96 500 22 800 163 000 0   Units issued Democratic People’s Republic of Korea 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Democratic Republic of the Congo 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 1527  278 403 121 171 2 485 0 1 845 0 0 Denmark 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 …  0 194 731 32 142∆ 1 767 43 654 1 145 877 Units transfused 2018 …  0 195 049 36 128∆ 1 948 40 438 1 441 956 Units transfused Djibouti 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Dominica 2014 1 11 901 166 0 208 0 0 2015 — — — — — — — — — 2016 1 18 992 219 0 261 0 0 2017 1 21 799 112 77 …  0 0   Dominican Republic 2014 … 19 969 33 824 1 400 495 300 0 20 2015 … 6 152 1 378 197 0 39 0 0 2016 … 17 380 37 993 1 635 0 94 11 46 2017 … 1 867 3 889 851 0  409 0  72   Ecuador 2014 … … … … … … … … 2015 217 0 51 711 29 120 130 35 711 3 112 2688 2016 331 0 93 234 … … 36 411 3 157 10 861 2017 353 110 107 445 39 437 444 41 807 2 708 4 346   5 Platelets data provided are total of whole blood-derived and apheresis platelets in units equivalent to adult dosage. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021142 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Egypt 2014 — — — — — — — — — 2015 … 1 719 915 142 95 389 23 701 300 524 100 686 76 727 Units issued 2017  … 1 510 453 586 96 364 18 371 333 080 20 248 89 679 Units issued 2018  … 1 276 411 288 91 907 20 816 311 797 17 129 76 620 Units issued El Salvador 2014  …  …  …  …  …  …  …  … 2015 32 3 109 100 227 41 073 13 204 42 310 0 14 184 2016 22 680 108 595 … … 49 856 54 175 10 861 2017 36 1 123 78 198 …  7 078 26 832 26 848 7 416   Equatorial Guinea 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Eritrea 2014 26 415 6 645 196 0 403 0 Units issued 2015 26 166 5 708 205 0 4 070 0 1 Units issued 2017 — — — — — — — — — 2018 25 21 8 483 528 0  615 0  0 Units issued Estonia 2014 24 36 57 747 22 960 1 516 25 843 0 2 260 Units issued 2015 24 66 53 541 22 484 1 615 19 324 0 2 183 Units issued 2017 24 17 49 734 55 00∆ 2 006 11 654 0  2 826 Units issued 2018 23 17 48 682 51 15∆ 1 490 11 312 0 2 148 Units issued Eswatini 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 …  0 13 263 0 600 4 380 0 0 Units issued 2018 17 0 14 504 502 …  4 835   0 Units issued Ethiopia 2014 263 50 820 … … .. ... ... … Units issued 2015 345 95 683 24 979 22 345 0 0 0 0 Units issued 20176 395 135 039 23 476 21 804 0  13 019 0  18 Units issued 2018 429 …  36 654 36 649 0  36 637 0  70   Fiji 2014 3 1 050 11 915 4 834 0 4 533 1 275 671 Units issued 2015 — — — — — — — — Units issued 2017 — — — — — — — — Units issued 2018 3 1 050 11 915 4 834 0 4 533 1 275 671 Units issued Finland7 2014 60 188 196 005 35 916∆ 3 496 41 034 0 0 Units issued 2015 46 0 197 547 37 000∆ 3 497 0 0 0 Units issued 2017 60 0 202 000 33 000∆ 2 500 34 000 0 0  Units issued 2018 56 0 192 472 32 160∆ 5 500 192 000 0 0  Units issued France 2014 1 392 0 2 445 775 161 254∆ 144 210 355 102 677 0 Units issued 2015 1 419 0 2 546 678 173 548∆ 132 954 350 342 1 625 0 Units issued 2017 — — — — — — — — 2018 …  0 2 295 441 208 585∆ 118 859 287 922 0 0 Units transfused Gabon 2014 106 0 17 435 629 0 1 485 0 0 Units issued 2015 15 0 15 968 687 0 1 527 0 0 Units issued 2017 40 5 000 21 032 1 735 0  1 940 0  0  Units issued 2018 15 0 18 861 907 0  1 863 0  0  Units issued 6 Data cover the national center in Addis Ababa only. Data of the whole blood cover all the 25 centers in Ethiopia. 7 Only Solvent/Detergent (SD)-treated FFP (produced by a company) is used as a plasma product in Finland. 143ANNEX 6. CLINICAL USE OF BLOOD AND BLOOD COMPONENTS 2014–2018 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Gambia 2014 … … … … … … … … 2015 — — — — — — — — — 2017 — — — — — — — — 2018 10 … … … … … … … Georgia 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Germany 2014 1 404 0 4 170 589 194 007∆ 334 227 884 423 34 724 0 Units issued 2015 1 395 0 3 919 374 206 900∆ 329 825 776 045 30 155 0 Units issued 2017 — — — — — — — — — 2018 — — — — — — — — — Ghana 2014 354 100 768 25 969 601 10 18 188 0 451 Units issued 2015 357 115 314 39 936 3 243 0 12 567 0 55 Units issued 2017 160 … … … … … … … 2018 319 18 459 23 933 5 899 0  36 256 0  590 Units issued Greece 2014 124 50 400 546 117 482 16 570 185 976 0 0 Units issued 2015 … 0 436 822 30 040∆ 16 925 186 292 0 0 Units issued 2017 — — — — — — — — — 2018 — — — — — — — — — Grenada 2014 — 1 520 21 0 44 4 0 2015 — — — — — — — — — 2016 — — — — — — — — — 2017 — — — — — — — — — Guatemala 2014 48 1 069 114 637 24 369 3 155 32 901 521 3 186 2015 48 1 159 131 840 28 155 4 257 37 876 1 020 4 567 2016 39 1 319 126 277 29 135 3 205 36 133 … 4 657 2017 39 1 216 131 507 28 202 3 507 39 112 81 …    Guinea 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Guinea-Bissau 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Guyana 2014 — — — — — — — — — 2015 14 … … … … … … … 2016 14 … … … … … … … 2017 11 … … … … … … … Haiti 2014 90 6 288 23 459 533 0 204 4 … 2015 … 2 988 25 247 583 0 355 0 1 2016 12 3 474 23 580 601 0 170 0 47 2017 12 1 037 27 550 784 0  255   73 GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021144 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Honduras 2014 62 2 227 26 817 6 826 491 9 410 34 1 619 2015 … 1 767 53 245 15 901 503 16 732 798 2 292 2016 36 1 941 65 729 23 313 580 22 997 1 323 2 455 2017 33 1 464 71 056 22 238 265 20 694 1 090 1 799 Hungary 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Iceland 2014 6 0 10 664 415∆ 1 394 2 172 0 0 Units transfused 2015 6 0 9 846 606∆ 1 415 1 976 0 0 Units transfused 2017 10 0 9 627 2 4208 1 172 2 033 0  0  Units transfused 2018 — — — — — — — — — India 2014 … … … … … … … … 2015 … … … … … … … … 2017 … … … … … … … … 2018 … … … … … … … … Indonesia 2014 … 694 724 2 122 824 400 756 6 087 104 794 181 155 23 993 Units issued 2015 … 662 020 2 284 807 546 700 730 122 031 11 450 19 462 Units issued 2017 … 53 695 2 554 545 536 957 11 563 101 112 19 660 13 728 Units transfused 2018 …  521 337 2 741 680 597 706 12 457 113 005 24 681 14 910 Units transfused Iran (Islamic Republic of) 2014 862 43 632 1 923 513 895 175 4 293 747 815 35 323 141 202 Units issued 2015 862 44 012 1 967 269 1 162 317 5 119 1 794 017 136 640 133 408 Units issued 2017 929 4 248 1 957 192 922 094 15 325 689 946 22 683 132 732 Units issued 2018 929 3 779 1 962 214 906 420 20 958 661 378 11 756 128 337 Units issued Iraq 2014 — — — — — — — — — 2015 284 … … … … … … … 2017 — — — — — — — — — 2018 — — — — — — — — — Ireland 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Israel 20149 33 713 236 611 124 873 443 55 850 0 36 246 Units issued 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Italy 2014 1 217 565 2 456 571 147 759∆ 67 963 247 419 0 3 296 Units transfused 2015 1 208 352 2 471 435 151769∆ 65 274 213 038 0 2 065 Units transfused 2017 1 550 44 2 457 300 163 749∆ 55 187 165 002 0  1 996 Units transfused 2018 1 544 18 2 443 359 170 867∆ 55 596 140 395 0  1 786 Units transfused Jamaica 2014 41 9 313 20 077 3 958 0 11 519 633 1 571 2015 42 0 37 655 4 885 0 13 438 563 1 426 2016 42 … … … … … … … 2017 15 … … … … … … … 8 Whole blood-derived Platelets are made of pools of 4 individual units. The number reported is in individual units. 9 The units of blood components issued only include data of Magen David Adom (MDA). 145ANNEX 6. CLINICAL USE OF BLOOD AND BLOOD COMPONENTS 2014–2018 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Japan 201410 10 726 177 3 388 944 0 832 179 957 318 0 0 Units issued 2015 10 211 80 3 329 459 0 833 780 955 517 0 0 Units issued 2017 …  15 3 292 884 0  856 375 938 410 0  0  Units issued 2018 — — — — — — — — — Jordan 2014 106 6 763 105 960 78 907 65 105 960 10 596 Units issued 2015 106 3 564 113 590 79 630 75 113 470 0 11 410 Units issued 2017 111 0 63 047 42 450 13 43 713 0 13 020 Units issued 2018 113 61 997 61 997 … … ... … … Units issued Kazakhstan 2014 482 168 016 10 415 18 661 155 361 0 8 543 Units issued 2015 474 0 168 846 11 749 24 217 142 536 0 9 443 Units issued 2017 — — — — — — — — — 2018 459   175 482 13 245 34 918 135 936 0  14 685 Units issued Kenya 2014 400 65 759 112 901 4 757 0 5 431 67 128 Units issued 2015 … … … … … … … … 2017 — — — — — — — — — 2018 530 59 931 99 852 7 280 0  6 409 … 34 Units issued Kiribati 2014 3 … … … … … … … 2015 3 888 730 0 0 0 8 0 Units transfused 2017 4 … … … … … … … 2018 3 888 730 … … … 8 …  Units transfused Kuwait 2014 — — — — — — — — — 2015 33 0 61 889 0 50 962 14 312 15 424 6 915 Units issued 2017 38 0 89 618 0 57 737 23 606 18 850 8 452 Units issued 2018 43 0 91 455 0 … … … 101 320 Units issued Kyrgyzstan 2014 90 … … … 7131 … … 1454 Units issued 2015 90 0 18 597 4 780 976 26 929 0 1 748 Units issued 2017 — — — — — — — — — 2018 … … … … … … … … Lao People’s Democratic Republic 2014 50 20 410 13 539 489 848 6 62 2015 47 18 861 17 541 427 0 1 049 9 218 Units issued 2017 57 22 013 21 074 155 0 464 0 0 Units issued 2018 57 17 731 31 522 751 0  2 174 0  559 Units issued Latvia 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 54 0 47 072 5 124∆11 2 434 24 027 0 8 651 Units issued 2018 54 0 50 127 5 664∆ 2 874 24 637 0  8 288 Units issued Lebanon 2014 … … 150 000 … 10 000 … … … 2015 … … 150 000 … 10 000 … … … 2017 — — — — — — — — — 2018 — — — — — — — — — Lesotho 2014 21 0 6 863 … … … … … Units issued 2015 19 0 6 679 35 0 89 0 0 Units issued 2017 20 0 4 596 … … … … … Units issued 2018 19 6 5 308 32 0  82 0  0  Units issued  10 An adult-sized blood bag is 400 ml in Japan, and 200 ml bags are used as well. The 200 ml bag was counted as 0.5 unit for whole blood, red cells and FFP. In the case of apheresis platelets, a component of 200 x 109 platelets is regarded as 1 unit of adult dosage. 