Evolution of Thalassaemia Management Four Decades in Thalassaemia Care – Our Achievements and Challenges

Enhancement of Transfusion Safety

In the 1970s, transfusion of blood components and products was practiced widely in clinical care and in the field of haematology. Patients with transfusion-dependent thalassemia needed regular transfusion every 3 to 5 weeks interval for survival. There were concerns about inadequate supply of various blood components and blood products during early days. Without sufficient blood transfusion, all sorts of complications resulting from anemia still occurred for TDT patients.

Transfusion-transmitted virus infections were major hazards to patients during the old days. In fact, a significant proportion of patients were infected with different viruses including hepatitis B virus, hepatitis C virus and HIV through transfusion. In Hong Kong, 34% of thalassaemia patients were infected with HCV reported in a study published in 2010. Ref. 1 The transfusion-transmitted infections have been nightmares and tragedies for many patients and their families, and it is a painful lesson for health care providers. It was fortunate that the Hong Long Red Cross Blood Transfusion Services (BTS) in Hong Kong had timely introduced new tests to screen donated blood for various viral infections, namely HIV test in 1985, and HCV test 1990.

Hong Kong Red Cross Blood Transfusion Service (BTS) is the only supplier of blood and blood components for the territory. Transfusion safety in Hong Kong has progressively been enhanced, from the introduction of serologic testing for hepatitis B, C, and then HIV from mid-80 and early 90s. From 2002 onwards, implementation of rapid nucleic acid testing (NAT) for various infectious agents and can screen out unsuitable blood from donor at early phase of carrying the infective agents. Fig. 10

In 2009, it was estimated that 9.5% of the territory blood supply in Hong Kong (13,460 units) was utilized by about 380 transfusion-dependent thalassaemia patients, with a predicted annual consumption increment of 0.8%. Ref. 2 Thalassaemic patients have been provided with pre-storage filtered blood or leukodepleted blood (removing white blood cells from blood) as a standard for the past 30 years and this measure has largely reduced fever reactions associated with blood transfusion. Unfortunatly, new or emerging infective agents remains threats in clinical blood transfusion. Though there is an ongoing threat from emerging infectious diseases, the BTS has been securing the highest standards of blood safety through timely introduction of blood donor deferral criteria, infectious testing technologies, etc.