Harmonization in donor management – the Asia–Pacific perspective

Authors


  • 4A-S11-02

C. K. Lin, Chief Executive & Medical Director, Hong Kong Red Cross Blood Transfusion Service, 15 King's Park Rise, Kowloon, Hong Kong
E-mail: cklin@ha.org.hk

Overview of the APBN

The Asia Pacific Blood Network (APBN) was established in 2006. It currently comprises nine blood service operators in the Asia–Pacific Region including Australia Red Cross Blood Service, Beijing Blood Centre, Hong Kong Red Cross Blood Transfusion Service, Japanese Red Cross Blood Service, Korean Red Cross Blood Service, New Zealand Blood Service, Singapore Blood Service Group, Taiwan Blood Service Foundation and Thailand Red Cross Blood Service. The aims are to provide a forum for members to exchange ideas and insights and to compare operational practices, formulate a regional voice and perspective on blood-related themes, and to encourage a close cooperative approach to advance regional harmonization and cooperation in blood-related matters. Our vision is that every patient in the Asia–Pacific Region has appropriate access to safe blood and blood products appropriate to their needs, donated by voluntary non-remunerated blood donors, in an environment that safeguards their health and safety and our mission is to advance the self-sufficiency of blood systems in the Asia–Pacific Region by capturing and sharing the collective expertise, wisdom and learning of our members.

The APBN is committed to the promotion of blood safety, donor health and safety and efficiency of operations. Our Objectives are:

  • 1 to achieve high levels of regional cooperation and collaboration;
  • 2 to adopt the principle of voluntary non-remunerated blood donation as the basis of a safe and sustainable national blood supply and assisting other countries in the region to meet this goal;
  • 3 to facilitate information sharing to increase knowledge and to improve practices in transfusion medicine and blood safety within the region;
  • 4 to engage in regional cooperation and information sharing regarding disaster preparedness and management of blood-related issues when disasters occur;
  • 5 to collaborate with international non-government organizations (e.g. WHO) and other national blood operators to access technologies and processes to improve blood safety and availability;
  • 6 to consider policy positions on regional issues relating to blood and blood operations; and any other matter relating to blood system and operations as agreed by members from time to time.

APBN members operate in different domestic contexts

While blood services in some member countries are regulated by a sole regulatory agency, e.g. Australia and New Zealand, others are regulated by their MOH (for fresh blood and transfusion practices) and national drug regulatory agencies (for plasma derivatives), e.g. China and Singapore. The extent of regulation and the standards used also varies. For example, the Singapore Blood Services Group adopts the AABB standard whereas the Hong Kong Red Cross Blood Transfusion Service follows the Australia TGA GMP standards. The variation in regulation supports country specific donor management strategies, including the variable whole blood collection volumes. Differences in donor eligibility criteria such as haemoglobin (Hb) cut-off limits, body weight, donation frequency and volume may also reflect local country conditions. Different disease patterns and prevalence result in unique blood donor screening and positive reactive rates. Some member countries are endemic for malaria and dengue, which also requires different management approaches to those in mainstream Europe and America. To address the impact of these issues, members have developed innovative strategies taking into account the demographic and sociological variations of the region.

Blood collection volume

As shown in Fig. 1, among APBN, the small volume collection ranges from 200 to 350 ml and the standard volume from 400 to 500 ml. Except Australia and New Zealand, members collect both small and standard volume of whole blood. It is mainly because, in many countries in our region, there are many donors whose body weight cannot meet the eligibility standard for standard volume whole blood donation. To some extent, it is a compromise between donor health management and sufficiency of blood supply. If these donors were deferred, it would definitely have negative impact on blood supply and donor recruitment.

Figure 1.

 Blood collection volume practiced among APBN Members.

Pre-donation Hb level

Table 1 summarizes the pre-donation Hb level practised among APBN members. It can be noted that Hong Kong has the lowest Hb cut off for females at 11·5 g/L and Thailand has the highest Hb cut off for female donors (125 g/L) but the lowest for male donors (125 g/L). It should be noted that because many countries in our region have a high incidence of thalassaemia, there is a tendency to adopt a lower pre-donation Hb level for donor selection.