400 x 109 components were calculated as 2 units in this table. 11 In adult dosage. 1 unit contains 5 pooled units. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021146 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Liberia 2014 … … … … … … … … 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 38 15 034 Libya 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 53 38 542 95 280 55 236 25 600 41 776   336 Units issued 2018 53 28 174 101 322 50 887 30 455 70 565 2 856 180 Units issued Lithuania 2014 — — — — — — — — — 2015 — — — — — — — — — 2014 — — — — — — — — — 2015 — — — — — — — — — Luxembourg12 2014 5 0 19 895 2 079∆ 633 3 364 0 0 Units issued 2015 5 0 19 913 2 234∆ 860 3 754 0 0 Units issued 2017 — — — — — — — — — 2018 4   19 243 2 079∆ 907 3 348     Units issued Madagascar 2014 114 20 533 8 417 0 0 3 062 69 0 Units issued 2015 114 21 341 9 724 0 0 4 050 1 341 0 Units issued 2017 81 … … … … … … … 2018 70 13 283 28 833 3191 0  6 350 0  0 Units issued Malawi 2014 87 45 552 5 889 1 794 0 1 481 0 154 Units issued 2015 87 53 089 8 486 1 417 0 937 0 619 Units issued 2017 88 … … … … … … … 2018 87 59 644 8087 1774 0  840 0  491 Units issued  Malaysia13 2014 128 59 841 492 349 118 111 5 628 140 624 0 58 410 Units transfused 2015 128 46 686 423 271 115 238 6 922 140 563 0 55 473 Units transfused 2017 — — — — — — — — — 2018 — — — — — — — — — Maldives14 2014 79 589 9 153 536 0 373 0 0 Units issued  2015 23 263 6 102 0 0 0 0 0 Units issued  2017 — — — — — — — — — 2018 91 …  6 390 o  0  …  0  0  Units issued  Mali 2014 … … … … … … … … 2015 … 16 626 13 590 0 0 1 531 0 0 Units issued  2017 … … … … … … … … 2018 59 24 214 15 297 0 0 1 302 0 616 Units issued  Malta 2014 — — — — — — — — — 2015 6 0 15 190 1 343∆ 482 1 723 0 0 Units transfused 2017 10 0 13 934 1 558∆ 562 2 241 0 0 Units transfused 2018 — — — — — — — — — 12 Fresh frozen plasma issued are Solvent/Detergent (SD)-treated FFP produced from plasma collected in Luxembourg. 13 Data on whole blood and components transfused are for Ministry of Health facilities only. About 20–30% of blood collected in Ministry of Health facilities was supplied to private health care facilities under an individual memorandum of understanding. 14 Data given in this section are from Indira Gandhi Memorial Hospital and Maldivian blood services only. 147ANNEX 6. CLINICAL USE OF BLOOD AND BLOOD COMPONENTS 2014–2018 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Marshall Islands 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 … … … … … … … … … Mauritania 2014 18 2 242 11 952 1 226 0 1 151 0 0 Units issued  2015 7 13 153 4 631 0 9 902 0 0 Units issued  2017 — — — — — — — — — 2018 20   16 657 1 988   2 335   0 Units issued   Mauritius 2014 … 5 273 34 917 20 900 104 15 447 0 353 Units transfused 2015 26 1 364 43 095 24 317 88 0 0 0 Units transfused 2017 — — — — — — — — — 2018 23 …  40 546 16 148 …  17 950 0  316   Mexico 2014 … … … … … … … … … 2015 4 741 … … … … … … … … 2016 5 097 … 1 500 941 344 414 75 951 959 869 36 558 94 560 2017 5 010 … 807 125 370 934   301 864 6 204 55 200 Micronesia (Federated States of) 2014 5 1 151 311 105 0 0 0 0 Units issued 2015 5 1 249 332 150 0 0 0 0 Units issued 2017 5 536 642 40 0 0 0 0 Units issued 2018 5 565 681 45 0 0 0 0 Units issued Monaco 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Mongolia 2014 81 36 20 426 6 854 26 25 723 2 579 1 874 Units issued 2015 81 73 22 329 5 899 53 27 520 2 663 3 319 Units issued 2017 79 5 23 760 14 344 848 26 220 5 499 3 866 Units issued 2018 79 61 14 825 14 344 848 22 324 2 111 3 047 Units issued Montenegro 2014 10 1 625 13 736 2 940 0 9 164 0 817 Units transfused 2015 11 144 15 839 4 178 0 9 350 0 1 056 Units transfused 2017 — — — — — — — — — 2018 11 30 16 162 3 256 0 10 479 0 2 427 Units transfused Morocco 2014 … 0 273 682 168 038 100 181 384 0 0 Units issued 2015 … 0 285 003 117 640 100 213 892 213 892 0 Units issued 2017 — — — — — — — — — 2018 633 … … … … … … … Mozambique 2014 154 … … … …. … … … 2015 155 … … … … … … … 2017 162 … … … … … … … 2018 165 0 136 091 18 870 0  70 046 0  0    Myanmar15 2014 333 15 998 35 001 9 722 44 25 587 1 209 1 165 Units issued 2015 333 28 501 29 582 6 673 35 15 131 9 846 9 206 Units issued 2017 399 24 914 22 778 37 359 15 31 350 2 343 20 556 Units issued 2018 391 36 470 56 212 10 098 8 38 506 2 137 2 564 Units issued 15 Data cover National Blood Centre only. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021148 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Namibia 2014 — — — — — — — — — 201516 50 147 30 934 940 1 285 19 98917 0 0 Units transfused 2017 50 175 32 797 328 1 413 4 536 0 0 Units transfused 2018 51 214 32 610 2 083 …  5 014 0  15 Units transfused Nauru 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Nepal 2014 250 130 000 55 000 33 000 … 22 000 800 900 Units issued 2015 200 186 000 65 000 40 000 100 25 000 24 000 1 000 Units issued 2017 ..  199 554 72 000 38 000 …  33 379 1 000 1 000 Units issued 2018 …  20 5000 68 000 42 000 …  20 000 1 000 1 000 Units issued Netherlands 2014 — — — — — — — — — 2015 … 428 424 062 50 070∆ 3 972 6 797 0 0 Units issued 2017 — — — — — — — — — 2018 — — — — — — — — — New Zealand 2014 21 736 102 727 29 716 4 556 13 405 514 4 198 Units transfused 2015 21 822 99 553 30 732 4 231 13 173 536 4 482 Units transfused 2017 21 852 94 605 89 45∆ 4 168 12 197 101 4 201 Units transfused 2018 21 820 94 577 97 47∆ 9 747 13 355 175 5 281 Units transfused Nicaragua 2014 … … … … … … … … 2015 42 0 37 493 15 942 0 13 129 0 1 614 2016 47 0 57 005 30 347 0 13 753 0 3 363 2017 43 0  70 969 36 052 0  18 004 0  3 980   Niger 2014 47 69 015 1 970 90 0 1 970 0 0 Units issued 2015 47 78 790 2 400 332 0 2 400 0 0 Units issued 2017 — — — — — — — — — 2018 115 114 116 5 434 110 0  5 434   0 Units issued  Nigeria18 2014 26 29 298 690 325 0 692 0 0 Units issued 2015 26 31 047 116 29 0 139 0 0 Units issued 2017 …  9 558 31 999 523 0 1 731 0 7 Units issued 2018 46 156 540 … … … … … … Niue 2014 1 17 0 0 0 0 0 0 Units issued 2015 … … … … … … … … 2017 — — — — — — — — — 2018 … … … … … … … … North Macedonia 2014 21 7 612 24 747 7 622∆ 150 0 21 645 1 068 Units issued 2015 58 6 608 57 348 21 191 300 0 21 644 2 856 Units issued 2017 55 … … … … … … … 2018 55 … … … … … … … 16 2016 data was reported. 17 Of the 19989 units of Fresh frozen plasma, 4689 units were transfused in Namibia. The remaining 15300 units were exported to National Bioproducts Institute in South Africa for fractionation. 18 The data given in this section are from the Lagos State Blood Transfusion Service. Country data are not available. 149ANNEX 6. CLINICAL USE OF BLOOD AND BLOOD COMPONENTS 2014–2018 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Norway19 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 28 49 163 542 17 180∆ 7 363 40 715 0  0  Units transfused 2018 28 315 158 922 16 645∆ 6 313 39 783 0   0 Units transfused Oman 2014 13 … … … … … … … 2015 15 … … … … … … … 2017 — — — — — — — — — 2018 18 … … … … … … … Pakistan 2014 — — — — — — — — — 2015 … 590 715 520 361 286 540 0 520 361 0 0 Units issued 2017 606 … … … … … … …   2018 606 921 204 735 678 304 448 … … 450 316 49 703 Units issued Palau 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 … … … … … … … … Panama 2014 30 … … … … … … … 2015 29 104 40 550 17 819 5 529 14 693 0 3 233 2016 29 108 52 277 18 803 5 921 13 485 0 4 208 2017 29 58 48 613 19 532 5 162 12 321 0  4 688   Papua New Guinea 2014 35 … … … … … … … 2015 36 … … … … … … … 201720 33 7 553 12 195 …  0  159 0  …  Units issued 2018 — — — — — — — — Paraguay 2014 … … … … … … … … 2015 52 … … … … … … … 2016 61 310 75 546 29 167 26 419 444 5 642 2017 61 … … … … … … … Peru 2014 … … … … … … … … 2015 … … … … … … … … 2016 240 8 691 274 643 126 884 27 814 89 479 28 468 2017 360 1 849 288 592 129 089 48 612 154 953   25 104 Philippines 2014 — — — — — — — — — 2015 81 49 193 298 021 55 232 545 39 27821 0 5 665 Units transfused22 2017 — — — — — — — — — 2018 — — — — — — — — — Poland 2014 845 143 1 126 159 327 735 40 967 340 019 277 21 719 Units issued 2015 839 201 1 149 343 330 525 42 174 333 391 1 803 28 895 Units issued 2017 859 87 1 161 517 361 180 46 061 308 134 1 892 34 232 Units issued 2018 842 … 1 082 135 390 475 45 648 285 594 1 569 34 936 Units issued 19 Fresh frozen plasma (FFP) reported are Solvent/Detergent (SD)-treated FFP. 20 Platelets and cryoprecipitate were transfused but data are not available. 