Blood Safety Program: Needs Assessment Trip Adam Weiss MD1, Elizabeth Donegan MD1 GLOBAL HEALTH 1Department of Anesthesia and Perioperative Care, University of California, San Francisco

BACKGROUND EASTERN REGION BLOOD TESTING AND SAFETY

A safe, reliable blood supply is a key element of modern healthcare systems. The Philippines ranks 117 out of 187 countries in the UN Human Development Transfusion Transmitted Infection Screening* (%) However, in many developing countries, including the Philippines, the blood supply Ranking. In terms of healthcare, resources are severely limited as compared to the 3 lacks both the safety and capacity provided by a fully volunteer blood supply. United States and other developing countries. 2.67 Instead, replacement and remunerated donors comprise the majority of blood 2.43 HEALTH INDICATORS 2.5 collected for transfusion. Country USA Haiti Honduras Philippines 2 The World Health Organization has made blood transfusion safety a priority for Birth rate (per 1,000 population) 13.4 26 26.1 24.2 improving healthcare in the developing world. The five key elements of their plan Death rate (per 1,000 population) 8.15 8.8 4.5 4.92 1.5 include: Life expectancy (years) 78.9 63.1 73.8 68.7 1 0.73 0.73 • Voluntary donation of blood from low-risk populations Under-5 mortality rate (per 1,000 live births) 11 94 28 37 0.6 0.66 0.46 • Screening for transfusion transmitted infections HIV prevalence (per 100,000 population) 5 15 3 14 0.5 • Blood compatibility testing TB prevalence 4.1 254 74 438 0.07 0 • Blood component fractionation Incidence of malaria (per 100,000 population) N/A 13 1.5 1.3 • Reduction in unnecessary transfusions HIV Hepatitis B Hepatitis C Syphilis Incidence of dengue N/A 0.9 6.1 145 Screen Positive Seropositive PURPOSE Whole blood donations (per 1,000 populations) ≥30 <5 5-9.9 5-9.9 Percentage of voluntary, unpaid donations (%) 99-100 50-89.9 <25 50-89.9 *Total # of Units Tested Annually at The Philippines Blood Safety Program is working with Ormoc City in , Ormoc City’s population is 191,200 (second largest on Leyte). Its primary form of Ormoc Red Cross = 6,530 Philippines to develop a regional blood system that builds on the community’s commerce is agriculture. Principle crops are sugar cane, rice, and pineapple. There is limited blood testing, fractionation, and storage equipment scattered PROJECT GOALS existing resources, and that meets the World Health Organization’s goals. An initial across the six facilities. However, the frequent disrepair of these machines leaves needs assessment trip was completed in August, 2015. BLOOD SYSTEM IN ORMOC CITY the overall blood system unreliable. Additionally, there is no antibody screening • Development of a robust volunteer donor program. Accomplished through available when patient’s have reactive cross-matches. partnerships with local business and news media to increase awareness and Needs assessment trip goals: The Ormoc City healthcare community is comprised of one semi-private farmer’s community involvement in blood donation drives. • Collect data on Leyte’s regional blood supply hospital, one public district hospital, three private hospitals, and the Ormoc Red CLINICAL BLOOD UTILIZATION • Improve the quality and safety of blood product preparation and • Learn about Ormoc City’s healthcare infrastructure Cross blood bank. distribution. Accomplished by procurement and maintenance of blood banking • Meet community organizations interested in philanthropy equipment. As well as development of standard operating procedures and • Build personal and industry connections that will facilitate the program Ormoc City Hospitals’ Bed Capacity # of Transfused Units per Month Discarded Products quality assurance programs. 200 190 200 180 (%) • Decrease unnecessary transfusions through changing clinical practice. 180 12 APPROACH 150 Accomplished by hosting regional transfusion symposiums on rational 150 160 10 transfusion guidelines, and online modules with updates on clinical practice. 140 10 The Philippines Blood Safety Task Group, a multidisciplinary group of volunteers 100 100 100 120 100 78 8 from UCSF, was formed in order to plan and implement improvements to the 100 6 Ormoc City blood system. They teamed up with Global Healing, an East Bay non- 50 40 80 5 CONCLUSIONS 50 56 profit with expertise in developing blood systems. 20 10 60 4 40 The destruction of 0 25 20 2 Methods for assessing need: OSPA-FMC Ormoc District Doctor's Gatchalian Women's and 20 adversely affected Ormoc City’s • Remote data collection forms emailed to the five Ormoc City hospitals and Hospital Hospital Children's 0 0 healthcare system. Now, we have Ormoc Red Cross OSPA-FMC Ormoc Doctor's Gatchalian OSPA-FMC Ormoc the opportunity to work with local Total Capacity Average Census District Hospital District • Face to face meetings with directors of each hospital, Ormoc Red Cross, Rotary Hospital Hospital physicians, hospitals, and the Ormoc club, and Ormoc City government When patients require blood transfusions they must negotiate an antiquated Red Cross to develop and put in place a functioning, model blood • Tour each facility to better understand the process and limitations of the current ordering and procurement system that requires them to personally, or via family, Transfusions by Department Products Transfused at blood system pay for and pick up blood products from the Ormoc Red Cross. They must also system; one that also can be at Ormoc District Hospital (%) Ormoc District Hospital (%) provide a replacement donor. This process often takes up to 24 hours, making replicated in other regions of the 5 5 emergency blood for transfusions virtually unattainable. 3 Philippines. Support the Philippines Blood Safety Program today! 20 Blood Product Costs ($ USD) Ormoc Red Cross Donor 17 40 38 Types (%) PhilippinesBloodSafety.org 32 47 30 26.4 21 20 ACKNOWLEDGEMENTS 10 28 0 75 73.6 Support in part by grants from the Global Health Clinical Scholars Grant, Ormoc Red Cross Medicine OB/Gyn Surgery Global Healing, and the Donegan Lab. Whole Blood pRBC Platelet/FFP Replacement Volunteer Pediatrics Other Whole Blood pRBC Platelets/FFP