Strategy for Safe Blood Transfusion: Introduction

World Health Day 2000

Strategies of Safe Blood Transfusion

Transfusion- Associated Infections in South-East Asia

BLOOD TRANSFUSION is the most efficient mode of transmission of infectious agents, such as HIV and hepatitis B and C. Transfusion-transmitted infections are also the most easily preventable and can be substantially reduced by the following strategies:

Establishment of an organized blood transfusion service

Careful selection of donors to ensure that blood is collected only from low-risk, voluntary non-remunerated donors

Screening of donated blood for presence of infectious agents such as HIV, HBV, HCV, etc.

Appropriate use of blood

Blood transfusion service (BTS) is an essential component of the health care system. The primary objective of this service is to ensure safety, adequacy, accessibility and efficiency of blood supply in an efficient, cost-effective and coordinated manner. Blood and blood products must be made available wherever and whenever they are required. It is necessary to plan blood collection after assessing the demands, including contingencies. It is imperative to observe high technological and clinical standards and provide assurance of safety to both donors and recipients through good manufacturing, laboratory and hospital practices as well as good clinical approach. In addition, blood and blood components should be appropriately utilized to ensure their availability for patients in need as well as to avoid unnecessary risk of transfusion-transmitted diseases.

A well-organized national blood transfusion programme is needed in all Member Countries to ensure effective and efficient implementation of these strategies to provide safe blood to all those who need it.

Provision of safe blood to the community is one of the responsibilities of the government. Ensuring blood safety requires government commitment and support in terms of resources, both human and financial.

Transfusion-Associated Infections in South-East Asia

Transfusion of blood and blood products accounts for approximately 5-10% of the global HIV infection. In some countries of the South-East Asia Region, blood transfusion contributes substantially to HIV infection and AIDS. For example, nearly 7% of AIDS patients reported to the National AIDS Programme in India acquired infection following transfusion of infected blood and blood products.

Much progress has been made in all countries in the provision of safe blood through appreciable increase in the proportion of donated blood tested prior to transfusion, the safety and quality of blood still varies greatly among countries in South-East Asia. Almost all donated blood is screened for HIV in many countries, including Thailand, Indonesia, Maldives, Nepal and Sri Lanka. However, for other countries in the Region, particularly India, Bangladesh and Myanmar, safe blood transfusion still remains an issue of major concern needing commitment and support both at national and international levels.

Developing Blood Transfusion Service

In many developing countries, particularly in the South-East Asia Region, little importance has been given to the subject of transfusion medicine. Keeping in view, however, the risk of transfusion-transmitted infections that is appreciable in many countries, there is an urgent need for developing strategies for safe blood transfusion in the Region. Moreover, with the advances in medical and surgical specialities, the demand for blood and blood components has also increased throughout the world, and South-East Asia is no exception. The absence of a coordinated national blood transfusion programme in some countries can make it difficult for the BTS to meet these requirements.

The basic strategic priorities in the development of BTS and of the national blood transfusion programme are:

Education, recruitment and retention of low-risk donors

Testing of donated blood for transmissible agents

Rational use of blood

Capacity building and training of staff

To implement these strategies effectively, government commitment is necessary. The governments should recognize their responsibility to fully support national blood transfusion programmes which could include:

Developing a national policy and a plan for blood transfusion services

Establishing a national blood transfusion programme

Identifying the responsible authority and building partnerships

Appointing a management structure and assigning responsibilities

In order to ensure an effective and efficient blood transfusion service, national blood transfusion programmes should be established in all countries and full support provided to it.

There is also a need to develop guidelines for appropriate use of blood, autologous transfusion, use of recombinant blood products, pharmacological options and simple blood substitutes i.e. crystalloid/colloids. The option of contract fractionation should be considered where plasma derivatives are required.