Blood transfusion safety

WHO EQA Scheme for blood group serology

The blood transfusion laboratory plays an important role in the provision of safe and compatible blood to meet patient requirements. There is evidence from 'haemovigilance' schemes that laboratory errors continue to be one of the main causes of incompatible or inappropriate blood transfusion, compromising patient safety and resulting in mortality or severe morbidity. Implementing a quality system in the laboratory minimises errors and ensures that the right test is performed on the right sample, the right results obtained and the right blood product provided to the right patient at the right time.

It is essential to obtain accurate results for blood group serology (BGS) tests such as ABO/RhD typing of the donor and patient, and compatibility testing and it is equally important that results are transcribed, collated and interpreted correctly so that compatible and appropriate blood products are issued.

The errors in the laboratory can be due to technical failure in serological testing, inadequate procedures leading to misidentification of patient or donor samples, or due to misinterpretation of results. There is often a combination of factors, with the original error being compounded by a lack of adequate checking procedures in the laboratory.

WHO organizes EQA schemes for BGS at international and regional levels and assists in the establishment of National EQA schemes. WHO HQ identifies the organizing centres and assist in providing funding for the international and regional EQA schemes. The WHO International EQA scheme is organized to provide assessment and support for the WHO Regional EQA centres. The Regional EQA schemes (REQAS) provide EQA to member states in each region. The Regional EQA centres also assist in the establishment of National EQA schemes (NEQAS) where appropriate.

Role of WHO international EQA scheme
  • To monitor performance of regional EQA centres;
  • To support Regional EQA Schemes by providing initial exercise material, training for Regional EQA scheme organizers and assistance in scheme development.

The WHO International EQA scheme is operated by UK NEQAS BTLP. Four exercises are distributed each year to the WHO Regional EQA centres. These exercises include ABO grouping, RhD typing, crossmatching, antibody screening and identification. There are currently nine participating laboratories. Existing and potential WHO Regional EQA centres are registered in the International EQA scheme. A biennial report of the WHO IEQAS results is produced. The material used in WHO International EQA exercises is the same as that distributed via the UK NEQAS (BTLP) scheme. Reports giving details of the exercise material, overall UK results and learning points are available to view on this site.

Role of WHO regional EQA schemes
  • To participate in the WHO International EQA scheme;
  • To identify participants for Regional EQA;
  • To provide EQA to region including performance monitoring and advice;
  • To assist in establishment of National EQA schemes (NEQAS).

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