Blood Transfusion Services

Blood Transfusion Services (BTS) is the vital part of modern health care system without which efficient medical care is impossible. The aim of blood transfusion services should be to provide effective blood and blood products, which are as safe as possible, and adequate to meet patients need. A Blood Transfusion Service is a complex organization, requiring careful designing and management.

Basic Guidelines for the Organization of BTS
The development of blood transfusion service should be based upon the following recommendations of the International Society of Blood Transfusion and Immunohematology (ISBTI), and the World Health Organization (WHO)

• The development of blood transfusion service should base on voluntary and non-remunerated blood donations. Reliance on family/replacement donors should be phased out.
• The development and implementation of national strategy for the screening of all donated blood for transfusion-transmitted infections, using the most appropriate and effective assays to test for HIV 1 & 2, hepatitis B and C viruses. syphilis and malaria.
• To enact effective legislation governing the operation of blood transfusion service so that it meets the prescribed standards.
• Develop good manufacturing and laboratory practices in blood bank in order to protect the health of both blood donors and recipients of blood and its products.
• To provide safe and adequate blood and its components to meet patients need. An adequate service includes availability of at least whole blood, red blood cells, platelets, fresh frozen plasma (FFP), cryoprecipitate (Factor VIII) and plasma.
• The maintenance of a register of voluntary non-remunerated blood donors.
• To establish a voluntary blood donation unit within the blood transfusion service, with an officer responsible for the blood donation programme and designated as donor recruitment officer.
• The training of staff responsible for donor education, motivation, recruitment and selection.
• The training of staff of blood transfusion service for safe blood collection procedures, including donor selection and donor care.
• To train laboratory technical staff in all respect of blood screening, blood grouping, compatibility testing, components preparation and the issue of blood and its products for transfusion.
• To develop good laboratory practice, including the use of standard operative procedures, in all respect of blood screening, blood collection and processin.
• Monitoring and evaluation of clinical use of blood.
• To promote cooperation between the blood transfusion services, health services and hospitals, educational institutes, religious, social and industrial organizations, mass media and the general public.
• To ensure adequate and separate budget for blood transfusion services.
• Blood Transfusion Service in a country may be centralized, regionalized, hospital based or some combination of them. Once a system has been established in a region it is difficult to change. The size, history, culture, political structure, level of economic
  development and administrative control effect the evolution of blood transfusion services. So in a developing country of big size the development of centralized or regionalized blood transfusion services at the level of metropolitan and big cities, states and/or district levels is more practical.
• Estimation of donor requirement is essential for the development of blood transfusion services. Estimates of need may be based on fixed percentage (5 % recommended by WHO) of the population. But this assumption ignores the disparity between the size of population and the number of hospital beds in an area. Estimate of blood needs on the number of hospital acute beds is more realistic. The figure may vary from 5-15 units per bed per year. The lower ratios apply to hospitals where blood is needed in the management of bleeding as a complication of pregnancy or trauma or simple surgery. The higher ratios apply to hospitals with more specialized facilities like oncology, open-heart surgery, renal dialysis/transplant or replacement therapy in thalasseamia, hemophilia, leukemia, and other blood disorders.
  

Donors Recruitment Strategies
Donor’s recruitment is critical to the success of supply of safe and adequate blood and its products to meet patients need.

Donors Recruitment Strategies Are:

• Pure voluntary-based recruitment.
• Social persuasion-based recruitment.
• Remunerated-based donations.

The first two types of strategies result in voluntary blood donation, because they do not rely on monitory remuneration and the information of their health provided by these donors can be trusted. Remunerated based blood donation is done by blood sellers, who conceal the facts about their health and diseases which they may carry, about their last donation and their identity. Their blood is not safe.

Pure Voluntary Recruitment strategy:
It depends on the internally generated sense of altruism or community responsibility. A voluntary donor donates the blood on his/her own free will without distinction of caste, creed, religion, color and status of recipient and does not expect any monitory benefit from the collecting facilities or other sources at the time of donation or in future.

However, most donors do not donate blood as often as they can but small incentives like pins, badges and plaques given to donors who have donated blood to a specified numbers express appreciation to regular donors and enhance their feelings of altruism and encourage more frequent donations.

Social Persuasion-based Recruitment Strategy:
It is associated with persuasion and pressure of friends and colleagues, heads of religious organizations and political leaders to donate blood. Such donations are often associated with outdoor (mobile) blood donation drives at the work place like colleges, schools, factories, offices, or at some other place where a group of individuals collect as a social, political or religious unit.
In many cases, group or organizer promises the recruiter a minimum number of donations of blood units and the social pressure on individual member of the group is quite effective to encourage donations and to meet the promised target.

In second form of social persuasion-based strategy are replacement donors also who donate blood for specific patients, usually close friends or relatives without any monitory reward. These donors may feel an expression of their caring and concern for the recipients. The replacement donors can be easily motivated and persuaded to become regular voluntary donors. There is often undue pressure (coercion) upon the family/friends of the patients, which force them to pay professional paid donors to serve as family surrogates and donate blood resulting in unsafe supply of blood. Reliance on replacement donations may be phased out.