"There have been advances over the last few years, but with one of the fastest growing rates of HIV infection, the shortcomings of the systems used to collect blood and screen it for HIV and hepatitis B and C indicate that if improvements aren't developed quickly, China could find itself on the upslope of transfusion-borne infection," says Hua Shan, M.D., assistant professor of pathology, associate medical director in transfusion medicine and associate medical director of the HIV Specialty Testing Laboratory at Johns Hopkins.
"The Chinese government recognizes the country's need in this area and is asking for help, and it's vital to China and the world that help is provided," she adds.
The Johns Hopkins researchers and their Chinese colleagues published an analysis of the country's blood banking systems -- from how blood donors are recruited to how blood products are given to patients -- in the British journal The Lancet last fall.
"Problems like those seen in China's blood banking system are common in countries without infrastructure, means or expertise in this area, and they are critical problems for public health," notes Paul Ness, M.D., director of transfusion medicine at Johns Hopkins and an author of the study. "We hope improvements in China's system might be adopted or translated to address similar issues elsewhere."
Working closely with the Chinese Ministry of Health and with blood banking and transfusion organizations in China, the researchers hope their study will provide the most comprehensive, single source of reliable information about the systems currently in place, making it possible to identify the country's needs and develop workable solutions.
One problem is that China's current blood collection system is fragmented, reflecting the country's size as well as marked differences between its rural and urban areas. For example, more than 400 blood centers nationwide collect whole blood, and each local government is responsible for providing oversight, even though national agencies create policies and pass blood-bank-related laws, the researchers point out.
A major obstacle, also, is converting China's system to volunteer-donors-only, a proven step in improving blood safety, says Shan. The scarcity of volunteer donors and a chronically low blood supply have created a market for paid blood donations, a practice that attracts illegal activities and infected donations, and tends not to overcome traditional beliefs.
"Young, educated people are likely to volunteer to donate blood, but older Chinese are more likely to believe that blood is a gift from their ancestors and that losing even a little bit can be harmful," she says.
The researchers note that important advances have been made in increasing the number of volunteer donors since 1998, when a law went into effect banning clinical use of paid-for whole blood. But even in 2000, only 67 percent of clinically used blood was actually from volunteers, according to the Chinese Society of Blood Transfusion. (In 1996, just 11 percent was collected from volunteers.)
Education and training is another hurdle, the researchers say. With a grant from the Fogarty International Center, part of the U.S. National Institutes of Health, Shan and others at Hopkins, along with physicians in China, are in their third year of providing U.S.-based training and China-based workshops to people involved in blood collection, processing and transfusion.
A native of China, Shan's interest in the country's blood banking system stems in part from her work with Jay Brooks Jackson, M.D., Ph.D., director of pathology at Johns Hopkins. As they studied ways to prevent HIV infection in Africa and Asia, poor blood banking and transfusion practices stood out as major obstacles to reducing the risk of HIV epidemics.
Authors on the paper are Shan and Ness of Johns Hopkins; Jing-Xing Wang and Yang Ji of the Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China; Fu-Rong Ren, Hai-Yan Zhao and Guo-Jing Gao of the Beijing Red Cross Center, Beijing; and Yuan-Zhi Zhang of the Xinjiang Autonomous Regional Center for Disease Control and Prevention, Urumqi, China. The research was funded by the Fogarty International Center and The Johns Hopkins University/China HIV Prevention Trial Network Project, which is funded by the National Institute of Allergy and Infectious Diseases.
On the Web:
The paper (Lancet 30 Nov 2002; 360: 1770-1775) is available free of charge online: http://www.thelancet.com/journal/vol360/iss9347/full/llan.360.9347.editorial_and_review.23354.1
The Fogarty International Center: http://www.fic.nih.gov/
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Journal
The Lancet