1. Iranian Blood Transfusion Organization Facts and Figures

2. Table of Contents History of blood transfusion
IBTO Organizational Chart
IBTO as a Centralized National Blood Program
The Iranian Blood Supply System
Regulation, Standardization and Certification
Recruitment of Blood Donors
Medical Assessment of Whole Blood Donors
Laboratory Testing of Donated Blood
Preparation and Storage of Components
Clinical Uses of Blood Components
Quality Assurance System
Safety
Education and Research
Iranian Plasma Collection and Manufacturing Organization

3. 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 by the British Doctors in this hospital.
Despite that the establishment of blood transfusion centers was not mentioned in the Constitution of the year 1948 of Iran Red Lion and Sun society (Red Crescent), regarding the goals set by the general director of the Group, including:
1- corpsmen, 2- the youth, 3- nurse training, 4- blood transfusion, this Group determined to establish blood transfusion center.
From 1940s onward, blood transfusion has been sporadically done in various hospitals. Sina Hospital was one of the most significant centers of blood transfusion in Iran.

4. History of blood transfusion in Iran (con’t)
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
1955: Establishment of the First Center for preparation of Blood Derivatives
1955: Establishment of the First Provincial Blood Transfusion Center
1960s: The decade of 1960, conduced to valuable accomplishments for the activists of the blood transfusion medicine field in Iran.
1962: Establishment of the First Independent Iran Red Lion and Sun society (Red Crescent) Blood Transfusion Center.

5. History of blood transfusion in Iran (con’t)
1974: Establishment of National Blood Transfusion Organization
1976: Establishment of the First Provincial Blood Transfusion of Iran Blood Transfusion Organization
1978: Iran Blood Transfusion Organization & Islamic Revolution
1979:the Blood Transfusion Organization was assigned to the Ministry of Health and Welfare.
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 Supervisor of the Supplying Blood and Blood Products in Iran

6. Screening tests 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

7. 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
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.

8. The Iranian Blood Transfusion Organization

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

10. 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

11. 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

12. The Iranian Blood Supply system
Type of Blood collected annually
100 %
Volunteer Whole Blood
Per- request
Autologous
Replacement
Directed

13. The Iranian Blood Supply system
1.80 % average growth rate of Whole Blood collection ( )

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

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

16. Regulation, Standardization and Certification
Registrations/ Certifications
Obtained
4 blood centers
ISO
IBTO Diagnostic Reference Laboratory 2004
ISO
In process
Remaining BCs

17. Regulation, Standardization and Certification
Technical & QA Deputy acts as National Regulatory Authority
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.

18. 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

19. Recruitment of Blood Donors

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

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

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

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

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

25. Amount of Blood Collected

26. Future changes in process
Total Laboratory Automation will be implemented in regional IBTO Blood Center in order to centralize the testing of the donated blood.

27. Future changes in process

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

29. On the Road to ISBT 128 Conversion

30. 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.

31. 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.

32. 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

33. 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.

34. 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 2006
Total donation
Autologous donors
Paid donors
Family Replacement donors
Donations from
Regular donors
Lapsed donors
New donors
Per request
0.0% 1%
38.22%
19.92%
41.86%

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

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

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

38. 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

39. 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

40. Preparation and storage of components

41. Preparation and storage of components

42. Clinical Uses of Blood Components
Establishment of Hospital Transfusion Committees in all medical centers that administer blood is in process
Complications of transfusion
Documentation, follow up and reports of infectious and noninfectious complications of blood transfusion needs to be improved
Biovigilance
Efforts are underway to establish a national biovigilance system to collect and analyze data regarding transfusion related adverse events

43. Clinical Uses of Blood Components
Percentage
Blood Issued in 2007
Total
1.45
Whole Blood
52.9
Red Blood Cells
20.2
FFP
19.25
Platelets (Random)
4.09
Cryoprecipitated AHF

44. Quality Assurance System
A Quality Assurance management system has been implemented in IBTO
Standards from ISO , AABB Quality System Essentials, European Council and WHO Quality Recommendations are used as guidelines

45. Quality Assurance System
The goals of the IBTO quality assurance system program are to:
Decrease errors
Obtain credible results consistently
Improve product safety
Improve product quality
A QC department exist in each Blood Center with a QC officer in charge
QC department monitors all processes that take place in IBTO, from donor recruitment, donor selection, blood collection, distribution of blood and blood components, donor testing, labeling, storage, compatibility testing etc.

46. Quality Assurance System
Hospital blood banks
All hospital blood banks are monitored by IBTO’s Blood Center QC department and hospital inspector, periodically.
A comprehensive Quality Directive for hospital blood banks in cooperation with the Ministry of Health and Medical Education is in place

47. Safety New Occupational Safety & Health Unit was established in 2000
IBTO’s policy is to emphasize on a safe workplace for the safety of the employees, donors, patient and visitors

48. Education & Research
Deputy of Research and Development is responsible for National & International Educational programs
34 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
An educational program leading to a master degree is offered by educational department for 7 students holding B.S. degree annually

49. Education & Research
IBTO’s technical & scientific materials in transfusion services have been provided for neighboring Persian speaking countries through collaboration with WHO office in Cairo EMRO

50. IBTO Research Center 2003
IBTO-Research Centre has published more than 70 specialized educational pamphlets and 20 books about blood transfusion, blood safety, and transfusion sciences in Farsi language in last 4 years.
IBTO-Research Centre embarked on publishing its specialized quarterly entitled “Khoon” (Blood) that is indexed by IMEMR and Index Copernicus.
We forward copies of all our pamphlets, books, and journals to WHO and EMRO so as to be used in Farsi-speaking communities (such as Afghanistan). IBTO hopefully won the status of being a WHO Collaborating Center.
Iranian blood transfusion organization-Research centre
Iranian blood transfusion organization-Research centre

51. Iranian Plasma Collection & Manufacturing Organization
There is a national strategy for the provision of plasma derived products
Iranian Blood Research and Fractionation Center a public/ not for profit fractionation center has been built in Tehran which is being upgraded
At present, Plasma derivative products are imported from abroad as contract fractionation (Octapharma Austria and Biotest Germany, Kedrion Italy)

52. Iranian Plasma Collection & Manufacturing Organization