HEMOVIGILANCE PROGRAMS & IMMUNOHEMATOLOGY IN MASS CASUALTY EVENTS 1 Hemovigilance programs - are systems and processes established to monitor and improve the safety and quality of blood transfusions. - The term "hemovigilance" is derived from "hemo," which refers to blood, and "vigilance," indicating the careful monitoring and reporting of adverse events or reactions associated with the administration of blood and blood components. 2 Hemovigilance programs - A set of surveillance procedures covering the entire transfusion chain. > from the DONATION, PROCESSING of blood and its components to their PROVISION and TRANSFUSION to patients and their follow-up. 3 4 5 6 TRANSFUSION CHAIN 7 BLOOD SAFETY 8 Hemovigilance ensures blood safety 9 Key components of hemovigilance programs include: ❏ Monitoring and Reporting: - Hemovigilance programs involve the systematic monitoring of blood transfusions for adverse events, including transfusion reactions, errors, and complications. ❏ Data Collection: - Collection of data related to donor, recipient, blood components, and the circumstances of the transfusion. This information helps in identifying patterns, trends, and potential risks. 10 Key components of hemovigilance programs include: ❏ Analysis and Evaluation: - Analysis of collected data to assess the safety and efficacy of blood transfusions. This includes evaluating the occurrence and severity of adverse events and identifying areas for improvement. ❏ Reporting Systems: - Implementation of reporting systems that encourage healthcare professionals to report any unexpected or adverse events associated with blood transfusions. These systems may include both voluntary and mandatory reporting mechanisms. 11 Key components of hemovigilance programs include: ❏ Feedback and Communication: - Establishing feedback mechanisms to communicate findings, recommendations, and lessons learned to healthcare providers, blood establishments, and relevant authorities. This fosters continuous improvement and enhances transfusion safety. ❏ Quality Improvement Initiatives: - Implementation of quality improvement initiatives based on the findings of hemovigilance programs. This may involve changes to procedures, protocols, and training to prevent the recurrence of adverse events.. 12 Key components of hemovigilance programs include: ❏ Education and Training: - Providing education and training to healthcare professionals involved in the transfusion process, emphasizing best practices and safety measures. ❏ Regulatory Compliance: - Ensuring compliance with regulatory requirements related to blood transfusion safety. Hemovigilance programs are often established in accordance with national and international regulations and guidelines. 13 Key components of hemovigilance programs include: ❏ Risk Management: - Identifying and managing risks associated with blood transfusions, including potential complications for both donors and recipients. ❏ Public Awareness: - Raising public awareness about the safety of blood transfusions, the importance of blood donation, and the role of hemovigilance in ensuring quality healthcare. 14 ❏ Risk Management: - Identifying and managing risks associated with blood transfusions, including potential complications for both donors and recipients. ❏ Public Awareness: - Raising public awareness about the safety of blood transfusions, the importance of blood donation, and the role of hemovigilance in ensuring quality healthcare. 15 CONCLUSION: Hemovigilance programs contribute to the overall safety and effectiveness of blood transfusions, reducing the risks associated with the transfusion process. By systematically monitoring and analyzing data, these programs play a crucial role in preventing adverse events, improving patient outcomes, and maintaining public confidence in blood transfusion services. 16 The goal of achieving reforms in the Philippine healthcare system has moved our government to push regulations in all key areas. With the objective of ensuring access to safe, quality and affordable blood products, improved facilities and services, the transfusion system in the Philippines is now in focus. Hence, the issuance of several administrative memos to guarantee the achievement of an effective blood service network in the country. 17 The idea of Blood Services Centralization or Regionalization began to be implemented over 30 years ago in United Kingdom, France, United States, Australia, Japan and other countries. It was the World Health Organization who conceptualized the blood center Model and recommended the system to developing countries like the Philippines 18 Legislations of the government: Department of Health (DOH) released the Department Circular No. 99 s. of 1987. ➢ It aimed to provide an adequate supply of safe blood for transfusion from voluntary non-remunerated blood donation. ➢ It also aimed to encourage the efficient utilization of blood resources among blood service facilities (BSFs). 