In Blood

B.D.S

The idea of writing brief information about majority of countries in this region is to give an idea to readers about diversity among all countries in terms of size of the country, population, blood collection, types of BTS, presence of national blood policy and existing regulations. It is evident that there is no similarity on above parameters on member countries. Even the size of the country does not influence the quality of BTS. Three relatively larger countries i.e. India, Bangladesh and Pakistan have highly fragmented BTS. On the other side, smaller countries like Sri Lanka have set an excellent example of a nationally coordinated effective BTS. If we analyze above data, we can see that voluntary blood donation is high in Sri Lanka (86%) and Thailand (> 95%). On the other hand, Pakistan (~90%) and Timor-Leste (80%) has high dependence of family relative donors. Paid blood donors are discouraged by all international agencies like WHO and International Red Cross Crescent Society (IRCS). However, paid donors exist officially in Pakistan and Bangladesh and about 10% blood is collected from this source. In the region, only 66% blood is collected from voluntary sources and repeat voluntary donors are still less in number. If we look into total yearly requirement, this region needs more than 17 million units and there is a deficit of 6.5 million units every year.

Testing for infectious markers is the basic necessity to make transfusion safe. As per country regulation, types of tests and minimum standard are defined by each country. Every country is supposed to do at least three viral markers like HIV, hepatitis B and C. Thailand is the only country which does NAT testing

regularly on majority of blood units collected to reduce the possibility of viral diseases transmission. However, 20-40% of total blood units are not screened in Pakistan for any disease markers probably due to weak regulatory surveillance system. All other countries do these tests as on record. It is a well-known fact that carrying out tests in BTS is not sufficient unless proper quality system is implemented. Most of the countries need properly managed quality management system assisted by international agencies like WHO or by an intra governmental organization like SAARC or ASAIN. It would have been ideal if an accreditation or a grading program could have been planned for these countries for measuring continuous quality improvement.

Another weak area is the component preparation and rational use of blood. Only 37% blood is separated into component and remaining 63% is transfused as whole blood. Demand for component is limited due to lack of awareness among clinicians and non availability of sufficient components. Both are a vicious cycle. Component preparation may increase economical use of a scarce resource and reduce dependence on blood donors. It needs a commitment for all stake holders like government, blood bankers and clinicians.

Another area which needs improvement is hemovigilance. It is almost nonexistent in this region due to lack of proper coordinating agency at inter and intra country level. Therefore, we do not know long-term implications of blood transfusion on patients in this part of the world. Lack of governance and commitment from governments and regulatory bodies allows BTS to slip down from desired quality standard. Even many blood centers do not follow minimum quality standard for their financial gains, especially in private sectors. A good example is unscreened blood transfusion in Pakistan and continuance of paid donors in Bangladesh and Pakistan. Probably, the only way out is the community mobilization with multipronged approached involving, all stake holders including general public, government, blood bankers, clinicians, NGOs, international agencies like WHO/ IFRC and various funding agencies. It is time to work together.