21 Including both fresh frozen plasma (FFP) and frozen plasma (FP). 22 Partial data. Not all reporting facilities included data on transfusion. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021150 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Portugal 2014 238 50 328 101 138 897 5 002 71 766 0 597 Units transfused 2015 241 45 312 906 134 781 5 752 65 291 0 354 Units transfused 2017 246 23 300 334 9 363∆ 5 790 54 624 0 332 Units transfused 2018 249 30 290 001 8 441∆ 5 665 …  0  273 Units transfused Qatar 2014 5 0 25 468 17 689 508 9 965 0 3 317 Units transfused 2015 5 68 24 932 11 183 738 10 000 35 3 847 Units transfused 2017 5 69 24 858 21 920 815 5 154 5 366 3 790 Units transfused 2018 28 27 25 373 20 012 843 6 120 3 072 3 300 Units transfused Republic of Korea 2014 … 1 352 1 906 189 1 352 012 165 876 574 618 1 893 63 462 Units issued 2015 … 1 216 1 933 066 1 283 436 197 024 566 913 827 74 230 Units issued 2017 2 638 899 1 911 378 1 410 123 204 234 525 547 325 86 883 Units issued 2018 1 013 764 1 904 380 1 545 917 204 442 529 388 588 88 564 Units issued Republic of Moldova 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 68 70 42 027 770∆ 1 533 41 821 7 535 10 775 Units transfused Romania23 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 317 9 043 365 766 81 131 7 062 209 581 …  11 699 Units transfused 2018 314 5 296 374 095 91 467 7 820 211 570 ….  10 791 Units transfused Russian Federation 2014 … 620 1 794 341 683 493 … 1 778 984 12 893 24 287 Units issued 2015 … 231 1 866 936 701411 … 1 759 364 8 673 24 732 Units issued 2017 … 26 1 857 855 228 619 170 930 1 627 840 12 660 34 923 Units issued 2018 … 38 1 922 106 227 560 195 092 1 549 048 13 476 41 772 Units issued Rwanda 2014 64 0 41 289 13 210 0 7 012 0 250 Units issued 2015 65 0 53 402 15 200 92 10 410 1 120 2 310 Units issued 2017 — — — — — — — — — 2018 69 0 74 044 15 256 …  5 898 …  608 Units issued Saint Kitts and Nevis 2014 — — — — — — — — — 2015 1 … … … … … … … 2016 1 … … … … … … … 2017 1 … … … … … … …   Saint Lucia 2014 … … … … … … … … 2015 3 0 1 572 0 0 591 599 0 2016 3 0 2 383 684 0 614 0 0 2017 3 …  2 308 410 …  741 …  …  Saint Vincent and the Grenadines 2014 … … … … … … … … 2015 3 … … … … … … … 2016 4 4 1 074 90 0 181 0 0 2017 4 7 1 229 75 0 281  0 0    Samoa 2014 2 171 1 488 28 0 25 0 0 Units issued 2015 2 316 2 068 44 0 118 0 0 Units issued 2017 — — — — — — — — — 2018 — — — — — — — — — 23 the total number of fresh frozen plasma (FFP) reported include cryosupernatant. 151ANNEX 6. CLINICAL USE OF BLOOD AND BLOOD COMPONENTS 2014–2018 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate San Marino 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Sao Tome and Principe 2014 2 51 749 0 0 58 0 1 2015 2 63 787 0 0 79 0 0 2017 — — — — — — — — — 2018 3 6 1185 6 0  185 0  0   Saudi Arabia 2014 331 … … … … … … … 2015 331 … … … … … … … 2017 — — — — — — — — — 2018 — — — — — — — — — Senegal 2014 86 … … … … … … … 2015 168 32 108 35 124 611 0 29 160 0 0 Units issued 2017 65 … … … … … … … 2018 60 223 29 176 602 0  3 057 0  0    Serbia 2014 107 … … … … … … … 2015 107 … … … … … … … 2017 — — — — — — — — — 2018 — — — — — — — — — Seychelles 2014 1 1 678 … 10 0 4 0 0 Units issued 2015 6 1 631 113 72 0 42 0 0 Units issued 2017 — — — — — — — — — 2018 — — — — — — — — — Sierra Leone 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Singapore 2014 21 0 105 530 58 580 9 901 28 455 57 11 760 Units transfused 2015 21 0 109 505 57 192 10 685 28 158 35 14 601 Units transfused 2017 21 0 110 523 54 000 10 146 24 064 0 14 108 Units transfused 2018 21 0 111 070 58 240 9 614 23 908 42 18 986 Units transfused Slovakia 2014 105 412 199 706 9 566∆ 10 867 85 113 0 0 Units transfused 2015 105 522 202 406 11 295∆ 11 108 89 732 0 0 Units transfused 2017 115 477 194 010 10 968∆ 10 939 70 372 0 0 Units transfused 2018 115 102 198 179 46 803 10 729 63 405 0 0 Units transfused Slovenia 2014 27 0 83 200 7 726∆ 2 687 22 932 0 0 Units issued 2015 27 0 83 455 8 031∆ 2 756 21 615 0 0 Units issued 2017 27 0 82 562 10 418∆ 2 979 19 224 0 0 Units issued 2018 — — — — — — — — — Solomon Islands 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 … … … … … … … … — GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021152 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Somalia 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — South Africa 2014 408 3 481 925 520 161 912 3 1539 143 666 0 35 658 Units issued 2015 669 2 820 965 650 38 214∆ 3 1415 151 901 113 411 37 995 Units issued 2017 418 1 318 871 955 206 050 2 7515 151 651 244 43 030 Units issued 2018 736 1 888 934 745 74 161∆   147 195   50 933 Units issued South Sudan 2014 15 108 0 0 0 0 0 0 Units issued 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 18 1 238 0 0 0  0 0  0   Spain24 2014 456 55 1 489 696 193 347∆ …. 185 695 0 1 868 Units transfused 2015 456 107 1 512 697 198 464∆ … 183 248 0 1 271 Units transfused 2017 467 28 1 492 766 209 880∆ …  166 701 0  1 914 Units transfused 2018 — — — — — — — — — Sri Lanka 2014 90 0 347 668 155 859 12 369 191 368 13 558 71 971 Units issued 2015 25 0 361 308 202 058 15 965 191 755 14 063 66 142 Units issued 2017 105 0 392 390 131 658 21 775 153 496 …  49 647 Units issued 2018 103 0 412 154 134 059 17 682 156 512 …  48 622 Units issued Sudan 2014 … … … … … … … … 2015 372 … … … … … … … 2017 — — — — — — — — — 2018 — — — — — — — — — Suriname 2014 5 0 10 205 1 794 0 2 012 0 0 2015 5 0 16 132 2 004 0 2 005 0 0 2016 5 0  8 854 1 620 0  1 414 0  0    2017 5 0 11 166 1 947 0 2 127 0 0 Sweden 2014 … 0 441 818 33 554∆ 14 497 58 983 0 0 Units transfused 2015 … 0 424 772 33 248∆ 15 490 48 593 0 0 Units transfused 2017 …  0 390 593 28 288∆ 17 167 49 081 0  0  Units transfused 2018 …  0  390 404 47 608∆ 16 12825  41 56926 0 0 Units transfused Switzerland 2014 240 … 296 080 10 371∆ 23 651 42 810 0 0 Units issued 2015 240 … 248 647 11 636∆ 24 803 27 743 0 0 Units issued 2017 240 …  226 240 13 396∆ 24 085 29 303 0 0 Units issued 2018 241 …  221 100 13 750∆ 25 197 23 568 0  0  Units issued Syrian Arab Republic 2011 — — — — — — — — — 2013 — — — — — — — — — 2014 — — — — — — — — — 2015 — — — — — — — — — Tajikistan 2014 120 … … … … … … … 2015 106 0 27 886 604 125 41 576 0 6 788 Units issued 2017 0  0 51 374 2 641 0 55 734 0 7 864 Units issued 2018 124 … … … … … … … 24 Data provided are total of whole blood-derived and apheresis platelets in units equivalent to adult dosage. 25 The number reported are the units of apheresis platelets collected through apheresis procedure. 26 Additional 7202 units of Solvent/Detergent (SD)-treated FFP were transfused. 153ANNEX 6. CLINICAL USE OF BLOOD AND BLOOD COMPONENTS 2014–2018 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Thailand 201427 1 326 0 613 074 278 009 11 232 135 443 1 527 183 654 Units issued 2015 1 326 0 638 998 309 679 11 757 145 631 1 304 179 310 Units issued 201728 1 332 0 1 008 957 404 181 12 713 226 078 1 219 214 754 Units issued 2018 1 332 0 1 049 777 428 189 13 448 215 837 562 235 027 Units issued Timor-Leste 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 6 2 954 459 66 0 459 0  0  Units issued Togo 2014 … 11 173 31 465 528 0 2 361 0 0 Units issued 2015 … 12 580 35 160 423 0 2 140 0 0 Units issued 2017 …  9 756 37 590 969 0 3 992 0  0 Units issued 2018 …  2 217 50 243 858 0   4 109 0  0 Units issued Tonga 2014 … … … … … … … … 2015 … … … … … … … … 2017 5 … … … … … … … 2018 5 … … … … … … … Trinidad and Tobago 2014 … … … … … … … … 2015 … … … … … … … … 2016 … … … … … … … … 2017 … … … … … … … … Tunisia 2014 … … … … … … … … 2015 — — — — — — — — — 2017 … … … … … … … … 2018 … … … … … … … … Turkey 2014 1 080 82 103 2 079 578 506 216 30 374 1 175 193 0 16 669 Units issued 2015 1 110 60 405 2 185 260 571 525 33 367 1 258 944 0 20 105 Units transfused 2017 1 121 221 2 265 965 191 325 32 490 1 039 507 0 28 383 Units transfused 2018 — — — — — — — — — Turkmenistan 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Tuvalu 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Uganda 2014 227 … … … … … … … 2015 257 … … … … … … … 2017 395 … … … … … … … 2018 369 137 249 275 130 4 016 0  51 310 0  0    Ukraine 2014 — — — — — — — — — 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — 27 Data only cover blood components issued from the National Blood Centre in Bangkok. 