Xin chào

Situation of the Thalassemia and Blood Transfusion Services

in Lao PDR.

Presented by: Dr. DouangChanh 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 3levels:– 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 runby government staffs after working hours.• Non‐communicable diseases national strategyis being developed• No special policy on Hb diseases.

Chlidren’s Hospital in Laos Official Opening Ceremony on 11.11.2011

•

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; 1st 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

Thalassemia patients 229 cases:TDT/NTDT (111/118)

• 98 cases of Thalassemia HbE disease • 04 cases of Beta Thalassemia Major• 61 cases of Thalassemia E/B• 58 cases of Thalassemia HbH disease• 50 cases of Iron Overload • 20 cases of Spleenectomy

ITP 03 cases IDA 04 cases

Statistics

Accumulated Patients

162

173

223

199

Thalassemia Clinic Statistics at Children’s Hospital

• Monthly patients

0

50

100

150

200

Nov Dec Jan Feb Mar Apr May Jun

Patient …

6977

8596

110100

145

116

Statistics

• Monthly transfusions

5562 68 64

7985 88

121

Statistics/Project

• L-one supported L-one

12 cases 18 cases

33 cases

Project: 1000T/m

33 cases44 cases

77 cases

55 cases

Statistics/Project • Filter supported Filter

14 cases

30 cases

21 cases23 cases

Project: 10pieces/m

22 cases

14 cases15 cases

8cases

Splenectomy support

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 7times/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. DouangChanh KongphalyNational 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

1

2

3

4

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 recruitmentBased 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

0

5000

10000

15000

20000

25000

30000

Bloo

d un

its

Year

Blood collection

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

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Thank you for your attention