WEST AFRICA

The reference for this article is:
Thomas MJG. The History of the Blood Care Foundation. In Blakey G ed: West Africa. London, Maxhill Group of Companies, 1996; 134-8.

Blood transfusion plays a vital role in all areas of medicine. It is lifesaving in trauma and obstetrics, has ensured the speedy recovery of patients undergoing general, orthopaedic and cardio-thoracic surgery and has facilitated the use of bone marrow transplantation and chemotherapy in the treatment of cancer and leukaemia. It is not an exaggeration to say that, without the availability of blood, medicine as we know it today could not be practised.

In the United Kingdom (UK) we take it for granted that fully screened blood, compatible with our own blood group, will always be available should we ever be unfortunate enough to require it. However, recent surveys have indicated that there are less than 25 countries in the world, which could match the stringent criteria, set by the National Blood Service and the Scottish National Blood Transfusion Service.

In many countries the problem is not so much one of the quality of the product, but rather its availability. In these countries there is always an acute shortage, far worse than anything we ever face in the UK. You or a member of your staff, when visiting or living in one of these countries, could need an emergency blood transfusion. By using locally donated blood, you may well be depriving a citizen of that country of life-saving treatment.

There is, therefore, a moral obligation for senior management to ensure that adequate provision is made for their staff without unduly imposing on the medical services of that country. Historically, one alternative has been to set up and maintain a Walking Blood Bank. A Walking Blood Bank is comprised of a group of people who are prepared to be called upon to donate blood to meet a particular emergency. This has always been seen as a stopgap solution until a satisfactory alternative became available. The American Association of Blood Banks now consider this practice "a relic of less sophisticated times" and, in their technical manual1, mention it only to identify the hazards. Even in this situation, no shortcuts may be taken and all the internationally agreed standards must be maintained2-4.

There are numerous problems, medical, technical and financial, in setting up and maintaining a Walking Blood Bank, the more important of which are as follows:

• Because a Walking Blood Bank, by its very nature, is a small enterprise, it is extremely difficult to ensure that an adequate level of quality assurance is maintained, similar to that available in a major blood bank.
  
  
• Potential donors are drawn from the local and expatriate population, who is constantly exposed to the local endemic insect-vectored diseases, such as malaria. For many of these diseases there is no rapid screening test which can be performed in an emergency. This increases the risk of an infected donation, a risk that is avoided if blood is provided from a Western European country.
  
  
• As it is now both medically and legally unacceptable to administer inadequately screened blood, even in an emergency, when an alternative is available, the normal screening tests have to be performed on any blood obtained from a donor panel. This inevitably delays the provision of the blood, probably for a longer period than it would take to deliver the same number of units from a major blood bank.
  
  
• In an emergency situation, it may be very difficult or even impossible to provide blood of the specific group in the amount required. This is especially true when the physician requests a large number of units. Although there may be a number of people on the panel of the required group, there is no guarantee that any of them will be available at the material time or, if they are available, be fit to give a donation. The situation is more likely to be critical if the potential recipient has a rare blood profile. The availability of supplies from a major blood bank will provide a much greater likelihood of the requested number of units of suitable blood being at hand within the required time-scale. The time taken to transport the blood from a blood bank to the hospital where it is required is totally independent of the number of units to be supplied.
  
  
• As Walking Blood Banks are frequently drawn from a small community, embarrassment can arise if certain members are rejected because of their life style. Because of this, there is an increased risk that potential donors will not be entirely truthful as to their risk factors and be included on the panel. This, of course, immediately increases the risks to the potential recipients.
  
  
• If there has been a change in a donor's social behaviour, since originally joining the panel, he/she is almost certain to be unwilling to divulge this information because of the questions which would be asked within the community as to the reason for deferral. This risk is particularly high if the donation is to be made to a relation or friend. If the potential donor has recently been involved in high-risk activities, the last people to whom he would wish this information to be transmitted are his family and friends.
  
  
• There are numerous administrative tasks to be performed with regard to keeping track of potential donors and recruiting replacements. This makes the exercise; if it is to be performed safely and efficiently, an expensive one.
  
  
• All aspects of product liability are vested in the administrators of a Walking Blood Bank whereas, when blood is provided by a major blood bank, product liability remains with them.

