UK blood donation needs reorganisation

Editor—Fifty years after the start of the National Blood (Transfusion) Service collection of blood from volunteers in the United Kingdom still takes place predominantly in church halls and community centres, uses an archaic assessment of haemoglobin concentration (the copper sulphate test), and sees fleets of pantechnicons trundling many miles across the countryside. The collection service mainly operates from Monday to Friday, and each team’s period of productive blood collection is perhaps four hours a day. Despite this, most hospitals have no permanent National Blood Service presence and act as users of blood but not as suppliers.

The service has recently produced a patient information leaflet outlining the risks of blood transfusion, which it recommends that most patients who need transfusion should receive.¹ The leaflet offers patients the possibility of predepositing blood for transfusion should this be needed after elective surgery. This is not a new procedure but has been introduced haphazardly. In a few areas the National Blood Service has taken the lead, but elsewhere it has been left to local initiatives, and for most hospitals the necessary funding has not been forthcoming. Haematologists have been left to reassure patients of the relative safety of homologous blood while discouraging their colleagues from unnecessary use of a potentially hazardous material. This may not be an argument that we can sustain without being able to offer autologous transfusion to patients who might reasonably benefit from it.

Surely the time has come for a radical rethink of blood collection in the United Kingdom. The service should have collection centres in all district general hospitals and should have much more flexibility to collect blood from donors at times to suit people who work. Autologous predeposit could then run alongside, with the reassurance for both groups of donors that adequate testing can take place and medical support facilities are close at hand if needed. There would also be the scope to increase the pool of aphaeresis donors, and therapeutic aphaeresis could be done at many more hospitals. The hospital haematologist would become an integral part of the transfusion service and not just a user and go between.