IBTAAnnualReport2019 22jan2020

Zaheer HA, Waheed U, Nasir K, Tahir S. IBTA Annual Report. 1st Ed.
2019
IBTA Annual Report 2019
ISLAMABAD BLOOD TRANSFUSION AUTHORITY

Ministry of National Health Services, Regulations & Coordination
Government of Pakistan
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Zaheer HA, Waheed U, Nasir K, Tahir S. IBTA Annual Report. 1st Ed. 2019
Copyright © 2019 Islamabad Blood Transfusion Authority
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise,
without the prior written permission of the publisher
Published by:
Islamabad Blood Transfusion Authority
Ministry of National Health Services, Regulation & Coordination
Website: https://www.ibta.gov.pk
Facebook: https://www.facebook.com/IslamabadBTA
Authors
Prof. Hasan Abbas Zaheer
Dr. Usman Waheed
Kaenat Nasir
Saira Tahir
Cite this publication as: Zaheer, H. A., Waheed, U., Nasir, K., & Tahir, S. (2020). IBTA Annual Report
2019 (1st ed.). Islamabad, Pakistan: Islamabad Blood Transfusion Authority, 978 969 9881 46 6
Printed in Islamabad, Pakistan
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TABLE OF CONTENTS
Abbreviations and Acronyms ................................................................................................................................... i

Acknowledgements by Prof. Hasan A. Zaheer........................................................................................................ ii
Message by Dr. Zafar Mirza ................................................................................................................................... iii
Executive Summary ................................................................................................................................................ 1
1. Introduction ....................................................................................................................................................... 5
2. IBTA Governing Board ..................................................................................................................................... 9
3. IBTA Inspectors’ Profile ................................................................................................................................. 10
Col. (Retd.) Prof. Dr. Muhammad Farooq Khattak............................................................................................ 10
Prof. Dr. Khalid Hasan ...................................................................................................................................... 10
Brig. (Retd.) Prof. Dr. Javaid Usman ................................................................................................................ 10
Brig. (Retd.) Dr. Nadir Ali .................................................................................................................................. 11
Dr. Syed Imtiaz Hasan ...................................................................................................................................... 11
Prof. Dr. Haroon Khan ...................................................................................................................................... 11
Brig. (Retd.) Prof. Dr. Nuzhat Salamat ............................................................................................................. 11
Wg. Cdr. Dr. Kamran Nazir Ahmad .................................................................................................................. 12
Dr. Noor e Saba ................................................................................................................................................ 12
Dr. Faiza Fahim ................................................................................................................................................ 12
Dr. Usman Waheed .......................................................................................................................................... 13
Dr. Shawana Kamran ....................................................................................................................................... 13
4. W.H.O. Country Support Mission on Blood Safety in Pakistan .................................................................. 14
5. Ceremony to Felicitate IBTA Panel of Inspectors ........................................................................................ 16
6. Orientation Session for Khyber Pakhtunkhwa BTA Inspectors.................................................................. 17
7. IBTA Inspections with the Khyber Pakhtunkhwa Blood Transfusion Authority ....................................... 19
8. Orientation Session for Blood Bank Inspectors in Sindh ........................................................................... 21
9. Blood Bank Inspections ................................................................................................................................. 23
9.1 Inspection Photographs .............................................................................................................................. 25
10. Data from ICT Blood Banks: Results and Analysis ................................................................................... 31
10.1 Data Collection ........................................................................................................................................ 31
10.2 Number of Public and Private/NGO Blood Banks in Islamabad............................................................... 33
10.3 Number of Blood Donations in Islamabad Capital Territory ..................................................................... 34
10.4 Gender Distribution of Blood Donors ....................................................................................................... 36
10.4 Types of Blood Donations in ICT ............................................................................................................. 36
10.5 Component Preparation........................................................................................................................... 39
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10.6 Donations Screened for Transfusion Transmissible Infections ................................................................ 40

10.7 Donations Reactive for Transfusion Transmissible Infections ................................................................. 40
10.8 Screening Techniques for Transfusion Transmissible Infections. ............................................................ 41
10.9 Data Management Methodology .............................................................................................................. 41
10.10 Haemovigilance ...................................................................................................................................... 42
10.12 Reason for Discard of Blood ................................................................................................................... 44
10.13 Cross-Match Technology ........................................................................................................................ 45
10.14 Donor Deferral ........................................................................................................................................ 45
11. National Guidelines – Quality Control in Transfusion Medicine ............................................................... 47
12. Functional Brief for Blood Transfusion Authority ..................................................................................... 48
14. Field Manual for Blood Bank Inspectors..................................................................................................... 49
16. Handbook of Clinical Transfusion Practice ................................................................................................ 51
17. Comments on IBTA Performance ................................................................................................................ 53
18. List of Publications by IBTA Team .............................................................................................................. 54
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ABBREVIATIONS AND ACRONYMS

AFIT Armed Forces Institute of Transfusion
AIDS Acquired Immunodeficiency Syndrome
AJK Azad Jammu and Kashmir
AMC Ali Medical Centre
AMC Army Medical Corps
BHU Basic Health Unit
BTA Blood Transfusion Authority
BTS Blood Transfusion Service
CDA Capital Development Authority
CDC Centre for Disease Control and Prevention
CLIA Chemiluminescence Immuno Assay
CUB Clinical Use of Blood
DOH Department of Health
ELISA Enzyme Linked Immuno Sorbent Assay
FCPS Fellow of the College of Physicians and Surgeons
FFP Fresh Frozen Plasma
FGPC Federal Government Polyclinic Hospital
GIZ German International Cooperation
HBV Hepatitis B Virus
HCV Hepatitis C Virus
HIV Human Immunodeficiency Virus
HTC Hospital Transfusion Committee
IBTA Islamabad Blood Transfusion Authority
ICT Islamabad Capital Territory
IMDC Islamabad Medical and Dental College
ISBT International Society of Blood Transfusion
ISO International Organization for Standardization
KfW German Development Bank
KIH Kulsum International Hospital
M/o NHSR&C Ministry of National Health Services, Regulation & Coordination
MDG Millennium Development Goals
MIH Maroof International Hospital
NACP National AIDS Control Programme
NAT Nucleic Acid Testing
NBP National Blood Policy
NGO Non-Governmental Organization
NIH National Institute of Health
NSF National Strategic Framework
PESSI Punjab Employees Social Security Institute Hospital
PIMS Pakistan Institute of Medical Sciences
QA Quality Assurance
QC Quality Control
QIH Quaid-e-Azam International Hospital
RHC Rural Health Centre
RIHS Rawal Institute of Health Sciences
SBTP Safe Blood Transfusion Programme
SIH Shifa International Hospital
SOP Standard Operating Procedure
SZABMU Shaheed Zulfiqar Ali Bhutto Medical University
ToR Terms of Reference
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ACKNOWLEDGEMENTS
The Islamabad Blood Transfusion Authority (IBTA) is pleased
to present its Annual Report for 2019. The Report provides a
review of the regulatory functions performed by the Authority
in the Islamabad Capital Territory including the publication of
technical documents and reports. The Report also
documents the support extended to the provincial
counterparts. The IBTA is indebted to Dr. Zafar Mirza,
Special Assistant to Prime Minister, National Health
Services, Regulations & Coordination, for his support and
encouragement. The Authority also expresses gratitude to Dr. Allah Bakhsh Malik,
Federal Secretary, Ministry of National Health Services, Regulations & Coordination,
for his cooperation and guidance. The IBTA is also grateful to Dr. Assad Hafeez,
Director General, Ministry of National Health Services, Regulations & Coordination, for
his support and facilitation to the Authority to enable it to perform its assigned role.
The Authority is also very thankful to the members of the IBTA Governing Board who
have always been very generous in giving their valuable time to the IBTA. Their
technical oversight in developing the vision, strategy and implementation roadmap of
the Authority has been very praiseworthy. The Authority is fortunate to have such
distinguished professionals to guide it. The field work of regulation would not have
been accomplished effectively without the whole hearted support and commitment of
the co-opted team of Inspectors consisting of Prof. M. Farooq Khattak, Prof. Khalid
Hasan, Prof. Javaid Usman, Brig. (R) Dr. Nadir Ali, Prof. Nuzhat Salamat, Dr. Samina
T. Amanat, Dr. Syed Imtiaz Hasan, Dr. Noor e Saba, Wg. Cdr. Dr. Kamran Nazir
Ahmed and Dr. Faiza Fahim.
The Authority would also like to record special appreciation for Dr. Usman Waheed,
Technical Expert SBTP, Ms Kaenat Nasir, Programme Officer, SBTP and Ms. Saira
Tahir, Programme Officer SBTP, who played a key role in the strengthening the
Authority and managing the regulatory work in a professional and committed manner.
The administrative support provided by Mr. Sajid Hussain Shah, Administrative Officer,
SBTP and Mr. Imtiaz Shah, Finance Manager SBTP, is also highly appreciated which
ensured that the technical work proceeded smoothly.
Last but not the least I would be failing in my duties if I do not acknowledge the whole
hearted support, cooperation and encouragement received from the management and
staff of the blood banks that were inspected. Especially acknowledged is the timely
and full compliance of all blood banks in submission of their annual data. The
constructive approach of IBTA in building the capacity of these centres has been very
well appreciated.
Prof. Hasan Abbas Zaheer