For the above reasons, Walking Blood Banks are now no longer considered acceptable clinical practice within the international transfusion medical community. Blood, whenever conceivably possible, should be provided from a major licensed blood bank, where a high degree of quality assurance can be maintained, and the large turnover will give a much greater likelihood of the rapid provision of the requested number of units of suitable blood, especially of rare groups, or blood which will be compatible with patients having complicated antibody profiles.

In response to the difficulties in locating reliable sources of blood, and with the active encouragement of the expatriate medical and residential communities in Nigeria, a blood bank was established in Lagos in 1989 as a pilot exercise. The experience gained in setting up and operating, on an international basis, effective procedures for the handling, transportation, importation and storage of blood, resuscitation fluids and sterile equipment led, in 1991, to the establishment of the Blood Care Foundation.

The Blood Care Foundation is a charitable organisation registered in England, dedicated to provide, in emergency, screened blood, obtained from internationally recognised sources in Western Europe, resuscitation fluids and sterile transfusion equipment to its members in countries where these are not readily available.

Today the Foundation operates a global network of blood banks, enabling it to provide whole blood, by courier service, to almost any location in the world within 12 hours, subject to the availability of scheduled air services.

In cases of emergency, resuscitation fluids are normally required and will support the patient until blood can be provided. To ensure they are readily available when needed, the Foundation is setting up an integrated network of Regional Supply Points (RSPs) throughout the world, holding stocks of resuscitation fluids, including plasma expanders, and the sterile equipment needed for transfusion purposes.

Should an emergency occur, one of the Foundation's alarm centres is contacted. The Duty Medical Officer (DMO) in the alarm centre will contact the doctor in charge of the case to identify the transfusion requirements. If required, the DMO will arrange for the provision of resuscitation fluids from an RSP and for a courier to take the blood to the patient. The couriers are paramedics, trained in cardio-pulmonary resuscitation, and are capable of putting up a transfusion, even in the shocked patient.

Another benefit of membership is the ability to hire an Up-Country Pack (UCP), should you, or a member of your staff, be visiting an area where medical supplies are not readily available. UCPs contain sterile syringes and needles, which may be needed to administer antibiotics or other injectible drugs, as well as sterile transfusion equipment and resuscitation fluids.

The Foundation has a strict quality assurance programme. The Quality Assurance Manager, who is directly responsible to the Chairman of the Foundation, conducts a programme of irregular, unannounced visits to our sourcing blood banks and RSPs. He validates the storage and transport facilities and ensures that all the relevant documentation is maintained to allow proper accounting for all the Foundation's medical material.

Membership of the Blood Care Programme is open to everyone. The Foundation offers Full membership, designed to meet the needs of the individual, family and small company, plus a Stand-by membership for larger organisations. Many thousands of individuals are members of the Foundation, as well as some of the largest multi-national corporations in the world .

Full membership, which covers all costs involved in the provision and delivery of blood and incurs no additional charges, incurs an Annual fee plus a one time Registration fee.

Stand-by membership enables anyone nominated by the member organisation to call one of the Foundation's alarm centres for assistance in an emergency. This programme is of particular interest to the larger organisation, as it is not only complimentary to their existing medical assistance arrangements, but has also proved to be the most cost effective way of protecting their members of staff. In addition, the Foundation's services may be extended to cover company conferences, outside contractors and visitors at no additional cost. Membership incurs an Annual Corporate fee. No charge is made for any blood supplied, but the cost of delivery and any additional services rendered are billed, at cost, to the organisation.

These membership fees are used by the Foundation to finance the provision, maintenance and quality management of its Blood Banks and RSP network.

It is our aim to provide you with the peace of mind engendered by the knowledge that, should you require a transfusion, it will be safely and speedily provided, but not at the price of depriving someone else of the chance of vital treatment.

References

Neo-natal and obstetric practice. In: Walker RH ed. Technical Manual. 11th ed. Bethesda, Maryland: American Association of Blood Banks, 1993:448. ISBN 1-56395-019-7.

Guidelines for the Blood Transfusion Service. 2nd ed. London, England: HMSO, 1994. ISBN 0-11321-568-6.

Guide to the preparation, use and quality assurance of blood components. 2nd ed. Strasbourg, France: Council of Europe Press, 1995. ISBN 92-871-2687-9.

Widmann FK ed. Standards for Blood Banks and Transfusion Services. 15th ed. Bethesda, Maryland: American Association of Blood Banks, 1993. ISBN 1-56395-020-0.