2Presented by: Dr. DouangChanh Kongphaly Dr. Khounthavy Phongsavath Situation of the Thalassemia and Blood Transfusion Services in Lao PDR.Presented by: Dr. DouangChanh KongphalyDr. Khounthavy Phongsavath
3Country profile Population of 6.0256.197 Laos is also very ethnically diverse, and socio‐cultural beliefsand practices among the 49ethnic groups.Laos is having geographic andfinancial barriers and relativelypoor health infrastructure.Laos has experienced relativelyhigh economic growth in the lastdecade.Source:
4Health system in Laos• Health services system in Laos is divided into 3levels:– Primary care : Health centers and district hospitals– Secondary care: Provincial and regional hospitals– Tertiary care: Central and University hospitals• No private hospital, only private clinic are runby government staffs after working hours.• Non‐communicable diseases national strategyis being developed• No special policy on Hb diseases.
5Chlidren’s Hospital in Laos Official Opening Ceremony on
6Background -Jan; KOICA launches Thalassaemia project in MCH 2009 – Start managing Thalassaemia patients in Mother and Child Hospital2010-Jan; KOICA launches Thalassaemia project in MCH2011-Nov; The Children’s Hospital opens-Dec; 1st Staff meeting for preparing Thalassaemia clinic2012- Feb; Thalassaemia conference in BangkokMar; Blood Strorage unit established in Children’s hospital- May ; Thalassaemia Clinic opens supported by KOICA, HHA- July; Start importing L-one (deferiprone) in Children’s Hospital
7Official Opening The Thalassemia Clinic Ceremony on 4.05.2012
8Activity Publishing Books Patient support Patient education Dec, 2010 -Translating TIF book “About Thalassaemia” in Lao language.-Translating Patient follow up book in Lao language.Patient supportJan, 2010 ~Support transfusion, filter, iron chelation available ( Provide only at Children’s hospital ).Support splenectomy (20 cases for poor patients )Patient educationSep 2011 ~ July 2012Total 8 times of patient meetings and lectures
9Diagnostic services available: CBCMorphologyFerritin SerumHemoglobin ElectrophoresisUnavailability of diagnostic testPolymerase Chain ReactionSerum Iron/Transferrin/TIBC ( referred Example to Thailand ).Bone Marrow Analysis( Setthatilath’s Hospital )
10The Hematology Data in Children’s Hospital Thalassemia patients 229 cases:TDT/NTDT (111/118)98 cases of Thalassemia HbE disease04 cases of Beta Thalassemia Major61 cases of Thalassemia E/B58 cases of Thalassemia HbH disease50 cases of Iron Overload20 cases of SpleenectomyITP 03 casesIDA 04 cases
16Splenectomy support Case No Sex/Age OP date #1 Male/9 14/Mar/2012 #2 Female/824/May/2012#3Male/1121/June/2012
17we work together between KOICA’s volunteer and staff in Children’s Hospital.
18We had educate for Thalassemia family to know about this disease more for 7times/year and more in the future.
19Made a poster about take care and treatment Thalassemia Made a poster about take care and treatment Thalassemia. ( Useful Brief Poster)
20Thalassemia Handbook Translation supported by the KOICA
21Future Task Enhance the ability of Laboratory Development of national strategic planning for thalassemia treatment and prevention.Development of update national treatment guidelines for thalassemia.Initiation of national thalassemia screening program.Import Desferal to the hospitalFind more support from Foreign Organizations (WHO etc…)Make National Guideline, National RegistrationMake deep relationship with the National Patient’s Association (Not organized yet)Keep on good relationship with the Blood BankParticipate blood donation activities
22Blood Transfusion Services Presented by: Dr. DouangChanh KongphalyNational Blood Transfusion Centre
23Background 1995 -2003: blood services were structured with: 1975 Blood service started in Vientiane Capital and played a leading roles in providing adequate and safe blood supply.1991, MOH transferred this responsibility to the Lao Red Cross.: blood services were structured with:- Official national blood program- National Blood Policy ( Decree 84/PM, 30/12/1995)National Blood Transfusion Committee( Decree 01/PM,05/01/1998)
24System of Management 4 3 2 1 Govt. provides upgrading 10 Storage Units in District & Military HospitalsGovt. provides upgradingNBTC provides equipment for set up and training for staff in group X-matching, cold chain management and transfusionPBC or BB in PH provides blood (2O, 2B, 1A)13 Blood Banks in Provincial HospitalPH provides space and staff for the collection, processing, testing, storage and distribution of bloodLRC provincial branch provides staff for donor recruitmentNBTC provides equipment, reagents, training, supervision and management of blood program3 Provincial Blood CentreManaged by LRCFull function of blood programNBTCResponsibility for whole countryProvide full function of blood programProvide management , training and resource support to provincial blood centers, provincial hospital blood banks and district hospital storage unit4321
25Main Activities Blood donor recruitment Blood collection Blood testing:- Immuno-haematology- Transfusion Transmitted InfectiousBlood storage and distributionsQuality managementTraining: Lab tech, Blood Centre staff, medical staff
26NotesWHO recommends an integrated strategy for safe blood transfusion and for minimizing the risks associated with transfusion. The strategy includes:collection of blood from safe, voluntary unpaid blood donorstesting of donated blood for transfusion-transmissible infections and blood groups in quality-assured manner, and correct storage and transportation of bloodsafe and rational use of blood for improving clinical transfusion practicesestablishment of nationally-coordinated blood transfusion services with quality systems in all areassystem for monitoring, reporting and investigation of adverse events associated with transfusion26/2126
27Blood donor recruitment Based on non-remunerated blood donation. How to make a campaign? - Public relations: oral talk, posters, pamph songs,banners, invitation; or through mass media(radio/TV,Newsp,magazine..) - Organize special event in the main days - Organize blood donation campaign planning meeting with partner sectors - Training donor recruiters: Youth donor club: universities, colleges, high schools, army, police
29Blood TestingAll collected blood unit had been systematically testing for:- Blood Grouping,- Antibody screening- Cross-matching- Identification Antibody- Screening for TTI ( HIV, HBV, HCV and Syphilis )before transfusion to the patients.
31Blood Storage and supply Whole blood (WB) %Blood components: %- Concentrate Red Cells (CRC)- Fresh Frozen Plasma (FFP)- Platelet Concentrate (PC)- Platelet Rich Plasma (PRP)Promotion of clinical appropriate use of blood/blood components
32Quality management SOPs and Guidelines Trainings Monitoring and Follow upEQAS (External Quality Assurance Scheme)IQC (Internal Quality Control)Data base
33Difficulties/Challenges Increasing demand of blood supplyPercentage of VNRD VS Number of CollectionAwareness people on blood donation still limitedHigh percentage of infected blood unitSelf sufficient sustainabilityHRInfrastructure
34Future DirectionIncrease Number of Blood Collection through blood donation promotionsFollow up the Strategic PlanExtend blood transfusion services to district levelHuman Resource DevelopmentImprove Quality Management SystemStrengthen the capacity of Provincial networks