MBBS, MBA, FCPP, PhD (Lon)
Chairman, IBTA
January 2020
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MESSAGE
DR. ZAFAR MIRZA

Special Assistant to Prime Minister
The present PTI government places special emphasis on strengthening of the

healthcare system in the country. Regulation of the healthcare system is a key
component of this strategy and quality regulation of the blood transfusion system is a
very vital part of the overall health regulatory system. The government is thus
committed to not only improve the blood transfusion service delivery system and
ensure access to safe and efficacious blood for transfusion to all in the country but also
streamline its regulatory system as well.
The Pakistan Government has embarked on a reform process to ensure access to safe
and efficacious blood for all in the country since 2010. This ambitious goal is being
achieved through structural and functional reorganization of the system with the
assistance provided by the German Government. One of the key elements of this
reform process is the re-activation of blood transfusion authorities to guide and steer
the development of the blood sector in Pakistan. These efforts will help fulfil the
government’s commitment in achieving the Sustainable Development Goals (SDGs).
In Pakistan, various sectors are regulated through single national authorities. However,
the blood sector has separate regulatory bodies in all the provinces and regions. Until
the revival of the Islamabad Blood Transfusion Authority in late 2013, blood regulation
was by and large neglected. But now as a result of the sustained efforts of the IBTA,
blood regulation has been strengthened all over the country and is now being accorded
due priority. The National Blood Policy and Strategic Framework (2014-20) was
revised in 2014 and identified clear priority areas, including regulation, to be pursued
for attaining self-sufficiency in blood products in the country. Indeed, empowered and
effective regulatory systems are an essential pre-requisite for an efficient and reliable
blood transfusion service.
The revived IBTA has in a very short time developed a very successful model of
regulation in Pakistan based on constructive non-punitive approach. I am very pleased
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to see the progress of the Authority despite administrative challenges. As a result of

the IBTA endeavours, there are now marked and visible improvements in the standard
of blood banks in Islamabad and streamlining and revival of the provincial authorities
as well. The model of regulation developed for Islamabad is well suited to the needs
of the system in Pakistan and needs to be replicated in the provinces through the
provincial authorities. Continued collaboration between IBTA and the provincial BTAs
will go a long way in improving the standard of blood safety in Pakistan.
I express my special appreciation to the IBTA Chairman, Prof. Hasan Abbas Zaheer,
and his committed team for uplifting the blood regulatory framework not only in
Islamabad but also throughout the country. Indeed the IBTA has performed this
challenging task in a very professional manner and with very limited resources. The
Health Ministry commits its full support to the IBTA and expects continuous
consolidation and strengthening of the blood regulatory system not only in the Federal
Capital but also throughout the country.
DR. ZAFAR MIRZA

Special Assistant to Prime Minister
January 2020
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EXECUTIVE SUMMARY
Following the devolution of the health sector in June 2011 under the 18th constitutional
amendment, the Islamabad Blood Transfusion Authority was revived by the Ministry of
National Health Services, Regulation & Coordination in September 2013. A new
Chairman and an Advisory Board were also notified. The revived IBTA developed a
plan of action which laid out the framework of the scope of activities including;
development of an evaluation tool for inspection of the blood banks, formation of a pool
of eminent experts to act as IBTA inspectors, announcements in the press for
applications for registration and licensing, processing of applications and organizing
the initial, routine, surprise and annual inspections as well as conducting regular
capacity building activities. Currently 20 blood banks have been granted licenses
following successful inspections (in some cases after more than one inspection) and
six blood establishments have been closed down due to poor standards. Three blood
banks are only registered and not licensed. One initially licensed blood bank is
currently on probation.
The Islamabad BTA conducted annual inspections of Blood Banks in Islamabad in

March-April 2019. During the 2018 reporting period, 22 annual inspections/re-
inspections were conducted. Licenses of 20 blood banks were renewed while one was
placed on probation. The Trauma Centre Blood Bank at the Islamabad International
Airport, NORI Hospital Blood Bank and Watim Medical College Hospital Blood Bank
have been registered and license will be issued once the Centres are functional.
The inspection checklist was revised in 2019 on the basis of the Inspectors feedback
and was improved to check compliance of the blood banks with national standards. To
achieve this, each and every standard was assessed through questions in the
inspection checklist. The order of inspection was systematic to ensure that all points
are covered.
Data collection, management, analysis and its publication is the responsibility of blood
regulatory authority. This is essential for improved planning and evaluation of services.
IBTA collects the annual data from all its licensed blood banks regularly in the month
of January every year. This year also the licensed blood banks submitted their 2019
data on the prescribed form to the IBTA. The compliance was 100% and within the
prescribed four weeks period. One of the striking finding of the data remains that many
licensed Blood Banks have insufficient workload and they do not justify their full-
fledged existence. And because of low workload they always have insufficient
inventory and thus have to rely on other blood banks to cover their needs. This
evidence supports the SBTP strategy of consolidation and the concept of large
Regional Blood Centres supporting the linked Hospital Blood Banks.
For the blood donations in ICT, as in the previous years, the data indicated heavy
reliance on replacement blood donors (87.25%) with the exception of two centres. The
rate of voluntary blood donors in 2019 was 12.75% compared to 13% in 2018 and
11.3% in 2017. Blood is mostly donated by males (97.7%). Female donations are still
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very rare. This finding is also consistent with the 2018 and 2017 figures. In 2019, a
total of 7,041 blood components were discarded. About 48.67% blood components
(mostly platelet concentrates) were discarded due to expiry of their shelf life, mostly in
smaller centres while the larger blood banks faced chronic shortages. This
underscores the significance of developing linkages between the blood banks
operating in the ICT.
In contrast to pre-2013 period, most of the blood screening in ICT is now conducted
on automated systems based on NAT, CLIA and ELISA technology. Automation has
been actively promoted by IBTA during the last five years and screening of 99% of
blood collected in Islamabad on good quality automated technology has strengthened
the weakest link of the vein-to-vein blood transfusion. This is an encouraging finding
as automation and use of quality kits on advanced sophisticated equipment ensures
better safety standards. All licensed blood banks reported 100% testing for HIV,
Hepatitis B and C infections, Malaria and Syphilis. In 2014, about 25% of the total
donations were screened for Syphilis and Malaria. This rate increased to about 46% in
2015 and to about 60% in 2016, 77% in 2017 and finally 100% in 2018 and in 2019,
as a result of continuous advocacy and effective regulation by IBTA.
Facilities for component production and storage have been made mandatory by the
IBTA for licensing since 2014. Nearly 95% of the blood units collected in ICT are now
separated into at least three blood components which were much less in previous
years. This is in stark contrast to the practice in the rest of the country where only about
40% of the collections are processed into blood components. In many centres across
the country despite having the required equipment, manpower and resources not all
whole blood donations collected are processed mainly due to physician preference for
‘fresh whole blood’.
The documentation standards have improved considerably as a result of the IBTA

