|Year : 2022 | Volume
| Issue : 1 | Page : 82-86
Current state of blood transfusion service in Mongolia
Erdenebayar Namjil1, Munkhsoyol Gan-Ochir1, Yanjindulam Natsagdorj2
1 Department of Research and Information Technology, National Center for Transfusion Medicine, Ulan Bator, Mongolia
2 Department of Administration and Marketing, National Center for Transfusion Medicine, Ulan Bator, Mongolia
|Date of Submission||21-Jun-2021|
|Date of Decision||17-Jul-2021|
|Date of Acceptance||12-Nov-2021|
|Date of Web Publication||29-Apr-2022|
Dr. Erdenebayar Namjil
Department of Research and Information Technology, National Center for Transfusion Medicine, Ulan Bator
Source of Support: None, Conflict of Interest: None
In 1963, Mongolian blood transfusion service was established officially with the independent creation of Blood Transfusion Central Station in Ulaanbaatar. In the following year of 1964, rural blood centers were organized under the provincial central hospitals in all provinces, thus blood transfusion care and service has started nationwide. As part of the continuous improvement of the legal framework for the blood transfusion sector, the Donor Law of Mongolia was adopted in 2000, amended in 2012, and revised in 2018. In 1994, Mongolian blood transfusion service has shifted from paid blood donation practice to the nonremunerated and has achieved a 100% voluntary nonremunerated blood donor, in 2016. The World Health Organization recommends that in low- and middle-income countries, the share of blood donors in the total population to be 1.5. As of 2020, this figure has reached at 1.8% in Ulaanbaatar. The National Center for Transfusion Medicine (NCTM) has introduced drastic technological innovations in blood and blood products (BBP) production periodically. Since 2007, the NCTM has been implementing three international standards in its activity including requirements for quality and competence for medical laboratories MNS ISO 15189:2015, quality management system MNS ISO 9001:2016, and occupational health and safety management system OHSAS 18001:2007/MNS OHSAS 18001/2012. In 2020, the Mongolian blood transfusion service provided safe and quality assured BBP to health care organizations with 100% of fulfillment nationwide.
Keywords: Blood transfusion service, National Center for Transfusion Medicine, rural blood center
|How to cite this article:|
Namjil E, Gan-Ochir M, Natsagdorj Y. Current state of blood transfusion service in Mongolia. Glob J Transfus Med 2022;7:82-6
| Introduction|| |
In Mongolia, until the beginning of ХХ century, oriental medicine was predominant, especially Traditional Mongolian Medicine and Tibetan. There were no specialized medical institutions yet, and only traditional methods of providing medical and nursing care at home were available. In 1938, a blood transfusion from a surgeon to her patient at the state central hospital is considered to be the first blood transfusion recorded in the history of Mongolia.
In 1963, Mongolian blood transfusion service was established officially with the independent creation of Blood Transfusion Central Station in Ulaanbaatar. In the following year of 1964, rural blood centers (RBC) were organized under the provincial central hospitals in all provinces, thus blood transfusion care and service has started nationwide.
The process of recruiting blood donors varies in the Asia Pacific region. VNRBD is important forblood safety. The Blood Program is an integral part of the national health system and its goal is to provide a safe and stable blood supply to patients in need based on the VNRBD.
In 1994, Mongolian blood transfusion service has shifted from paid blood donation practice to the nonremunerated blood donation. In 2016, Mongolia has proudly achieved a 100% voluntary nonremunerated blood donor (VNRBD). As part of the continuous improvement of the legal framework for the blood transfusion sector, the Donor Law of Mongolia was adopted in 2000, amended in 2012, and revised in 2018. The law stipulates that blood donors must be a VNRBD.
According to the Resolution No. 45 of Parliament of Mongolia, 2007, the national policy on increasing the supply of donor blood and blood products (BBP) and improving safety was approved identifying the main directions of activities and ways to implement the continuous supply of effective and safe, quality-assured BBP to hospitals, and the establishment of sufficient emergency supply in the event of disasters. According to the Resolution No. 111 of Parliament of Mongolia, 2008, action plan 2008-2015 on the implementation of the national policy was approved. The implementation of the national policy and its action plan was accomplished with the rate of 97% of performance bringing management, technical and material supply, and human capacity of provision safe and reliable BBP to the international level.
In recent years, the National Center for Transfusion Medicine (NCTM) has introduced drastic technological innovations and since 2007, has been implementing three international standards in its activity including requirements for quality and competence for medical laboratories MNS ISO 15189:2015, quality management system MNS ISO 9001:2016, and occupational health and safety management system OHSAS 18001:2007/MNS OHSAS 18001/2012.
| Structure of Blood Transfusion Service|| |
The NCTM is a national reference center for blood safety and blood transfusion services under the Ministry of Health, located in Ulaanbaatar, Mongolia. The NCTM provides BBP to more than 100 hospitals that are public and private for 24/7. In some exceptional cases, provincial hospitals are provided with custom-made BBP. The center is also responsible for the national resource of BBP during national disasters and emergencies.