28 Data cover blood components issued from National Blood Centre in Bangkok and the regional centres. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021154 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate United Arab Emirates 2014 147 0 126 374 27 137 10 241 46 995 662 12 174 Units issued 201529 147 118 14 173 4 076 0 5 472 0 557 Units issued 2017 — — — — — — — — — 2018 …  0 108 709 19 625 9 585 32 238 1 000 6 701 Units issued United Kingdom of Great Britain and Northern Ireland30, 31 2014 136 0 226 487 19 448∆ 23 310 24 318 0 14 555 2015 136 0 215 535 19 330∆ 23 053 24 604 0 9 034 2017 — — — — — — — — — 2018 — — — — — — — — — United Republic of Tanzania 2014 263 83 247 30 467 1 613 0 4 186 104 0 Units issued 2015 263 … … … … … … … 2017 283 … … … … … … … 2018 283 … … … … … … … United States of America 2014 … … … … … … … … 2015 … … … … … … … … 2017 … … … … … … … … 2018 … … … … … … … … Uruguay 2014 … … … … … … … … 2015 72 1 116 75 607 34 176 2 050 2 0803 164 1 748 2016 73 308 64 566 27 132 2 479 17 833 121 1 655 2017 67 472 73 722 35 149 3 070 18 616 180 2 031   Uzbekistan 2014 205 0 23 787 1 027 308 22 366 0 5 042 2015 205 0 25 522 1 404 421 24 127 0 4 780 2017 — — — — — — — — — 2018 — — — — — — — — — Vanuatu 2014 — — — — — — — — — 2015 4 921 267 23 45 19 15 12 Units transfused 2017 — — — — — — — — — 2018 — — — — — — — — — Venezuela (Bolivarian Republic of) 2014 … … … … … … … … 2015 339 … … … … … … … 2016 — — — — — — — — — 2017 — — — — — — — — — Viet Nam 2014 489 212 503 745 305 274 732 51 124 119 843 39 743 31 536 Units issued 2015 — — — — — — — — — 2017 — — — — — — — — — 2018 — — — — — — — — — Yemen 2014 — — — — — — — — — 2015 112 2 925 4 679 4 043 0 4 919 234 0 2017 — — — — — — — — — 2018 271 3 041 10 975 8 828 0 8 552 0 0 Units issued Zambia 2014 160 64 157 32 000 12 500 0 32 000 0 500 2015 160 59 999 30 000 12 000 0 15 000 0 200 Units issued 2017 — — — — — — — — — 2018 — — — — — — — — — 29 Partial data. 30 Subnational data provided by Scottish National Blood Transfusion Service (SNBTS) and Welsh Blood Service (WBS). SNBTS: units transfused; WBS: units issued. 31 Platelets derived from whole blood are pooled from 4 units of platelet concentrates. Pooled frozen cryoprecipitate is derived from 5 individual units. 155ANNEX 6. CLINICAL USE OF BLOOD AND BLOOD COMPONENTS 2014–2018 Country Data year No. hospitals performing blood transfusion No. units of blood components issued/transfused (excluding autologous blood units) in the country Whole blood Red cells Whole blood-derived platelets Apheresis platelets Fresh frozen plasma Plasma Cryo- precipitate Zimbabwe 2014 120 1 778 43 417 1 924 55 3 326 223 Units issued 2015 138 778 41 496 2 558 104 3 327 0 147 Units issued 2017 97 845 51 174 3 521 198 4 855   219 Units issued 2018 176 715 67 422 4 403   6 461   506 Units issued GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021156 Annex 7. Provision of plasma-derived medicinal products (PDMP) through the fractionation of plasma collected in the country 2014–2018 … Not reported/not available. Blank cell: Not required/not applicable. — No response. * Arrangement for the fractionation of plasma collected in the country: A: fractionation through the public/not-for-profit sector in the country; B: fractionation through the for-profit sector in the country; C: contract fractionation in another country; D: plasma were sold to PDMP manufacturers. IVIG: intravenous immunoglobulin. ** % of PDMP supplied through the products manufactured by fractionation of plasma that were collected in the country. Country Data year Fr ac tio na tio n ar ra ng em en t* Volume of plasma used for fractionation, or sold to the manufacturers of PMDP for fractionation Products manufactured by fractionation of plasma collected in the country % of self-reliance of PDMP supplies** Recovered plasma (L) Apheresis plasma (L) Total (L) L per 1000 population % of recovered plasma Albumin IVIG Factor VIII Factor IX Albumin IVIG Factor VIII Argentina 2014 A 150 000 0 150 000 3.5 100 Yes Yes Yes Yes 50 50 2 2015 A, D 100 000 0 100 000 2.3 100 Yes Yes Yes Yes 50 50 10 2016 A, D 120 000 400 120 400 2.7 99 Yes Yes Yes Yes 90 60 2 2017 A, D 120 000 400 120 400 2.7 99 Yes Yes Yes Yes 90 60 2 Armenia 2014 C … … … … … … … … … … … … 2015 C … … … … … … … … … … … … 2017 — — — — — — — — — — — — — 2018 — — — — — — — — — — — — — Australia 20141 B 171 981 360 000 531 981 22.8 32 Yes Yes Yes Yes 2015 — — — — — — — — — — — — — 2017 — — — — — — — — — — — — — 2018 — — — — — — — — — — — — — Austria2 2014 B, D 69 295 8.1 Yes Yes Yes Yes 2015 B, D 105 827 12.3 Yes Yes Yes Yes 2017 … … … … … … … … … … … … … 2018 … … … … … … … … … … … … … Belgium 2014 A 108 517 63 613 172 130 15.2 63 Yes Yes Yes Yes … … … 2015 A 105 461 66 889 172 350 15.3 62 Yes Yes Yes Yes … … … 2017 — — — — — — — — — — — — — 2018 — — — — — — — — — — — — — Brazil 2014 — — — — — — — — — — — — — 2015 A 189 000 0 189 000 0.9 100 Yes Yes Yes Yes … 39 8 2016 A, C3 81 857 0 81 857 0.4 100 Yes Yes No No … 40 … 2017 A, C 81 857 0 81 857 0.4 100 Yes Yes Yes Yes …4 39 8 Bulgaria 2014 A 11 741 0 11 741 1.6 100 Yes Yes No No … … … 2015 A 13 063 0 13 063 1.8 100 Yes Yes No No … … … 2017 — — — — — — — — — — — — — 2018 A … … … … … … … … … … … … 1 2013 data. Data of recent years can be found in ‘Australian Red Cross Blood Service Annual Reports’ (available at: https://www.lifeblood.com.au/about/our-strategy/annual-reports). 2 Data source for volume of plasma used for fractionation: The Collection, Testing and Use of Blood and Blood Components in Europe published by the European Directorate for the Quality of Medicines & HealthCare (EDQM) of the Council of Europe. Available at: https://www.edqm.eu/en/reports-blood 3 HEMOBRÁS has a Contract with LFB for technology transfer. 4 All albumin from the fractionation of Brazilian plasma collected in Brazilian is donated to public hospitals. 157ANNEX 7. PROVISION OF PLASMA-DERIVED MEDICINAL PRODUCTS (PDMP) THROUGH THE FRACTIONATION OF PLASMA... Country Data year Fr ac tio na tio n ar ra ng em en t* Volume of plasma used for fractionation, or sold to the manufacturers of PMDP for fractionation Products manufactured by fractionation of plasma collected in the country % of self-reliance of PDMP supplies** Recovered plasma (L) Apheresis plasma (L) Total (L) L per 1000 population % of recovered plasma Albumin IVIG Factor VIII Factor IX Albumin IVIG Factor VIII Canada 2014 A 212 757 6 159 218 916 6.1 97 Yes Yes No Yes 59.3 22 05 2015 A 184 500 4 853 189 353 5.3 97 Yes Yes No Yes 49.6 20.5 0 2017 c 226 113 8 032 234 145 6.4 97 Yes Yes Yes No 48.5 15.4 26.5 2018 — — — — — — — — — — — — — Chile 2014 C6 11 9647 0 11 964 0.67 Yes Yes Yes No 17.5 3.6 … 2015 C 17 8877 0 17 887 0.99 100 Yes Yes Yes No 17.5 3.6 … 2016 … … … … … … … … … … … … … 2017 c 17 658 0 17 658 0.94 100 Yes Yes Yes No 17.5 3.6 … China 2014 A 0 5 206 552 5 206 552 3.8 0 Yes Yes Yes Yes … … … 2015 A 0 5 836 971 5 836 971 4.2 0 Yes Yes Yes Yes … … … 2017 … 0 7 717 357 7 717 357 5.4 0 Yes Yes Yes Yes … .. … 2018 B 0 8 342 819 8 342 819 5.8 0 Yes Yes Yes Yes Croatia 2014 …8 … … … … … … … … … … … … 2015 … … … … … … … … … … … … … 2017 C, D Yes Yes Yes Yes 2018 C, D Yes Yes Yes Yes Cuba 2014 A … … … … … Yes Yes NO NO … … … 2015 … … … … … … … … … … … … … 2016 … … … … … … … … … … … … … 2017 A Yes Yes NO NO Czechia 2014 D 67 032 501 131 568 163 53.9 11 2015 D 70 000 514 500 584 500 55.4 11 2017 — — — — — — — — — — — — — 2018 C.D 65 000 496 0009 561 000 52.6 12 100 100 100 Denmark 2014 — — — — — — — — — — — — — 2015 — — — — — — — — — — — — — 2017 C 42 040 37 585 79 625 13.8 52.8 Yes Yes No No 94 30 010 2018 C 42 461 42 994 85 455 14.9 49.7 Yes Yes No No 100 34 0 Estonia 2014 C, D 10 470 0 10 470 8.0 100 Yes Yes Yes No 100 100 100 2015 C, D 11 076 0 11 076 8.4 100 Yes Yes Yes No 100 100 50 2017 C, D 11 685 011 11 685 8.8 100 Yes Yes Yes Yes … … … 2018 C, D 11 338 0 11 338 8.6 100 Yes Yes Yes Yes … … … Finland 2014 … … … … … … … … … … … … … 2015 C, D 55 000 0 55 000 10.0 100 No No No No … … … 2017 C 55 000 0 55 000 10.0 100 No No No No … …12 … 2018 D 50 000 0 50 000 9.1 100 No No No No … … … France 2014 A 675 769 93 946 769 715 12.0 88 Yes Yes Yes Yes … … … 2015 A 594 437 200 265 794 703 12.3 75 Yes Yes Yes Yes … … … 2017 — — — — — — — — — — — — — 2018 B … … … … … … … … … … … 5 All factor VIII supplied are recombinant. 6 Agreement on exchange of plasma for PDMP with the National University of Cordoba, Argentina. 7 In Kg 8 In 2013 Croatian fractionation plant was closed. Contract fractionation was considered during the year, but it was not approved then. 9 Including 448500 litres of apheresis plasma collected by stand-alone plasmapheresis centres. 