The blood transfusion service and the National Health Service

Blood transfusion in the Caribbean: Historical perspective in the context of Trinidad and Tobago

To compare the historical development of blood transfusion in Britain and a former British West Indian colony. International transfusion bodies recommend national coordination and exclusively voluntary non-remunerated donation as essential pre-requisites for blood safety. These ideals have been achieved in high-income countries including Great Britain, the United States of America and Canada. However, most West Indian countries have fragmented, hospital-based blood services that rely on family replacement and remunerated donors. Comparative historical analysis of blood transfusion service development in Great Britain and Trinidad and Tobago was undertaken to provide insight into their dichotomous development and inform policy decisions to bridge the gap between the two types of transfusion service. The British National Blood Transfusion service was based on voluntary non-remunerated blood donation from its inception but achieved national coordination over 50 years that included a period of regional control during which incoordination contributed to a tainted blood scandal. Failure to establish community voluntary non-remunerated donation in Trinidad and Tobago during the colonial period, before independence in 1962, allowed regionally-controlled family replacement and remunerated blood donation to become entrenched then perpetuated by path dependence. A university-led programme has recently used historically-proven methods, drawing on the experiences of the British National Blood Transfusion Service, to establish a model for developing a voluntary non-remunerated programme. The programme aims to avoid historical pitfalls during its national extension. Historical analysis provided information for introducing voluntary non-remunerated blood donation and planning a nationally-coordinated blood transfusion service.

Barriers to blood donation in African communities in Australia: the role of home and host country culture and experience

BACKGROUND

An influx of African migrants and refugees can strain a host country's blood services, because often migrants have unique blood needs that cannot be sourced from local donors. To increase blood donation by the new migrants, host country blood services need to understand how blood and blood donations are viewed by immigrant communities, because recruitment models that are not culturally adapted may have limited success.

STUDY DESIGN AND METHODS

Nine focus groups representing a cross-section of Australian-based African communities were conducted in multiple languages, facilitated by bilingual workers. The qualitative protocol was guided by the literature on blood donation by African migrants and communities in Africa. Thematic analysis identified the relevance of issues previously included in the literature and whether other issues facilitated or prohibited blood donation.

RESULTS

Home country cultural issues were not generally raised as barriers to donation, and respondents were positively disposed toward donation. Home country experiences shaped respondents' views in Australia. Participants focused on assisting "individuals in need," rather than giving to a blood service that many viewed with suspicion because of issues in their home country. There was a lack of knowledge about the donation process in Australia. More importantly, respondents perceived that their blood would not be wanted, based on a perception of host country mistrust and discrimination.

CONCLUSION

Developing an intervention that encourages migrants to donate blood needs to be culturally focused. It appears that addressing perceptions based on home country experiences is essential. Overcoming a general perception of discrimination is beyond any blood service, but there can be an attempt to ensure that blood donation is seen as an inclusive process-blood from everyone, for everyone.

Cross-matched blood for major head and neck surgery: an analysis of requirements

We retrospectively analysed our blood ordering practice; the number of units of cross-matched blood requested was compared with the number transfused, in 70 patients undergoing a total of 82 ablative operations for malignant disease. Patients undergoing neck dissection alone, or excision of tumour with free revascularized flap reconstruction without neck dissection, are unlikely to require blood transfusion. Operations that include excision of tumour with primary closure and neck dissection, excision of tumour with pedicled flap reconstruction and excision of tumour with any form of flap reconstruction and neck dissection in continuity, will probably require transfusion. If atypical antibodies are present in the patient's serum on screening, cross-matched blood should always be available preoperatively. Provided that atypical antibodies are not present and that blood is available within 40 minutes from the blood bank, our results show that it is safe to adopt a policy of blood grouping and saving serum, for patients undergoing neck dissection alone, but cross-matching two or more units of blood for patients who are to have more extensive operations.

Cross-match requirements in orthognathic surgery: an audit

A retrospective audit was undertaken of the value of routine cross-matching of blood for patients undergoing orthognathic surgery at Canniesburn Hospital, Glasgow. Overall, routine cross-matching of blood was wasteful of resources for all but the more major types of osteotomy procedure: Le Fort III, Le Fort II, malar osteotomies requiring a bicoronal flap and bimaxillary osteotomies. The study has financial implications regarding the proper use of cross-matching in selected patients undergoing elective orthognathic surgery. A blood ordering tariff has been suggested for the various procedures studied.

Do children need routine preoperative blood tests and blood cross matching in orthopaedic practice?

A review of 315 children admitted for elective orthopaedic surgery on 346 occasions showed that 88.7% had a full blood count and 8.1% had serum urea and electrolyte estimations performed preoperatively. Two abnormal haemoglobin concentrations were found. One was known beforehand and the other clinically suspected. No other haematological or urea and electrolyte abnormality was found. On 82 occasions (23.7%) blood was cross matched. Blood was transfused on 15 occasions (18.3%) using 23% of cross matched blood. Routine preoperative full blood count, serum urea and electrolyte estimations are not indicated in healthy children. In our experience, only children who may need blood transfused postoperatively need a preoperative haemoglobin concentration estimation as a baseline. These are patients undergoing major spinal, pelvic girdle and upper femoral surgery.