advocacy and the mandatory requirement of sharing the annual data. Now all ICT
blood banks use uniform blood component issuance forms developed by the Authority.
This time the IBTA collected data about donor deferral in the year 20198 which
indicated that about 6.46% of the blood donors who presented for blood donations
were found unfit for donations, temporarily or permanently. Permanent deferrals were
usually due to TTI reactivity while anaemia and low body weight were the main causes
of temporary deferral. Knowledge of the reasons for donor deferral can help in planning
effective donor recruitment and retention campaigns aiming at the availability of safe
donors. The IBTA had introduced the internationally recommended AE (Adverse
Event) and AR (Adverse Reaction) reporting system in the year 2016. Earlier, the blood
banks were not familiar with the new system and failed to properly report the adverse
events. The IBTA in collaboration with SBTP has also updated the National Quality
Control Guidelines (3rd Ed. 2020) and the new reporting forms have been added to
these guidelines which were shared with the blood banks and trainings conducted on
the new reporting system. It is thus expected that improved quality of haemovigilance
data will be generated in 2020.
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IBTA advocates collaboration between blood banks to reduce duplication and avoid
wastage of blood components due to expiry. In the course of the year strong
collaborations were developed by the PIMS Blood Bank with Sundas Foundation
Thalassaemia Centre and the PRCS Blood Donor Centre. In Sundas Foundation
Thalassaemia Centre, FFPs and platelets are not usually required and are now
provided to the PIMS Blood Bank. The PRCS Blood Centre shares its inventory with
the PIMS Blood Bank and PIMS patients are directed to the PRCS to get blood
components in case of non-availability in PIMS. These patients are provided blood
components by PRCS free of cost if they are Zakat entitled or on nominal charges
otherwise. PIMS is the largest tertiary care hospital in ICT and routinely faces
component shortage as component therapy is widely practiced in PIMS and patients
from other hospitals from Islamabad and Rawalpindi and nearby regions also get blood
components from PIMS Blood Bank. Therefore partnerships with PRCS and Sundas
Foundation Thalassaemia Centre have considerably improved the component
supplies in PIMS especially for platelet concentrates. There are still some hospitals in
ICT where FFP and platelet concentrates remain un-utilized due to non-prescription by
the clinicians. IBTA encourages the licensed blood banks to collaborate with each
other to reduce the wastage of blood, practice rationale use of blood and meet the
demand of components in larger hospital blood banks.
The IBTA continued with the coordination and strengthening of the provincial blood
transfusion authorities in 2019. A meeting was held with the Punjab BTA to share
updates on the implementation of the PBTA Action Plan for strengthening the blood
regulation system in Punjab. The IBTA team visited Peshawar and Karachi to conduct
regulatory activities with BTA Inspectors. The Karachi BTA meeting was very
successful in which the stakeholders from Karachi were briefed about the new reform
agenda and strategy of the new leadership in Sindh BTA. It is expected that the revived
vibrant provincial BTAs will not only strengthen the standard of blood banking but also
streamline the establishment of the linkages between the new RBCs and their attached
HBBs. The BTA meeting in Peshawar was most useful and served to orient the new
blood bank inspectors and the BTA about the best strategy to regulate the sector in
the province in the light of the IBTA experience of the last six years. To ensure smooth
kick-start of the blood bank inspections, the IBTA accompanied the KP team in the
inspections of the blood banks in Peshawar. The inspections were highly appreciated
by all the blood centres inspected. The blood centres deemed the inspections as an
opportunity to reform their systems and highlight the equipment and human resource
deficiencies for rectification as the recommendations of the regulatory authority are
legally binding. The non-punitive constructive approach adopted by the Inspectors was
much appreciated.
The IBTA organized a ceremony to felicitate its Panel of Inspectors. Appreciation

certificates were awarded to the Inspectors to recognize and acknowledge their support
in strengthening the blood transfusion sector in the Islamabad Capital Territory.
In October 2019, a WHO Country Support Mission for Blood Transfusion to Pakistan
came for a week-long assignment. The Mission took place on the special request of
the Health Ministry. The Mission met the Special Assistant to Prime Minster in the
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beginning to take his guidance and at the end of the Mission for debriefing and his
feedback. The Mission spent a very hectic time and visited Islamabad, Lahore,
Karachi, Hyderabad and Jamshoro, held deliberations with a number of key partners
and visited some large blood centres. The Mission Report has been submitted which
has recorded the achievements of the blood safety reforms ad gives a clear road map
for the future.
The Islamabad BTA has developed a model regulatory system over the last five years
which is well suited to the national needs and is functioning quite effectively. The IBTA
also coordinates with the provincial counterparts and has strengthened their capacity.
The IBTA efforts are widely appreciated by the national stakeholders, provinces and
also the international partners. The World Health Organization has recommended the
Pakistan BT regulation model to the regional countries. The roadmap IBTA followed
was very structured and systematic and had a huge impact on the quality of blood
transfusion services in the federal capital.
The inspection checklist has been revised by the IBTA ‘Task Force on Regulation’
including eminent national experts. The first meeting of the task force was organized
in January 2019. The IBTA plans to generate real time data of the licensed blood banks
on the IBTA website. All the licensed blood banks will be provided a link through which
they can update their blood inventory status online on the IBTA website. The IBTA is
continuously coordinating with the provincial BTAs and it is expected that these efforts
will result in further strengthening of the regulatory authorities in the provinces. Proper
operationalization of the provincial BTAs and their capacity building by the IBTA will go
a long way in reducing the gap in the regulatory standards between the federal capital
and the rest of the country.
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1. INTRODUCTION
The internationally recommended blood system consists of blood regulatory system,
blood supply system and blood transfusion system. The blood regulatory system deals
with legislations, regulations, policies while the blood supply system is responsible for
product liability i.e. blood. The blood transfusion system has to ensure protection of
the rights of the consumers, blood transfusion recipients. The role of regulation in
ensuring the quality and safety of blood supply and transfusion systems has been
recognized by WHO for over 40 years. Accordingly, the SBTP Pakistan has taken
concrete and positive steps in establishing and strengthening the blood regulation to
improve the blood safety standards throughout the country.
Blood transfusion is an indispensable, potentially life-saving medical intervention.

However, the inherent risks of blood and the complexity of providing adequate, timely
and equitable access to safe blood and blood components require an organized
national or regional blood regulatory system. Within that system, a competent blood
regulatory authority assures that appropriate standards are met for production of blood
products and monitoring of blood safety.
The World Health Assembly has passed more than 25 resolutions on various aspects
of blood safety since 1975. The resolutions essentially urge the Member States to
promote the development of national blood transfusion services based on voluntary
non-remunerated blood donors and enact effective legislation which should govern
operations of the blood transfusion services. The World Health Organization also
advocates the need for a standardized Blood Safety Legislation with a policy
commitment to action; communicating government policy; setting the foundation for
executive action; ensuring that policies and strategies are effective and sustainable;
protecting public health, health of donors and recipients of blood; making provisions
for the human, financial and technical resources that are necessary for quality and
safety; and facilitating co-ordination of all activities of the blood transfusion
programmes.
The regulation of blood sector implies enactment and enforcement of laws and rules
by the government for safe blood transfusion practices. The independent, autonomous
Blood Transfusion Authority (BTA) performs a steering role to guide the overall
development of the Blood Transfusion Services and regulates the transfusion system
on the internationally accepted blood transfusion system models. In exercise of its
functions, the BTA not only conduct inspections and other control measures, but also
develops, adopts or adapts rules, regulations, standards, guidelines and other tools to
achieve the objective, provides training and education to blood banking professionals
and blood bank staff on how to achieve the standards set by the Authority and
collaborates with other professionals in the field of education, training and other related
purposes.
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To achieve regulation and harmonization of blood transfusion services in the country