10 Only recombinant FVIII is used. 11 Plasma obtained through plasmapheresis is used for transfusion 12 Domestically collected plasma does not cover the need for PDMPs, especially for IVIG. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021158 Country Data year Fr ac tio na tio n ar ra ng em en t* Volume of plasma used for fractionation, or sold to the manufacturers of PMDP for fractionation Products manufactured by fractionation of plasma collected in the country % of self-reliance of PDMP supplies** Recovered plasma (L) Apheresis plasma (L) Total (L) L per 1000 population % of recovered plasma Albumin IVIG Factor VIII Factor IX Albumin IVIG Factor VIII Germany 2014 D 1 205 680 2 021 831 3 227 511 40.0 37 Yes Yes Yes Yes … … … 2015 D 1 009 803 1 900 278 2 910 081 36.1 34 Yes Yes Yes Yes … … … 2017 — — — — — — — — — — — — — 2018 — — — — — — — — — — — — — Greece 2014 C — — — — — — — — — — — — 2015 … … … … … … … … … … … … … 2017 — — — — — — — — — — — — — 2018 — — — — — — — — — — — — — India 2014 A, B, C … … … … … Yes Yes No No … … … 2015 … … … … … … … … … … … … … 2017 … … … … … … … … … … … … … 2018 … … … … … … … … … … … … … Iran (Islamic Republic of) 2014 A, B, C 176 433 151 213 327 646 4.1 53 Yes Yes Yes No 35 100 20 2015 A, B, C 156 236 150 501 306 737 3.9 50 Yes Yes Yes No 35 100 20 2017 A, B, C 183 684 225 963 409 647 5.0 45 Yes Yes Yes No … … … 2018 A, B, C 179 791 160 042 339 833 4.1 53 Yes Yes Yes No … … … Israel 2014 A 43 314 0 43 314 100 No Yes No No 0 45 0 2015 — — — — — — — — — — — — — 2017 — — — — — — — — — — — — — 2018 — — — — — — — — — — — — — Italy 2014 A 565 120 191 078 756 198 12.6 74 Yes Yes Yes Yes 61 64 53 2015 A 570 957 191 768 762 725 12.7 74 Yes Yes Yes Yes 64 74 53 2017 — — — — — — — — — — — — — 2018 A, C13 586 999 211 251 798 250 13.1 674 Yes Yes Yes Yes 72 76 59 Japan 2014 A, B, D 608 000 31 600 639 600 5.1 95 Yes Yes Yes Yes 57.7 95.8 100 2015 A, B, D 586 000 323 000 909 000 7.2 64 Yes Yes Yes Yes 56.4 95.6 100 2017 A, B, D14 582 225 352 775 935 000 7.4 62 Yes Yes Yes Yes 62.9 94.8 100 2018 — — — — — — — — — — — — — Kazakhstan 2014 A 37 680 0 37 680 2.1 100 Yes Yes … … … 2015 A 37 127 0 37 127 2.1 100 Yes No No No … … … 2017 — — — — — — — — — — — — — 2018 A 18 337 0 18 337 1.0 100 Yes No No No 56 … … Kyrgyzstan 2014 A … … … … … … … … … … … … 2015 A 1 506 0 1 506 0.3 100 Yes … … … … … … 2017 — — — — — — — — — — — — — 2018 A … … … … … Yes … … … … … … Latvia 2014 — — — — — — — — — — — — — 2015 — — — — — — — — — — — — — 2017 A, C, D 6 857 2 921 9 778 5.1 70 Yes Yes No No 100 100 0 2018 A, C 4 287 1 444 5 731 3.0 75 Yes Yes No No 100 100 100 Luxembourg 2014 A, B , C 5 654 2 218 7 872 13.9 71 Yes Yes No No 100 35 0 2015 A, B, C 5 446 1 132 6 578 11.6 82 Yes Yes No No 90 50 0 2017 — — — — — — — — — — — — — 2018 C, D 0 762 762 1.3 0 Yes Yes 47 28 0 13 Around 20% – 25% is sent for contract fractionation in another country (Switzerland). 14 Source plasma collected or separated by Japanese Red Cross Society are distributed to both not-for profit sector and commercial companies. 159ANNEX 7. PROVISION OF PLASMA-DERIVED MEDICINAL PRODUCTS (PDMP) THROUGH THE FRACTIONATION OF PLASMA... Country Data year Fr ac tio na tio n ar ra ng em en t* Volume of plasma used for fractionation, or sold to the manufacturers of PMDP for fractionation Products manufactured by fractionation of plasma collected in the country % of self-reliance of PDMP supplies** Recovered plasma (L) Apheresis plasma (L) Total (L) L per 1000 population % of recovered plasma Albumin IVIG Factor VIII Factor IX Albumin IVIG Factor VIII Malaysia 2014 C 33 110 0 33 110 1.1 100 Yes Yes Yes … … … … 2015 C 31 680 0 31 680 1.0 100 Yes Yes Yes No … … … 2017 — — — — — — — — — — — — — 2018 — — — — — — — — — — — — — Mexico 2014 C … … … … … … … … … … … … 2015 C … … … … … Yes Yes Yes Yes … … … 2016 C 10 770 0 10 770 0.1 100 Yes Yes Yes Yes 85 … … 2017 C … Yes Yes Yes Yes … … … Morocco 2014 C 12 000 0 12 000 0.4 100 Yes Yes Yes Yes … … … 2015 C 9 652 0 9 652 0.3 100 Yes Yes Yes Yes 50 85 50 2017 — — — — — — — — — — — — — 2018 C 6 486 0 6 486 0.2 100 Yes Yes Yes Yes 50 100 50 Namibia 2014 2015 2017 D 6 483 0 6 483 2.6 100 2017 Netherlands 2014 — — — — — — — — — — — — — 2015 A … … 277 437 16.4 … Yes Yes Yes Yes … … … 2017 — — — — — — — — — — — — — 2018 — — — — — — — — — — — — — New Zealand 2014 C 22 822 32 400 55 222 12.2 41 Yes Yes Yes Yes 100 100 100 2015 C 28 499 33 061 61 560 13.6 46 Yes Yes Yes Yes 100 89 100 2017 C 32 027 36 349 68 376 14.4 47 Yes Yes Yes Yes 100 87.3 100 2018 C 32 793 41 019 73 812 15.6 44 Yes Yes Yes Yes 100 87.8 100 Norway 2014 — — — — — — — — — — — — — 2015 — — — — — — — — — — — — — 2017 D 45 049 69 06 51 955 9.7 87 No No No No 0 0 0 2018 D 45 658 3 174 48 832 9.1 93 Yes Yes Yes Yes 0 0 0 Paraguay 2014 C15 2015 C16 4 45017 0 4 450 0.7 100 Yes Yes No No … … 2016 C 4 27817 0 4 278 0.6 100 Yes Yes No No 18.8 17.6 2017 C 4 46417 0 4 464 0.6 100 Yes Yes No No 18.8 17.6 Poland 2014 B 171 729 28 739 200 468 5.2 85 … … … … … … … 2015 B 249 170 74 503 323 673 8.4 76 … … … … … … … 2017 C, D 193 206 21 404 214 610 5.7 90 2018 C … … … … … … … … … … … … Portugal 2014 2015 2017 2018 C18 30 000 0 30 000 2.9 100 Yes Yes Yes Yes 36 22 30 15 In process. 16 Through an agreement with the National University of Cordoba. 17 In Kg. 18 The contract fractionation started in 2018. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021160 Country Data year Fr ac tio na tio n ar ra ng em en t* Volume of plasma used for fractionation, or sold to the manufacturers of PMDP for fractionation Products manufactured by fractionation of plasma collected in the country % of self-reliance of PDMP supplies** Recovered plasma (L) Apheresis plasma (L) Total (L) L per 1000 population % of recovered plasma Albumin IVIG Factor VIII Factor IX Albumin IVIG Factor VIII Republic of Korea 2014 A, B, D 367 993 732 650 1 100 643 21.9 33 Yes Yes Yes Yes 79.9 100 100 2015 A, B, D 296 167 596 345 892 512 17.7 33 Yes Yes Yes Yes 95.4 100 100 2017 A 322 134 462 965 785 099 15.3 41 Yes Yes Yes Yes 71.3 100 100 2018 A, B, D 445995 492044 938039 18.33 48 Yes Yes Yes Yes 68.7 100 100 Republic of Moldova 2014 — — — — — — — — — — — — — 2015 — — — — — — — — — — — — — 2017 — — — — — — — — — — — — — 2018 A 86 6 858 6 942 1.7 1 Yes No No No 100 Russian Federation 2014 A 156 148 0 156 148 1.1 100 Yes Yes Yes … … … … 2015 A 147 160 0 147 160 1.0 100 Yes Yes Yes … … … … 2017 A 192 630 0 192 630 1.3 100 Yes Yes No … … … … 2018 A 185 669 0 185 669 1.3 100 Yes Yes No … … … … Serbia 2014 A 5 500 650 6 150 0.7 89 Yes No No No 12 0 0 2015 A 5 350 630 5 980 0.7 89 No No No No 11 0 0 2017 — — — — — — — — — — — — — 2018 — — — — — — — — — — — — — Singapore 2014 C 15 074 3 861 18 936 3.4 79 Yes Yes Yes No 64.7 24.3 11 2015 C 13 407 671 14 078 2.5 95 Yes Yes Yes No 45 47 9 2017 C 14 879 226 15 105 2.6 99 Yes Yes Yes No 60.7 100 38.6 2018 C 14 879 203 15 082 2.6 99 Yes Yes Yes No 73.8 100 41.5 Slovakia 2014 C 26 077 0 26 077 4.8 100 Yes Yes Yes No 58 45 31 2015 C 34 801 0 34 801 6.4 100 Yes Yes Yes No 58 45 31 2017 C 39 105 0 39 105 7.2 100 Yes Yes Yes No 54 41 29 2018 C 28 669 0 28 669 5.3 100 Yes Yes Yes No 54 41 29 Slovenia 2014 C 19 835 33 19 868 9.6 99 Yes Yes Yes Yes 2015 C 15 000 170 15 170 7.3 99 Yes Yes Yes Yes 70 60 100 2017 C 16 964 975 17 939 8.6 95 Yes Yes Yes Yes 56 54 100 2018 — — — — — — — — — — — — — South Africa 2014 A 161 588 0 161 588 3.0 Yes Yes Yes Yes 90 100 100 2015 A 185 097 1896 186 993 3.4 98 Yes Yes Yes Yes 80 100 100 2017 A, D 299 703 5760 305 463 5.2 98 Yes Yes Yes Yes 80 80 100 2018 — — — — — — — — — — — — — Spain 2014 B 367 235 0 367 235 8.0 100 Yes Yes Yes Yes 71 49 50 2015 B 373 055 0 373 055 8.1 100 Yes Yes Yes Yes 72 48 50 2017 B 370 336 0 370 336 7.9 100 Yes Yes Yes Yes 70 43 48 2018 — — — — — — — — — — — — — Sri Lanka 2014 2015 2017 2018 C 36 000 0 36 000 1.7 100 … … … … … … … Sweden 2014 B,C 95 101 22 853 117 954 12.1 80 … … … … … … … 2015 B,C 102 124 21 544 123 668 12.6 82 … … … … … … … 2017 C, D 91 620 19 715 111 335 11.1 82 2018 C, D 89 263 18 605 107 868 10.8 83 161ANNEX 7. PROVISION OF PLASMA-DERIVED MEDICINAL PRODUCTS (PDMP) THROUGH THE FRACTIONATION OF PLASMA... Country Data year Fr ac tio na tio n ar ra ng em en t* Volume of plasma used for fractionation, or sold to the manufacturers of PMDP for fractionation Products manufactured by fractionation of plasma collected in the country % of self-reliance of PDMP supplies** Recovered plasma (L) Apheresis plasma (L) Total (L) L per 1000 population % of recovered plasma Albumin IVIG Factor VIII Factor IX Albumin IVIG Factor VIII Switzerland 2014 A, B 66 598 0 66 598 8.0 100 Yes Yes Yes … … … … 2015 A, B 67 874 1 108 68 982 8.3 98 Yes Yes Yes … … … … 2017 B, D 63 063 925 63 988 7.5 99 2018 B, D 60 839 834 61 673 7.2 98 Thailand 2014 A, C 30 000 0 30 000 0.4 100 Yes 25 0 0 2015 A 32 375 2 022 34 397 0.5 94 Yes Yes Yes No 25 2017 A 98 223 10 632 108 855 1.6 90 Yes Yes Yes No 25 15 5 2018 A 90 600 6 819 97 419 1.4 93 Yes Yes Yes Yes 50 25 10 United States of America 2014 B, C … … … … … Yes Yes Yes Yes … … … 2015 … … … … … … … … … … … … … 2017 … … … … … … … … … … … … … 2018 … … … … … … … … … … … … … Uruguay 2014 C19 11 794 0 11 794 3.4 100 Yes Yes Yes No … … … 2015 C 13 291 0 13 291 3.8 100 Yes Yes Yes No … … … 2016 C 13 580 471 14 051 4.0 97 Yes Yes Yes No … … … 2017 C 13 142 0 13 142 3.8 100 Yes Yes Yes No … … … Uzbekistan 2014 A 3 122 936 4 058 0.1 77 Yes No No No 26 0 0 2015 A 3 528 1 058 4 586 0.1 77 Yes No No No 31 0 0 2017 — — — — — — — — — — — — — 2018 — — — — — — — — — — — — — Venezuela (Bolivarian Republic of) 2014 A, D … … … … … Yes Yes Yes Yes … … … 2015 A, D … … … … … Yes Yes Yes Yes … … … 2016 — — — — — — — — — — — — — 2017 — — — — — — — — — — — — — 19 Through a binational agreement for the interchange of plasma and PDMP with the fractionation plant of the National University of Cordoba. