[#Eritrea’s] blood transfusion service striving towards attaining provision of safe, adequate blood supply nationwide
By Semir Seid
As far as banks are concerned, there are plenty of them. These banks include those that operate for business, loaning with interest rates; those that work for mutual benefit, building people’s prosperity; and those that open their doors to deposits other than cash. The third ones are interesting! In this regard we arrive at topic of the National Blood Transfusion Center or, as we commonly know it, the Blood Bank.
The prominence of blood and blood transfusion was initially recognized during the struggle for liberation. The two Mekane Hiwet blood transfusion centers of the 1980s were the only ones built under the Ethiopian occupation and later by the Eritrean People’s Liberation Front (EPLF) to supply blood for war soldiers. Roughly eleven years after independence, in January 2002, Eritrea created the free-standing National Blood Transfusion Center (NBTC).
In the first days of operation, the center, led by a medical director, had only a laboratory, blood donor and administrative services. Starting in 2007, however, more imperative divisions such as a quality management service and data management system were included in the organizational structure. The blood donor service is the division responsible for conducting campaigns and collecting blood from volunteers. Under this division, sections such as the donor clinic recruit as well as provide counselling services. In considering remote areas in the country, mobile teams are often assigned to deliver the same comparable services and relieve people from travelling to the centers.
Since the establishment date, the blood transfusion service has been striving towards attaining the provision of safe and adequate blood supply nationwide, to the public and private medical services. To attain this aim, the center has adapted the World Health Organization’s (WHO) recommendation for an integrated strategy to adequately and safely supply blood. One component of this strategy is the “Appropriate Clinical use of blood and blood products.” Blood components or products are any therapeutic substance prepared from human blood. These are the red blood cells (RBC), platelets (PLT), packed red cells (PRC), fresh frozen plasma (FFP) and cryoprecipitate (CRYO). The blood component section under the laboratory service started preparing these components in 2006.
Most importantly, over years of operation, the NBTC has developed the separation of blood components from a whole blood (WB). This simply means that a patient in demand of a blood component gets it separately, whether it is RBC, plasma or platelets, in line with what the injury demands instead of indiscriminately overloading the patient with WB. This is significant in that it avoids placing unnecessary pressure on the heart, allowing it to pump normally.
Pediatricians explain that it is possible to prepare more than one blood component from just one unit of blood (450ml). In the previous year, the center was able to prepare a total of 8,202 blood components and 7,252 units of blood. These figures are subject to change depending on the volume of donations accepted in any particular period of time. In normal situations, Mr. Abraham Yemane, medical director of NBTC, states that a blood properly transfused can be stored up to 35 days without spoilage and can be supplied anytime within these days to patients.
The annual target of the NBTC is to collect 12,000 units from voluntary non-remunerated donors. The estimation of 12,000 units a number approved by WHO and is calculated in relation to past blood usage, hospital beds, total population and medical facilities. The donated and accepted blood units in those years range from 7000 up to 10,000 units. Family replacement is taken as another option. Family replacement is meant to support the regular blood donations and is performed when a family member’s blood type is found incompatible with donated blood supplies.
Blood transfusion remains an essential part of modern health care. If conducted properly, it saves lives and if otherwise, endangers it. The blood collected by the NBTC is sourced from regular individual donors, governmental and private organizations, line ministries, Civil Society organizations (NUEWs, NUEYS, FBOs), high schools (main sources) and from the National Volunteers Blood Donors Association (NVBDA). According to the policy and policy regulations of the blood transfusion in Eritrea blood should not be transfused unless it has been obtained from appropriately selected, voluntary, non-remunerated blood donors, screened for transfusion-transmissible infections and tested for compatibility between donor’s red cells and antibodies in the patient’s plasma. A person’s health status, age, weight, reactions, and any doubtful behaviors are the factors that are considered before transfusion is performed. Mr. Abraham states, the awareness of society in donating blood has gradually increased over the past years. He praises the regular donors, proactively helping to address baseline demands at critical times. Campaigns are executed every now-and-then through meetings, pictorial exhibitions as well as staged dramas to enhance the willingness of society to contribute blood. It is to their benefit as it may reciprocally be transfused to them.
During the last seven years the center has received an offer of 48,209 male and 27,451 female volunteers donating blood yet only 36,158 (66.52%) and 18,201 (33.48%), respectively, were obtained from those volunteers. Failure in medical checkups post-donation nullifies blood before reaching patients. Out of the latter stated figures, blood of 1,348 male donors and of 605 females was registered as a rejected donation. Still, a total of 52,341 donor’s blood was accepted and supplied to hospitals. Family donated blood transfusions counts for the additional 10% overall blood collection, a total of 5,586 donors. Stats of the bank indicate that 71% of demand is satisfied by these amounts.
