Government commitment and support National blood policy/plan Legislation/regulation Organization with responsibility and authority for the BTS BTS management committee BTS medical director BTS quality manager Specialist BTS advisory groups Trained BTS administrative and technical staff Adequate budget National quality system Blood donors National blood donor programme officer Blood donor unit Blood donor recruitment officer Standard operating procedures Training of staff in blood donor unit Low-risk donor populations Educational materials Register of voluntary non-remunerated blood donors Donor selection, deferral, care and confidentiality Donor notification and referral Monitoring of TTIs Testing of donated blood Technical officer Screening strategies and protocols Training of laboratory technical staff Screening of all donated blood for TTIs Blood grouping and compatibility testing Good laboratory practice, including standard operating procedures (SOPs) Continuity in testing Effective blood cold chain Clinical use of blood National policy and guidelines on the clinical use of blood Training of clinicians and BTS staff Prevention, early diagnosis and treatment Alternatives to transfusion (crystalloids and colloids) Effective clinical use of blood Monitoring and evaluationA well-organized blood transfusion service (BTS), with quality systems in all areas, is a prerequisite for the safe and effective use of blood and blood products.#
The HIV/AIDS pandemic has focused particular attention on the importance of preventing transfusion-transmitted infections (TTIs). Between 5% and 10% of HIV infections worldwide are transmitted through the transfusion of contaminated blood and blood products. Many more recipients of blood products are infected by hepatitis B and C viruses, syphilis and other infectious agents, such as Chagas disease.
The global burden of disease due to unsafe blood transfusion can be eliminated or substantially reduced through an integrated strategy for blood safety which includes:

# Establishment of a nationally-coordinated blood transfusion service
Collection of blood only from voluntary non-remunerated blood donors from low-risk populations Testing of all donated blood, including screening for transfusiontransmissible infections, blood grouping and compatibility testing Reduction in unnecessary transfusions through the effective clinical use of blood, including the use of simple alternatives to transfusion (crystalloids and colloids), wherever possible.

# Words of advice
Secure government commitment and support for the national blood programme Establish a blood transfusion service as a separate unit with responsibility and authority, an adequate budget, a management team and trained staff Educate, motivate, recruit and retain voluntary nonremunerated blood donors from low-risk populations Ensure good laboratory practice in screening for transfusion-transmissible infections, blood grouping, compatibility testing, blood component production and the storage and transportation of blood products Reduce unnecessary transfusions through the effective clinical use of blood, including alternatives to transfusion Establish a quality system for the BTS Train all BTS and clinical staff to ensure the provision of safe blood and its effective clinical use

# Test all donated blood
The BTS should develop and maintain a national strategy for the testing of all donated blood and blood products, using the most appropriate and effective tests, and for good laboratory practice.

# Reduce unnecessary transfusions by effective clinical use of blood
Blood transfusion has the potential for acute or delayed complications and the transmission of infection. The risks associated with transfusion can be reduced by minimizing unnecessary transfusions through the effective clinical use of blood and blood products and the appropriate use of simple alternatives to transfusion which are safer and more costeffective.
Important activities include:

# Development of a national policy and guidelines on the clinical use of blood
Training in the clinical use of blood for all clinicians involved in the transfusion process and for BTS staff Commitment to the prevention, early diagnosis and treatment of conditions that could result in the need for transfusion (obstetrical complications, trauma and other causes of anaemia)