Improving blood transfusion systems using an evidence-based approach

By Chris Bird, MSc Health Policy student at Imperial College and Project Manager in the System Engagement Programme at NICE

Today mark’s World Blood Donor Day – an event to celebrate and thank volunteers the world over, who generously donate blood to support life-saving care and to raise awareness of the continued need for donations of blood and blood products to support high quality safe care for patients who need it most.

The focus of this year’s campaign by the World Health Organisation (WHO) is ‘blood donation as an action of solidarity’ and highlights the fundamental human values that underline and sustain voluntary unpaid blood donation systems.

Transfusion of blood and blood products helps save millions of lives every year. It is a precious resource in the supply chain of healthcare resources and often demand for particular types of blood and blood products can outstrip the supply.

An evidence-based approach – ‘transfuse and check’

In the U.K, the National Institute for Health and Care Excellence (NICE) has published evidence-based guidance for blood transfusion to support healthcare professionals who assess for and manage blood transfusion and the commissioners and providers of such services.

The difference an evidence-based approach can make in optimising the use and stewardship of this most precious of healthcare resources, is illustrated in the ‘Tranfuse and Check’ project led by the team at Warrington and Halton Hospitals NHS Foundation Trust. As a result of implementing NICE guidance in a cohort of patients with fractured neck of femur through the development of a local protocol and full audit cycle, the team have reduced red blood cell transfusion costs and reduced the number of units transfused per patient.

Currently 47% of the world’s blood donations are collected in high-income countries, home to less than 19% of the world’s population[i]. Internationally efforts are being made to strengthen blood donation and transfusion services across the developing world. Initiatives such as the 2004 U.S President’s Emergency Plan for AIDS relief has provided approximately $437 million in bilateral financial support to strengthen national transfusion services in a number of countries that have high prevalence of HIV*.

Across these countries, during 2011-2014, overall blood collection rates increased by 19%. It’s encouraging to note that despite high HIV rates, the amount of blood donated that actually tested positive for HIV decreased in the same period, demonstrating the positive effect of local public health awareness campaigns. The U.K, through its Department for International Development also works with a number of these countries and in one of these cases, Zambia, the U.K has invested £6.5m over the past financial year into strengthening its national health systems[ii].

Improving blood management in Zambia

In the city of Lusaka, Zambia, through its international development programme, the U.K’s NHS Blood and Transplant service has worked with the principal University Teaching Hospital (UTH) to improve the management of major haemorrhage and to promote the safe handling of blood products. UTH Zambia is the largest hospital in the country and notionally serves the whole country.

This project was particularly concerned with post-natal haemorrhage. With over 90,000 admissions a year, a significant proportion are obstetric and maternity in-patient admissions. Perioperative mortality at UTH is very high and usually avoidable. It is commonly due to systems failures. Lack of availability of blood products is the leading systems cause of perioperative mortality at UTH. For example, in 2014, around 7.2 units of whole blood were collected per 1000 people in Zambia compared with 17 units per 1000 population in South Africa.[iii]

The project, supported by the Tropical Health and Education Trust and Zambian National Blood Transfusion Service and UK Aid sought to improve the management of major haemorrhage and introduce improved safety systems in the handling of blood products at the UTH.

Through the innovative use of a web-based interface to input blood data at the hospital in Zambia, analysis was conducted by a clinical audit manager in the UK. The findings suggested some key areas where fundamental improvements could be made. These included high levels of un-traceability of components, principally whole blood and documentation of essential parameters associated with blood transfusion practice. These were generated into an instant report which could be fed back to UTH staff to help inform and further improve local practice.

Wherever in the world you read this article, there will always be a human need for blood donation to support vital healthcare services. You should always check the local eligibility criteria before donating. Where you meet this criteria, I would encourage you to donate. In the U.K, you can register to donate blood and blood products to the NHS here.

Chris Bird MSc is a post graduate from IGHI’s Centre for Health Policy and a Project Manager in the System Engagement Programme at NICE.

References:

[i] WHO, 10 facts on blood donation. Available online at: http://origin.who.int/features/factfiles/blood_transfusion/en/

[ii] DFID, Zambia Country Profile. Available online at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/630904/Zambia.pdf

[iii] Michelle S. Chevalier, MD; Matthew Kuehnert, MD; Sridhar V. Basavaraju, MD; Adam Bjork, PhD; John P. Pitman, PhD. Progress Toward Strengthening National Blood Transfusion Services — 14 Countries, 2011–2014. Centres for Disease Control and Prevention, Weekly / February 12, 2016 / 65 (5);115–119

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