Table 1.   Summary of pre-donation Hb practised among APBN members
Hb
Whole blood donation
Male (g/L)Female (g/L)
Australia130–185120–165
Beijing≥130≥125
Hong Kong130–175115–175
Japan120 (small collection)
125 (std collection)
120 (small collection)
125 (std collection)
Korea125125
New Zealand130–185120–175
Singapore125125
Taiwan≥130≥120
Thailand≥125≥125

Donor age eligibility

Table 2 summarizes the donor age eligibility for whole blood and plasmapheresis donation among APBN members. The range is from 16 to 80 for whole blood donation and 17 to 80 for plasmapheresis.

Table 2.   Summary of donor age eligibility practised among APBN members
 Donor age
Whole blood
Donor age
Plasmapheresis
AustraliaNew 16–70
Repeat 16–80
New 18–60
Repeat 18–80
Beijing18–5518–55
Hong KongNew 16–65
Repeat 16–70
New 18–60
Repeat 18–65
Japan16–69 (small collection)
18–69 (std collection)
18–69
Korea16–64 (small collection)
17–64 (std collection)
17–64
New ZealandNew 16–60
Repeat 16–75
New 18–60
Repeat 18–70
SingaporeNew 16–60
Repeat 16–65
New 18–50
Repeat 18–65
Taiwan17–6517–65
Thailand17–7017–60

Donor weight eligibility

Table 3 summarizes the donor weight eligibility for whole blood donation among APBN members. For both male and female donors, the lowest acceptable weight is 41, 45, 50 and 60, with the provision of small volume donation or medical assessment.

Table 3.   Summary of donor weight eligibility practised among APBN members
Donor weight
Whole blood
Males (kg)Females (kg)
Australia>45>45
Beijing≥50≥45
Hong Kong>41
Small WB 41–49
Std WB >50
>41
Small WB 41–49
Std WB >50
Japan45Small WB 40
Std WB 50
KoreaSmall WB 50
Std WB >50
Small WB 45
Std WB >50
New Zealand>50
48–50 medical assessment
>50
48–50 medical assessment
SingaporeSmall WB 45–49
Std WB >50
Small WB 45–49
Std WB >50
TaiwanSmall WB >50
Std WB >60
Small WB >45
Std WB >60
Thailand>45>45

Disease pattern

Different disease patterns and prevalence are observed among APBN members. For example, some member countries such as Korea and Singapore are endemic for Malaria and Dengue whilst others are not. For countries that are endemic of these transfusion transmissible infections, the strategy to ensure blood safety cannot solely rely on donor selection based on exposure and have to adopt suitable blood test.

Donor deferral

Among APBN, we do share some common reasons for deferral (Fig. 2) and are working within the network to share and exchange various management practices to improve all members’ outcomes. Low pre-donation Hb is the commonest reason for deferral, followed by medication and current medical investigation.

Figure 2.

 Summary of reasons for donor deferral.

New donor recruitment

To address the impact of the above mentioned issues on donor participation, APBN members have developed innovative donor recruitment strategies. Some members such as Hong Kong, Beijing, Taiwan specially focus on youth and young donor participation whereas some focus on older donors, e.g. Australia. (Fig. 3)

Figure 3.

 Summary of new donor recruitment age below and above 24.

Clinical demand and transfusion management practices

Among APBN members, clinical demand and transfusion management practices also differ, especially where the indigenous population has a genetic predisposition to specific disease patterns. For example, the high degree of population homogeneity in Japan requires routine irradiation of cellular products prior to transfusion to prevent GVHD, which in turn reduced the red cell inventory shelf life.

Furthermore, it is highly interesting that we have one of the lowest red cell utilization ranges internationally, perhaps indicating the success of our specific blood management activities. (Fig. 4)

Figure 4.

 Summary of combined red cell + whole blood issues per 1000 population.

Conclusion

Because of issues unique to their domestic setting, APBN members have similarities and differences in their practices such as donor management. Each year, APBN conducts a detailed comparison of practices among members. Donor management is one of the major areas that is compared. The exercise has enabled members to understand the differences in their donor management practices because of the different demographic and sociological backgrounds. It also facilitates members to identify the best practice in the region and the opportunities for their own improvement. Through the comparison and sharing of strategic information, we have significantly harmonized our donor management and other areas of our operations in the region as a whole.

Disclosures

C. K. Lin is the current Chair of the Asia Pacific Blood Network but have not received any monetary benefit or assistance from the Network.

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