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021162 Annex 8. Policy, governance, quality assurance and monitoring 2017/2018 … Not reported/not available. Blank cell: Not required/not applicable. — No response. Part: partial or in process. * Data of 2017/2018 was not available. Data of earlier years were listed in the table. Country Unit within MoH with responsibility for governing blood provision and transfusion activities National blood policy Multiyear national strategic plan for blood safety or equivalent Specific legislation covering the safety and quality of blood and blood products for transfusion National blood committee (or equivalent) Specific government budgetary line item for the NBTS/BTS System of cost recovery for NBTS/ BTS National standards for the collection, testing, processing, storage and distribution of blood and blood components National guidelines on the appropriate clinical use of blood Afghanistan Yes Yes No … Yes No No Yes No Albania No No No Yes Yes Yes No Yes Yes Algeria Yes* Yes Yes Yes … Yes Yes Yes No Andorra — — — — — — — — — Angola Yes* No Yes Yes Yes* Yes No … Yes Antigua and Barbuda — — — — — — — — — Argentina Yes Yes Yes Yes Yes Yes Yes Yes Yes Armenia* No Yes Yes Yes Yes Yes Yes Yes Yes Australia* Yes Yes Yes Yes Yes Yes No Yes Yes Austria Yes Yes … Yes Yes … … Yes … Azerbaijan — — — — — — — — — Bahamas No Part Yes No No No Part Yes No Bahrain Yes Yes Yes Yes Yes Yes Yes Yes Yes Bangladesh Yes Yes Yes Yes Yes Yes Yes Yes Yes Barbados No No … … No No No Yes Yes Belarus — — — — — — — — — Belgium* Yes Yes No Yes Yes Yes Yes Yes Yes Belize Yes Part No No No No No Yes No Benin Yes* Yes Yes Yes No* Yes Yes Yes* Yes Bhutan Yes Yes Yes Yes Yes Yes No Yes Yes Bolivia Yes No Yes Yes No Yes Yes Yes Yes Bosnia and Herzegovina* No No No Yes No No No No No Botswana Yes Yes Yes Yes No Yes Yes Yes Yes Brazil Yes Yes NO Yes Yes Yes Yes Yes Yes Brunei Darussalam No No No No No Yes No Yes No Bulgaria Yes Yes Yes Yes Yes Yes No Yes Yes Burkina Faso Yes Yes Yes No … Yes No Yes Yes Burundi Yes* Yes Yes Yes No* Yes Yes Yes*- Yes Cabo Verde Yes Yes Yes … No No … No Cambodia* Yes Yes Yes Yes Yes Yes No Yes Yes Cameroon Yes Yes Yes Yes No Yes Yes Yes No Canada Yes Yes Yes Yes Yes Yes No Yes Yes Central African Republic Yes* Yes No No No* Yes Yes Yes* No Chad No* No No No No* Yes No Yes* Yes 163ANNEX 8. POLICY, GOVERNANCE, QUALITY ASSURANCE AND MONITORING 2017/2018 Country Unit within MoH with responsibility for governing blood provision and transfusion activities National blood policy Multiyear national strategic plan for blood safety or equivalent Specific legislation covering the safety and quality of blood and blood products for transfusion National blood committee (or equivalent) Specific government budgetary line item for the NBTS/BTS System of cost recovery for NBTS/ BTS National standards for the collection, testing, processing, storage and distribution of blood and blood components National guidelines on the appropriate clinical use of blood Chile Yes Yes Yes Part Yes Yes No Yes Yes China Yes Yes Yes Yes No Yes Yes Yes Yes Colombia Yes Yes Yes Yes Yes Yes Yes Yes Yes Comoros Yes* Yes No Yes No* No Yes No* No Congo No Yes Yes No No Yes Yes No No Cook Islands Yes Yes No No No No Yes Yes Yes Costa Rica No No Part Part No No Yes Part No Côte d’Ivoire Yes Yes Yes Yes Yes Yes Yes Yes Yes Croatia Yes No No Yes Yes Yes Yes No Yes Cuba Yes Yes Yes Yes Yes No No Yes Yes Cyprus Yes Yes Yes Yes … Yes Yes Yes No Czechia Yes Yes No Yes Yes No Yes Yes Yes Democratic People’s Republic of Korea — — — — — — — — — Democratic Republic of the Congo Yes* Yes Yes No No* No Yes … No Denmark Yes Yes No Yes Yes No1 Yes Yes Yes Djibouti — — — — — — — — — Dominica … … … … … … Yes … … Dominican Republic Yes Yes No No No No Yes Yes Yes Ecuador Yes Yes Yes Yes Yes Yes Yes Yes Yes Egypt No Yes Yes Yes No Yes Yes Yes Yes El Salvador Yes Yes Yes No Yes No No Yes Yes Equatorial Guinea — — — — — — — — — Eritrea Yes* Yes Yes No No* Yes No … Yes Estonia No No No Yes Yes Yes Yes Yes Yes Eswatini Yes Yes … Yes Yes No Yes Yes No Ethiopia Yes Yes Yes Yes Yes Yes No Yes Yes Fiji Yes Yes No Yes Yes Yes No Yes Yes Finland Yes No Yes Yes No No Yes Yes Yes France Yes Yes Yes Yes Yes No Yes Yes Yes Gabon Yes Yes No No No Yes Yes Yes Yes Gambia Yes* Yes Yes No No* Yes No Yes Yes Georgia — — — — — — — — — Germany* Yes Yes … Yes Yes No Yes Yes Yes Ghana Yes Yes Yes No Yes Yes Yes Yes Yes Greece* Yes Yes Yes Yes Yes Yes … Yes Yes Grenada — — — — — — — — — Guatemala Yes Part Yes Yes Part Yes No Yes Yes Guinea — — — — — — — — — Guinea-Bissau — — — — — — — — — Guyana Yes No Yes Part Yes Yes … Yes Yes 1 All blood centre activities are financed by the government through taxes. Blood is free of charge for wards and patients. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021164 Country Unit within MoH with responsibility for governing blood provision and transfusion activities National blood policy Multiyear national strategic plan for blood safety or equivalent Specific legislation covering the safety and quality of blood and blood products for transfusion National blood committee (or equivalent) Specific government budgetary line item for the NBTS/BTS System of cost recovery for NBTS/ BTS National standards for the collection, testing, processing, storage and distribution of blood and blood components National guidelines on the appropriate clinical use of blood Haiti Yes Yes No No Yes Yes No Yes Yes Honduras No Part No No Yes Yes Yes Yes No Hungary — — — — — — — — — Iceland Yes No No Yes Yes No No Yes Yes India* Yes Yes Yes Yes Yes Yes Yes Yes Yes Indonesia Yes Yes Yes Yes Yes No No Yes Yes Iran (Islamic Republic of) Yes Yes Yes Yes Yes Yes Yes Yes Yes Iraq* Yes No No No Yes No No … No Ireland — — — — — — — — — Israel* No Yes No No Yes No … Yes Yes Italy Yes Yes Yes Yes Yes Yes … Yes Yes Jamaica Yes Yes Yes No Yes No Yes Yes Japan Yes Yes Yes Yes Yes Yes Yes Yes Yes Jordan Yes Yes Yes Yes Yes Yes Yes Yes Yes Kazakhstan Yes Yes Yes Yes Yes Yes Yes Yes Yes Kenya Yes* Yes Yes Yes Yes* Yes No Yes* Yes Kiribati Yes Yes No No Yes Yes No Yes Yes Kuwait Yes Yes Yes Yes No Yes Yes Yes Yes Kyrgyzstan Yes Yes Yes Yes Yes Yes No Yes Yes Lao People’s Democratic Republic Yes Yes Yes Yes Yes Yes Yes Yes Yes Latvia No No No Yes No Yes Yes Yes Yes Lebanon* Yes Yes No Yes Yes Yes No Yes No Lesotho Yes Yes Yes No No Yes No No Yes Liberia Yes* Yes No No No* Yes No No Libya Yes No No No No No No No No Lithuania — — — — — — — — — Luxembourg Yes No No Yes No Yes Yes Yes No Madagascar Yes Yes No No No Yes No Yes Yes Malawi Yes Yes Yes No Yes No Yes Yes Yes Malaysia* Yes Yes Yes Yes Yes Yes Yes2 Yes Yes Maldives Yes Yes Yes Yes Yes Yes No No No Mali Yes Yes Yes Yes … Yes No Yes No Malta Yes No No Yes Yes Yes No Yes … Marshall Islands No No No No Yes Yes No … … Mauritania Yes* Yes Yes No No* Yes No … No Mauritius Yes Yes No No Yes Yes Yes Yes Mexico Yes Yes Yes Yes No Yes Yes Yes Yes Micronesia (Federated States of) No No No No No No3 No Yes No Monaco — — — — — — — — — 2 Partial cost recovery (only for processing and screening cost) for private health care facilities. 3 No dedicated governmental fund for blood services. All funding for blood services is derived from funding for the hospital laboratory. 