The blood transfusion services in Malaysia.

INTRODUCTION The special nature of Blood Transfusion Services has been very well described by Wolf' who states that "unlike other clinical laboratories the blood bank provides a parenteral therapeutic agent. Unlike the pharmacy's primarily synthetic parenterals, blood and its components resemble tissue or organ transplants. They require individual patientdonor matching. The unique aspects of transfusion practice are attributable to the complexity of the biological agent administered, the resultant sequelae, its perishability, and the vagaries of a supply that is dependent on a complex technology of collection and the good will and cooperation of physicians, patients, and the general public. It is these factors which increasingly determine the activities of the hospital blood bank and explain its evolution towards a transfusion service quite unlike its sister laboratories, and not entirely similar to the pharmacy or the organ transplant service, yet sharing with them several important similarities. At the same time, the service continues to have an important role as a diagnostic laboratory not unlike that of any other clinical laboratory. In this role, the blood service shares the same organizational and managerial problems common to all clinical laboratories and all too familiar to clinicans such as prompt and accurate reporting of results and reliability of assays". Therefore the important considerations in the organization of a Blood Tranfusion Service are (i) the complexities of blood and its use as several vital therapeutic agents, (ii) the dangers involved and technology required in its administration, (iii) the safe, effective and economical utilization of blood, (iv) the problems associated with the need to maintain continuous supplies in the face of increasing and seasonal peak demands of a necessarily limited resource, (v) the need for co-operation and good will of people at both hospital and public levels as well as the need for public relation skills, (vi) the need for close co-operation of all blood banks in the country and co-ordinated planning in order to project future needs. In recent years, blood component therapy has made a great impact in the more effective management of various disorders. Many of the components of blood such as fresh frozen plasma, cryoprecipitate, packed red cells and platelet concentrates, can be easily prepared in blood bank laboratories equipped with blood bank centrifuges. Many other derivatives of blood of therapeutic value can befractionated, However this type of processing requires the use of much more sophisticated machinery. Today as many as 20 therapeutic agents can be produced from blood as distinct components and fractions. While blood transfusion is like a miracle life saving drug, it is important to recognize that the procedure can be dangerous to patients, that every activity involved in the handling of blood from the initial donor interview to eventual blood transfusion can affect the quality, safety and efficacy of blood transfusions. As the effective and safe use of various blood components and products in a variety of clinical conditions are important considerations, a strong clinical bias is certainly .necessary in the organization of transfusion services, apart from the establishment of appropriate technology, general blood bank management, and quality control systems. While certain aspects of laboratory management do resemble that of other clinical laboratories, there are aspects peculiar to blood bank laboratories e.g. problems of blood inventory, control and the proper storage, despatch and transport of blood. The grouping, cross-matching and serological procedures have also to be considered. As the transfusion service is dependent on community support and the good-will and generosity of the public, continuing meaningful publicity programmes at national and local levels combined with well organized expert bleeding teams are essential to ensure the ready availability and supply of blood. Because of the obvious limitation of procurement of blood, resource sharing activities have to be developed. An integrated network of blood banks having the same standards of performance throughout the country would be able to share blood resources resulting in efficient utilization of every unit of blood collected. Such a co-ordinated national system