it is essential that the blood establishments comply with the provisions of blood
transfusion law by conforming to the rules and regulations, standards and guidelines
developed under the light of blood transfusion law.
The regulatory authorities in the developed countries include the European Blood
Inspection System (EuBIS), Health Sciences Authority-Blood Services Group of
Singapore, National Blood Authority of Australia and Medicines & Healthcare products
Regulatory Agency of the UK, etc. In the developing countries, the common barriers to
the implementation of a legislative framework include insufficient political commitment
and support; absence of or weak blood transfusion policy and strategy; insufficient or
inadequate human, technical and financial resources; inappropriate priority setting;
absence of norms, standards and transparent procedures; lack of inspection and
control mechanisms; poor communication between stakeholders; poor attention to
cultural and religious constraints; and weak consumer and professional associations.
In Pakistan, the blood transfusion laws were developed from 1997-2004. A consensus
uniform updated draft legislation was developed recently by all the stakeholders under
the auspices of the SBTP. Three provinces (KP, Sindh and Punjab) have adopted this
new legislations through their respective legislatures (Figure 1.1). These legislations
intend to regulate collection, testing, processing, storage, distribution, issuance and
transfusion of human blood and blood components, ensuring health protection and
prevention of transfusion transmissible diseases. Approval and enactment of the law
requires a Blood Transfusion Authority to be established as a truly operational
regulatory authority. This BTA regulates all aspects related to safe blood transfusion
structures and processes, including registration and licensing, introduction of
standards, quality systems and haemovigilance. In the Blood Transfusion Law, a
‘Blood Transfusion Authority’ is defined as “a regulatory body” established under the
Department of Health with the objective to regulate the Blood Transfusion Services of
the Region.
The regulatory body for Islamabad, Islamabad Blood Transfusion Authority, was
established in 2005, through the ICT Blood Safety Ordinance promulgated in 2002.
After this Ordinance, the blood banks cannot opt in or out of the law, compliance is
mandatory and to be ensured by the IBTA. In 2005, the Federal Government notified
the establishment of the Islamabad Blood Transfusion Authority and appointed Prof.
Khalid Hasan, Consultant Haematologist, Pakistan Institute of Medical Sciences
(PIMS), Islamabad as its first Chairman. In the absence of a proper structure or
resources, the IBTA secretariat was established in PIMS. An Advisory Committee of
technical experts consisting of haematologists, transfusion medicine experts,
microbiologists, representative of the armed forces and members of private sector and
other stakeholders was notified. The Committee published advertisements in the press
for ICT blood banks registration and licensing. A database of the ICT blood banks was
thus generated and blood banks registered and licenses issued. From 2007-09, Maj.
Gen. (R) Prof. Masood Anwar, Executive Director, National Institute of Health
6
remained Chairman IBTA and the IBTA secretariat was shifted to the NIH. During this
period, some inspections were made and licenses issued. In 2009, Dr. Birjees Mazhar
Kazi, Executive Director, NIH, was appointed Chairman IBTA by the Ministry of Health.
Figure 1.1: BTS Legal Framework in Pakistan
The regulatory body for Islamabad, Islamabad Blood Transfusion Authority, was
established in 2005, through the ICT Blood Safety Ordinance promulgated in 2002.
After this Ordinance, the blood banks cannot opt in or out of the law, compliance is
mandatory and to be ensured by the IBTA. In 2005, the Federal Government notified
the establishment of the Islamabad Blood Transfusion Authority and appointed Prof.
Khalid Hasan, Consultant Haematologist, Pakistan Institute of Medical Sciences
(PIMS), Islamabad as its first Chairman. In the absence of a proper structure or
resources, the IBTA secretariat was established in PIMS. An Advisory Committee of
technical experts consisting of haematologists, transfusion medicine experts,
7
microbiologists, representative of the armed forces and members of private sector and
other stakeholders was notified. The Committee published advertisements in the press
for ICT blood banks registration and licensing. A database of the ICT blood banks was thus
generated and blood banks registered and licenses issued. From 2007-09, Maj. Gen. (R)
Prof. Masood Anwar, Executive Director, National Institute of Health remained Chairman
IBTA and the IBTA secretariat was shifted to the NIH. During this period, some inspections
were made and licenses issued. In 2009, Dr. Birjees Mazhar Kazi, Executive Director, NIH,
was appointed Chairman IBTA by the Ministry of Health.
After the devolution of the Health Ministry in 2011, the IBTA was revived by the Ministry of
National Health Services, Regulation and Coordination (M/o NHS,R&C) in October 2013.
A new Chairman and a new Advisory Board consisting of eminent transfusion experts,
haematologists, pathologists and public health experts were also notified by the Ministry.
Figure 1.2: Functions of IBTA
The functions of the IBTA include; registration and inspection of the blood banks; issuing
licenses to the blood banks that fulfil the minimum licensing criteria; annual and surprise
inspections of the licensed blood banks; haemovigilance, surveillance of all components
of the vein-to-vein transfusion chain; compliance with the legislation, bylaws and
regulations; and data management of all the blood banks functioning in the federal capital
(Fig 1.2). In addition, IBTA also coordinates, strengthens and built the capacity of the
provincial BTAs. The IBTA thus performs a steering role to guide the overall development
of the Blood Transfusion Services in the country and promote uniform regulation of the
transfusion sector throughout the country.
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2. IBTA GOVERNING BOARD

The Ministry of National Health Services, Regulation & Coordination constituted a
Governing Board of the Islamabad Blood Transfusion Authority vide notification no.
20(150)/2013-SO(A) on September 13, 2013. The members of the Board include
eminent haematologists, transfusion medicine experts and public health experts to
guide and steer the process of regulation in the Islamabad Capital Territory.
Prof. Hasan Abbas Zaheer Maj. Gen. M. Ayyub, H.I. (M)

Chairman, Islamabad Blood Transfusion Authority Former Commandant
M/o National Health Services, Regulation & Armed Forces Institute of
Coordination, Government of Pakistan Pathology, Rawalpindi
Prof. Khurshid Ahmed Prof. M. Farooq Khattak

Scientist Emeritus Consultant Haematologist,
National Institute of Health Quaid-i-Azam International
Islamabad. Hospital, Islamabad
Prof. Khalid Hasan Dr. Huma Qureshi

Principal Executive Director
Islamabad Medical and Dental College PHRC
Islamabad Islamabad
Prof. Tahira Zafar Prof. Haroon Khan

Professor of Pathology Consultant Pathologist
Pak International Medical College SZAB Medical University,
Peshawar PIMS, Islamabad
Dr. Asma Cheema Dr. Syed Imtiaz Hasan

Former Director Consultant Pathologist and
Pakistan Red Crescent Society HOD, Federal Government
Islamabad Polyclinic Hospital, Islamabad
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3. IBTA INSPECTORS’ PROFILE

Col. (R) Prof. Muhammad Farooq Khattak (MBBS, MCPS,
MPhil, Fellow Hematopatholopgy) a member of IBTA Advisory
Board, is Consultant Haematologist and Head of Pathology
Department at the Quaid-i-Azam International Hospital,
Islamabad. He has worked at the Armed Forces Institute of
Pathology as a Consultant Haematologist and in Armed Forces
Institute of Transfusion as its Commandant. He has authored
many research publications and was a co-author of the National
Standards and Guidelines for BTS in 1999 and 2012. He was
also an active member of the team who formulated the National
Blood Policy and Strategic Framework in 2002, 2008 and in 2014.
Prof. Dr. Khalid Hasan (MBBS, DCP, MPhil, FCPP) is serving

as Principal at the Islamabad Medical and Dental College.
Earlier he has served as the Professor/HOD Pathology
Department, Pakistan Institute of Medical Sciences (PIMS),
Islamabad. He has also served in the Rawalpindi Medical
College as Assistant and Associate Professor Pathology. He is
a founding member and former President of the Pakistan
Society of Haematology (PSH). The Ministry of Health
appointed Prof. Khalid as the first Chairman of the Islamabad Blood Transfusion
Authority from 2005-07 and is currently serving on the Advisory Board of the Authority.
He is Editor of many peer-reviewed journals and have published more than 100
research articles in national and international journals. He has trained a number of
haematologists for their MPhil and FCPS programmes in haematology.
Brig. (R) Prof. Dr. Javaid Usman (MBBS, MCPS, MPhil,

FCPS) is a Professor of Microbiology. During his 30 years’
military career, he worked at many stations and Armed Forces
institutions and has extensive experience in transfusion
medicine and has supervised various blood banks. His area of
expertise includes community and health care associated
infectious diseases, emerging pathogens and antibiotic
resistance. He has been actively involved in the training of
pathologists, microbiologists, laboratory technicians/
technologists and MPhil and Fellows in Microbiology. He has more than seventy
publications to his credit and is a CPSP and Aga Khan University examiner.
10
Brig. (R) Dr. Nadir Ali (MBBS, FCPS, PhD) is working as

consultant haematologist at the Kulsum International Hospital,
Islamabad and has more than 25 years’ experience as clinical
haematologist. He has also served as Associate Professor at the
Armed Force Post Graduate Medical Institute and has trained
more than 71 post-graduate residents. He is a member of various
professional bodies including American Society of Haematology
and Pakistan Society of Haematology. He has represented
Pakistan in many scientific conferences and has presented his
research work. He has more than 50 publications to his credit.
Dr. Syed Imtiaz Hasan (MBBS, MPH, PhD) did his graduation
from the Rawalpindi Medical College and PhD in Pathology from
the University of London. Since 1987, he has served in the
federal government as Medical Officer, Assistant Professor and
now as Consultant Pathologist, working in administrative,
teaching, and research posts in large public-sector hospitals and
institutes in Pakistan and Saudi Arabia. He also completed a
Fellowship in Public Health Resource Management, HIV/AIDS
from CDC, Atlanta. He is a member of the IBTA Advisory Board and has been
instrumental in implementing the inspection tools through inspections with IBTA team.
Prof. Dr. Haroon Khan (MBBS, MSc, FCPP, PhD) is serving as

Professor of Pathology in a private medical college and is also an
adjunct faculty member of Health Informatics at COMSATS
Institute of Information Technology. His core competencies
include accreditation and standardization of hospitals along with
development and implementation of HMIS. He is the Chairman of
Pakistan’s National Accreditation Standards for Hospitals and
Team Leader for establishing and implementing the first HMIS
system in a public sector hospital (PIMS). He is the founding member and former
president of e-Health Association of Pakistan which is working on Health and
TeleHealth in Pakistan.
Brig. (Retd.) Prof. Nuzhat Salamat, Tamgha-e-Imtiaz (M)

