Xin cho Situation of the Thalassemia and Blood

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Situation of the Thalassemia and Blood Transfusion Services in Lao PDR. Presented by: Dr. Douang. Chanh Kongphaly Dr. Khounthavy Phongsavath

Country profile • Population of 6. 0256. 197 • Laos is also very ethnically diverse, and socio‐cultural beliefs and practices among the 49 ethnic groups. • Laos is having geographic and financial barriers and relatively poor health infrastructure. • Laos has experienced relatively high economic growth in the last decade. Source: www. who. int/countries/lao/en/

Health system in Laos • Health services system in Laos is divided into 3 levels: – Primary care : Health centers and district hospitals – Secondary care: Provincial and regional hospitals – Tertiary care: Central and University hospitals • No private hospital, only private clinic are run by government staffs after working hours. • Non‐communicable diseases national strategy is being developed • No special policy on Hb diseases.

Chlidren’s Hospital in Laos Official Opening Ceremony on 11. 2011 •

Background • 2009 – Start managing Thalassaemia patients in Mother and Child Hospital • 2010 -Jan; KOICA launches Thalassaemia project in MCH • 2011 -Nov; The Children’s Hospital opens -Dec; 1 st Staff meeting for preparing Thalassaemia clinic • 2012 - Feb; Thalassaemia conference in Bangkok - Mar; Blood Strorage unit established in Children’s hospital - May ; Thalassaemia Clinic opens supported by KOICA, HHA - July; Start importing L-one (deferiprone) in Children’s Hospital

Official Opening The Thalassemia Clinic Ceremony on 4. 05. 2012

Activity • Publishing Books – Dec, 2010 -Translating TIF book “About Thalassaemia” in Lao language. -Translating Patient follow up book in Lao language. • Patient support – Jan, 2010 ~ Support transfusion, filter, iron chelation available ( Provide only at Children’s hospital ). Support splenectomy (20 cases for poor patients ) • Patient education – Sep 2011 ~ July 2012 Total 8 times of patient meetings and lectures

Diagnostic services available: • CBC • Morphology • Ferritin Serum • Hemoglobin Electrophoresis Unavailability of diagnostic test • Polymerase Chain Reaction • Serum Iron/Transferrin/TIBC ( referred Example to Thailand ). • Bone Marrow Analysis ( Setthatilath’s Hospital )

The Hematology Data in Children’s Hospital v Thalassemia patients 229 cases: v. TDT/NTDT (111/118) • • • 98 cases of Thalassemia Hb. E disease 04 cases of Beta Thalassemia Major 61 cases of Thalassemia E/B 58 cases of Thalassemia Hb. H disease 50 cases of Iron Overload 20 cases of Spleenectomy v ITP 03 cases v IDA 04 cases

Statistics Accumulated Patients 223 199 173 162

Thalassemia Clinic Statistics at Children’s Hospital • Monthly patients 145 69 77 85 96 110 116 100

Statistics • Monthly transfusions 121 79 55 62 68 64 85 88

Statistics/Project • L-one supported L-one 77 cases 55 cases 44 cases 33 cases 12 cases 18 cases Project: 1000 T/m

Statistics/Project • Filter supported Filter 30 cases 23 cases 22 cases 21 cases 14 cases 15 cases 8 cases Project: 10 pieces/m

Splenectomy support Case No Sex/Age OP date #1 Male/9 14/Mar/2012 #2 Female/8 24/May/2012 #3 Male/11 21/June/2012

we work together between KOICA’s volunteer and staff in Children’s Hospital.

We had educate for Thalassemia family to know about this disease more for 7 times/year and more in the future.

Made a poster about take care and treatment Thalassemia. ( Useful Brief Poster)

Thalassemia Handbook Translation supported by the KOICA

Future Task • Enhance the ability of Laboratory • Development of national strategic planning for thalassemia treatment and prevention. • Development of update national treatment guidelines for thalassemia. • Initiation of national thalassemia screening program. • Import Desferal to the hospital • Find more support from Foreign Organizations (WHO etc…) • Make National Guideline, National Registration • Make deep relationship with the National Patient’s Association (Not organized yet) • Keep on good relationship with the Blood Bank • Participate blood donation activities

Blood Transfusion Services Presented by: Dr. Douang. Chanh Kongphaly National Blood Transfusion Centre

Background • 1975 Blood service started in Vientiane Capital and played a leading roles in providing adequate and safe blood supply. • 1991, MOH transferred this responsibility to the Lao Red Cross. • 1995 -2003: blood services were structured with: - Official national blood program - National Blood Policy ( Decree 84/PM, 30/12/1995) - National Blood Transfusion Committee ( Decree 01/PM, 05/01/1998)

System of Management 10 Storage Units in District & Military Hospitals • Govt. provides upgrading • NBTC provides equipment for set up and training for staff in group X-matching, cold chain management and transfusion • PBC or BB in PH provides blood (2 O, 2 B, 1 A) 3 13 Blood Banks in Provincial Hospital • PH provides space and staff for the collection, processing, testing, storage and distribution of blood • LRC provincial branch provides staff for donor recruitment • NBTC provides equipment, reagents, training, supervision and management of blood program 2 3 Provincial Blood Centre • Managed by LRC • Full function of blood program 4 1 NBTC • Managed by LRC • Responsibility for whole country • Provide full function of blood program • Provide management , training and resource support to provincial blood centers, provincial hospital blood banks and district hospital storage unit

Main Activities • Blood donor recruitment • Blood collection • Blood testing: - Immuno-haematology - Transfusion Transmitted Infectious • Blood storage and distributions • Quality management • Training: Lab tech, Blood Centre staff, medical staff

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Blood donor recruitment Based on non-remunerated blood donation. How to make a campaign? - Public relations: oral talk, posters, pamph songs, banners, invitation; or through mass media(radio/TV, Newsp, magazine. . ) - Organize special event in the main days - Organize blood donation campaign planning meeting with partner sectors - Training donor recruiters: Youth donor club: universities, colleges, high schools, army, police

Blood Testing • All collected blood unit had been systematically testing for: - Blood Grouping, - Antibody screening - Cross-matching - Identification Antibody - Screening for TTI ( HIV, HBV, HCV and Syphilis ) before transfusion to the patients.

Percentage of TTI (+) (Year 2011)

Blood Storage and supply • Whole blood (WB) 80 % • Blood components: 20% - Concentrate Red Cells (CRC) - Fresh Frozen Plasma (FFP) - Platelet Concentrate (PC) - Platelet Rich Plasma (PRP) • Promotion of clinical appropriate use of blood/blood components

Quality management • • • SOPs and Guidelines Trainings Monitoring and Follow up EQAS (External Quality Assurance Scheme) IQC (Internal Quality Control) Data base

Difficulties/Challenges • Increasing demand of blood supply • Percentage of VNRD VS Number of Collection • Awareness people on blood donation still limited • High percentage of infected blood unit • Self sufficient sustainability • HR • Infrastructure

Future Direction • Increase Number of Blood Collection through blood donation promotions • Follow up the Strategic Plan • Extend blood transfusion services to district level • Human Resource Development • Improve Quality Management System • Strengthen the capacity of Provincial networks

Thank you for your attention 35