National blood system: current status and prospects. Organization of transfusion care in a medical institution
Background. Blood safety is a system of measures to organize equal and timely access of citizens to high-quality and safe components of donated blood in the required quantity, their safe and proper use, as well as the safety of donors and patients.
Objective. To describe the state and prospects of the development of national blood system.
Materials and methods. Analysis of available regulatory documents and literature sources.
Results and discussion. In Ukraine, there is a need to create a sustainable self-sufficient national blood system, which could include both the provision of services by medical institutions and the supervision of their provision. This system should be based on voluntary gratuitous donation. It is also necessary to coordinate and standardize such processes as blood procurement, processing, testing for transfusion-transmission infections, determination of blood group and rhesus, storage, distribution, transportation of blood and its components, monitoring of adverse reactions. The hospital transfusion committee (HTC), the hospital blood bank (HBB) and the transfusion immunological laboratory should be the part of the transfusion service of health care facilities. The functions of HTC are to determine the algorithms for the organization of transfusion care, to establish the rules for the appointment of blood and its components, and to assist in education and training of personnel and more. In turn, the functions of HBB include centralized receiving, accounting, storage and dispensing of blood or its components, control of transportation and storage of blood, introduction of alternative therapeutic transfusion methods, control of clinical efficacy assessment, hemovigilance, control of the records and documents of transfusion assistance. It is recommended to allocate four rooms for HBB: for receiving, storage and distributing blood; for collecting and processing applications; for immunohematological examinations and for the staff. Requirements for the provision of blood transfusion services in a health care facility include the organization of the listed above units, inventory management, guidance on the proper use of blood components, quality management, reporting system, and staff training. The blood centre and health care facility must work together to manage blood supplies. When transporting blood, it is extremely important to adhere to the cold chain from the moment the blood is received from the donor to the transfusion of its components to the recipient. Blood and erythrocyte-containing blood components should be stored at 2-6 °C to prevent hemolysis and microbial contamination. Plasma blood components need to be stored frozen (-30 °C), and platelet-containing – in a thermoshaker at a temperature of 20-24 °C. Depending on the type of preparation, plasma, erythrocyte and platelet preparations may have different clinical efficacy. Before transfusion, the doctor must perform a macroscopic assessment of the suitability of the blood product, determine the blood group and rhesus of the recipient, compare the result with the patient’s medical record, determine the blood group and rhesus of the donor, compare the result with plastic container label, perform blood compatibility tests, perform clinical and biological test. Reports on the serious hazards of transfusion (SHOT) indicate that there are adverse transfusion reactions that cannot be prevented, as well as reactions that can be avoided by improving practice and control, and human-related reactions. An important role in the functioning of the blood system is played by hemovigilance. The advantages of hemovigilance are to identify trends in adverse reactions, to reveal the areas for improvement in transfusion medicine, to stimulate research, to raise awareness of risk factors, and to increase the safety of transfusions for patients.
Conclusions. 1. In Ukraine there is a need to create a stable self-sufficient national blood system. 2. It is necessary to coordinate and standardize such processes as procurement, processing, testing for transfusion-transmission infections, determination of blood group and rhesus, storage, distribution, transportation of blood and its components, monitoring of adverse reactions. 3. Hemovigilance plays an important role in the functioning of the blood system.
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