RISKS ASSOCIATED WITH A WALKING BLOOD BANK

A Policy Statement by The Blood Care Foundation

Introduction

In countries where adequate supplies of blood are not available, or the standards of quality are unreliable, arrangements have to be made to provide blood cover in an emergency. Historically, one alternative has been to set up and maintain a Walking Blood Bank. A Walking Blood Bank (donor panel) is comprised of a group of people who are prepared to be called on to donate blood to meet a particular emergency. This has always been viewed as a stop-gap solution until a satisfactory alternative became available. The American Association of Blood Banks(1) now consider this practice "a relic of less sophisticated times" and, in their Technical Manual, mention it only to identify the hazards. Although, in those rare situations where no other solution is available, such a panel might still be set up, it should always be viewed as a solution of last resort. Even in this situation, no shortcuts may be taken and all the internationally agreed standards must be maintained(2, 3, 4).

Method

Having advertised the requirement for donors, one person is nominated to administer the panel. This person is responsible for recording each donor's personal data, ensuring the list is kept up to date as and when donors move or return to their native country, and for recruiting new donors to replace those who leave the panel for any reason. Each volunteer has to be interviewed to screen out those whose medical history or life style would make them unsuitable to act as donors. Those who pass the interview have a number of tests performed to ascertain their blood group and antibody status. These tests include those for HIV 1 & 2, hepatitis B & C, syphilis and any other disease, such as malaria, which might be endemic in that particular country.

Problems arising from a walking blood bank

1. Because a Walking Blood Bank is, by its very nature, a small enterprise, it is extremely difficult to ensure that an adequate level of quality assurance is maintained, similar to that available in a major blood bank.
2. Potential donors are drawn from the local and expatriate population, who are constantly exposed to the local endemic insect-vectored diseases, such as malaria. For many of these diseases there is no rapid screening test which can be performed in an emergency. This increases the risk of an infected donation, a risk which is avoided if blood is provided from a Western European country.
3. As it is now both medically and legally unacceptable to administer inadequately screened blood, even in an emergency, when an alternative is available, the normal screening tests have to be performed on any blood obtained from a donor panel. This inevitably delays the provision of blood, probably for a longer period than it would take to deliver the same number of units from a major blood bank.
4. In an emergency situation, it may be very difficult or even impossible to provide blood of the specific group in the amount required. This is especially true when the physician requests a large number of units. Although there may be a number of people on the panel of the required group, there is no guarantee that any of them will be available at the material time or, if they are available, be fit to give a donation. The situation is more likely to be critical if the potential recipient has atypical antibodies. The availability of supplies from a major blood bank will provide a much greater likelihood of the requested number of units of suitable blood being at hand within the required time-scale. The time taken to transport the blood from a blood bank to the hospital where it is needed is totally independent of the number of units to be supplied.
5. As Walking Blood Banks are frequently drawn from a small community, embarrassment can arise if certain members are rejected because of their life style. Because of this, there is an increased risk that potential donors will not be entirely truthful as to their risk factors and be included on the panel. This, of course, immediately increases the risks to the potential recipients.
6. If there has been a change in a donor's social behaviour since originally joining the panel, he/she is almost certain to be unwilling to divulge this information because of the questions which would be asked within the community as to the reason for deferral. This risk is particularly high if the donation is to be made to a relation or friend. If the potential donor has recently been involved in high risk activities, the last people to whom he would wish this information to be transmitted are his family and friends.
7. Unless provision can be made via a local blood bank, equipment and reagent kits have to be purchased, and a laboratory staffed and maintained to provide the testing facilities. In addition, provision has to be made for the counselling and clinical follow-up of those donors who are either found to be repeat reactive or positive for one of the screening tests. Such counselling is time-consuming and expensive, as trained counsellors must be employed. As the concept of a Walking Blood Bank is no longer considered safe in international transfusion medicine circles, it is unlikely that a reputable blood bank would cooperate in such a venture.
8. There are numerous administrative tasks to be performed with regard to keeping track of potential donors and recruiting replacements. This makes the exercise, if it is to be performed safely and efficiently, an expensive one.
9. All aspects of product liability are vested in the administrators of a Walking Blood Bank whereas, when blood is provided by a major blood bank, product liability remains with them.

Conclusion

Walking Blood Banks are now no longer considered acceptable clinical practice within the international transfusion medical community'. The Blood Care Foundation fully supports this view. Blood, whenever conceivably possible, should be provided from a major licensed blood bank, where a high degree of quality assurance can be maintained, and the large turnover will give a much greater likelihood of the rapid provision of rare groups, or blood which will be compatible with patients having complicated antibody profiles.

References

1. Neo-natal and obstetric practice. In: Walker RH ed. Technical Manual. 11th ed. Bethesda, Maryland: American Association of Blood Banks, 1993:448. ISBN 1-56395-019-7
2. Guidelinesfor the Blood Transfusion Service. 2nd ed. London, England: HMSO, 1994. ISBN 0- 11321-568-6.
3. Guide to the preparation, use and quality assurance of blood components. 2nd ed, Strasbourg, France: Council of Europe Press, 1995. ISBN 92-871-2687-9.
4. Widmann FK ed. Standards for Blood Banks and Transfusion Services. 15th ed. Bethesda, Maryland: American Association of Blood Banks, 1993. ISBN 1-56395-020-0.

© The Blood Care Foundation

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