Soisangwan Patravee
Bureau of Laboratory Quality Standards, Department of Medical Sciences, Ministry of Public Health, Thailand.
WHO South East Asia J Public Health. 2012 Oct-Dec;1(4):423-431. doi: 10.4103/2224-3151.207044.
The quality of blood transfusion services (BTS) is essential for the treatment of patients who need blood or blood products. BTS involve several steps, including the acquisition of the donor's blood, blood grouping, unexpected antibody screening, blood storage, transfusion, etc. There is a need to check the effectiveness of all elements in the BTS can be assessed and monitored by an external quality assessment.
To assess and evaluate the performance of ABO and Rh(D) blood grouping and unexpected antibody screening of the selected World Health Organization (WHO) South-East Asia Region Member country laboratories.
WHO Collaborating Centre on Strengthening Quality of Health Laboratories (Thailand) organized a regional external quality assessment scheme for blood group serology (REQAS-BGS) between 2002 and 2008 for laboratories in countries of the WHO South-East Asia Region. Test items for ABO and Rh(D) blood groupings and unexpected antibody screening and identification were distributed three cycles per year to BTS laboratories in Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand. By the end of the project, a total of 20 BTS laboratories had participated for differing lengths of time.
It was found that 87.5%, 93.3%, 81.3%, 92.3%, 100% and 87.5% of laboratories returned the test results in 2002, 2003, 2004, 2006, 2007 and 2008, respectively. Laboratories with excellent quality or a trend of quality improvement for ABO and Rh(D) blood grouping, unexpected antibody screening and identification during the six years were 60% (12/20), 50% (10/20), 52.9% (9/17) and 81.8% (9/11), respectively. At the initiation of the scheme, most laboratories were using substandard methods for ABO and Rh blood groupings, i.e. performing only direct blood grouping alone but subsequently adopted the standard methods, i.e. performing both direct and reverse blood groupings.
REQAS-BGS in South-East Asia countries has been useful for assessing, monitoring and improving the quality of testing. Challenges such as high costs and regulatory requirements for international shipment of blood samples could be solved by amending the regulation(s) for shipment, or establishing a national EQAS.
输血服务质量对于需要血液或血液制品的患者治疗至关重要。输血服务涉及多个步骤，包括采集献血者血液、血型鉴定、意外抗体筛查、血液储存、输血等。有必要通过外部质量评估来检查输血服务中所有环节的有效性是否能够得到评估和监测。
评估和评价选定的世界卫生组织（WHO）东南亚区域成员国实验室的ABO和Rh（D）血型鉴定及意外抗体筛查的表现。
WHO加强卫生实验室质量合作中心（泰国）于2002年至2008年为WHO东南亚区域各国的实验室组织了一项血型血清学区域外部质量评估计划（REQAS - BGS）。ABO和Rh（D）血型鉴定以及意外抗体筛查和鉴定的测试项目每年分三个周期分发给孟加拉国、不丹、印度、印度尼西亚、马尔代夫、缅甸、尼泊尔、斯里兰卡和泰国的输血服务实验室。到项目结束时，共有20个输血服务实验室参与了不同时长的项目。
发现分别有87.5%、93.3%、81.3%、92.3%、100%和87.5%的实验室在2002年、2003年、2004年、2006年、2007年和2008年返回了测试结果。在这六年中，ABO和Rh（D）血型鉴定、意外抗体筛查和鉴定质量优秀或有质量改进趋势的实验室分别为60%（12/20）、50%（10/20）、52.9%（9/17）和81.8%（9/11）。在该计划启动时，大多数实验室在ABO和Rh血型鉴定中使用的是不合格方法，即仅进行直接血型鉴定，但随后采用了标准方法，即同时进行直接和反向血型鉴定。
东南亚国家的REQAS - BGS对于评估、监测和提高检测质量很有用。诸如血液样本国际运输成本高和监管要求等挑战可以通过修订运输规定或建立国家外部质量评估计划来解决。
