International Program Expands Efforts to Improve Blood Transfusion Safety

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has launched an $87.2 million international research program to extend a highly successful program assessing blood banking and transfusion medicine. Research conducted under the seven-year program will focus on improving transfusion benefits and reducing its risks.

"Transfusion therapy is among the most common medical procedures in this country, where about five million people undergo transfusion therapy each year. This research effort will protect both blood donors and recipients from existing and future risks, benefitting both the United States, and countries struggling to ensure blood safety and availability," said Susan B. Shurin, M.D., acting director of the NHLBI.

The U.S. and international research groups participating in the program, called the Recipient Epidemiology and Donor Evaluation Study III (REDS-III), are determining the specific epidemiologic, survey, and laboratory studies to be carried out. REDS-III will build upon and extend the findings of the original REDS and REDS-II programs, and cover several new research areas. These include finding new ways to enhance blood supply safety and helping reduce the transmission of HIV and other infectious agents, such as hepatitis B and C, in nations in which these agents continue to limit the safety of the blood supply.

The first REDS program was created in 1989 in response to the emerging HIV/AIDS epidemic. Under the original program, researchers studied human retroviruses (such as human T-lymphotropic virus and HIV) and their impact on the blood supply. Implementation of findings from these studies has dramatically improved blood safety. REDS-II approached both infectious and non-infectious problems such as transfusion-related acute lung injury that could affect the U.S. and international blood supply.

Through these research efforts, scientists identified the factors which affected the risks of a viral infection such as HIV being transmitted through blood transfusion. This knowledge dramatically improved donor screening methods, and identified the factors which motivate or deter people from donating blood.

The U.S. portion of REDS-III has four research hubs:

  • BloodCenter of Wisconsin, Milwaukee
  • The Institute for Transfusion Medicine, Pittsburgh
  • University of California, San Francisco
  • Yale University School of Medicine, New Haven, Conn.

Each hub has a blood center and transfusion services that serve specialty-care and community hospitals. Hubs will participate in three general areas of research related to blood banking and transfusion medicine:

  • Studies addressing blood donors, including evaluating donors' health to learn their iron status, assessing the prevalence of infectious agents in blood donors, and improving donor screening techniques;
  • Studies addressing blood banking practices, including refinements to existing approaches and developing strategies to enhance blood collection, laboratory screening, and processing to minimize waste and maximize the value of each donation;
  • Studies addressing transfusion practices, including evaluation of blood product use in various clinical settings; non-infectious and infectious complications of transfusion; and clinical outcomes in patient populations that receive specific blood products.

The international portion of REDS-III involves collaborations between investigators in the U.S. and scientists at blood centers in Brazil, China, and South Africa:

  • The Blood Systems Research Institute in San Francisco is collaborating with the Fundação Faculdade de Medicina and Hospital das Clinicas of the Medical School of the University of Sao Paulo in Brazil, with the participation of four blood centers located in Belo Horizonte - Minas Gerais (Fundação Hemominas), Recife - Pernambuco (Fundação Hemope), São Paolo (Fundação Pró-Sangue), and Rio de Janeiro (Fundação Hemorio);
  • The Johns Hopkins University in Baltimore is collaborating with the Chinese Institute of Blood Transfusion, with participation of five blood centers located in Kunming, Urumqi, Luoyang, LiuZhou, and Mianyang;
  • The University of California San Francisco is collaborating with the South African National Blood Service, which operates across all of South Africa except the Western Cape.

A major research focus of the international sites will be to identify effective ways to reduce the transmission of HIV/AIDS and other known and emerging infectious agents through transfusion. Lack of resources often prevents the implementation of highly sensitive donor testing in countries where HIV incidence is high. Effective, low cost strategies such as screening of the safest possible prospective donors, become particularly important in resource-poor settings. A better understanding of the factors that motivate people to donate blood as well as their risk factors for diseases may identify strategies to improve blood supply safety.

Techniques to minimize risky behaviors and discourage people who mainly seek to donate blood to get access to HIV testing are also important in these settings. People should instead be encouraged to seek HIV tests as part of their clinical care. Researchers will study blood use patterns and evaluate safety concerns in patients likely to require blood, such as patients with sickle cell disease and women with obstetrical hemorrhages.

The research activities of all REDS-III centers will be supported by a data coordinating center (RTI International) and a central laboratory (Blood Systems Research Institute, San Francisco).

A particularly important component of the collaborative research effort in REDS-III is the opportunity to train junior investigators in blood banking and/or transfusion medicine research, building the research capacity in an area of tremendous global public health importance.