1. IBTO Research Center1

2. 2 Iranian Blood Transfusion Organization

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4. 4 History of blood transfusion in Iran The first hospital of National Iranian oil company was established in Masjed Soleiman in 1924 and the blood transfusion was first carried out in this hospital. 1948: Establishment of the First Private Blood Transfusion in Iran as Dr. Motamed blood transfusion center 1949: Publication of the First Notice to Call for Blood Donation 1950s: Hospitals started to use replacement blood 1952: Establishment of Army’s Blood Transfusion Center 1954: Establishment of the First Iran Red Lion and Sun society (Red Crescent) blood Transfusion Center

5. 5 1955: Establishment of the First Center for preparation of Blood Derivatives 1955: Establishment of the First Provincial Blood Transfusion Center 1962: Establishment of the First Independent Iran Red Lion and Sun society (Red Crescent) Blood Transfusion Center. 1974: Establishment of National Blood Transfusion Organization 1978: Iran Blood Transfusion Organization & Islamic Revolution 1979:The Blood Transfusion Organization was assigned to the Ministry of Health and Welfare. History of blood transfusion in Iran (con ’ t)

6. 6 1980: Iran Blood Transfusion Organization & Imposing War Supply of blood and blood products required by the thousands of wounded soldiers 1984: Introduction of the Organization as the Sole responsible of the Supplying Blood and Blood Products in Iran 1974: HBs Ag Screening test 1987: HIV-Ab Screening Test 1997: HCV screening test 2005: Implementing HIV-Ab, HIV-Ag screening test 2006: Development of Iran Blood Transfusion Network 2006: Commencement of technical and software automation of Iran blood transfusion stations 2007: Achievement the 100% voluntary nonremmunerated blood donation

7. 7 Ministry of Health & Medical Education IBTO's High Council Managing Director Department of Legal Affairs Department of Public Relation & International Affairs Security OfficeOffice of Activity Evaluation & Complaints Managing Director Office Deputy of Management Expansion & Improvement Deputy of Technical & Quality Assurance Deputy of Research & Development Technical Department Quality Assurance Department Blood Donors Education & Recruitment Department Occupational Safety & Health Department Department of Research Department of Education Research Center Director of Renovation & Administrative Improvement Department of Administrative Affairs Department of Financial Affairs Department of Supply, Maintenance & Services for Medical Equipments Provincial Blood Centers

8. 8 The Iranian Blood Transfusion Organization 288  Total number of Blood Centers/ Blood Donation Centers 206 Blood Donation Centers 17 Blood Collection & Preparation Centers 65 Blood Centers Provincial Centers 30 Regional & Educational Centers 9 Blood donation center: Responsible for the collection of blood and associated activities for donor recruitment and recall, assessment of donor suitability and donor care. Blood Collection & Preparation Centers: Responsible for recruitment, blood collection, processing, storage & distribution. Blood center: Carries out donor recruitment, blood collection (whole blood and in some cases, apheresis), testing for transfusion- transmissible infections and blood groups, processing in to blood components, storage, distribution to other blood centers and hospital blood banks within a defined region, the clinical use of blood and surveillance of adverse transfusion events.

9. 9 The Iranian Blood Supply system Blood centers are nonprofit and governed by a director appointed by the IBTO ’ s Managing Director Major function is to provide the community ’ s blood supply and hospitals within the blood collection area and hospitals in other areas as well Area covered is determined by Historical factors An overall plan by Central Technical & QA Department

10. 10 IBTO Research Center10

11. 11 The Iranian Blood Supply system Whole blood is collected Only in IBTO blood centers Fixed centers Mobile (Factories, Offices, Universities)

12. 12 3.promoting the network of providing blood supply and transporting system

13. 13 Blood Centers ArakIsfahan

14. 14 Blood Centers QomRasht

15. 15 Blood Donation Center Karaj Zabol

16. 16 The Iranian Blood Transfusion Organization Major equipments and consumables are approved and procurement nationally Examples: Blood Bags Test Kits Refrigerated Centrifuges ELISA Processors Blood Bank Refrigerators Hemoglobin Color Scale strips

17. 17 The Iranian Blood Supply system Blood is provided to hospitals free of charge No charges or fees are requested for the cost of collecting, testing, processing, storing and shipping the blood Central Immunohematology Reference Laboratory provides advance techniques for serological investigations on donors / patients Produces home made panel cells to be used by the Blood Centers

18. 18 Regulation, Standardization and Certification IBTO constitution adopted in 1974 revised in 1984 is approved by the I.R of Iran ’ s Parliament The 2 nd version of IBTO standards titled » Iranian National Standards for Blood Transfusion «was published in 2005 and went in to effect in Sep. 2005

19. 19 Regulation, Standardization and Certification Technical & QA Deputy acts as National Regulatory Authority Same Standard Operating Procedures (SOPs) are in use in all Blood Centers Establishment of all Blood Centers/ Blood Donation Centers is required to be approved by IBTO ’ s Higher Council. Licenses are issued by Central Technical & QA Department before any facilities are operative renewed annually.