(MBBS, CTM, FCPS) is former Commandant of the Armed Forces
Institute of Transfusion. She graduated from Army Medical
College with a Chief of Army Staff (COAS) Gold Medal and Pfizer
Gold Medal for the best Graduate. She did her Fellowship in
Haematology from College of Physicians and Surgeons, Pakistan
and grading in Pathology from AFPGMI. She is also a certified
Transfusion Medicine specialist from the Royal College of
Physicians Edinburgh, UK. She has also worked as a Fellow at the St. Louis University
Hospital, USA. She is actively involved in teaching and training of Medical
Technologists, Junior Residents, and Fellows in Haematology and Transfusion
Medicine. She has published her research work at reputable national and international
journals and authored a chapter in the AFIP Manual of Laboratory Medicine.
11
Wg. Cdr. Dr. Kamran Nazir Ahmad (MBBS, FCPS) is working

as Consultant Haematologist and Head of the Pathology
Department at the PAF Hospital, Islamabad. He is also teaching
as Assistant Professor of Pathology at the Fazaia Medical
College, Islamabad. A graduate of Army Medical College,
Rawalpindi, he attained post-graduate diploma in Pathology
from AFPGMI Rawalpindi and Fellowship in Haematology
(FCPS) from AFIP, Rawalpindi. He has 15 years of diverse
experience in laboratory work and management including teaching in the field of
Pathology at various military hospitals. His special areas of interest include bone
marrow pathology, molecular studies and blood transfusion services. He has over a
dozen research publications in various prestigious national and international journals
to his credit.
Dr. Noor e Saba (MBBS, MPH, MPhil Haematology) is working

as Director and Consultant Haematologist at the Regional Blood
Centre, Peshawar. She was trained in Transfusion Medicine at
the Iranian Blood Transfusion Organization, Iran. Her
contributions to the blood safety system reform in Peshawar are
extremely complex, ambitious and comprehensive at the same
time. In addition to the technical input, her tireless advocacy
work has largely contributed to setting the course of Regional
Blood Centre on the right track. Her research in the field of transfusion medicine and
public health has been published in leading international journals. At RBC Peshawar,
she is actively involved in teaching and training of medical technologists in
Haematology and Transfusion Medicine and has been instrumental in implementing
quality control and data management through a harmonized computer-based
information system. She also supported the Khyber Pakhtunkhwa Blood Transfusion
Authority in its successful operationalization.
Dr. Faiza Fahim (MBBS, FCPS) is working as Consultant

Haematologist and Incharge Blood Bank, KRL Hospital
Islamabad. She is a graduate of Rawalpindi Medical College and
trained in Haematology at the Armed Forces Institute of
Pathology (AFIP). She has a keen interest in medical research,
has published her research work in prestigious journals and
presented it at national and international conferences. She has
also authored a chapter in the AFIP Manual of Laboratory
Medicine. She has developed a Haemovigilance system which is considered by IBTA
as a model for rest of the blood banks in ICT.
12
Dr. Usman Waheed (BS MLT, MSc, MPhil, Dip. Public Health,
Fellowship Transfusion Medicine, Ph.D.) is serving as
Technical Advisor in the national Safe Blood Transfusion
Programme and the Islamabad Blood Transfusion Authority,
Ministry of National Health Services, Pakistan. Dr. Waheed
holds postgraduate diplomas in Epidemiology (Lon),
Transfusion Medicine (Germany) and Quality Management
(Netherlands).
As a founding member of the national blood programme, his
contributions to the Blood Transfusion sector in Pakistan are
diverse. His strong academic and professional background allowed him to competently
address all areas of the blood system reforms project co-funded by the German and
Pakistan governments. Dr. Waheed is involved with the teaching and training of under-
and post-graduate students in the field of medical laboratory sciences, transfusion
medicine and virology. As a keen researcher, he has authored more than 90 research
publications besides authoring four handbooks, 13 technical manuals and co-authoring
a millstone joint publication by SBTP and WHO – the National Blood Policy and
Strategic Framework. He also supervised the team formulating the HIV testing strategy
for Pakistan.
Dr. Waheed was awarded the prestigious ‘Young Investigator’ award by the
International Society of Blood Transfusion in 2014 (South Korea) and 2015 (UK). He
is also the Editor of three peer-reviewed international journals. A member of many
professional bodies and international expert working groups, Dr. Waheed has
represented Pakistan in many scientific conferences abroad and is serving on Advisory
Boards of American Society for Clinical Pathology, USA Science Advisory Board,
South Asian Association of Medical Laboratory Scientists and Asian Association of
Transfusion Medicine.
Dr. Shawana Kamran (MBBS, FCPS) is an Assistant Professor

of Pathology and Associate Consultant Haematologist at the
Shifa International Hospital/Shifa College of Medicine,
Islamabad. She is also the Supervisor of Haematology by the
CPSP Pakistan (FCPS post graduate training programme) and
performing duties of Associate Program Director, Shifa
International Hospital. She was trained at the Armed Forces
Institute of Pathology and completed her Fellowship in
Haematology in 2010. She also received specialized training in Cytogenetics and
Fluorescence in situ Hybridization from The University of Chicago, Cancer Research
Center, Illinois, in 2014. Presently, she is the Section Head of Cytogenetics Lab,
Department of Pathology, Shifa International Hospital.
13
4. W.H.O. COUNTRY SUPPORT MISSION ON

BLOOD SAFETY IN PAKISTAN
A WHO Country Support Mission on Blood Safety performed its assignment in
Pakistan from October 7-12, 2019. The Mission was organized on the request of the
Ministry of National Health Services, Regulation and Coordination to provide
recommendations for accelerating the blood system reform programme. The Mission
consisted of experts with experience in blood system reforms at national, regional and
global levels and included Mr. Yu Junping, WHO HQ, Dr. Yetmgeta E. Abdella, Medical
Officer, WHO EMRO, Dr. Lars Erik Eberhart, Austrian Red Cross/Blood Services, Dr.
Khalid Rashid al Balushi, Blood Bank Services of Oman, Prof. Hasan Abbas Zaheer,
National Coordinator, SBTP, Dr. Usman Waheed, Technical Expert, SBTP, Prof. Abdul
Bari Khan, CEO, Indus Hospital, Dr. Saba Jamal, Director, Indus Hospital Blood Center
and Dr. Muhammad Umer Iqbal, WHO Pakistan.
The Mission held deliberations in Islamabad and met the Special Assistant to the Prime
Minister on Health Dr. Zafar Mirza and the Acting WR. In addition to the briefings from
SBTP and IBTA the Mission also met the CEO, KPBTA, Dr. Jamal Nasir, RBC
Manager, Dr. Noor e Saba, and the KP BT Programme Manager Dr. Shams ur Rehman
Afridi. A skype meeting was held with the Balochistan BT Programme Manager. The
Mission then proceeded to Lahore and met the Director General Health, Punjab, Dr.
Haroon Jehangir Khan; Secretary, Punjab Blood Transfusion Authority and Director,
Institute of Blood Transfusion Services, The Mission also visited the Mayo Hospital
Blood Bank. In Karachi, the Mission met the Provincial Secretary Health, Director,
Sindh Blood Transfusion Authority, Representative of Sindh Health Care Commission.
The Mission also visited the blood banks in Civil Hospital, Jinnah Post Graduate
Medical Centre and the Indus Hospital. The Mission also visited the Jamshoro RBC
and its attached HBB in Civil Hospital Hyderabad.
The Mission recorded the achievements of the SBTP and evaluated the progress of
the blood safety reforms, identified operational and systemic gaps and outlined the
recommendations for scaling up the reform program. At the end of the Mission, a
detailed debriefing was given to the Health Advisor in which the WHO representative
was also present. The Advisor appreciated the efforts of the Mission and the
performance of the SBTP and offered valuable recommendations and suggestions.
Soon afterwards the Mission submitted its report outlining the operational plan for the
future.
14
15
5. CEREMONY TO FELICITATE IBTA PANEL OF

INSPECTORS
For the year 2019, the Islamabad Blood Transfusion Authority felicitated its
distinguished ‘Elite Panel of Inspectors’ at a ceremony held in Islamabad. The Chief
Guest on the occasion was Maj. Gen. Prof. Saleem Ahmed Khan, HI (M). Prof. Saleem
A. Khan accompanied by Chairman IBTA, Prof. Hasan Abbas Zaheer, awarded
appreciation certificates to the Inspectors to recognize and acknowledge their support
in strengthening the blood transfusion sector in the Islamabad Capital Territory.
Chairman, IBTA, Prof. Zaheer in his address said the Authority is very thankful to the
Inspectors who have always been very generous in giving their valuable time to the
IBTA. Their technical oversight in developing the vision, strategy and implementation
roadmap of the Authority has been very praiseworthy. The Authority is fortunate to
have such distinguished professionals to guide it. The field work of regulation would
not have been accomplished effectively without the whole hearted support and
commitment of the co-opted team of Inspectors. The Chief Guest highly appreciated
the IBTA efforts in strengthening the regulation of the blood transfusion sector in the
federal capital and also in rest of the country. The IBTA efforts have been
acknowledged at the international level also by WHO and other partners which is a
source of pride for the Health Ministry as well as the country. He acknowledged the
contribution of the IBTA leadership in promoting the cause of blood safety at the
national and international forums.
Brig. (R) Dr. Nadir Ali, Prof. Javaid Usman, Wg. Cdr. Dr. Kamran Nazir Ahmed, Dr.
Noor e Saba, Dr. Shawana Kamran and Col. Mehreen Ali Khan receiving souvenirs from
the Chief Guest, Maj. Gen. Prof. Saleem Ahmed Khan, HI (M), and Prof. Hasan Abbas
Zaheer, Chairman IBTA
16
6. ORIENTATION SESSION FOR KHYBER