The NCTM's organizational structure and operational rule and the RBC operational rule were revised as a whole document and approved by Health Ministry's order No.A/445, 2020, to improve the internal cooperation in the blood transfusion service. Therefore, although RBC operates under the regional diagnostic and treatment centers, provincial central hospitals or soum health centers, the NCTM provides an integral administration of blood transfusion service.
| Transfusion in Mongolia, Actual Facts and Figures|| |
In 2020, the Mongolian blood transfusion service provided safe and quality assured BBP to health care organizations with 100% of fulfillment nationwide. The WHO recommends that in low- and middle-income countries, the share of blood donors in the total population to be 1.5. As of 2020, this figure has reached at 1.8% in Ulaanbaatar, which makes it possible to fully supply hospitals orders of BBP.
The total number of blood collections nationwide has increased 2.5 times from 2003 to 2020. [Figure 2].
Due to the consumption of BBP and the size of the population, the number of blood collection per 1000 population in Ulaanbaatar and rural areas has increased steadily in recent years. In 2020, especially in Ulaanbaatar, there was an increase of 6.3 from 2003 [Figure 3].
In recent years, the NCTM has introduced technologies such as the multifunctional blood collection devices, additional blood collection bag method, and collection of two units of red blood cells by apheresis alongside of the provision of the blood donor retention and promotion activities. As a result, the share of regular blood donors increased by 14.3% compared to 2003 [Figure 4]. Increasing the proportion of regular blood donors is important to ensure the quality and safety of BBP and to create a continuous supply.
The transfusion-transmitted infection (TTI) testing is mandatory for every single unit of blood and blood component collection. The proportion of deferrals for TTI is steadily declining. In 2020, it was 4.8 times lower than in 2003 [Figure 5].
To improve the production and storage condition of BBP, the NCTM has introduced technologies and devices, namely, a pathogen inactivation technology for plasma and platelet products, rapid-freezing devices for plasma products, the X-ray irradiation technology, freeze and store red cell in glycerol, and walk in room +2+6C, −30–40C. In 2015, the NCTM used to produce 15 types of BBP, as a result of abovementioned technologies types of BBP have reached up to 34, in 2020.
In 2003, 68.8% of the total BBP produced in the country was produced at the NCTM, but by 2020, this figure increased to 11.4% [Figure 6].
In the future, we aim to increase the number of leukocyte depleted red cells and pathogen- inactivated BBP to 100% by 2024 [Figure 7].
|Figure 7: Introducing of new technologies in the production of leukocyte depleted red blood cells and pathogen inactivated BBP, 2020-2024|
Click here to view
| Testing for Transfusion Transmissible Infections|| |
The integrated laboratory of the NCTM consists of quality control, infection detection, and immunohematology laboratories, and introduces fully automated technologies for transfusion- transmitted infections, blood clotting, immunohematology, and bacteriological testing. The PCR is mandatory for HIV and hepatitis B and C, and the ELISA method for syphilis. In addition, at the soum hospital level, a rapid method of detecting blood-borne infections has been introduced, in the event of an emergency blood transfusion [Table 1].
As a result of those measures, the risk of any TTI has been drastically reduced in our country, which has a high prevalence of hepatitis B and C viruses and a high rate of sexually transmitted diseases among population. One of the major successes we have achieved is the fact that there has not been recorded a case of TTI related to the blood transfusion.
With the increase in the number of dedicated refrigerators and freezers, blood samples can be stored for 1 year, which is crucial for tracking posttransfusion reactions and research use. Since 2005, the laboratory has been regularly involved in the external quality assurance program for the quality of TTI testing funded by the WHO and the Global Fund, and since 2010, it has expanded to 26 RBC, thus has become as a national. As for the reference laboratory, antibody detection and differentiation tests were introduced on a trial basis of National EQAS in 2012 and on a daily basis in 2013.
| Future Development|| |
In recent years, the Mongolian health sector has successfully introduced new technologies such as kidney, liver, and bone marrow transplantation surgery. The birth rates and birth-related complication have increased steadily. The use of BBP associated with chronic disease and cancer are increasing year by year and is expected to continue in the future. Over the past 5 years, the Mongolian blood transfusion service has been able to meet its growing needs of BBP by upgrading its buildings and infrastructure, introducing new technologies, and training its human resources.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Erdenebayar Namjil. Life saving heroes. Ulaanbaatar: Munkhiin useg:2013. p.92-95.
Tsai, S. Lin. “Challenge of donor recruitment.” ISBT Science Series 4.n2 (2009): 302-306.
Dhingra, Neelam. “In defense of WHO's blood donation policy.” Science 342.6159 (2013): 691-692.
Tadokoro, Kenji. “Management of blood programme and quality: Asian approach.” ISBT Science series 3.1 (2008): 26-29.
World Health Organization. Blood donor selection: guidelines on assessing donor suitability for blood donation. World Health Organization, 2012.
Erdenebayar Namjil. The XVII Scientific Conference on Blood Transfusion Service. Ulaanbaatar: Admon; 2020:72,113. 2
Health Development Center, Health indicators2003-2020. Ulaanbaatar: Admon; 2020
Erdenebayar Namjil. The XVII Scientific Conference on Blood Transfusion Service. Ulaanbaatar: Admon; 2019: 16,21.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]