20. 20 Trend of Blood Donation in Iran (1974-2007) Units

21. 21 Percent Trend of Transition to 100% Voluntary Blood Donation in Iran (1996-2007)

22. 22 The Iranian Blood Supply system Per capita rate Blood Collection 24/1000 (06- 07) Collection rate age- eligible donors (18+) 36/1000 (05- 06)

23. 23 Medical Assessment of whole Blood Donors Blood containers Blood is collected in to FDA or CE licensed container (450±10% plus 63 ml CPDA) Number of Whole Blood collected in 2007 Total donation 1735000 Autologous donors Paid donors Family Replace ment donors Donations from Regular donors Lapsed donors New donors Per request 0.0% 40%21%39%

24. 24 Laboratory Testing of Donated Blood Prevalence of marker of infection in blood donations in 2007 PercentageType of Infection 0.004%HIV 0.41%HBV 0.12%HCV 0.04%Syphilis 0.0%Malaria 0.02%HTLV

25. 25 Education & Research Deputy of Research and Development is responsible for National & International Educational programs 32 Faculty members of the Research Center provide teaching and training including basic scientific research in the field of transfusion medicine in cooperation with other IBTO scientific investigators in the country Blood Centers conduct seminars, and educational/ technical training classes & in-services to provide updates and continuing education for technologists, nurses and physicians involved in collection, preparation and transfusion of blood and components

26. 26 Education & Research An educational program leading to a master degree is offered by educational department for 7 students holding B.S. degree and 4 phD annually Publication and translation of technical & scientific books & literatures are provided by Educational department IBTO ’ s technical & scientific materials in transfusion services have been provided for neighboring Persian speaking countries through collaboration with WHO office in Cairo EMRO

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29. 29 Laboratory Testing of Donated Blood Each unit of whole blood undergoes a standard battery of tests Required tests Total Units TestedBlood Grouping tests 100%ABO Grouping 100%RhD Typing

30. 30 Recruitment of Blood Donors A national recruitment department Director of recruitment department leads the related activities Lectures, media printed/ visual, community social activities etc. A system of pre-donation counseling of blood donors exist

31. 31 IBTO – Red crescent cooperation in blood donor recruitment

32. 32 The Iranian Blood Supply system

33. 33 Recruitment of Blood Donors Demographic characteristics of Blood Donors 2006 Gender

34. 34 Recruitment of Blood Donors Demographic characteristics of Blood Donors 2006 Age

35. 35 Recruitment of Blood Donors Demographic characteristics of Blood Donors 2006 Education

36. 36 Recruitment of Blood Donors Demographic characteristics of Blood Donors 2006 Employment

37. 37 Recruitment of Blood Donors Demographic characteristics of Blood Donors 2006 Marital Status

38. 38 Laboratory Testing of Donated Blood Total Units Tested Transmissible Disease Testing 100%Hepatitis B surface antigen (HBsAg) 100%Hepatitis C antibody (anti-HCV) 100%HIV 1 & 2 antibody-antigen (HIV Ab/Ag) 8%HTLV I, II antibody (anti- HTLV I, II) 100%Syphilis (RPR) 0.5%Malaria

39. 39 Quality Control of Laboratory Testing External controls WHO BBI Lab Quality Finland Acro-Metrix The Netherlands, NRL Australia EQAS collaboration Run Control Samples (go- no-go samples) IBTO Central QC laboratory sends samples to provincial Blood Centers

40. 40 Quality Control of Laboratory Testing National Internal Controls Central Quality Control Laboratory Blood group serology Positive and Negative controls Supplemental Tests HIV (Western Blot) or Line Immuno Blot / HIV P24 Ag / HIV-1 Ag confirm HTLV (Western Blot) HCV (Riba) HBsAg (Neutralization)/ (HBcAb) RPR (FTA - ABS) There are specific and clear Strategies (Algorithms) set by Technical and QA department to be used by laboratories for all screening test results

41. 41 changes in process Total Laboratory Automation has been implemented in regional IBTO Blood Center in order to centralize the testing of the donated blood.

42. 42 changes in process

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48. 48 Extraction-Automation IBTO Research Center48

49. 49 Production-Blast Freezer IBTO Research Center49

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53. 53 On the Road to ISBT 128 Conversion Internationally recognized Barcode System ISBT128 was replaced the old system. Tracking of specimens, test results and individual components is done by computers using these labels.

54. 54 On the Road to ISBT 128 Conversion

55. 55 Implementing new software system IBTO is in the process of implementing the use of a single Organizational Wide Software System “ MAK System ” in all its blood centers through out the country.

56. 56 Tracing Blood Electronically Recipient Tracing There is a process of recipient tracing (Look- Back) in IBTO by making sure that records (Manual & semi- manual) are carefully reviewed, in order to identify the patients who have received seronegative blood from a donor later found to be infected by blood borne pathogens. The Use of a single National Computer Network System is an effort to make sure that, the current look back process work more efficiently.

57. 57 Cord Blood and other cellular therapies Establishment of a National Public Cord Blood Bank based on National & International standards and to be accredited internationally (Net Cord) is in process

58. 58 Disaster preparedness Is promoted by establishing IBTO Disaster Task Force to prepare policies and guidelines on blood needs during disasters. Readiness between IBTO and other relevant government organizations at the time of disaster is the aim.

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