Eritrea: National Blood Transfusion Center 20 Years of Quality Services

In January of 2002, the National Blood Transfusion Center (NBTC) began its operation as a freestanding institution in Eritrea whose chief objective was to work on the safe collection, processing and transfusion of donated blood. Popularly known as the Blood Bank, the NBTC is the highest and most extensive of the three hierarchical divisions that fall under the purview of the National Blood Transfusion Service (the nationally coordinated network of blood transfusion), the other two being regional blood centers at zonal levels and hospital blood banks that provide service at medical facilities.

This article aims to trace the chronological progress of the National Blood Transfusion Center within a larger framework of the national and historical healthcare sector. But first, a little background.

In the span of nearly 50 years in which the National Blood Transfusion Service has been providing blood supply for Eritreans both during and after the 30-year war for independence, we have come a long way from laboring with kerosene-powered refrigerators and employing basic laboratory techniques in the Orotta Central Hospital of Arareb. In the early 80’s, the central laboratory began storing blood in 24-hour refrigerators that utilized solar power for energy. More advanced compatibility tests were also implemented.

Following independence in 1991, approximately 9 blood bank units were providing services in hospital bases. The biggest of these units was situated at Mekane Hiwet hospital in Asmara.

A few years later, a proposal was drafted outlining the necessity of upgrading the blood bank services in Eritrea. In 1997, medical personnel including a medical director, an administrator, a senior laboratory technician and a nurse were sent to Uganda to undergo training on advanced processes and procedures involved in blood transfusion.

In early 1999, the blood bank unit located in Mekane Hiwet Hospital was moved outside hospital grounds to function as a separate, central blood bank. With an extended collaboration between the Swiss Red Cross (SRS) and the Eritrean government, a new facility was assembled and supplied with the necessary equipment.

In 2002, the National Blood Transfusion Center, a newly built, autonomous facility with the principal objective to coordinate and supervise all blood transfusion services became operational. The SRS continued to assist the NBTC for the following 10 years and greatly contributed to the current working structure of the facility. At this time, the NBTC was made up of three departments: Administration Department, Laboratory Department, and Donor Service Department.

A year later, the NBTC, which to this day adheres to WHO guidelines, developed WHO-based policies to attain and maintain its goal of carrying out safe and secure blood transfusion services nationwide.

These policies were revised in 2006, and again in 2011.

In 2006, the NBTC’s laboratory, which had thus far utilized only whole blood for transfusion, was implemented with the component section where the main task was to separate blood into its five component parts. Patients could obtain a blood component that was best suited to their needs. Similarly, the transfusion transmissible infection section (TTI) which screened all donated blood for diseases was accommodated with the highly sensitive and specific ELISA diagnostic machine and its complementary diagnostic kits.

Within the same year, owing to the natural scarcity of Rh-Negative blood type in the population, a committee of donors known as Rh-Negative Donors was formed with the aid of Donor Service department. Subsequently, a second committee known as Rh-Positive Donors was created.

A crucial development took place in the organizational structure of the NBTC in 2007. The previous three departments (Administration, Laboratory and Donor Services) expanded to include an additional two departments: Data Management Systems, and Quality Management Systems. The complementary contributions of these new management systems were essential in guaranteeing the safety and high functionality of the facility. The Quality Management produced and implemented documentation like quality manuals, standard operating procedures, clinical guidelines, and medical criteria for blood collection. While Data Management ensured the total confidentiality of donors and maintained a strict and ethical code of operating among staff.

Both systems supervise the blood transfusion service in its entirety – from the moment a prospective donor is identified and registered, to the varying stages of separating and screening that takes place in the NBTC, to the time when the fully processed blood unit is issued from the center to a medical facility (civilian or military) to then be transfused to a patient.

The National Blood Transfusion Center was assessed by the South African Bureau of Standards and, fulfilling the requirements of ISO 9001-2008, was certified in 2010.

In 2011, both Rh-Positive and Rh-Negative donor committees were joined to make the larger and substantially more effective National Association of Voluntary Blood Donors. This collective oversees consciousness-raising campaigns, donor recruitment, and promotional events.

In 2012, the NBTC’s Immunohematology section of the laboratory began implementing the highly sensitive Gel card system of blood group testing, becoming one of the first countries in Africa to do so. The NBTC was again inspected in 2013 and found to satisfy the required standards. That year it was re-certified by the SABS.