Clinical Use of Blood
An
essential measure towards improving the quality of the transfusion process is
the rational clinical use of blood. As the initial step, the SBTP team designed
a standard training module for clinicians and nurses on clinical use of blood
based on a WHO template and conducted a pilot workshop in Islamabad (2011). The
major outputs of the workshop included the development of a standardized blood
request form and TOR for hospital transfusion committees (working group
activities). Moreover, the pilot seminar brought forward the requirement of a
more thorough, step-wise intervention in this area.
National CUB Guidelines
An essential measure towards
improving the quality of the transfusion process is the rational clinical use
of blood. Effective clinical use of blood requires clinical transfusion
guidelines to be in place. In this priority area, the SBTP team facilitated the
formulation of a task force from representatives of the Medical Associations. The task force consisted
of a ‘Core Group’ and ‘Corresponding Members’. The core group representing haematologists and one or
more members from each of the medical associations of Pakistan dealing with
haemotherapy (oncology, anaesthaesia, surgery, gynaecology, paediatrics,
orthopaedics, neurosurgery, medicine and cardiac surgery) held several
Technical Meetings for this purpose in Lahore. The first edition of the
guidelines for the clinical use of blood in Pakistan was developed in 1999
which remained un-implemented. During development of the document, a special
emphasis was placed on the applicability of the document to most facilities in
Pakistan. An effort has been made to include all of the common clinical
situations requiring the use of blood/blood components. These guidelines are,
however, not absolutely binding and situations may arise in which deviations
based on the clinical judgment may be required. The purpose of this document is
to assist clinical decisions about the transfusion of blood and blood
components. Many of the conventional and widely taught indications for the
transfusion of blood components are not justified, resulting in irrational use
of blood and wastage of this scarce resource. The document is intended for all
clinical staff dealing with blood and blood components including nurses, ward
and theatre staff. The document is divided into four parts. The first one
provides background and the rationale for the development of the guidelines.
The second one provides guidelines for the storage, issuance and transport of
blood and components. The third section contains guidelines for the transfusion
of blood and components. The fourth section provides guidelines for the use of
other blood products. In the month of
September 2012, a workshop was held in which these guidelines were approved
formally and a work plan was formulated for the implementation of these
guidelines which included the institution of the hospital transfusion
committees (HTCs) and incorporation of these guidelines in the medical
curricula. The primary target groups of the CUB Guidelines developed are
the clinicians of the 60 hospitals included in the current phase of the
project. However, as the guidelines are
intended to be ‘national’ the dissemination process will ideally be beyond the
group of 60 public hospital blood banks and eventually include hospitals
outside this sub-system as well as teaching institutions.
TOR Hospital Transfusion Committees
Hospital
Transfusion Committees will play a key role in the dissemination and adoption
of the CUB guidelines. HTCs are very suitable for this purpose, as their
members typically include blood bank, hospital management and clinical people,
and their regular meetings allow a well-documented follow-up and learning
process under the concept of haemovigilance. The SBTP team has prepared TOR for
the smooth functioning of the committee and is promoting the
institutionalization of HTCs in the hospitals though advocacy, sensitization
and also through the BTAs.
Pakistan Haemovigilance Network
A network has been created in a workshop in Islamabad.
The founding members have agreed to extend the knowledge gained to other
potential members. The network will guide the management of haemovigilance data
which includes the identification and documentation of all adverse reactions, notification
of Serious Adverse Reactions and Events (SARE) by Blood Centres. The scope of
haemovigilance will, however, eventually have to be extended to donors and to
the surveillance of products/processes.
Handbook of Clinical Transfusion
Practices
The Safe
Blood Transfusion Programme derived a ‘Handbook of Clinical Transfusion
Practices’ from the WHO’s The Clinical Use of Blood with the permission of the
WHO. The pocket handbook is designed for quick reference to promote rational
use of blood components and avoid unnecessary blood transfusions. The Handbook
is not designed to replace the conventional textbooks or to provide a
definitive text on the clinical use of blood. Rather, its purpose is to provide
an easily accessible learning tool that will assist prescribers of blood to
make appropriate clinical decisions on transfusion and contribute to wider
efforts to minimize the unnecessary use of blood and blood products. It is
expected that the use of this document in the Pakistan healthcare system will significantly
improve the blood transfusion practices in our hospitals. It will also help
overcome to a large extent the chronic shortage of blood and blood components
in our blood centers and promote the rational and judicious use of blood and
blood components.