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 Table of Contents  
SPECIAL COMMUNICATION
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 233-236

Status of blood transfusion service in Bhutan


1 Department of Pathology and Laboratory Medicine, JDWNRH, Thimphu, Bhutan
2 Department of Medical Services, Ministry of Health, Thimphu, Bhutan

Date of Submission18-Oct-2021
Date of Decision29-Oct-2021
Date of Acceptance30-Oct-2021
Date of Web Publication30-Nov-2021

Correspondence Address:
Dr. Tshering Yangdon
Department of Pathology and Laboratory Medicine, JDWNRH, Thimphu
Bhutan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/gjtm.gjtm_94_21

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  Abstract 


Blood transfusion services in Bhutan are operated as a unit of the hospital laboratory services. There are currently 26 hospital-based blood banks that provide blood donation and transfusion services and one National Blood Bank at National Referral Hospital at Thimphu, the capital city of Bhutan. The National Blood Bank serves the additional activities of providing technical support to blood safety program (BSP) under the Ministry of Health and conducting quality assessment scheme for peripheral blood banks in blood group serology. BSP oversees the overall functioning of the blood transfusion services in the country. The program compiles and evaluates the report obtained annually from all the blood banks. This serves as a part of monitoring and assessment for the further improvement of blood transfusion services as per the National Standards for Blood Transfusion Service 2013.

Keywords: Blood donation, quality, transfusion service


How to cite this article:
Yangdon T, Getshen M, Yangzom P. Status of blood transfusion service in Bhutan. Glob J Transfus Med 2021;6:233-6

How to cite this URL:
Yangdon T, Getshen M, Yangzom P. Status of blood transfusion service in Bhutan. Glob J Transfus Med [serial online] 2021 [cited 2022 Aug 10];6:233-6. Available from: https://www.gjtmonline.com/text.asp?2021/6/2/233/331631




  Introduction Top


Blood acts as a lifesaving intervention and is a vital component of every country's health-care delivery system. World Health Organization (WHO) states that providing a safe and adequate blood should be an integral part of every country's national health-care policy and infrastructure.[1]

The Kingdom of Bhutan, situated in the Eastern Himalayas with a population of 756,129 (National Statistics Bureau 2021), provides free health-care services. Health services in the country are available through a three-tier structure: (i) basic health-care unit at the primary level; (ii) district general hospitals at the secondary level; and (iii) regional and national referral hospitals at the tertiary level. There are no private hospitals in the country; however, few diagnostic centers are available in the capital city and other major districts.

The blood safety program (BSP) under the Department of Medical Services, Ministry of Health, oversees the blood transfusion services in the country. The program ensures that adequate and safe blood supply is provided through the operation of blood transfusion service (BTS), promotes for 100% voluntary nonremunerated blood donation system, establishes appropriate technology for testing and processing the blood units, encourages rational use of blood and component therapy by the prescribers, and implements an effective quality management system.[2] Based on the principle of delivering effective quality service, BSP has developed a manual on National Standards for BTS 2013 with the objective to maintain and enhance the quality and safety of blood transfusion in the health facilities.[3]

WHO recommends that the national blood system should be governed by national blood policy and legislative framework to promote uniform implementation of standards and consistency in the quality and safety of blood and blood products. Since BTS has moved from a cottage industry to being considered as a pharmaceutical industry requiring good manufacturing practices, blood and blood products are categorized as “drug” due to its nature of internal administration, therapeutic and side effects.[4] Therefore, the drug regulatory authority of Bhutan is responsible for regulating or authorizing licenses to BTS. It is responsible for administering the provision of Bhutan Medicines Act 2003 and Bhutan blood and blood products regulation.[5]

In Bhutan, blood transfusion is most commonly used to treat pregnancy and childbirth-related complications, severe anemia, and massive trauma and also for supportive care in various types of cancers and patients on regular dialysis. At National Referral Hospital, the maximum order for blood amounts to the patient anemic management and chemotherapy treatment management.[6]

The BTS in Bhutan is operated as unit of the hospital laboratory services and basic health unit at the districts. There are 26 functional hospital-based blood centers (BCs) throughout the country including regional blood banks and one National Blood Bank at National Referral Hospital [Figure 1].
Figure 1: Organization structure of blood transfusion service (source: Status report on blood safety and availability in Bhutan 2011–2016: Country report, Bhutan)

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Each of the hospital-based blood banks is responsible for blood donor screening, collection, infectious disease testing, and precompatible testing before issuing to the patients. All the blood banks collect whole blood unit and issue for transfusion except for National and Regional Blood Bank where blood is processed into blood products such as packed red cells (PRC), platelet concentrate, and fresh frozen plasma (FFP). In addition, the National Blood Bank at the referral hospital provides technical guidance to BSP, teaching fraternity for the Diploma in Medical Laboratory Technology under Nursing and Public Health Program at Khesar Gyalpo University of Medical Sciences, Bhutan, and conducts national external quality assessment scheme in blood group serology for the district blood banks.