Despite the fact that schools, the main sources of blood donations, are on break during the summer, the bank arranges to meet students during the Summer Work Program by meeting them in the fields.
The Ministry of Health, through its clinical service under the medical department, arranges international relations to the center, if necessary. An organization named Swiss Red Cross (SRC) has contributed considerably in establishment of the NBTC, providing necessary equipment and played important role for the blood bank to have its current structure.
Other than the main blood bank located in Asmara, it is made possible for the Gash Barka region to have access to the same service situated in the town of Barentu. In other regions such as Southern Red Sea, particularly Assab, it is difficult to provide such services for the reason of harsh climate, refrigeration systems and transportation. Nonetheless, this doesn’t mean the regions are totally dependent on the only center in Asmara, they manage the emergency blood collection and transfusion services through their referral hospitals. The NBTC serves many hospitals across the country and the procedure of distributing blood to these hospitals is in a compromising way since it delivers the demands of all.
On top of this scarcity, Mr. Abraham strongly condemns the rumor that blood is sold, exchanged, or paid for in blood bank. The medical director addresses that there is no such marketing related with the activities of NBTC. Blood is collected freely and distributed free of cost.
The quality management service is one of the prides of the institution. It follows standards to measure every inch of activities within the center. It uses quality documents such as standards, quality manuals, Standard Operational Procedures (SOPs) and forms to assess whether activities are performing well, assess challenges and service disruptions. Audits of two types are regularly performed: the internal and external audits. The yearly internal audit is directed by the internal staff to assess every division in accordance to its mission. While the external audit is executed every three years by the WHO-recognized South African bureau of standards for blood banks. These auditors visit the center yearly for surveillance audit and every three year for certification.
As part of the assessment, Eritrea was able to earn a Certification of Quality System more than once. The first Certification of ISO 9001:2008 was on August 2010. Recertification took place in 2013 and in 2016 with “no nonconformance” rating for the center. The efficient blood transfusion of the NBTC ranked Eritrea among the top and only three countries; Mauritius and Zimbabwe being the two. The medical director proudly explains that people feel confident about the center donating their blood since safety is assured.
The intention of the NBTC is to make the bank a center of research and excellence apart from transfusing blood only. To maintain its quality, the bank is equipped with blood group testing and also infectious marker-detecting machines. The center focuses on checking infectious markers for any blood collected. These include HIV, hepatitis B and C as well as Syphilis. Donors are provided with pre- and post- counseling services and are recommended for further medical examinations, if their blood is found with some complications.
Alongside the NBTC, there is the National Volunteer Blood Donors Association. This association is the right hand of the blood bank with branches in five regions in the country. The mission of this association is allied with that of the center to solve the blood shortage in the country and provide safe blood to people while no person requiring blood dies missing it. It is a nonprofit association that targets children and mothers.
Blood sourced from the blood bank contributes significantly to cardiac and other surgeries performed on children and adults around the nation. A life saved by blood transfusion is highly important for the blood bank let alone the many successful surgeries, Mr. Abraham notes.
Staff recruited into the blood bank, new or experienced medical personnel, are given proper training before beginning work so they can seamlessly onboard into the bank’s system. The bank is run by 102 committed administrative (24) and technical staff (78). The technical staff deal with conducting campaigns, laboratory tasks, quality assurance and other technical issues.
Of course, occasional challenges are part of operations. One challenge is the fluctuation in achieving the annual target for accumulated blood. This is due to the irregularity of new donors to the bank, not to mention the regular donors.
The message of the bank to the society is to keep donating blood, just as people go for the financial banks. If the blood bank is to operate, it is with the participation of the overall population. In a similar manner performed with other banks, blood bank call for blood to balance the medical demands with the supplies and deal with saving more lives.
The perspective of the blood bank is to get as much blood as possible and achieve more than the annual target. This can only happen if people are volunteering to serve themselves and their population. The National Blood Transfusion Center optimistically looks for vigorous societal awareness.
“Blood is with everyone and everyone needs it at a certain point in time,” said the medical director in a final remark. It is scientifically proven that under normal circumstances, any average and healthy man and woman can donate blood four and three times a year, respectively. Donation by volunteers allows for a healthy population, supporting their priceless lives and the lives of others.