HEALTH SECTOR
BLOOD TRANSFUSION SERVICES
The National Blood Transfusion Center (NBTC) was established in 1960. There is a blood bank in each governorate and some hospitals have transfusion units which are not authorised to collect blood donations. The NBTC is the administrative responsibility of the First Deputy Minister of Health and with technical supervision by the MOH Technical Affairs. Since 1990, regulations concerning blood have not been enforced and no systematic inspections have been carried out. The NBTC organizes the on-site collection of blood as well as mobile collection units at schools, army, churches and. They perform basic tests like blood groupings and cross matching and screening tests for blood-borne communicable diseases. The NBTC is the only unit that distributes blood to health facilities. It supplies fresh blood and derivatives to 30 public and 40 small private polyclinics (small hospitals). Only about 10% goes to the private sector. Hospitals are not allowed to collect blood except in rare cases of life threatening.
The blood transfusion service was inadequate prior to the 2003 war. Even before 1990 the NBTC and the blood banks failed to meet international standards. It normally collects 100,000 450 ml blood bags a year. 60 % of these are separated into plasma and other derivatives. According to the NBTC management this quantity covers about half of the needs for fresh blood and 10-20 % for blood components. The capacity fell by about half after the 2003 war.
The NBTC was the only unit in Iraq equipped to separate platelets, plasma and cryoprecipitate. The equipment is old and no blood separation is now possible. The centre has about 140 staff, comprised of 28 university graduates (doctors, pharmacists and biologists), 61 laboratory assistants and 51 support staff . The governorate blood banks have about 20 staff each.
Blood banks have no administrative or technical/supervisory linkages with the NBTC. In Baghdad, the blood transfusion services (BTS) have been always considered separate from laboratory services. In all other governorates, the BTS are part of clinical laboratory services.
Blood bags are screened for HIV, HbV, HcV, and syphilis. Positive tests are transmitted monthly to Preventive Medicine Department of the MOH. About 1-3 % of blood donations found to be infected by hepatitis B and 1 % by Hepatitis C. According to the NBTC management, no tests have been positive for HIV.
WHO carried out a study on laboratory systems in October 2000 in Dohuk, Erbil and Suleiymaniyah. Laboratory and blood transfusion services lacked essential reagents. There was no referral system or quality assurance system.
In 2000 MOH and the NBTC had developed a plan to reorganise the blood transfusion services into a central “National Blood Transfusion Organisation” based in Baghdad and to expand gradually the blood transfusion services in governorates. The new centre would have five main activities:
· Collection (i.e. organisation of blood collection, selection of proper equipment and vehicles)
· Preparation (i.e. storage, separation),
· Qualification of blood products to ensure there are of required quality
· Distribution
· Immuno-haematology
The suggested centralisation was in line with the recommended international blood transfusion standards aimed to ensure safe blood products. As a first step toward this plan, NBTC was partially rehabilitated with the support of WHO and the French NGO “Premiere Urgence” to serve as the training centre.
NBTC management now wants to develop the Iraqi National Blood Transfusion as planned. Until this occurs, actions are needed to:
· Ensure that reagents and laboratory equipment are ordered on time
· The NBTC oversees governorate blood banks and serves to refer blood
· Insure adequate training
· Update existing regulations
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