PAKHTUNKHWA BTA INSPECTORS
The Khyber Pakhtunkhwa Blood Transfusion Authority organized a consultative
meeting of the blood bank inspectors at Regional Blood Centre, Peshawar. The
meeting was convened with the objective to provide the recently appointed Inspectors
with an orientation of the regulation in blood transfusion services. The meeting was
facilitated by technical experts from Islamabad Blood Transfusion Authority (IBTA),
including Prof. Hasan Abbas Zaheer, Chairman IBTA, and Usman Waheed, Technical
Expert, IBTA.
The meeting started with a welcome address by the CEO, KP BTA, Dr. Jamal Abdul
Nasir who acknowledged the presence of all Inspectors. He also thanked the IBTA
team for sparing time to attend the meeting. He retreated the commitment of KP
government to ensure the safe blood transfusion practices in the provinces through a
robust blood transfusion authority.
Mr. Ali Khan, Assistant Director, KP BTA, presented the progress made by the KP BTA
and the future plans for the implementation of regulation in the province of KP.
Prof. Zaheer, Chairman IBTA, updated on the operationalization of the Islamabad BTA
in 2013 and the progress made in last six years. He informed that in Pakistan various
sectors are regulated through single national authorities. However, the blood sector
has separate regulatory bodies in all the provinces and regions. Until the revival of the
17
Islamabad Blood Transfusion Authority in late 2013, blood regulation was by and large
neglected. But now as a result of the sustained efforts of the IBTA, blood regulation
has been strengthened all over the country and is now being accorded due priority.
The revived IBTA has in a very short time developed a very successful model of
regulation in Pakistan based on constructive non-punitive approach. The model of
regulation developed for Islamabad is well suited to the needs of the system in
Pakistan and needs to be replicated in the provinces through the provincial authorities.
International partners including WHO and senate standing committees have highly
admired the functioning of IBTA.
Dr. Usman Waheed, Technical Expert IBTA, presented the Inspection Checklist used
for inspection in Islamabad. He informed that the inspection checklist was formulated
in 2013 and later revised in January 2019 on the basis of the Inspectors feedback and
was improved to check compliance of the blood banks with national standards. To
achieve this, each and every standard was assessed through questions in the
inspection checklist. The order of inspection was systematic to ensure that all points
are covered. The same Checklist has been adopted by provincial/regional authorities
in Punjab, Balochistan, AJK and Gilgit and KP. The Inspection Checklist is key for
successful and uniform implementation of regulatory model throughout the country as
it eliminates any chances of biasness. The presentations were followed with a detailed
question and answer session where the Inspectors were informed about the
assessment of blood banks through the checklist.
18
7. IBTA INSPECTIONS WITH THE KHYBER

PAKHTUNKHWA BLOOD TRANSFUSION
AUTHORITY
The Khyber Pakhtunkhwa Blood Transfusion Authority (KPBTA) initiated the process
of regulation of the blood banks in the province under the KP Blood Transfusion
Authority Act of 2016. In the first phase, seven registered blood banks in Peshawar
were inspected on April 8-9, 2019. The inspection team included representatives of the
Islamabad Blood Transfusion Authority (IBTA) and KPBTA Inspectors and officials.
The inspected blood banks included those functioning in Lady Reading Hospital,
Khyber Teaching Hospital, Rehman Medical Institute, Hayatabad Medical Complex,
Institute of Kidney Diseases, Burns and Trauma Center and the Peshawar Regional
Blood Center. All the blood centers inspected extended their full support and
cooperation to the Inspection team and appreciated their suggestions and
recommendations for improvements.
In the second phase, the Authority inspected 10 blood banks from May 27-30, 2019,
in Peshawar including Shaukat Khanum Memorial Cancer Hospital; North West
General Hospital; Fatimid Foundation Thalassaemia Centre; Mercy Teaching Hospital,
Frontier Foundation Thalassaemia Centre; Kuwait Teaching Hospital; Hamza
Foundation Thalassaemia Centre; Govt. Naseerullah Babar Memorial Hospital; Moulvi
Ameer Shah Memorial Hospital; and Naseer Teaching Hospital.
The KPBTA was notified in 2017 and a Board of Governors formed which appointed
Dr. Jamal Abdul Nasir as its first Chief Executive Officer. The BTA secretariat was
established in the premises of the Peshawar Regional Blood Center and the first
meeting of the Board of Governors was held soon afterwards. On the basis of the
decisions taken by the Board, some technical and administrative staff was hired,
budget developed and funds released and some provincial experts identified to act as
its honorary Inspectors. An advertisement was also placed in the press to invite
applications for registration of all public and private sector blood banks functioning in
the province.
The CEO also established regular coordination with Prof. Hasan Abbas Zaheer,
Chairman, IBTA to seek technical assistance to establish the KPBTA on strong
19
footings. Accordingly, the IBTA has shared all its technical tools (Inspection forms,
Checklists, Reporting formats, etc) with KPBTA, briefed its panel of Inspectors and
prepared them to perform their assigned role with optimum efficiency. On the request
of the KPBTA, the IBTA team (Prof. Zaheer and Dr. Usman Waheed) participated in
the inspections conducted in two phases on April 8-9, and May 27-30, 2019 in
Peshawar.
20
8. ORIENTATION SESSION FOR BLOOD BANK

INSPECTORS IN SINDH
The Sindh Blood Transfusion Authority (SBTA) organized an orientation session with
the Blood Bank Inspectors in its office in Karachi on March 26, 2019. Dr. Durrenz
Jamal, Director, SBTA especially invited Prof. H.A. Zaheer, Chairman, Islamabad
Blood Transfusion Authority (IBTA) to the meeting to share the IBTA experience of
regulation of the blood transfusion sector. The objective of the meeting was to take into
confidence the provincial experts about the reform agenda of the SBTA and its plans
to conduct the regulation of blood centres in Sindh in conformity with the national and
international guidelines and recommendations.
The invited experts included the representatives from all the leading public, private and
NGO sector blood banks in Karachi. Dr. Durrenaz informed that the SBTA is now
regulating the provincial blood banks in a very methodical and recommended manner
and adopting a non-punitive constructive approach to strengthen the standard of
services of the large and medium sized reputable blood centres. At the same time the
smaller blood banks operating from miscellaneous settings (clinics, pharmacies,
laboratories etc.) without proper human resource and facilities are being dealt strictly
according to the legislation. It is expected that with this new approach very soon the
commercially oriented smaller centres providing unsafe and poor quality of services
will be legally eliminated or will cease to exist. She also shared the data of 147 licensed
blood banks in Sindh and its analysis. This is the first time that Sindh BTA has collected
detailed proper and authentic data from all the licensed blood banks in Sindh.
Chairman IBTA thanked the SBTA for coordinating with the IBTA and reaffirmed full
support from IBTA and SBTP to reform the BT regulation in Sindh. He informed that
all the tools and technical documents developed by IBTA and SBTP were now being
used and implemented by the SBTA. He stressed the need to ensure the presence of
minimum standards (human resource, equipment and facilities) as a basic pre-
requisite for licensing. Any blood bank, public or private sector, not fulfilling the
minimum standards should be provided reasonable time to address the deficiencies
and then re-inspected before being granted a license. After ensuring this primary
objective, subsequent inspections should focus on improving the technical standards,
practices, donor management, voluntary blood donations, quality of consumables,
21
automation, rational use of blood, component therapy, haemovigilance, data

management, etc. Dr. Usman Waheed, Technical Expert, IBTA shared the IBTA Blood
Banks Inspection check list with the participants to brief them about the process of the
unbiased and non-subjective uniform inspections. The SBTA plans to notify some of
the leading experts to act as honorary Inspectors of SBTA. The entire meeting session
was interactive in which detailed discussion took place during the presentations. The
experts congratulated the SBTA leadership on adopting a participatory and inclusive
approach to manage the challenging task of regulating the large blood transfusion
sector in Sindh and assured Dr. Durrenaz of their full support and cooperation. Also
discussed thoroughly was the excellent experience of outsourcing the four new
Regional Blood Centres and their 29 attached Hospital based Blood Banks and the
benefit that they are providing to the people of Sindh in terms of blood safety,
accessibility and affordability.
22
9. BLOOD BANK INSPECTIONS

