The need for well-organized blood donation and transfusion services is critical for the safety and efficacy of blood products. Blood safety, or hemovigilance, refers to a set of surveillance procedures that encompass every stage of the transfusion chain. The term hemovigilance is derived from the Latin word for ‘watchful’ (‘vigilans’) and Greek term for blood (‘hema’) and has the goal of improving the safety of blood transfusion.
Blood Donation. Image Credit: LightField Studios/Shutterstock.com
According to the World Health Organization (WHO), integrated strategies of hemovigilance can substantially reduce the worldwide burden of disease from unsafe blood transmission. For example, an estimated 3% of all HIV infections globally are transmitted via transfusion of contaminated blood. To ensure that national systems of hemovigilance are robust and fit for purpose, the WHO make the following recommendations:
- Nations should establish blood transfusion services that are controlled at the national level,
- Blood donations should only be collected from low-risk groups, who volunteer donations without remuneration
- All donor blood should be tested for blood grouping, compatibility, and transmittable disease
- Unnecessary transfusions should be minimized.
National blood transfusion services
The WHO maintains that the responsibility to ensure a safe and sufficient blood supply is essential to public health and consistency in the quality and supply of blood products is not possible without a nationally coordinated service and blood policy. Whilst this government responsibility may be delegated to a third sector non-profit organization, the transfusion service should form part of the nation’s overall healthcare infrastructure.
The key activities involved in establishing a robust blood transfusion service should include formal government support, including a commitment to sustaining services via budget allocation or cost recovery, development of national blood policies and plans, supported by appropriate legislation and governance, and the development of a national quality monitoring system.
Case study: Better Blood Transfusion in the United Kingdom
In 1999, the United Kingdom established national guidelines for the safe administration of blood which have been used as a blueprint for hospital transfusion policies across the country. These guidelines followed a Department of Health Service Circular, issued in 1998 with the focus on improving the safety of blood transfusions. This was expanded on in 2002 to include recommendations on the appropriate use of transfusions.
At the same time, the Serious Hazards of Transfusion (SHOT) scheme was established. This is a confidential national reporting system for significant patient events and ‘near-misses’ and includes categories such as ‘patient transfused with a product intended for another patient’ and ‘posttransfusion infection’.
Voluntary blood donation
The first step in preventing the transmission of bloodborne infections through the route of transfusion is the blood donors themselves. Voluntary donors are the safest donors because they are motivated by altruistic reasons, or a sense of social duty, rather than due to pressure or financial factors. This means they are highly unlikely to withhold information regarding their lifestyle or medical history that would render them ineligible to donate.
Paid donors, by contrast, have been shown to more often lead lifestyles that expose them to the risk of HIV or hepatitis, be undernourished, and in poor health generally. They may be reliant on donations as a means of income, placing them at risk of exploitation and reducing their motivation to be truthful during health screenings.
Research has shown that voluntary donors have significantly lower levels of transfusion-transmissible markers of infection, with the lowest rates found among regular donators. The highest rates of infection markers are found among paid donors.
Testing all donated blood
As part of wider transfusion policies, transfusion services should include national strategies for the testing of all donations, including deployment of the most reliable and valid tests and rigorous laboratory standards.
The WHO specifies that all blood donations should be tested for relevant infectious diseases. The National Health Service (NHS) Blood and Transplant Service specify that every donation should be tested for syphilis, hepatitis B, C & E, and HIV. First donations should also be tested for HTLV, and additional tests for diseases such as malaria and West Nile Virus should be conducted if the donor has traveled to certain areas.
In addition, first donations should be tested for blood type and all donations should be tested for non-specific reactivity. This may affect the eligibility of donors in the future to minimize transfusion reactions.
Unnecessary transfusions should be minimized
Although blood transfusions play an important role in emergency medicine and the treatment of acute illnesses, they also carry the risk of transmission of infections and post-transfusion complications.
Such risks associated can be reduced by reducing unnecessary transfusions through the appropriate use of simple alternatives to transfusion which cost-effective and safer. Such alternatives include:
- A commitment to early intervention in the treatment of conditions that can lead to the need for transfusion
- Effective clinical use of intravenous replacement fluids such as crystalloids and colloids. Crystalloids are electrolyte-containing solutions that expand plasma volume (and therefore circulatory volume) without changing the chemical balance in vascular areas. Colloids work similarly but remain in intravascular areas for longer
- Increasing the use of pharmaceutical medicines and devices
References:
- Beal, R. W., & van Aken, W. G. (1992). Gift or good? A contemporary examination of the voluntary and commercial aspects of blood donation. Vox sanguinis, 63(1), 1–5. https://doi.org/10.1111/j.1423-0410.1992.tb01210.x
- Jain, A., & Kaur, R. (2012). Hemovigilance and blood safety. Asian journal of transfusion science, 6(2), 137–138. https://doi.org/10.4103/0973-6247.98911
- Stainsby, D., Jones, H., Asher, D., Atterbury, C., Boncinelli, A., Brant, L., Chapman, C. E., Davison, K., Gerrard, R., Gray, A., Knowles, S., Love, E. M., Milkins, C., McClelland, D. B., Norfolk, D. R., Soldan, K., Taylor, C., Revill, J., Williamson, L. M., Cohen, H., … SHOT Steering Group (2006). Serious hazards of transfusion: a decade of hemovigilance in the UK. Transfusion medicine reviews, 20(4), 273–282. https://doi.org/10.1016/j.tmrv.2006.05.002
- Taylor, C. J., Murphy, M. F., Lowe, D., & Pearson, M. (2008). Changes in practice and organization surrounding blood transfusion in NHS trusts in England 1995-2005. Quality & safety in health care, 17(4), 239–243. https://doi.org/10.1136/qshc.2007.023895
- https://www.who.int/
Further Reading