165ANNEX 8. POLICY, GOVERNANCE, QUALITY ASSURANCE AND MONITORING 2017/2018 Country Unit within MoH with responsibility for governing blood provision and transfusion activities National blood policy Multiyear national strategic plan for blood safety or equivalent Specific legislation covering the safety and quality of blood and blood products for transfusion National blood committee (or equivalent) Specific government budgetary line item for the NBTS/BTS System of cost recovery for NBTS/ BTS National standards for the collection, testing, processing, storage and distribution of blood and blood components National guidelines on the appropriate clinical use of blood Mongolia Yes Yes Yes Yes Yes Yes … Yes Yes Montenegro Yes Yes Yes Yes No Yes Yes Yes No Morocco Yes Yes Yes Yes Yes Yes Yes Yes Yes Mozambique Yes No No Yes Yes Yes No … Yes Myanmar No No No Yes Yes Yes No Yes Yes Namibia Yes Yes Yes Yes Yes No Yes Yes Yes Nauru — — — — — — — — — Nepal Yes Yes … … Yes … Yes Yes Yes Netherlands* Yes Yes Yes Yes Yes Yes Yes Yes Yes New Zealand No Yes Yes Yes No No Yes Yes Yes Nicaragua Yes Yes Yes Yes Yes Yes Yes Yes Yes Niger Yes Yes No Yes No Yes No Yes Nigeria Yes Yes Yes No Yes Yes Yes Yes Yes Niue No No No No No No Yes Yes North Macedonia … No No Yes No Yes Yes Yes No Norway* Yes Yes No Yes Yes No No Yes Yes Oman Yes Yes … … Yes Yes No Yes Yes Pakistan Yes Yes Yes Yes Yes Yes Yes Yes Yes Palau No … No … No … … Yes … Panama Yes Yes Yes Yes No Yes No Yes Yes Papua New Guinea Yes Yes Yes Yes No No Yes No Paraguay Yes Yes Yes Yes No Yes Yes Yes Yes Peru Yes Yes Yes Yes No Yes No Yes No Philippines* Yes Yes Yes Yes Yes Yes Yes Yes Yes Poland Yes Yes Yes Yes Yes Yes Yes Yes Yes Portugal Yes Yes Yes Yes Yes Yes Yes Yes Yes Qatar No No No No No Yes No Yes Yes Republic of Korea Yes Yes Yes Yes Yes Yes Yes Yes Yes Republic of Moldova Yes Yes Yes Yes Yes Yes No Yes Yes Romania Yes Yes No Yes Yes Yes No Yes Yes Russian Federation Yes Yes Yes Yes Yes Yes … Yes Yes Rwanda Yes* Yes Yes Yes Yes No Yes* Yes Saint Kitts and Nevis … … … … No … … … … Saint Lucia No No No No No No No Yes No Saint Vincent and the Grenadines No No No No No No No No No Samoa* Yes No No No Yes Yes No Yes Yes San Marino — — — — — — — — — Sao Tome and Principe Yes* Yes Yes No No* No No Yes* Yes Saudi Arabia* Yes Yes Yes Yes Yes Yes No Yes Yes Senegal Yes* Yes Yes Yes Yes* Yes Yes Yes* Yes Serbia* Yes Yes Yes … Yes Yes Yes Yes Yes GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021166 Country Unit within MoH with responsibility for governing blood provision and transfusion activities National blood policy Multiyear national strategic plan for blood safety or equivalent Specific legislation covering the safety and quality of blood and blood products for transfusion National blood committee (or equivalent) Specific government budgetary line item for the NBTS/BTS System of cost recovery for NBTS/ BTS National standards for the collection, testing, processing, storage and distribution of blood and blood components National guidelines on the appropriate clinical use of blood Seychelles* Yes Yes Yes Yes Yes No No Yes Yes Sierra Leone — — — — — — — — — Singapore Yes No Yes Yes No Yes Yes Yes Yes Slovakia Yes No No Yes Yes No Yes … Yes Slovenia Yes Yes Yes Yes Yes No Yes Yes Yes Solomon Islands No No No No No No No Yes Yes Somalia — — — — — — — — — South Africa Yes Yes Yes Yes … No Yes Yes Yes South Sudan … Yes Yes No … Yes No … Yes Spain Yes Yes No Yes Yes No No Yes Yes Sri Lanka Yes Yes Yes … Yes Yes No Yes Yes Sudan* No Yes Yes Yes Yes Yes No Yes Yes Suriname Yes Yes … Yes Yes No Yes Yes Yes Sweden Yes No No Yes Yes No Yes Yes No Switzerland Yes Yes … Yes Yes No Yes Yes No Syrian Arab Republic — — — — — — — — — Tajikistan Yes Yes Yes Yes Yes Yes Yes Yes Yes Thailand Yes Yes Yes Yes Yes Yes Yes Yes Yes Timor-Leste Yes No Yes No Yes No No Yes Yes Togo Yes Yes No Yes Yes Yes Yes Yes No Tonga Yes … … … No … … Yes Yes Trinidad and Tobago Yes Yes No No No Yes No Yes Yes Tunisia Yes Yes Yes Yes Yes No Yes Yes … Turkey Yes Yes … Yes Yes Yes Yes Yes Yes Turkmenistan — — — — — — — — — Tuvalu — — — — — — — — — Uganda Yes Yes Yes No No Yes No Yes Yes Ukraine — — — — — — — — — United Arab Emirates Yes Yes No Yes No Yes … Yes … United Kingdom of Great Britain and Northern Ireland* … Yes Yes Yes Yes … No Yes Yes United Republic of Tanzania Yes No Yes No No Yes No Yes Yes United States of America Yes … … Yes Yes … Yes Yes Yes Uruguay No Yes Part Yes No No No Yes Yes Uzbekistan* Yes Yes No Yes Yes Yes Yes … Yes Vanuatu* No Yes Yes … No Yes No Yes Yes Venezuela (Bolivarian Republic of)* Yes … No Yes No Yes No Yes No Viet Nam* No No No Yes Yes No Yes Yes No Yemen Yes No Yes Yes Yes No No Yes Yes Zambia* Yes Yes Yes Yes Yes Yes No Yes Yes Zimbabwe Yes Yes Yes No Yes Yes Yes … Yes 167ANNEX 8. POLICY, GOVERNANCE, QUALITY ASSURANCE AND MONITORING 2017/2018 Annex 8. Policy, governance, quality assurance and monitoring 2017/2018 (continued) … Not reported/not available. Blank cell: Not required/not applicable. — No response. Partial: partial or in process. * Data of 2017/2018 was not available. Earlier year data was listed in the table. Country Programme of continuing education for personnel involved in blood transfusion Educational programmes that offer a nationally recognized university degree or diploma in blood transfusion National haemovigilance system Regular inspection of the BTS Licensing of the BTS BTS accreditation Number of centres accredited BTS having computerized information management system Number of centres having computerized information management system Afghanistan Yes No No No No No No Albania Yes Yes No Yes Yes No Yes 1 Algeria Yes Yes No Yes* Yes* No No* Andorra — — — — — — — — — Angola Yes No No Yes* Yes* No … Antigua and Barbuda — — — — — — — — — Argentina Yes Yes Yes Yes Yes Yes Yes Armenia* No No Yes No Yes No No Australia* Yes No Yes Yes Yes Yes 82 Yes Austria … Yes Yes Yes Yes Yes 2 Yes Azerbaijan — — — — — — — — — Bahamas Part … No Part Yes Part Yes Bahrain Yes No Yes No Yes Yes Yes Bangladesh Yes No No Yes Yes No No Barbados No … No No … No … Belarus — — — — — — — — — Belgium* Yes Yes Yes Yes Yes Yes 2 Yes 6 Belize Yes No No Yes Yes NO Yes Benin Yes No Yes No* No* No Yes* Bhutan Yes Yes Yes Yes No No Yes 4 Bolivia Yes … No Yes Yes Yes Yes Bosnia and Herzegovina* Yes No No No No Yes 1 Yes Botswana Yes No No No No Yes 2 Brazil Yes … Yes Yes Yes Yes Yes Brunei Darussalam Yes No No No No Yes 1 Yes 4 Bulgaria Yes Yes Yes Yes Yes Yes 29 Yes 29 Burkina Faso Yes Yes Yes No No No Yes 4 Burundi No No No Yes* Yes* No No* Cabo Verde No No No Yes* Yes* No … Cambodia* Yes No No Yes Yes No Yes 1 Cameroon No No Yes No No No No Canada Yes Yes Yes Yes Yes No Yes Central African Republic No No No No* No* No Yes* 1 Chad Yes No No No* No* No Yes* 1 Chile Yes … Part Yes Yes Yes1 Yes China Yes Yes No Yes Yes No Yes 452 1 Accreditation of health providers since 2009. All blood services providing services as health care providers. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021168 Country Programme of continuing education for personnel involved in blood transfusion Educational programmes that offer a nationally recognized university degree or diploma in blood transfusion National haemovigilance system Regular inspection of the BTS Licensing of the BTS BTS accreditation Number of centres accredited BTS having computerized information management system Number of centres having computerized information management system Colombia NO … Yes Yes Yes No2 Yes Comoros No No No Yes* Yes* No No* Congo Yes No No No No No No Cook Islands Yes No Yes No No No No Costa Rica No … No Part Yes Yes Yes Côte d’Ivoire Yes No Yes Yes Yes No Yes 22 Croatia Yes Yes Yes Yes Yes No Yes 7 Cuba Yes … Yes Yes Yes Yes Yes Cyprus Yes No Yes No No Yes Yes 2 Czechia Yes Yes Yes Yes Yes Yes3 Yes 77 Democratic People’s Republic of Korea — — — — — — — — — Democratic Republic of the Congo Yes No No No* No* No … Denmark Yes Yes Yes Yes Yes Yes4 5 Yes 5 Djibouti — — — — — — — — — Dominica … … … … … … … Dominican Republic No … No Yes Yes No Yes Ecuador Yes … Yes Yes Yes Yes Yes Egypt Yes Yes No Yes No Yes5 1 Yes 17 El Salvador Yes … No Part Yes No Yes Equatorial Guinea — — — — — — — — — Eritrea Yes No No No* No* No … Eswatini Yes Yes Yes No No No Yes Estonia No Yes Yes Yes Yes … Yes 4 Ethiopia Yes No No No No No Yes 1 Fiji No Yes Yes Yes No No No Finland Yes No Yes Yes Yes Yes Yes 1 France Yes Yes Yes Yes Yes … Yes Gabon Yes No Yes Yes Yes No Yes 1 Gambia No No No No* No* No No Georgia — — — — — — — — — Germany * Yes Yes Yes Yes Yes … N/A Ghana Yes No No Yes Yes No Yes 1 Greece * Yes Yes Yes Yes Yes Yes 59 Yes 70 Grenada — — — — — — — — — Guatemala Yes … No Yes Yes No Yes Guinea — — — — — — — — — Guinea-Bissau — — — — — — — — — Guyana Yes … No Yes Yes No Yes Haiti Yes … No No No No No Honduras No … No No No No No Hungary — — — — — — — — — 2 Two blood banks accredited by AABB. 3 Accreditation is not obligatory but around 90% of the blood services have some forms of accreditation against ISO or other standards. 