The field work of IBTA regulation would not have been accomplished effectively without
the whole hearted support and commitment of the co-opted team of honorary Inspectors.
The inspectors have the independence in conducting inspection process and signing final
report of the inspection and are authorized to examine any documents, records, forms
involved in blood transfusion service, etc. and take copies for future reference. This year
Inspectors from Blood Transfusion Authorities of Khyber Pakhtunkhwa, AJK and
Balochistan also participated in the inspections. The inspections in 2019 were conducted
according to the following schedule:
S. No. Blood Bank Inspection Team Date
Wg. Cdr. Dr. Kamran Nazir

Maroof International
1. Dr. Usman Waheed March 29, 2019
Hospital
Saira Tahir
2. PRCS Blood Donor Centre Dr. Usman Waheed March 29, 2019
Saira Tahir
Brig. (R) Dr. Nadir Ali
Dr. Noor e Saba
3. PAF Hospital Dr. Muhammad Nisar April 03, 2019
Mr. Abdul Haleem Baloch
Dr. Usman Waheed
Social Security Hospital Dr. Usman Waheed
4. April 03, 2019
(PESSI) Dr. Muhammad Nisar
Dr. Noor e Saba
Dr. Shawana Kamran
5. F.G. Polyclinic Hospital Dr. Usman Waheed April 05, 2019
Kaenat Nasir
Dr. Shawana Kamran
6. Medicsi Hospital Dr. Usman Waheed April 05, 2019
Kaenat Nasir
Brig. (R) Prof. Javaid Usman
7. KRL Hospital Kaenat Nasir April 09, 2019
Saira Tahir
Brig. (R) Prof. Javaid Usman
8. PAEC General Hospital Kaenat Nasir April 09, 2019
Saira Tahir
Dr. Faiza Fahim
Rawal Institute of Health
9. Dr. Usman Waheed April 11, 2019
Sciences
Dr. Amnah Shaukat
Dr. Faiza Fahim
10. Capital Hospital Dr. Usman Waheed April 11, 2019
Dr. Amnah Shaukat
23
Dr. Usman Waheed

Sundus Foundation
11. Saira Tahir May 15, 2019
Thalassaemia Centre
Kaenat Nasir
Al-Nafees Medical College Dr. Syed Imtiaz Hasan

12. May 16, 2019
Hospital Dr. Usman Waheed
Dr. Syed Imtiaz Hasan

13. Federal General Hospital May 16, 2019
Usman Waheed

Akbar Niazi Teaching
14. Dr. Usman Waheed May 17, 2019
Hospital
Saira Tahir
Dr. Faiza Fahim
Kulsum International
15. Dr. Usman Waheed May 20, 2019
Hospital
Kaenat Nasir
16. Ali Medical Centre Dr. Usman Waheed May 22, 2019
Saira Tahir
17. IMC Nescom Hospital Dr. Usman Waheed May 22, 2019
Saira Tahir
Quaid-e-Azam
18. Kaenat Nasir May 24, 2019
International Hospital
Saira Tahir
19. PIMS Hospital Kaenat Nasir May 28, 2019
Saira Tahir
20. Shifa International Hospital Kaenat Nasir May 30, 2019
Saira Tahir
Maroof International
21. Dr. Usman Waheed August 21, 2019
Hospital
Dr. Noor e Saba
PNS Hafeez Naval
22. Dr. Muhammad Nisar August 30, 2019
Hospital
Dr. Usman Waheed
24
9.1 Inspection Photographs
Al-Nafees Medical College Hospital, Lehtrar Road, Farash Town, Islamabad
Ali Medical Centre, F-8 Markaz, Islamabad
PAF Hospital, E-9, Islamabad
25
Akbar Niazi Teaching Hospital, IMDC, Bhara Kahu, Islamabad
Capital Hospital, G-6/2, Islamabad
Federal General Hospital, NIH, Islamabad
26
Federal Government Polyclinic Hospital, Islamabad
Social Security Hospital (PESSI), I-12, Islamabad
Medicsi Hospital, F-7, Islamabad
27
Kulsum International Hospital, Kulsum Plaza, Blue Area, Islamabad
KRL Hospital, G-9/1, Islamabad
Maroof International Hospital, F-10, Islamabad
28
IMC Nescom Hospital, H-11, Islamabad
PAEC General Hospital, H-11/4, Islamabad
PRCS Blood Donor Centre, Islamabad
29
Quaid-i-Azam International Hospital, Golra Morr, Islamabad
Rawal Institute of Health Sciences, Islamabad
Sundas Foundation Thalassaemia Centre, F-9, Islamabad
30
10. Data from ICT Blood Banks: RESULTS AND

ANALYSIS
Data gathering or known as data collection is a procedure that involved collecting facts or
information from specific sources and using some systematic methods, mainly for research
to improve services, utilization of the scarce national resources and to facilitate policy
planning for actionable insights. The professional management of data and information
lays the foundation for strengthening governance and leadership and development of an
effective quality system. The collection of detailed information from IBTA licensed blood
banks not only generates credible data but also helps gain insight into the activities of the
licensed blood banks and incorporate the advancements in practices and technology in the
blood transfusion sector in Islamabad.
10.1 Data Collection
Since its revival in September 2013, IBTA has received registration applications from a
total of 26 blood banks functioning in the Islamabad Capital Territory. Until December 2019,
licenses were granted to 20 blood banks fulfilling the minimum criteria under the Islamabad
Blood Safety Ordinance (Table 10.1). Some of these blood banks were initially only
registered and subsequently upon addressing their deficiencies were granted licenses.
Currently three blood banks are registered, two of which yet to become operational (Table
10.2-10.3). Six blood banks have been closed down in last six years as they did not fulfil
the licensing criteria (Table 10.4). The licensed blood banks are routinely inspected on
annual basis and their licenses renewed for one year if the inspection is successful. In
addition, surprise checks and formal and informal coordination is also maintained with the
ICT blood banks by the IBTA.
Table 10.1: Licensed Blood Banks in the Islamabad Capital Territory
Sr. No. Licensed Blood Banks
Akbar Niazi Teaching Hospital

1.
Ali Medical Centre
2.
Al-Nafees Medical College Hospital
3.
Federal Government Polyclinic Hospital
4.
5. Federal General Hospital
IMC Nescom Hospital

6.
KRL Hospital
7.
Kulsum International Hospital
8.
Maroof International Hospital
9.
Medicsi Hospital
10.
31
PAEC General Hospital

11.
PAF Hospital
12.
Sundas Foundation Thalassaemia Centre
13. (Pakistan Bait ul Mal)
PIMS Hospital
14.
PNS Hafeez Naval Hospital
15.
PRCS Blood Donor Centre
16.
Quaid-i-Azam International Hospital
17.
Rawal Institute of Health Sciences
18.
Shifa International Hospital
19.
Punjab Employees Social Security Institution
20. (PESSI) Hospital
Table 10.2: List of Registered (Not Licensed) Blood Banks
Sr. No. Registered Blood Banks
1. NORI Hospital
2. Trauma/Medical Centre, Islamabad Int’l Airpirt
3. Watim Medical and Dental College Hospital
Table 10.3: Blood Banks on Probation (earlier licensed)
Sr. No. Blood Banks in Probation
1. Capital Hospital
Table 10.4: List of Closed Down Blood Banks
Sr. No. Closed Down Blood Banks
Rahat Medical and Diagnostic Centre Blood