19 Legislations of the government: ● Committee on National Blood Service Program - comprised the DOH, Philippine Red Cross (PRC), and the Philippine Blood Coordinating Council (PBCC). DOH Administrative Order 118-A s. of 99 = Promulgated the National Blood Services Program. 20 21 22 23 24 25 26 Red Cross 143 (RC 143) program. ● a chapter based program wherein every chapter recruits 43 volunteers in each barangay (smallest unit of government). ● The volunteers will be tasked to assist the organization during disaster and emergencies, support us in community, health and welfare activities and act as standby or reserved donors who will donate blood in emergency situations. ● The country has 43 000 barangays and from the program, 1 800 000 volunteer donors will be recruited 27 The strategic objectives for the operation of PRC Blood Services are as follows: ❏ Safe and quality blood for all – ➢ each facility shall ensure to comply with quality standards. Our mantra that every client should not be turned away because of lack of blood is directed to each blood facility. 28 The strategic objectives for the operation of PRC Blood Services are as follows: ❏ 100% compliance with DOH standards and regulations ➢ the organization shall comply at all times the government’s regulation pertaining to minimum manpower and equipment requirement for blood service operations. 29 The strategic objectives for the operation of PRC Blood Services are as follows: ❏ Improve financial self-sustainability ➢ each blood unit corresponds to a blood processing fee. The fee collected conforms to the fee mandated by the government. For indigent clients, the Red Cross has a Blood Samaritan Program. The mechanism of the program is the solicitation of monetary assistance from individuals, groups, and private and government units. The donation is earmarked to subsidize processing fee of blood of indigent patients. 30 The strategic objectives for the operation of PRC Blood Services are as follows: ❏ Attain ISO 15189 rating in 2014 for all regional blood centers and other BSFs to follow ➢ the Red Cross have 22 regional blood centers that will aim to earn ISO 15189. In 2010, the National blood center obtained ISO 9001:2008 (Quality Management System). ➢ They are also tasked to work out for ISO 15189. Quality embodies notions of efficiency, effectiveness, competency and customer satisfaction. 31 The strategic objectives for the operation of PRC Blood Services are as follows: ❏ 100% voluntary blood donation ➢ currently the national average of voluntary blood donation of PRC is 79%. In parallel to the global strategic objective, the PRC shall improve voluntary blood donation to 100% by 2014. 32 33 34 35 36 37 38 39 40 ALTERNATIVE MODELS FOR SUSTAINABLE BLOOD SERVICES ➢ Individual doctors as well as surgical and obstetric wards find their own solutions to treat bleeding patients with blood transfusions even if no nationally organized or other official blood service system exists. Blood transfusion may sometimes be the only available treatment in countries with limited resources for hospital care, partly because alternatives to blood such as physiological saline solutions, colloids or other plasma expanders are not available. 41 ALTERNATIVE MODELS FOR SUSTAINABLE BLOOD SERVICES ➢ This in turn may lead to ineffective and unnecessary use of blood. It is conceivable that having an organized blood service in the hospital gives a better result with the same financial resources and saves time and energy of the clinical wards. These arguments, in addition to improved safety of transfusion, should be sufficient to justify building a blood service in the hospital. 42 43 Strengths, weaknesses, opportunities and threats of the government-operated national blood service system 44 45 Strengths, weaknesses, opportunities and threats of a Red Cross/Red Crescent operated national blood service system 46 Strengths, weaknesses, opportunities and threats of a Red Cross/Red Crescent operated national blood service system 47 Strengths, weaknesses, opportunities and threats of the hospital-based blood services coordinated by national health authorities 48 Strengths, weaknesses, opportunities and threats of the hospital-based blood services coordinated by national health authorities 49 FUNDING ➢ Stable funding for a national blood service is best achieved by an annual budget allocation from the government. The blood service may also have a permission to charge the hospitals for products and services (cost recovery principle), but this is less common in developing countries owing to weak social security system, non-existing sick insurance and inability of the patients to pay for blood transfusions. 