One of the mandates of the BSP is to compile annual reports from all the blood banks for final evaluation for national authorities and their partners. Such annual reports serve as a monitoring tool for developing improvement activities and strengthening the BTS. These reports also draw information for national statistics to submit to the WHO in its global database on blood safety.


  Blood Collection Top


[Figure 2] shows the total percentage of the voluntary versus replacement blood donation collected year wise from 2015 to 2020. On an average, 80% of the blood units collected are from voluntary blood donation, with 20% having to rely on replacement blood donors. The replacement donation especially amounts to the requirement of the platelet transfusion.
Figure 2: Total blood donation year wise

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The maximum voluntary blood unit collected happens from the mobile blood donation campaign conducted by collaborating with various institutes, schools, and NGOs throughout the country to meet the demand of the blood requirement. The total blood camps conducted over the years are as shown in [Figure 3].
Figure 3: Total number of blood donation campaigns conducted

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  Blood Screening for Infectious Diseases Top


The screening tests are conducted to detect transfusion transmissible infectious diseases against anti-HIV-1 and 2, HBsAg, and anti-HCV and serologic tests for syphilis to provide safety for blood transfusion [Table 1]. Moreover, confirmatory tests are conducted for initially positive tests. All blood units positive for confirmatory tests are not considered. BTS in Bhutan follows the national screening algorithm (2013) so that effective screening guidance is implemented to reduce the risk of transmission to very low levels. Testing is performed at all the blood banks, with a fully automated serological method at National Blood Bank, and rapid test method is followed at the district blood banks.
Table 1: Total number of transfusion transmissible infectious screen reactive year wise

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Table 2: Milestones in blood transfusion services

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  Blood and Blood Product Usage Top


Over the years, the maximum usage of blood and blood products is for PRC followed by whole blood, respectively [Figure 4]. The highest number of whole blood usage is at blood banks at the periphery, where there are no facilities for blood component preparation. The highest use of platelet concentrates and FFP occurs at the National Blood Bank at the National Referral Hospital.
Figure 4: Blood and blood product usage

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  Conclusion Top


Since blood banks in the country are fragmented with blood donations ranging from 25 to 4000 per year, there is a need for a systematic blood transfusion organization system. As per National Standards, they are consolidating from the existing 27 BCs to 6 or 9 BCs and the remaining centers into blood storage centers (BSCs) would improve the quality of the transfusion services. A hub of BSCs will be provided with screened blood units by an identified BC within the same region at periodic intervals so that bloodstocks are available to all health centers at all the times. A situational analysis of the BTS conducted by WHO experts meted out a national strategic plan in line with the existing national vision, policy, and standards to develop a well-organized, systematic BTS in the country.

Due to the increase demand for platelet products at National Hospital, the National Blood Bank is to introduce additional services of apheresis from 2022. This will address the issues of platelet shortages, and having to rely on replacement donors to meet the platelet demand.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Global Database on Blood Safety and Availability, WHO Report; 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability.  Back to cited text no. 1
    
2.
Status Report on Blood Safety and Availability in Bhutan 2011-2016: Country Report, Bhutan.  Back to cited text no. 2
    
3.
National Standard for Blood Transfusion Service. Bhutan Govt; 2013. Available from: https://www.who.int/bloodsafety/transfusion_services/BhutanNationalStandardsBTServices.pdf/. [Last accessed on 2021 Nov 20].  Back to cited text no. 3
    
4.
The Medicine Act of the Kingdom of Bhutan. Bhutan Govt; 2003. Available from: https://www.nationalcouncil.bt/assets/uploads/docs/acts/2017/Medicine-Act-of-the-Kingdom-of-Bhutan-2003-English1.pdf. [Last accessed on 2021 Nov 20].  Back to cited text no. 4
    
5.
Blood and Blood Product Regulation of Bhutan. Bhutan Govt; 2016. Available from: http://www.moh.gov.bt/wp-content/uploads/moh-files/2014/11/Blood-and-Blood-Products-Regulation-2016.pdf. [Last accessed on 2021 Nov 20].  Back to cited text no. 5
    
6.
Yangdon T, Getshen M, Tashi L. A retrospective analysis of blood requisition versus utilization practices at national blood bank, Jigme Dorji Wangchuck national referral hospital, Thimphu, Bhutan. Glob J Transfus Med 2020;5:54-7. Available from: https://apps.who.int/iris/bitstream/handle/10665/254987/9789241565431-eng.pdf. [Last accessed on 2021 Nov 20].  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
Blood Collection
Blood Screening ...
Blood and Blood ...
Conclusion
References
Article Figures
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