The pre-transfusion testing system of blood in all the hospital transfusion services around the country is incomplete, and patients sometimes receive blood transfusions before testing is done for transmissible infections.
This was identified as one of the weaknesses of the local blood transfusion service in the National Strategic Plan for Blood Safety, which was recently launched.
Providing an analysis of the current situation, the document, which outlines a five-year plan for improving blood safety practices, noted that the potentially catastrophic situation results from organisational problems.
The lack of clinical guidelines for the appropriate use of blood and its products is also another area of concern which was identified.
The report noted that the lack of knowledge of minimum requirements of the blood cold chain, particularly during transportation, holding on the ward, and infusion, also contributes to flaws in the system.
There needs to be greater temperature control of the refrigerators, with the appropriate knowledge of the reasons and frequency for checking and control of temperature of the blood during the infusion of patients, the document posited.
It added that transfusion-related record-keeping in the clinical setting is almost non-existent and there is no information available for the purposes for which blood and its products are actually being used.
There is also no information on adverse reactions to blood, the blood provided but not used, and how much is returned.
Pointing out some deficiencies in the staffing capacity at the National Blood Transfusion Service, the reports noted that some senior staffers have additional responsibilities outside the scope of the blood programme.
An example of this is given as the chief technologist, who is an employee of the FXB, and provides only part-time service to the Blood Bank.
“ Some staff are also taken up with providing non-blood banking services, such as clinical infectious disease testing, routine testing services for the Ante-Natal Clinics in Region Four, and HIV testing for VCT and PMTCT sites and the GUM Clinic” the report said.
The lack of support from a National Blood Policy and the relevant legislation within which to operate were also cited as distinctive weaknesses of the NBTS.
Another major and long standing challenge is that the current blood supply of the Blood Transfusion Service is not enough to meet the demand.
The documents report that inefficiency in the system led to only 67 percent of the blood needs being garnered from prospective donors in 2004, which it stated may well be the result of an almost total dependency on family replacement rather than volunteer blood donors.
Touching on some of the threats to the improvement of the system, it was noted that the low salaries paid to public servants is a disincentive to trained professionals for continued employment , and contributes to permanent migration to other countries by the public sector staff seeking a better standard of living.
The success of the Blood Transfusion System depends on complete faith that the system will respond in a timely fashion to requests, but the report pointed out that physicians have expressed several concerns about the sufficiency, safety, and inordinate delays in providing blood.
These concerns, it was noted, could lead to the misconception that having their own banks would improve the situation.
The document also posited that the delay in finalisation and adoption of the National Blood Policy and Legislation could contribute to delays in the implementation of a coordinated system.
However, some strides have been made regarding the local blood service system.
Although the system continues to operate with several sites, (one additional private hospital having been added to the mix), it is more coordinated.
The NBTS provides reference services and clinical testing services to all hospitals, public and private.
It also provides 82 percent of the blood supply needed, and tests all the units issued for transfusion for HIV, HBV, HCV, syphilis and malaria.
The possibility of adding HTLV1 and 11 as a routine test is being currently evaluated.
Through the President's Emergency Plan for AIDS Relief (PEPFAR), the American Association of Blood Banks (AABB) is providing technical assistance to strengthen the existing system. In collaboration with the NBTS, the AABB is developing and delivering high quality training for personnel at all levels to improve their knowledge and skills. Personnel from the regional and private hospitals are also to benefit from these training opportunities. Other opportunities are also being provided through CAREC.
• The current funding and equipment available at the NBTS is considered adequate for the current needs, the report states.