50 PERSONNEL ➢ In developing countries, the expertise of the blood service logistics, financing and medical and technical aspects often depends on the knowledge and skills of only one or a few persons. Such skills are also much demanded elsewhere. This makes the blood service extremely vulnerable to personnel changes because, for instance, private business and industry can often offer better financial as well as career opportunities to these rare experts 51 BLOOD DONORS ➢ A sufficient blood donor base is a prerequisite for the sustainability of the blood service. Blood donation should be based on voluntary and non-remunerated donors. They are the safest and in the long run more reliable as regular blood donors than family and replacement donors. Payment for blood donation, especially in a developing country, may result in a temptation for the donor to hide his/her lifestyle, illnesses or other factors which would cause rejection from blood donation. In addition, payment for blood donation creates a risk of exploitation of the poor. 52 PRACTICAL ASPECTS OF BUILDING BLOOD TRANSFUSION SERVICES ➢ If there are no national laws and regulations on blood transfusion services, the blood service should make and write down its own instructions according to which the operation must be run. Official regulations and laws are helpful, but the lack thereof should not prohibit the establishment of functioning blood services on a local or even on a national basis. However, regulations and standards must be written later on. They serve as a basis for the quality of blood collection and transfusion and clarify the chains of responsibility, the existence of which becomes important if untoward effects of transfusion occur. 53 Immunohematology plays a crucial role in mass casualty events by ensuring the safe and effective use of blood transfusions in emergency situations. The primary goal is to rapidly provide compatible blood products to those in need while addressing the challenges posed by the scale and urgency of the event. 54 key aspects of the role of immunohematology in mass casualty events: Rapid Blood Typing: - Immunohematology laboratories perform rapid ABO and RhD blood typing to quickly identify the blood groups of individuals affected by the mass casualty event. This information is essential for determining blood compatibility. Universal Donor Blood: - In situations where immediate blood typing is not possible, immunohematology recognizes the importance of O-negative blood as the universal donor. O-negative blood can be administered to individuals of any blood type in emergencies. 55 key aspects of the role of immunohematology in mass casualty events: Pre-Identified Donor Panels: - Some blood banks maintain pre-identified donor panels, consisting of individuals with known blood types and other relevant characteristics. This allows for expedited access to compatible blood during mass casualty events. Emergency Release of Blood: - Blood banks may implement emergency release protocols, allowing for the quick provision of blood products in critical situations. This process may involve bypassing some of the usual testing procedures to ensure timely access to blood. 56 key aspects of the role of immunohematology in mass casualty events: Limited Crossmatching: - Immunohematology allows for limited crossmatching or abbreviated crossmatching, which enables a faster assessment of compatibility between donor and recipient blood without the need for extensive testing. Documentation and Record Keeping: - Rigorous documentation of blood typing results, crossmatching, and transfusion records is critical to ensure accuracy and traceability. Proper documentation helps prevent errors and ensures patient safety. 57 key aspects of the role of immunohematology in mass casualty events: Communication and Coordination: - Effective communication between immunohematology laboratories, blood banks, healthcare providers, and emergency response teams is essential. Coordination ensures that the right blood products are available for the right patients at the right time. Blood Donation Drives: - Immunohematology is involved in organizing and conducting blood donation drives to replenish blood supplies in the aftermath of mass casualty events. These drives are essential to meet the increased demand for blood products. 58 key aspects of the role of immunohematology in mass casualty events: Education and Training: - Healthcare providers involved in emergency response should receive training on the specific immunohematological protocols and procedures applicable to mass casualty events. This training ensures that personnel can make informed decisions under time constraints. Ethical Considerations: - Immunohematologists and healthcare providers must consider ethical principles, such as prioritizing the use of limited resources and ensuring equitable access to blood products during mass casualty events. 59 SYNTHESIS: In summary, immunohematology is fundamental in the rapid and effective response to mass casualty events, ensuring that blood transfusions are administered safely and efficiently to those in need. The ability to quickly assess blood compatibility and provide timely access to blood products is critical in saving lives and mitigating the impact of mass casualty events on affected individuals. 60 61 62 63 64 Transfusion protocols 65 Transfusion safety 66