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1. Blood transfusion Services Wigina R N Blood Transfusion

2. Basic functions of a centre Organization of the service Recruitment of donors Collection processing storage and distribution of blood and blood components Laboratory investigations Participation in clinical use of blood Training and teaching Research and development

3. WHO/ ISBT Recommendations NBTS should be based on Voluntary Non Remunerated Blood Donations (VNRBD)/Autologous Implementation of a national strategy for the screening of all donated blood for TTIs using most appropriate and effective assays To enact effective legislation governing blood transfusion service operations

4. To provide adequate service. Adequacy means availability of at least whole blood, red cells, platelets,FFP,cryoprecipitate (FVIII) and plasma Establishment of Register of VNRBD To establishment a voluntary donation unit within blood transfusion service Training of staff in blood collection and laboratory staff in all aspects of blood processing, especially screening, grouping, antibody screening, compatibility testing, component preparation and issue of products

5. Monitoring and evaluation of clinical use of blood To establish cooperation between the blood transfusion services, health services, hospitals, educational institutes, mass media and the public.

6. Formulation of a National Blood Programme This is the responsibility of the national government. Should formulate a N ational Blood Policy that recognises blood transfusion as a standard method of treatment. The policy should include details of: legislation and rules Delegation eg to Red Cross Role of any commercial enterprises involved Role of other bodies eg professional bodies

7. Formulation of a national policy prevents uncoordinated and uncontrolled establishment of blood banks of dubious quality Enhances ethical practices eg elimination of paid donors. The Code of Ethics for Blood Donation and Tranfusion (ISBT) should be used to guide National Policy

8. Alternative structure Depending on the specifications of the national policy, blood transfusion services may be administered by different organizations: Govt Blood transfusion services (central /regional) Red Cross Red Crescent ( Islamic countries) Hospital based blood banks Commercial Enterprises All five types may coexist in one country, depending on the national blood policy specifications

9. Development of a National Blood Transfusion Service General considerations : establishment should be based on most up-to-date scientific and practical principles. However in a developing country, use of modern techniques and sophisticated equipments should be undertaken only when justified by workload and when funds, supporting infrastructure and technical expertise is available locally. Consider accurate cost efficiency to make best use of available national resources

10. WHO structure recommendation

11. Organization NBTS service may be centralised, regionalised, or hospital based This model is not rigid and depend on size of country and population, and the national blood policy. For example, small countries may have centralised centres whereas large countries may have regionalised centres. But many countries have a mixed system

12. Centralised service: one national centre operates the services for the whole country with or without satellite centres. There is better coordination and quality assurance but may be cumbersome in large countries Regionalised service: regionalised centres that have a degree of autonomy but with a mechanism of achieving national control. Suitable for large countries, but it may be difficult to maintain quality standards

13. Evolution and Levels of service Inadequate Basic-adequate Basic-fullrange Highly productive Advanced sophisticated

14. Stage Products TTIs Grouping Xmatch Storage Other Inadequate Whole blood only None ABO None or slide at RTP Uncontrolled - 2 Basic adequate Whole blood Syphilis, HBsAg, HIV, ABO, D (tube /Micro plate) Major 37 C Controlled - 3. Basic , full range Red cells As in 2 As in 2 + donor Ab screening AHG As in 2 Antibody ID 4. Highly productive WBC, RBC (0-30%plasma) As in 2 As in 3 As in 2, Ab Screening As in 2 Reagent production 5. Advanced Platelets, CryoP , FFP As in 2 As in 3 (patient) As in 3 As in 2 As in 3 6.Sophisticated/Advanced As in 3, RBC use of AS + 4,+frozen/washed RBC + 5 As in 2 As in 3 As in 3 As in 2 As in 3 Automation, tissue and stem cell banking

15. Personnel National and regional centres should be headed by personnel with appropriate postgraduate training in Transfusion Medicine- Role: make and enforce Policy Overall Responsibility Technical director : T echnologist with training in Transfusion Role: operations, Management: Administrative duties. Do not need any medical training Donor Panel Organizers ( DPO )- training in logistics Technologists Phlebotomists Public relations Support staff

