THE NEED FOR BLOOD, ITS AVAILABILITY AND QUALITY

In many countries there continue to be problems with the blood supply. The major ones are:

1. AVAILABILITY. In over half the countries in the world there are perpetual shortages. It is, therefore, likely that blood will not be available when required. Because of the poor availability, many countries allow the use of “family” or “replacement” donors. Such a practice can affect the quality of the blood because family members who have put themselves at risk of contracting a transfusion transmissible disease (TTD) are often unwilling to admit this in front of the rest of the family and so the risk of drawing an infected unit is increased. As many family members are reluctant to donate blood, they will often pay “professional” donors to stand in, in their stead. These “professional” donors have an even greater incentive to conceal any likelihood of carrying a TTD.
   
   
2. QUALITY. There are 3 main aspects which affect the quality of blood:
   
   a. The incidence of TTDs. The higher the incidence of a particular TTD in the donor pool, the greater is the chance of an infected unit failing to be detected during the “window” period. For example, if the incidence of HIV is 10,000 times higher in South Africa than it is in the U.K, then the chances of receiving a unit of infected blood are 10,000 times greater if that blood was drawn in South Africa than if it was drawn in the U.K. The Foundation only sources blood from countries where the incidence of TTDs, such as HIV, hepatitis B and C, malaria and syphilis, are extremely low.
   
   b. The extent and sensitivity of the screening process. The cost of fully screening a unit of blood, using the latest generation of tests, is around £95.00. In many countries this is far more than the total per capita annual health budget so they adopt two strategies. Firstly they use older generation kits, which, while being cheaper, are less sensitive and secondly they reduce the number of TTDs for which they screen.
   
   c. The integrity of the management of the blood centres. At the heart of all quality procedures is the integrity of the senior staff in the blood transfusion centre. There have been recent instances where quality procedures have been bypassed for financial gain and patients have been transfused with infected blood. All the centres from which the Blood Care Foundation (BCF) draws blood are rigorously audited on an annual basis and this is why BCF ensures that the blood it supplies is actually transfused into the BCF member.
   
   

BLOOD BANK NETWORK

The Foundation benefits from the support it receives from the Blood Authorities in France, the Netherlands, Singapore, Switzerland and the USA. This has three advantages:

- It allows BCF to stock it blood banks in Lagos and Hong Kong with blood of the highest quality,

- it is very likely that if a rare blood group is not available in any one particular centre, one of the others will be able to provide it and

- by having a network of blood centres in all areas of the globe, the delivery time is greatly reduced.

BCF continued its discussions with the Chinese Authorities during 2006, with a view to setting up blood banks in the Greater China Region. Verbal approval of its application was received from the Prime Minister’s office in Beijing and written approval is awaited.

BCF has been approached to run a blood bank in a joint medical centre in West Africa to be set up for the staff and dependants of a group of companies.

BCF has offered to run a Blood Bank for the children in Lesotho to assist the Sentebale Charity set up by Prince Harry and Prince Seeiso. A decision is expected in 2007.

ALARM CENTRE

Rabies is a disease, which once clinically apparent, is always fatal. It is especially prevalent in Asia, Africa, the Middle East and the United States. The World Health Organisation (WHO) has estimated 70,000 people die from rabies every year.

Time is critical if a life is to be saved following a bite from a rabid animal. The Trustees decided to extend its courier service to corporate members to include the provision and transportation of rabies human immunoglobulin (HRIg) and vaccine in an emergency.

Should a member be bitten, or have an open wound licked by a possibly rabid animal, it is recommended the Foundation’s Alarm Centre be called immediately, for advice and help. The duty doctor, in consultation with the treating physician, will decide the degree of risk and if treatment should be offered the patient.


DELIVERIES OF BLOOD AND HRIg

BCF only delivers blood to the treating physician using trained couriers. This is to prevent delays, losses or, as may occur in some countries, the original blood being exchanged for local, unscreened blood. It is a sad fact that in some countries, blood provided by BCF is considered a high value item, to be sold to the highest bidder.

When requested, the relevant blood centre packs the required units, which are collected by the courier and taken to the airport where he collects his flight tickets. Should an unexpected delay occur the courier has been trained to re-ice the transportation box, to ensure the blood remains between 2°-10°C whilst in his possession.

The courier carries the blood as hand baggage and it never leaves his possession. When he arrives at the hospital where the patient is being treated, the blood remains in the transportation box until the transfusion takes place. This eliminates the risk of the blood being accidentally switched in the blood bank.

FINANCE

As in previous years, Corporate Membership fees continued to provide the BCF with a stable income in 2006, which allowed it to maintain its network of blood banks and TSLs and continually improve its Quality Assurance activities. Despite the increases in these maintenance costs, the Foundation closed the year with a small surplus.

To meet the increasing need for the Foundation’s services, due to the exponential growth of expatriates and travellers throughout the world, the Foundation has decided to seek financial support (through donations), to introduce additional programmes designed to meet the needs of a much wider group of people, when faced with the requirement for an emergency blood transfusion.

INSURANCE

During 2006, BCF succeeded in establishing an insurance policy for its members, which allows them to insure the risk of paying for deliveries of blood. Because of its value to corporate budgets, many members have opted to take advantage of this option, which will now form an integral part of all future membership programmes

STANDARD OPERATING PROCEDURES

BCF has nearly 400 SOPs. These are in internationally agreed formats and set the quality standards for every aspect of the Foundation’s activities. They are continually revised to reflect the needs of members and the changes in transfusion medicine.

TRAINING

WHO is continually encouraging the governments of many countries to increase the budget for their National Transfusion Services, to provide better training for their blood banking staff, in particular, the quality assurance aspects of their work.

In view of its importance, the BCF’s staff take advantage of their visits to our blood bank locations, to carry out on-the-spot training sessions, to help raise the standards of the local transfusion service.

MEMBERSHIP

2006 showed an increased awareness of the inadequacy of the transfusion services in many countries. BCF opened discussions with a number of healthcare organisations during the year, with a view to their including BCP membership as a standard benefit on their policies. A new medical assistance company has added BCF’s services as a standard benefit of membership. It is expected the company will become operational in 2007.

The Trustees believe the most effective way for BCF to operate is to provide blood in an emergency without charge, to the entire population of a country, wherever their nationals may be in the world. Donations were received during 2006 to allow the development of an operational plan, which will be introduced as soon as sufficient funding has been secured. It is BCF’s intention to concentrate its activities in this field.

COMMUNICATIONS

The BCF Occasional Newsletter continues to receive plaudits from the Chief Medical Officers of many BCP Corporate members as, apart from their general interest in the topics, it helps them to keep up to date with latest developments on health protection in different parts of the world.

During the year, the BCF website was updated to provide much wider information about the Foundation and its activities. Plans are in hand to develop it further in 2007.

CONCLUSION

2006 was a year of continued development, spurred on by the increasing awareness of individuals and corporations that much greater care and protection needs to be taken, to meet the needs of an emergency, especially where a blood transfusion is involved.

Thanks to the dedicated concern and support of my fellow Trustees and colleagues, the Foundation was able to meet a series of challenges during the year whilst, at the same time, make positive plans for the expansion of the Charity’s services on a much wider basis. As in previous years, I should like to express my gratitude to them all for their unflagging encouragement and support. We all look forward to the privilege of continuing to provide this life-saving service for many years to come.


Michael G. Bruce
Chairman of the Trustees