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August 23, 2004
grant to improve blood transfusion safety
Transfusion medicine experts at Emory, the American
Association of Blood Banks (AABB) and the American Red Cross (ARC)
will use a new $12 million grant from the President’s Emergency
Plan for AIDS Relief (PEPFAR) to improve blood-transfusion safety
in Kenya, South Africa, Mozambique and Guyana. The goal is to significantly
decrease HIV transmission, ameliorating the personal, social, economic
and political effects of HIV in those nations.
“HIV is a disaster of enormous proportions in many developing
nations, including those in Africa and South America, and blood transfusion
plays a significant part in transmission of HIV in those countries,” said
Christopher Hillyer, director of Emory’s Transfusion Medicine
Program and professor of pathology and laboratory medicine at the
School of Medicine. Hillyer is AABB vice president and co-principal
investigator of the grant, which will provide $12 million over five
The United Nations Programme on HIV/AIDS estimates 40 million individuals in
sub-Saharan Africa are infected with HIV, and 2.5 million of those are children.
Five million new individuals in the region were infected with HIV in 2003.
The World Health Organization (WHO) estimates that 5–10 percent of global
HIV infections worldwide are caused by transfusion of unsafe blood and blood
In Africa, however, that percentage is likely much higher because few hospitals
regularly test blood products for HIV and fewer than one-third of African countries
have transfusion policies, procedures or guidelines to limit HIV transmission.
Karen Shoos Lipton, CEO of AABB, is principal investigator
of the grant, and Roger Dodd, executive director of biomedical safety
and head of the Transmissible Diseases Department at the ARC’s
Jerome H. Holland Laboratory for the Biomedical Sciences, is senior
co-investigator. All three primary investigators are recognized authorities
in national and international transfusion medicine. Hillyer is slated
to become the next president-elect of AABB, taking office as president
While the risk of HIV transmission due to blood transfusion in the United States
is approximately one in 5 million, this ratio approaches one in 500 in some developing
countries, according to Hillyer. Virtually all blood donations in this country
are voluntary, and extensive testing programs are in place to detect HIV and
hepatitis C virus. In contrast, developing countries often lack basic services
necessary for a safe blood supply, including reliable electricity, safe water
and passable roads. These factors are essential for testing donors and donated
blood, storing blood and rapidly transporting blood for transfusion.
While the majority of U.S. blood transfusions are performed in adults, in developing
nations more than half of transfused blood is given to children. The primary
reasons for maternal and pediatric transfusions in developing countries are anemia
in early childhood or pregnancy, trauma, malaria, sickle cell disease and thalassemia.
Cultural and social pressures contribute to a shortage of volunteer donors, and
transfused blood often is not tested due to lack of resources, untrained workers
or a cultural stigma against HIV awareness.
“Our first step with this new PEPFAR grant will be to send immediate response
teams of blood-banking professionals to the four countries to conduct assessments
and hold meetings with the ministries of health,” Hillyer said. “We
will develop a plan, create standards and conduct training programs that
incorporate all elements of transfusion medicine, including basic techniques,
testing, record keeping, transportation and the creation of geographic