Evaluating blood transfusion services in a low- and middle-income country: implications for quality assurance and...

Blood transfusions save millions of lives, but errors in the transfusion process can lead to serious adverse outcomes. There is a need to deliver this service using safe technologies and robust quality systems. In Palestine, the political situation requires full readiness for any emergency and attention to the availability of safe and sufficient blood units. The purpose of this study was to assess blood transfusion services (BTSs) throughout the West Bank, Palestine, to identify key gaps, pinpoint areas of strength, and direct timely enhancements to the safety and quality of the blood supply chain.

This cross-sectional study surveyed 28 blood banks from both the governmental and nongovernmental sectors of the West Bank, Palestine. We evaluated seven key areas: staffing, activity operations, quality control of equipment and reagents, blood unit handling procedures, the setting of blood donation, personnel training, and data management. An overall mean percent score for BTS was calculated.

The study showed strong performance in fundamental immunohaematology-related procedures, with ABO grouping and crossmatching nearly universal (> 89%). Equipment maintenance was excellent, with all centers reporting scheduled preventive maintenance and uninterruptible power supply availability, and staff-related indicators were strong, with an overall personnel score of 87.8%. Nevertheless, important gaps were observed in advanced testing, and quality assurance phenotyping was available in only 17.9% of the centers, extended antibody identification in 32.1%, and limited participation in international proficiency testing (10.7%). Similarly, only 53.6% of centers carried out routine quality monitoring of blood products (such as platelet counts and PRBC hematocrit) and patient education. A significant difference was in the use of blood bank information systems (100% governmental vs. 57.1% nongovernmental, p = 0.016). Overall, performance was largely similar between governmental and nongovernmental sectors, with no statistically significant differences in the majority of indicators.

The findings indicate that although governmental and nongovernmental blood banks operate at similar levels in most routine activities, important gaps remain in advanced immunohaematology testing and external quality assurance programs. These gaps may affect transfusion safety, particularly for patients who require repeated transfusions or complex compatibility testing. Strengthening external quality assurance participation, improving access to advanced testing, and expanding electronic data management systems should be considered priority areas for improving blood transfusion services in the West Bank.

Not applicable.