14. TESTING OF TTI. ⢠HIV Ab by. ELISA and. Syphilis Ab by VDRL. ⢠Supported by. NAP and. WHO. 2002. ⢠HBsAg by in
Filling The Gap in Safe Blood Transfusion service Of Myanmar Dr Thida Aung M.B;B.S, M.Med.Sc, PhD (Patho) National Blood Center Myanmar 1
Voluntary Donation
National Blood Center
National Blood Center
without
with
Organization
1962
2003
Organization
2015
2
Before 1975
3
After 1988
Donor recruitment
Donation Vs HIV
16000
20000
1.20%
14000
1.00%
15000
12000 10000 Volunteer Replacement
8000
10000
0.60% 0.40%
5000
6000
0.20%
4000
0
2000
Volunteer
0.80% Replaceme nt HIV positive rate
0.00% 1999 2000 2001 Year 2002 2003
0 1999
2000
2001
2002
2003
4
5
Constraints of Myanmar BTS Important constraints are Lack of awaresness of Importance and Quality of BTS • both in Administrator • Implementers • Public
• HIV Ab by ELISA and Syphilis Ab by VDRL • Supported by NAP and WHO
• HBsAg by inhouse RPHA method • HCV Ab by WHO prequalified Rapid Test
TESTING
1995
OF
TTI
2002
EQAS for TTI by National Serology Reference Laboratory Australia since 2002
14
1995
•
•
HIV Ab by ELISA and Syphilis Ab by VDRL Supported by NAP and WHO
2002
• •
HBsAg by inhouse RPHA method HCV Ab by WHO prequalified Rapid Test
EQAS for TTI by National Serology Reference Laboratory Australia since 2002
15
Hepatitis B Vaccination Programms
16
Testing Strategy for TTI Screening • • • •
HIV Ab by ELISA Syphilis by VDRL
•
HBsAg by in-house RPHA
HBsAg, HCV Ab by WHO prequalified RDT
HIV, HBV, HCV – 50% by NAT System and 50% by ECLIA
Information from NRL Reports 17
Nationally Coordinated Service
18
2003
• NBC without separate organization • Hosp Lab attached - >800
2015 April
• NBC with separate organization set up • Hosp Lab attached - >900
19
Development of Guidelines for Blood Transfusion Service
M&E of BTS around Myanmar (2009-2012)
20
21
Blood Group Serology
22
Case (1) • 20yrs old female • Thalassaemia, B RhD postive • In 2007 – shorten transfusion interval • 0nce/year twice per month twice per week • First antibody Anti-E & Anti-c
After 2 units of B RhE , Rhc neg blood
Not Responding 23
Case 1 cont Anti Fyb appear again
2 units of B RhE , Rhc, Fyb neg blood,
Hb rises Transfusion free upto 2015 Give these two units – search from donor register Upto now Transfusion free Normal life
Still Hb is not responding
Anti Jka appear
Total – B, RhE,c, Jka, Fyb neg blood from donors – only 2 units (Out of 50 donors) 24
Case 2 • 7 yrs old child for DHF • During grouping• Discrepancy between parents and child • Father – B RhD pos • Mother – O RhD neg • Child – Cell grouping O, Serum group A
25
Case 2 cont Anti A
Anti B
Anti A,B
A cell B cell O cell
Anti D
Anti H
son
0
0
2+
0
4+
0
4+
4+
Ael
Father
Mf
4+
4+
0
0
0
4+
Mf
A3B
mother
0
0
0
4+
4+
0
0
4+
O RhDneg
26
Case 2 cont Previous Group
Final Group
Father
B RhD pos
A3B RhDpos
Mother
O RhD neg
O RhD neg
Son
O RhD Pos with Discrepancy
Ael
27
28
29
30
Component preparation
31
• 30 yrs old, Haemophillic • In 2003 – he admitted for 45 days for intramuscular bleeding • Already 155 units of WB have been transfused • Used blood in glass Bottles for stored more than 8 hrs • Collected from replacement donors • Screening only HIV and Syphilis only • Already infected with HIV • Daily dressing by nurses • Risk of spreading infection
32
• Infusion of Cryo 4 units 12 hrly for 3 days • All bleeding arrested • Wound was healed
• Since 2012 , Factor VIII concentrate donated by World Federation of Haemophilia, Initiated by Dr Tin Nyunt From NHL in 2005
33
34
Continuous Education Program
35
Present Challenges Sustainability Equality throughout the country
36
Areas Needed to Improve Establishment of well organized Services Strengthening of Red cells Immunohaematology service throughout the country Introduction of Quality management system into all services Controlled Component preparation services
