The 2020 South African Haemovigilance Report

The 2020 South African Haemovigilance Report is compiled on an annual basis by the South African National Blood Service (SANBS) and Western Cape Blood Service (WCBS), and provides an overview of blood product usage and adverse events related to transfusion and blood donation during the preceding calendar year.

The COVID-19 pandemic had a significant impact on every sector in South Africa, including the blood services. The healthcare sector responded to the need to prioritise hospital space for COVID-19-affected patients by postponing elective surgeries and non-essential medical care. This, along with other socio-economic factors such as the alcohol sales ban during certain lockdown periods causing a reduction in the trauma patient load1, resulted in a 14.72% decline in overall blood product usage compared to the previous calendar year. This was most notably seen in red cell concentrate (RCC) usage that dropped by 16.94% compared to platelet and plasma product usage that declined by 6.99% and 1.13% respectively.

The more urbanised and populated provinces continue to have the highest RCC transfusion rates in the country, with Gauteng (22.75 units per 1000 population) and the Western Cape (17.59 units per 1000 population) in the lead. The public healthcare sector used 61.34% of all RCC products in 2020, which is disproportionate to the number of people who access public healthcare in South Africa.

Adverse transfusion reactions occurred at a rate of 86.16 per 100 000 products transfused in 2020. This is the highest rate seen in the past three years, although surmised under-reporting of transfusion reactions and the passive nature of the haemovigilance monitoring system in South Africa make accurate data collection and comparison over time, challenging. Febrile non-haemolytic and allergic transfusion reactions accounted for the majority of reactions, as has been consistently seen in the past. The rate of misdirected transfusions increased in 2020, which is of concern as these events are potentially life-threatening and usually attributable to human error. There were no confirmed cases of either transfusion-transmitted disease or blood product-related mortality reported in 2020.

A total of 1 035 902 donations were made at the South African blood services in 2020, of which 4537 were associated with donor adverse events (DAEs). This resulted in a steady DAE rate of 0.438 per 100 donations compared to previous years. Vasovagal reactions were the most commonly reported DAEs (80.23%), followed by haematomas at the venepuncture site (13.8%).

Several recommendations were proposed by the blood services with regard to the promotion of haemovigilance in South Africa, including ongoing support of restrictive blood product usage in keeping with Patient Blood Management (PBM) principles2 to avoid unnecessary risk to patients. The blood services are reliant on the recognition and timeous reporting of transfusion-related adverse events for accurate haemovigilance surveillance, and we are grateful for the assistance of those who contribute to this. Specific focus is encouraged on the prevention of misdirected, incompatible transfusions by educating hospital staff to be vigilant at each step of the transfusion process, particularly during patient verification prior to transfusion. There is also ongoing encouragement of the South African population to increase the blood donor percentage to above 1%.

The 2020 South African Haemovigilance Report is available here. Please refer any queries to Dr Caroline Hilton, Head – Medical Division WCBS (

  1. Manyoni M & Abader N. The effects of the COVID-19 lockdown and alcohol restriction on trauma-related emergency department cases in a South African regional hospital. African Journal of Emergency Medicine. Vol 11. Issue 2. Pg 227-230. June 2021.
  2. Thomson J, Hofmann A, Barrett CA, et al. Patient blood management: A solution for South Africa. S Afr Med J. 2019;109(7):471-6.

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