The Government of Pakistan, with financial and technical assistance from Government of Germany initiated reorganization of the fragmented blood transfusion services into a National Blood Transfusion System in accordance with WHO recommendations. After reform the system consists of two main components: Regional Blood Centers as production units on the one hand, and Hospital Blood Banks which use the blood products for patient care on the other hand. This separation of functions is in line with international standards and recommendations and contributes to quality, safety, cost effectiveness and adequate supply of blood. The legal framework has beenupdated accordingly and Blood Transfusion Authorities have been revived for the overall regulation of the system.

A “Regional Blood Centre” is a modern blood centre that is responsible for various aspects of collection and testing of human blood or blood components, and their processing, storage, and distribution when intended for transfusion. The RBCs are responsible to procure, process, and distribute blood and blood components. The basic functions of an RBC include mobilization, motivation and retention of voluntary non-remunerated blood donors; on-site and mobile blood collections; mandatory testing (TTI markers) and blood-grouping of donated blood; blood component preparation and storage; distribution of blood and blood components to the related hospital blood banks (HBB); appropriate documentation (donor traceability, haemovigilance); and research and development.RBCs will follow the principles of Good Manufacturing and Laboratory Practices (GMP & GLP).

The RBCsare equipped with modern, sophisticated and fully computerized medical equipment as well as well trained and qualified staff to ensure the safe transfusion of blood as per the international standards. The facility is a procurement and distribution center ensuring quality systems to regulate all activities including mobilization and retention of voluntary blood donors, maintenance of donor database, collection of blood donations and processing, screening, testing, component preparation and storage of the prepared components. The blood is collected from family replacement donors and voluntary blood donors on walk-in basis as well as through blood camps arranged by the donor motivation and recruitment teams of RBC visiting educational institutions, offices and other public places. The collected blood is then screened for Hepatitis B, C, AIDS, Syphilis and malaria and at least three blood components are produced from one blood unit.

Basic Functions of a Regional Blood Centre

1. Mobilization, motivation and retention of voluntary non-remunerated blood donors;

2. On-site and mobile blood collections;

3. Mandatory testing (TTI markers) and blood-grouping of donated blood;

4. Blood component preparation and storage;

5. Distribution of blood and blood components to the related hospital blood banks (HBB);

6. Appropriate documentation (donor traceability, haemovigilance);

7. Research and development.

Each RBC has various numbers of Hospital Blood Banks (HBBs) linked with it. As per the National Blood Policy,an HBB is a hospital unit which receives and stores screened blood and blood components from the respective RBC. It then performs blood grouping and compatibility testing prior to issuing the blood and blood components for clinical use within the hospital.

The safety of blood transfusion as a medical intervention does not only depend on the safety of the blood product but also on the safety of the clinical transfusion process and appropriate indications for transfusion. Hospital blood banks link blood centers (responsible for the product) clinicians (responsible for the transfusion), and the patient who receives the blood.

Basic Functions of a Hospital Blood Bank

  1. Storage of blood and blood products
  2. Patient blood grouping and compatibility testing
  3. Detection and identification of atypical antibodies in patient serum.
  4. Issuance of blood and blood products on clinicians advise.
  5. Traceability and haemovigilance.
  6. Proactive role of hospital transfusion committees.

The following chart depicts systematic functioning of HBB.

In the 1st Phase of the Programme (2010-2016), 10 RBCs (5 RBCs of 20,000 collections/year and 5 RBCs of 50,000 collections/year) were built and equipped across the country. In addition, 59 existing HBBs were renovated and upgraded and linked to their respective RBCs.

Based on the impressive project implementation, despite constitutional and administrative challenges, the German government committed to finance the SBTP Phase II, with an additional grant of € 10M through the KfW.In the current Phase II, the scope and scale of the Project is being further expanded (construction of 5 new RBCs and up-gradation of 23 hospital based blood banks) and the gains of the Phase I are being consolidated. The current Phase II of the national project will end in December 2020.