Evaluation of the immuno-hematological qualification of the blood donation at the Avicenne military hospital in Marrakech

Abstract

Blood transfusion is a therapeutic act that consists of administering blood, or one of its cellular or plasma components, from one or more healthy subjects called "donors" to a sick subject called "recipient. Transfusion safety is ensured by controlling all stages of the transfusion chain, from the collection of blood, its preparation and biological qualification, to the performance of the transfusion act and even the follow-up of the recipients. The basis of immunohematological safety is the compatibility between the erythrocyte characteristics of the donor and those of the recipient. Donation Biological Qualification (DQ) laboratories have a duty and an obligation to ensure maximum reliability and sensitivity of results. They must therefore put in place the human, technical, material, computer and organizational resources, method validation, traceability of operations and risk analysis of all stages of the analysis process, to guarantee reliable results obtained in a timeframe compatible with the optimal use of the blood products. Thus, the work methodology within the immunohematology laboratory must be structured in procedures and operating modes in order to respect the standards of the reference system and to reduce the causes of errors to a minimum. Our work focused on the evaluation of the immunohematological qualification of blood donations within the blood transfusion center (CTS) at the Avicenne military hospital (HMA) in Marrakech, including the state of the premises, personnel and techniques used in the QBD service with the following goals · Review the level of qualification within the CTS of HMA. · To highlight the techniques of immunohematological qualification of blood donation per-formed at the CTS at the Avicenne Military Hospital in Marrakech compared to what is done nationally and internationally. · To draw the phenotypic profile of ABO, RHD and Kell blood groups in a representative population of donors from the city of Marrakech and regions, recruited over a period of 5 years. · The study of the prevalence of phenotypic markers, blood donations collected in the blood transfusion center of the HMA in Marrakech between the years 2016-2017-2017-2018-2019-2020, led to the following results: · For the ABO system, group O is the most frequent (50.47%), followed by group A (30.14%), then group B (15.45%) and lastly group AB (3.93%). · The standard Rhesus system (D); the Rh positive phenotype (D+) predominates largely (89.21%) while the Rh negative (D-) is about 10.79%. · Of the 7713 donations studied, only 3130 were used to study the prevalence of Rh phenotypes. For the remaining 4583 donations, phenotyping was not performed because of a stockout of gel cards. The Ccee phenotype is the most frequent (40.31%). · For the Kell system, the prevalence of K anti-gen was 8.17%. · For the IAT: no IAT was positive in the donors. · In our series, there was no return of the incident report form (IRF) and no traceability of the number of adverse transfusion reactions (ADR). This study allowed us to highlight several shortcomings concerning · The lack of trained personnel · Insufficient techniques in terms of precision, sensitivity and specificity · The lack of high level technical automatons · Occasional reagent stockouts due to supply delays. However, the transfusion system of the Avicenne Military Hospital of Marrakech (HMA) is still lacking in new techniques that have proven their worth in the development of this field; namely · HLA histocompatibility typing. · The research of antiplatelet antibodies: HPA; · Molecular biology: by gene amplification (PCR) from genomic DNA, in particular when hemagglutination shows its limits in the con-text of transfusion medicine. In the light of this work, a list of recommendations has been proposed in order to overcome these dysfunctions and to ensure a better immunohematological safety, in front of the various situations envisaged during the daily practice by reinforcing the operational and technical capacities of the blood transfusion service. Furthermore, the improvement of automation and computerization will reduce the risk of human error, by automatically handling certain phases of the process. However, whatever the degree of automation safety, its quality is strictly linked to the pre-analytical phase of sample collection, sample acceptability and collection information entry, for which particular attention should be paid.