Looking Toward The Future… Ensuring a Safe Blood Supply

The South African National Blood Service (SANBS) is responsible for the collection of over one million units of blood annually and offers a world-class product. Receiving a blood transfusion in South Africa is as safe as in any developed country.

Blood donor recruitment in South Africa is based on a World Health Organisation endorsed programme, which specifies the selection of voluntary, non-remunerated blood donors. Low-risk blood donors have been identified as volunteer blood donors who give blood solely for the sake of helping others. Securing and maintaining a safe blood supply in a country with one of the highest HIV infection rates in the world is a constant challenge to SANBS.

The HIV/Aids pandemic in South Africa has focused particular attention on the importance of preventing transfusion-transmitted infection. In the past, strategies to promote blood safety tended to focus primarily on screening blood for transfusion-transmissible infections (TTIs). However, while systematic screening is essential, it is insufficient in itself to ensure the safety of the blood supply.

SANBS' strategy for blood safety emphasises an integrated three-fold approach. Effective quality assurance forms an essential part of this approach.

1. The collection of blood only from voluntary non-remunerated blood donors from low-risk populations and the use of stringent donor selection procedures.
2. The screening of all donated blood for transfusion-transmissible infections, including HIV, hepatitis viruses, syphilis and other infectious agents, and blood grouping, compatibility testing and processing of blood.
3. A reduction in unnecessary transfusions through the appropriate clinical use of blood, including the use of intravenous replacement fluids and other simple alternatives to transfusion, wherever possible.

-::- Recruiting voluntary, non-remunerated blood donors -::-

The SANBS employs various educational strategies to inform members of the public and regular blood donors of issues pertaining to the supply of sufficient, safe blood. The message of safe blood is disseminated with the assistance of local and national media and by conducting educational talks.

Potential blood donors, including regular blood donors, are required to complete a self-exclusion questionnaire each time they wish to donate blood. They also need to undergo a 'mini-medical', where trained staff checks their haemoglobin level and blood pressure and ensures that the donor is healthy and not at risk of contracting sexually transmitted diseases, prior to their blood donation.

If the potential donor is unable to donate blood due to a health or medical reason, they are deferred for a period of time. People who participate in sexual behaviour, which places them at increased risk (such as having casual sex or men who have sex with men), are told to please NOT donate blood and are not accepted as blood donors.

The commitment, honesty and responsibility of regular blood donors ensures the safety of the blood supply. SANBS therefore encourages donors to give blood for purely altruistic reasons - solely for the sake of helping others.

-::- Behind the scenes -::-

Laboratory testing systems have changed from a previously semi-automated system to a fully automated system where sampling and processing occurs on the same instrument.

SANBS ensures that, before transfusion, all donated blood is tested for:

• HIV 1 and 2;
• Hepatitis B;
• Syphilis; and
• Hepatitis C.

SANBS has developed a national policy and strategy to ensure the systematic and effective screening of blood for transfusion-transmissible infections. This requires:

• The development of protocols for the testing, selection and evaluation of the most appropriate and effective screening assays to be used;
• The development of quality systems for screening, blood grouping, compatibility testing and component preparation;
• The training, updating and continuing education of laboratory technical staff;
• The central procurement, storage and distribution of reagents and materials to ensure continuity in screening; and
• An adequate budget.

All donated blood units are also routinely tested for ABO and Rh (D) blood grouping and red cell antibody screening.

Good laboratory practice using standard operating procedures and the maintenance of an effective blood cold chain for the storage and transportation of blood and blood products is stringently followed.

Did you know?

• If one delves into the interestinghistory of blood transfusion, one discovers that the testing for transfusion transmissible diseases began as early as the 1940's! Testing for syphilis started in the early 1940's, hepatitis in the late 1960's and testing for HIV occurred during the mid 1980's.

Quality Assurance

This department ensures that all blood and blood components processed by the Service comply with the required standards. This is achieved through a system by which products are tested while they are being manufactured, and also at the end of processing. Quality Assurance ensures that all blood components and activities carried out by the Service meet required specifications.

Reducing unnecessary transfusions

The primary responsibility for ensuring the appropriate clinical use of blood lies with clinicians. However, the SANBS plays a key role in promoting effective transfusion practice by contributing to the development of a national policy and guidelines on the clinical use of blood.

For more information on blood donation or your nearest blood donor centre, call the South African National Blood Service (SANBS) toll free at 0800 11 9031 or visit www.sanbs.org.za

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