4 Five of five blood centres are accredited according to the Danish Quality Model for Hospitals; one of them is also accredited according to ISO 15189. 5 AABB (accredited with conditional status). 169ANNEX 8. POLICY, GOVERNANCE, QUALITY ASSURANCE AND MONITORING 2017/2018 Country Programme of continuing education for personnel involved in blood transfusion Educational programmes that offer a nationally recognized university degree or diploma in blood transfusion National haemovigilance system Regular inspection of the BTS Licensing of the BTS BTS accreditation Number of centres accredited BTS having computerized information management system Number of centres having computerized information management system Iceland No No Yes Yes Yes No6 Yes 1 India* Yes Yes No … Yes Yes7 … Indonesia Yes Yes No No No No No Iran (Islamic Republic of) Yes Yes Yes Yes Yes Yes 91 Yes 91 Iraq* No No Yes Yes Yes No Yes 1 Ireland — — — — — — — — — Israel* Yes No No No No Yes 1 Yes 8 Italy Yes No Yes Yes Yes Yes 278 Yes 278 Jamaica Yes No No Yes Yes No No Japan Yes No Yes Yes Yes8 Yes 54 Yes 54 Jordan Yes No No Yes Yes No Yes 2 Kazakhstan Yes … … Yes Yes Yes 7 Yes 18 Kenya Yes No Yes Yes Yes No … Kiribati Yes Yes Yes No No No Yes 1 Kuwait Yes No Yes Yes No Yes 1 Yes 1 Kyrgyzstan Yes Yes Yes Yes Yes Yes 3 Yes 7 Lao People’s Democratic Republic … No No No No No Yes Latvia Yes … Yes Yes Yes Yes 7 Yes 7 Lebanon* Yes … No Yes Yes No Yes 50 Lesotho No Yes Yes Yes Yes No Yes 3 Liberia … … No No No No … Libya No Yes No No No No No Lithuania — — — — — — — — — Luxembourg No No Yes Yes Yes Yes9 1 Yes Madagascar No Yes Yes No No No No Malawi No Yes Yes Yes Yes No Yes 4 Malaysia* Yes Yes Yes Yes Yes10 Yes11 7 Yes Maldives No No No No No No No Mali Yes No No No No No No Malta yes … Yes Yes Yes No Yes 1 Marshall Islands No No No No No No … Mauritania No No No No No No No Mauritius Yes No Yes No No Yes12 Yes 1 Mexico Yes … Part Yes Yes NO Yes Micronesia (Federated States of) Yes No No No No No Yes 3 Monaco — — — — — — — — — Mongolia Yes No Yes Yes Yes Yes 27 Yes 27 Montenegro Yes No No Yes No No Yes 1 6 ISO 9001:2008. 7 The National Accreditation Board for Hospitals and Health Care Providers (NABH) has a special programme for accreditations of blood banks. 8 The Japanese Red Cross Society (JRCS) is licensed by the government to collect blood. It is the only entity in Japan that collects donated blood. Every blood centre (blood collection room) in the JRCS needs permission from the Minister of Health, Labour and Welfare. 9 ISO 9001 and ISO 15189. 10 Medical Practice Division of Ministry of Health undertakes the licensing for private health care facilities. 11 Department of Standards, Malaysia. 12 Blood service is ISO 9001:2008 certified by the Mauritius Standards Bureau. GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021170 Country Programme of continuing education for personnel involved in blood transfusion Educational programmes that offer a nationally recognized university degree or diploma in blood transfusion National haemovigilance system Regular inspection of the BTS Licensing of the BTS BTS accreditation Number of centres accredited BTS having computerized information management system Number of centres having computerized information management system Morocco Yes No Yes Yes13 Yes No Yes 8 Mozambique Yes No Yes No No No Yes 1 Myanmar Yes Yes No Yes No No Yes 37 Namibia Yes No Yes Yes Yes Yes14 1 Yes 1 Nauru — — — — — — — — — Nepal Yes No Yes Yes Yes No N/A Netherlands* Yes Yes Yes Yes Yes Yes N/A New Zealand Yes Yes Yes Yes Yes Yes15 6 Yes 6 Nicaragua Yes … Part Yes Yes No Yes Niger No No No Yes Yes No … Nigeria Yes No No No No No … Niue No No No No No No No North Macedonia No Yes No No No No Yes 3 Norway Yes No Yes Yes Yes Yes 16 Yes 22 Oman Yes No Yes No No Yes 13 Pakistan Yes Yes Yes Yes Yes No Yes 50 Palau … No No … … No No Panama No … No Yes Yes No Yes Papua New Guinea Yes Yes Yes Yes … No No Paraguay Yes … Part Yes Yes No Yes Peru Yes … No Yes Yes No Yes Philippines* Yes No No Yes Yes No Yes 16 Poland Yes Yes Yes Yes Yes Yes16 23 No Portugal Yes Yes Yes Yes Yes No Yes 104 Qatar Yes No Yes Yes No Yes17 1 Yes Republic of Korea Yes No Yes Yes Yes Yes18 105 Yes 105 Republic of Moldova Yes Yes Yes Yes Yes Yes 17 Yes 17 Romania Yes No Yes Yes Yes No Yes 4 Russian Federation Yes Yes Yes Yes Yes … Yes Rwanda Yes No Yes Yes* Yes* Yes 5 Yes* 5 Saint Kitts and Nevis No … No NO No No Saint Lucia No … No NO No No … Saint Vincent and the Grenadines No … No No No No No Samoa* Yes Yes19 Yes No No No No San Marino — — — — — — — — — Sao Tome and Principe No No No No No No … Saudi Arabia* Yes Yes Yes Yes Yes Yes 24 N/A Senegal Yes Yes No Yes Yes No Yes 2 Serbia* Yes Yes Yes No No No Yes 13 The blood centres are inspected by the national centre, and each year an audit of all centres is conducted. 14 AfSBT accreditation. 15 Accredited by MedSafe, the New Zealand medicines regulatory authority. 16 According to article 14 of the Polish Blood Transfusion Act of 22 August 1997. 17 College of American Pathologists. 18 Blood centre approval by Korean CDC, and Blood Laboratory Centre ISO accreditation. 19 The Pacific Paramedical Training Centre (PPTC) provides distance learning for a Diploma in Medical Laboratory Technology. The two-year course covers blood transfusion science. 171ANNEX 8. POLICY, GOVERNANCE, QUALITY ASSURANCE AND MONITORING 2017/2018 Country Programme of continuing education for personnel involved in blood transfusion Educational programmes that offer a nationally recognized university degree or diploma in blood transfusion National haemovigilance system Regular inspection of the BTS Licensing of the BTS BTS accreditation Number of centres accredited BTS having computerized information management system Number of centres having computerized information management system Seychelles* Yes Yes Yes No No No Yes 2 Sierra Leone — — — — — — — — — Singapore Yes No Yes Yes Yes Yes20 1 Yes 1 Slovakia Yes Yes Yes Yes Yes No21 Yes 44 Slovenia Yes Yes Yes Yes Yes No Yes 3 Solomon Islands Yes No No No No No No Somalia — — — — — — — — — South Africa Yes Yes Yes Yes Yes Yes22 11 Yes 11 South Sudan Yes No No No No No … Spain Yes Yes Yes Yes Yes Yes 20 Yes 20 Sri Lanka Yes Yes Yes Yes Yes Yes23 1 Yes 103 Sudan* Yes Yes No Yes No No No Suriname Part No No Part Yes No No Sweden Yes Yes Yes Yes Yes Yes24 25 Yes 26 Switzerland Yes No Yes Yes Yes Yes25 11 Yes 11 Syrian Arab Republic — — — — — — — — — Tajikistan Yes Yes No Yes Yes Yes 4 Yes 4 Thailand Yes Yes Yes Yes No Yes26 13 Yes 13 Timor-Leste Yes No No Yes No No Togo Yes No No Yes Yes No Yes 2 Tonga No No No … … No Yes 1 Trinidad and Tobago No … No No No No No Tunisia … Yes Yes No No Yes27 1 Yes 4 Turkey Yes No Yes Yes Yes … Yes Turkmenistan — — — — — — — — — Tuvalu — — — — — — — — — Uganda Yes No Yes No No Yes 1 Yes 4 Ukraine — — — — — — — United Arab Emirates Yes No Yes Yes Yes28 4 Yes 11 United Kingdom of Great Britain and Northern Ireland* Yes Yes Yes Yes Yes Yes 10 Yes United Republic of Tanzania No No No No Yes Yes 2 Yes 6 United States of America Yes Yes Yes … Yes Yes … Uruguay Part … No … Yes No Yes Uzbekistan* Yes No No Yes Yes No … Vanuatu* No No No No No Yes 2 No Venezuela (Bolivarian Republic of)* Yes Yes … No Yes No … 20 AABB international accreditation. 21 Blood transfusion services are accredited according to European Commission blood directives. 22 SANAS (South African National Accreditation System). 23 National Blood Centre is accredited for ISO 1589:2012. 24 Technical accreditation according to ISO/IEC 17025 or ISO/IEC 15189. 25 GMP, ISO 17025, ISO 9001. 26 ISO 9001, 15189, 15190. 27 ISO 9001. 28 AABB, clinical laboratory accreditation standard (JCI), CAP (College of American Pathologists). GLOBAL STATUS REPORT ON BLOOD SAFETY AND AVAILABILITY 2021172 Country Programme of continuing education for personnel involved in blood transfusion Educational programmes that offer a nationally recognized university degree or diploma in blood transfusion National haemovigilance system Regular inspection of the BTS Licensing of the BTS BTS accreditation Number of centres accredited BTS having computerized information management system Number of centres having computerized information management system Viet Nam* No No Yes No No No Yes 2 Yemen No No No Yes Yes No No Zambia* Yes No No No No No Yes 9 Zimbabwe No No No No No No Yes 5 GUIDANCE ON CENTRALIZATION OF BLOOD DONATION TESTING AND PROCESSING CONTACT World Health Organization Department of Health Products Policy and Standards 20 avenue Appia CH-1211 Geneva 27 bloodproducts@who.int https://www.who.int/bloodproducts CONTACT World Health Organization Department of Health Products Policy and Standards 20 avenue Appia CH-1211 Geneva 27 bloodproducts@who.int https://www.who.int/bloodproducts