16. Donor Policy and Recruitment Donor recruitment Donor questionnaire Donor retention Donor incentives Donor Records Donor Monitoring

17. Donor recruitment Successful recruitment Donor Panel Organisers( DPO ) whose responsibilities are: Recruitment and prior event publicity Organization of donor panel Maintaining donor records and contacts Organizing collection programme in consultation with the regional centre director or technical director Reporting the overall status of the donor panel DPOs should be the liaison between community and the centre

18. Donor questionnaire Donor Heath Assessment Questionnaire ( DHAQ ) A tool used to select eligible Donors. This is central to blood safety. VNRBD information more accurate than from paid donors A self Administered donor Self-Exclusion Questionnaire SEQ is a recent development (ISBT) Donor screening –Registration, Medical history, Physical exam, Simple laboratory tests Donor questionnaire is the most important(medical History

19. Designing DHAQ Self administered section- deals with the Donors Heath status HCP assisted section : high risk behaviour leading to donor Deferral. An alternative is the SEQ , and which may be superior (Goldman et al, Transfusion, Vol 46, 2006) DHAQ is the only method of deferring donors at risk of CJD, vCJD, chaggas disease, kalaazar and babesiosis since no tests are available for donors.

20. Donor Selection and deferral The DHAQ should elicit at least the following information to allow selection or deferral: Previous donation Previous rejections and reasons thereof Pregnancy and childbirth Surgical procedures major illness Previous transfusion Unexplained weight loss and lymphadenopathy Drug history e.g anti-platelet agents, antibiotics, etc Hepatitis, Malaria, cancer, immunizations The DHAQ is dynamic and should be amended PRN

21. Donor Deferral Permanent deferral (rejection)- Cancer, bleeding disorder, Hep B, age, HIV, heart lung and endocrine disease e.g. thyrotoxicosis High risk behaviour e.g homosexual contact, IV drug use Short term deferral- (weeks to months) Minor illnesses, antibiotics, anti platelet agents, immunizations etc. Multiple sexual partners Long term deferral- ( 1 year) Previous transfusion, Jaundice -

22. Donor incentives The WHO discourages remuneration but encourages donor incentives Incentives are tools for image building for the donor Should be tokens of minimal monetary value and should be given infrequently Remuneration must not be disguised as incentives May include badges, inscribed plaques, pens, letters of acknowledgment, and annual prize giving for repeat donors e.t.c

23. Donor Retention Strategies Donor retention dependent on purposely designed Mobile collection units Static centres Ensure donor comfort, convenience and meet donor expectations Collection venues should be cheerful, attractive reception, with adequate seating arrangement. Light refreshments should be provided Mobile collection centres or blood buses attract people to donate for the first time on ‘‘impulse’’ Staff-confidence, friendly, professional, Efficient and personal warmth Interpersonal skills

24. Estimation of Donor Requirement May be based on fixed percentage e.g. 5% of population (WHO recommendation). Based on total number of hospital beds e.g. 5-15 units/bed/year. This is more realistic for a region Based on number of ACUTE BEDS. This is more realistic for a hospital. Lower ratios for hospitals dealing with pregnancy and trauma Higher ratios for hospitals dealing with specialties like oncology, open-heart surgery, transplantation, thallasemia , hemophilia , leukaemia etc. A combination of either or all the above.(Hybridization)

25. Blood collection Static centres But may include a walk–in voluntary blood donor collection centre Mobile collection centres.

26. Screening for transmissible infections Hepatitis B Virus Hepatitis C Virus HIV CMV Syphilis Malaria ‘Look back’ programmes

27. Quality Assurance Standards Main areas requiring attention in quality assurance Clerical procedures in all sections GMP Provision of SOPs Specification for and quality control of reagents Blood donations and Samples Collection storage transportation Reporting system for errors and adverse reactions Testing Automation Computation

28. End of Lecture Comments Questions Thank YOU!