Blood transfusion services in Iraq; an unfortunate field.

Iraq is unfortunately still delayed in the development of blood transfusion services. My tenure for over 18 months as head of the blood transfusion center in one of the major teaching hospitals in Baghdad, Iraq, Al-yarmouk Teaching Hospital, led me to this unpleasant conclusion. There is an absence of almost any type of scientific interest, e.g., no Iraqi blood banking or hematology journal and no actual scientific meetings to review and improve the work in this field. There is also a lack of proper training and continuing medical education programs for the staff. Other deficiencies in the blood transfusion services are summarized hereunder: 1. Absence of obligatory, clear and acceptable minimal standards that should be available before starting a new blood transfusion center, such as regarding building size and size and number of rooms. The blood transfusion center in Al-Yarmouk Teaching Hospital is composed of only a small part of the building housing the teaching laboratories, with a few small rooms that do not meet any written national or international standards [1]. 2. Unavailability of normal ranges for Iraqi hematological indices, as normal hemoglobin concentration or PCV %. As a result, there is continuing unfruitful debate about the lower accepted values for blood donation. 3. Absence of medical record profiling and a registration process, with absence of computerization and networking services. 4. Improper interviewing of blood donors due to lack of privacy, insufficient number of examining doctors and medical assistants, and inadequate history taking and physical examination. There is also insufficient attention given to the regular and onneed voluntary blood transfusion programs with self-acceptance and self-deferral issues. 5. Chronic inadequate and irregular supply of empty blood bags, instruments and disposables. The blood transfusion center in Al-Yarmouk teaching hospital was left without blood bags for a few months in 2008 [2]. 6. Incomplete choice of combination of tests on blood donation that should be used in each center, with absence of HCV NAT on pooled plasma, ELISA anti-CMV Ab, ELISA anti-HTLV-I Ab, and optional test for malaria. Not unexpectedly, no antibody screening is done on blood donations. 7. The choice of cross-matching procedure has not been reviewed in the last three decades, in order to delete unneeded and confusing steps or to add essential improved ones. For example, the immediate spin (IS) step is left for a 30-minute incubation period, leading to a high rate of false positives (detecting clinically insignificant cold antibodies, causing confusion), and as a result, many needed blood transfusions are cut short because tests are not carried out only at 37°C, but also at room temperature with a long incubation period. While not supported by any scientific reference, the staff are required to do so as mentioned in the standard procedures for Iraqi blood banking. Furthermore, apart from major cross-match, there Abbas Hashim Abdulsalam Al-yarmouk Teaching Hospital, Laboratory Department, Hematology Unit, Baghdad, Iraq