Regional
Blood Transfusion Services in Nepal
Nepal has a short history of blood transfusion services. This started 58 years ago with the establishment of the first blood bank, “Laxmi,” in Bir Hospital, located in the heart of Kathmandu. Due to its location, blood transfusion services were limited to the residents of Kathmandu Valley only. Following that, the Red Cross Society started providing blood transfusion services to various parts of the country.
With the growing demand for blood transfusion services, the government understood the need to establish blood transfusion services outside the Kathmandu Valley, for which the Nepal Red Cross Society was given the sole authority to conduct blood programmes in Nepal back in 1991. The Nepal Red Cross Society has been a cornerstone in providing blood transfusion services across the country for the past 30 years. Their services, spanning 108 locations within 73 districts, have been instrumental in providing over 4 million units of blood and blood components to those in need. Their commitment to stand-alone blood bank service has been unwavering, as evidenced by the 2022/23 report, which recorded a total blood donation of 281,316, with 391,853 blood components issued.
Nepal underwent rapid modernization in the early twentieth century, leading to the establishment of new hospitals and medical colleges and the expansion of specialized services in existing hospitals. This development significantly increased the demand for blood and blood products, prompting the government to formulate a national blood transfusion policy. This policy, revised twice in 2006 and 2014, serves as a strategic framework for regulating and managing blood transfusion services in the country.
The government established the National Bureau for Blood Transfusion Services (NBBTS), based at the National Public Health Laboratory (NPHL), to monitor and govern blood transfusion services strictly. This made it the national authority to implement the National Blood Programme (NBP), which was previously in the hands of the Nepal Red Cross Society. NBBTS ensures the safe and adequate supply of blood and blood products to meet transfusion needs. It develops policies, guidelines and standards for blood transfusion services. It is also responsible for governing the National hemovigilance program, training BTSC staff, supervising, monitoring, and licensing BTSCs, conducting motivational programs, and providing equipment to BTSCs to initiate or enhance related services. The national hemovigilance program was started in 2017, and 25 centres are enrolled in the Hemovigilance program. As per its 2023 report, 2.2% of transfusion reactions were reported out of 59,601 transfusions, of which the majority were FNHTR and Allergic reactions.1 Severe transfusion reactions such as AHTR, Septic, and TRALI are not reported due to underdiagnosis and due to ethical implications.
To further manage the operations of blood bank services, it has formulated regulatory guidelines for operating blood banks, which they have categorised into five categories: A, B, C, D and E. As per regulation, stand-alone blood banks must get a category A licence; the remaining categories are for hospital-based blood banks. However, due to the impractical criteria in the guidelines, only a few blood banks have been registered with government regulatory bodies, of which only one is of Category A type and more than 100 blood banks are running without being registered with the government body.
According to government data, an average of 300,000 blood units are collected annually. Around 80% of the donations are voluntary and collected via blood donation camps, a very positive sign for the country’s blood transfusion service. However, due to the high tendency of our young population to move out of the country for employment or study purposes and only 0.9% of the total population donating blood, the healthy donor pool has been scarce.2
Blood safety is a huge concern in our country, as there are reports of acquiring TTI following blood transfusions and even mortality due to septic transfusions. Only a few blood banks follow the proper blood donation process, i.e. donor questionnaire administration and haemoglobin testing, which directly affect product quality. Following that, more than 90% of blood banks rely on rapid kits to test transfusion-transmitted disease, and very less blood banks might be using Chemiluminescent. The cost of the testing is also one of the main factors compelling most of them to rely on rapid diagnostic kits. In our present scenario, going for nucleic acid testing in the blood bank seems a distant dream. Now, coming to blood typing, forward blood grouping on tiles is very popular and is followed in almost 99% of blood banks. There is a requirement for advocacy among blood bank technicians regarding the importance of doing forward and reverse grouping to correctly determine one's blood group in blood banking. Only four to five blood banks in the entire country have the facility of automated blood typing and tying for minor blood groups. Apheresis service was started a few years back from minimal centres, and it is slowly and steadily growing in many hospital-based blood banks in Kathmandu due to the increasing demand for plateletpheresis. All of that is due to the prevalent of stand-alone blood banks and the lack of hospital-based blood banks often patient visitor has to run from one blood bank to another in search of desired blood group blood component.
On the clinical side, there is still a high demand for Whole blood for transfusion, especially in obstetrics, gynaecology, and surgical patients, roughly 40% of total transfusions. Also, clinicians widely use platelet-rich plasma products instead of platelet concentrate for thrombocytopenia. There is a considerable gap in blood transfusion knowledge and practices among most clinicians in our country. Lack of transfusion medicine-related topics in the MBBS and postgraduate curriculum has been the main reason for clinicians' poor blood transfusion practices. However, the scenario has been changing with increasing awareness of the importance of Transfusion medicine knowledge in clinical practice. With the country starting to have experts in the field of Transfusion medicine, there is an optimistic hope for improving blood transfusion services in the near future. Nepal, being a low-middle-income country, besides government contribution, support and assistance from various international organizations related to blood transfusion would play a very important role in uplifting the blood transfusion services in our country.
References
1. National Hemovigilance Annual Report. Teku, Kathmandu, Nepal: Ministry of Health & Population, Department of Health Services, National Public Health Laboratory, National Bureau for Blood Transfusion Service.; 2023. 2. Shrestha RM. Blood Transfusion Service in Nepal. Global Journal of Transfusion Medicine. 2024;9(2):139-40.
