Selection of Blood, Blood Components, and Blood Products as Essential Medicines in 105 Low- and Middle-Income Countries

• Published in: Transfusion medicine reviews 2020-04, Vol.34 (2), p.94-100
• Main Authors: Samukange, Washington T., Gardarsdottir, Helga, Leufkens, Hubert G.M., Mantel-Teeuwisse, Aukje K.
• Format: Article
• Language: English
• Subjects: blood and blood products; low- and middle-income countries; selection of essential medicines
• ISSN: 0887-7963; 1532-9496
• DOI: 10.1016/j.tmrv.2019.10.005

Blood products of human origin are essential treatment options for several diseases, for example, hemophilia. We studied the alignment of national essential medicines lists (NEMLs) of low- and middle-income countries (LMICs) with the World Health Organization (WHO) Model List for the selection of blood products of human origin. The most recent versions of NEMLs from all LMICs were studied for the inclusion of blood products of human origin (blood and blood components, plasma products, and immunoglobulins). Data obtained from 105 NEMLs were compared to the 2017 WHO Model List. The median number of blood products of human origin on the NEMLs was 4 (range: 0-10). Immunoglobulins were most frequently included (73%). Blood and blood components were the least selected products (15%). The uptake of plasma products was around 50%. Nine countries did not have any blood products of human origin on their NEMLs. Some NEMLs included blood products not listed on the WHO Model List (albumin, hepatitis A immunoglobulin, and cryoprecipitate). We observed variation in selection according to WHO region, income level, and year of NEML update. Alignment of NEMLs with the WHO Model List varied greatly for different groups of blood products, ranging from good uptake for immunoglobulins, reasonable uptake for plasma products, to poor uptake for blood and blood components. This heterogeneity in selection and inclusion of blood products of human origin on NEMLs may be partly explained as being due to specific country characteristics, but some of it may not be explained. Policy makers need to rely on evidence in making decisions about which blood products to select, include, and remove on their NEMLs. •A total of 105 low- and middle-income countries' national essential medicines lists (NEMLs) were studied; only 9 of 105 did not have any essential blood and blood products on their NEMLs.•Most NEMLs in low- and middle-income countries include immunoglobulins and a reasonable selection of plasma products, but only a few NEMLs list blood and blood components.•Selection of blood products of human origin in low- and middle-income countries is suboptimal and highly diverse.