1.
Bank
2. Polytest Lab and Blood Bank
3. Beacon Clinical Laboratories
Ch. Muhammad Hussain Nat Trust Hospital

4.
Blood Bank
5. Islamabad Blood Donor Society Blood Bank
6. ASIA Diagnostic Centre Blue Area
32
With the revival of the IBTA in 2013, applications were invited from the blood banks
functioning in Islamabad Capital Territory to apply for registration through announcement
in the local newspapers. Some blood banks applied in response to the newspaper
advertisements. Other non-applicant known blood banks were encouraged to apply for
registration. Some blood banks were identified during inspections through referrals and
contacted for registration. A proper mapping of blood banks in Islamabad has not been
carried out due to resource constraints but is planned for the future subject to availability
of funds. A few diagnostic centres and laboratories that perform part time blood banking
were later identified through miscellaneous sources and were directed to close down as
they were not fulfilling the minimum criteria of licensing of blood banks under Islamabad
Blood Safety Ordinance LXXIII of 2002.
A comprehensive performa was designed by the IBTA in 2013-14 for the collection of data
from the licensed blood banks on the various aspects of their work. The performa is
periodically reviewed and revised. The IBTA shared the performa with the 20 licensed
blood banks and one registered blood bank (Capital Hospital) in the first week of January
2020 for the collection of 2019 data. All the blood banks returned the filled forms within two
weeks.
Collection of data from the licensed blood banks in the ICT was carried out to review the
situation and status of different aspects of blood transfusion services in the ICT blood
banks, individually and collectively. The data was collected through a pre-tested tool which
was based on the questionnaire of the WHO Global Database on Blood Safety. The
questionnaire was adapted to the local requirements. Data entry errors and inconsistencies
were frequent in the beginning and were corrected after rigorous follow up. The data were
subsequently aggregated and analyzed in order to improve service and quality of care in
the ICT blood banks.
10.2 Number of Public and Private/NGO Blood Banks in Islamabad
Out of the 21 blood banks, 12 are in public sector and nine in private/NGO sector (Fig.
10.1).
14
12
12
10 9
0
Public Private/NGO
Figure 10.1: Public and Private/NGO Sector Blood Banks
33
10.3 Number of Blood Donations in Islamabad Capital Territory
In 2019, 75,348 blood donations were collected from the 21 blood banks (Table 10.5). The
2019 data shows an uneven distribution of the burden of work, a finding consistent with the
data of the past six years. In ICT, ~ 60% (n=43,976) of the blood donations was collected
by the two large blood banks (PIMS and Shifa Int’l Hospital). Two medium sized blood
banks (FGPC and PRCS) collected 16.7% (n=12,649) blood donations.
The contribution of the remaining 17 blood banks was about 24% (n=18,725). The number
of donations in these 17 smaller blood banks ranged from 134 to 3,027 donations in 2019.
Out of these 17 blood banks, 10 centres collect less than 1,000 donations per year. Some
centres collect less than one donation per day. In other words, most of the blood banks
functioning in the Federal Capital do not justify their existence as full-fledged blood banks.
These blood banks can better serve as hospital based blood banks relying on a larger
blood bank or a Regional Blood Centre for their supply of blood and blood components.
Currently, irrespective of the workload, all the 21 blood banks (private and public sector)
have to maintain minimum standards (expensive equipment, costly HR and other facilities)
to fulfil the licensing requirements. Full-fledged existence of the small blood banks also
means that they and their host hospitals remain dependent on the larger blood banks as
they cannot possibly ever have sufficient inventory of the blood components of all the blood
groups.
Table 10.5: Number of Blood Donations in Individual Blood Banks
S. # Name of Blood Banks Annual Percentage

Donation
1. Ali Medical Centre 630 0.83%
2. Al-Nafees Medical Collage Hospital 332 0.44%
3. Capital Hospital 754 100%
4. Akbar Niazi Teaching Hospital 952 1.26%
5. Federal General Hospital 619 0.82%
6. Federal Govt. Polyclinic Hospital 4,717 6.26%
7. IMC Nescom Hospital 1,049 1.4%
8. Kulsum International Hospital 1,483 1.39%
9. KRL Hospital 2,160 2.86%
10. Medicsi Hospital 134 0.17%
11. Maroof International Hospital 633 0.84%
12. PAEC General Hospital 2,385 3.16%
13. PAF Hospital 1,024 1.35%
34
14. Punjab Employees Social Security 331 0.43%

Institution (PESSI) Hospital
15. PIMS Hospital 32,160 42.6%
16. PNS Hafeez Naval Hospital 592 0.78%
17. Sundus Foundation Thalassaemia 3,027 4.01%

Centre
18. Quaid-e-Azam International Hospital 2,054 2.72%
19. PRCS Blood Donor Centre 7,932 10.52%
20. Rawal Institute of Health Sciences 564 0.74%
21. Shifa International Hospital 11,816 15.68%
Total 75,348 100%
The uneven workload in the ICT blood banks strongly supports promotion of the
internationally recommended centralized model of blood transfusion services. This model
is being introduced in the country through the German government funded Safe Blood
Transfusion Programme. The model is based on the functional separation between
production units (Regional Blood Centres) and utilization units (Hospital based Blood
Banks). A Regional Blood Centre will be established in Islamabad in 2019 which will be
responsible for mobilizing voluntary blood donors, recruiting and retaining them, collecting
donations, processing, screening and testing the collected blood and preparation and
storage of the prepared blood components for distribution to the existing hospital based
blood banks in Islamabad. These hospital blood banks will then no longer be required to
do all these functions and will instead serve as “Consumption Units‟ and receive the
prepared components from the Islamabad Regional Blood Centre according to their needs
and store them until transfusion to the patients.
The same model already existed in Pakistan at the Armed Forces Institute of Transfusion
in Rawalpindi which serves as a Regional Blood Centre supplying blood to the adjoining
army hospitals, e.g. CMH, MH and AFIC, etc. The physical infrastructure developed by the
SBT project in Phase I (10 RBCs and up-gradation of 59 HBBs) is now functional. This
infrastructure also follows the centrally coordinated model with functional separation
between production (RBCs) and utilization (HBBs). At their full capacity, the Phase I
infrastructure will cover approximately 15% of the national coverage. In Phase II the scope
and scale of the coverage is being further expanded which is expected to cover 20-25% of
the coverage.
The ICT licensed blood banks support the concept of the SBTP model of centralized
services through large RBCs. The current management of the smaller blood banks also
realize that it does not make economic sense to maintain a full blood bank if their
transfusion requirements are low. A number of these blood banks exist in the private
medical college hospitals. And as per the PMDC requirements they are bound to establish
a full-fledged blood bank in their teaching hospitals. However, if they are allowed by the
PMDC, they are willing to enter into agreements with the larger blood banks and function
35
only as hospital based blood banks as per the SBTP model. The IBTA intends to write to
the PMDC to revise their policy in this regard when the Islamabad RBC is established and
functional.
A similar situation exists in the armed forces blood banks (PNS Hafeez and PAF Hospital).
As per rules the armed forces hospitals in Category A-C must have fully functional blood
banks. IBTA also intends to write to the Surgeon General Pakistan to revise their policy in
this regard and encourage their collaboration with the Armed Forces Institute of
Transfusion (AFIT) in Rawalpindi and other larger hospitals in other regions.
Currently the blood safety legislations do not have any provision to close down any blood
bank due to insufficient work load. But with the emergence of modern Regional Blood
Centres in the country and their reliance on regular voluntary blood donors, the full-fledged
existence of unsustainable and unsafe smaller and medium sized blood banks dependent
on the patients to provide blood donors should eventually fade out.
10.4 Gender Distribution of Blood Donors
Out of the total of 75,348 whole blood donations collected in ICT in 2019, 73,612 (97.70%)
were donated by male blood donors and only 1,736 (2.30%) were donated by female
donors (Figure 10.2). The percentage of female blood donors is slightly more in 2019 in
ICT as compared to last year (in 2018, it was 2.0%).
Low female donation rates in a high literacy region like the federal capital is a source of
concern. It is believed that lack of female friendly facilities, poor privacy, misconceptions,
nutritional status, cultural and social factors contribute to low female donation rates.
However, the response in mobile camps in female educational centres is encouraging.
Females
2.3%
Male
97.7%
Figure 10.2: Male and Female Blood Donors
10.4 Types of Blood Donations in ICT
Out of the 75,348 whole blood donations collected in ICT in 2019, 87.25% (n=65,736)
donations were collected from family replacement donors while only 12.75% (n=9,6102)
36
donations were collected from voluntary donors (Figure 10.3). Blood collection from
paid/professional donors was not reported by any blood bank in ICT.
VNRBC 12.75%
Family
Replacement
Donars
87.25%
Figure 10.3: Voluntary and Replacement Blood Donors
Out of the 21 blood banks, the Sundas Foundation Thalassaemia Centre collected highest
percentage of voluntary blood donations 98.3% (n=2,977) followed by PRCS Blood Donor
Centre 64.5% (n=5,119). The remaining blood banks have very low number of voluntary
blood donations. Most of the voluntary blood donations in ICT were collected in mobile
blood camps. Sundas Foundation Thalassaemia Centre and PRCS collect almost all
donations in mobile camps. Voluntary donation in blood bank setting is not very common.
The World Health Organization recommends that all countries should be self-sufficient in
all blood products and that every blood donation should be voluntary, anonymous and non-
remunerated. The collection of blood from voluntary, non-remunerated blood donors is an
important indicator of safety and quality. The situation in ICT regarding the source of blood
supply is similar to the rest of the country. The IBTA 2018 data reveals that the pre-
dominant reliance continues to be on the patients’ friends and relatives, the “Family
Replacement Donors”. Despite the increase in the voluntary blood donations, the overall
share of voluntary blood donations is still not sufficient. This is despite the fact that
Islamabad has the highest literacy rate in the country and also possibly the most sensitized
populace. And in times of national crisis, droves of volunteers throng the blood banks for
blood donations to save the lives of unknown recipients as witnessed in many natural and
man-made calamities in the recent past. This implies that lack of voluntary blood donors in
routine times is due to lack of a proper system to manage the voluntary donors and
channelize the spirit of altruism in the society. Another main contributing factor for the
shortage of voluntary blood donors and our reliance on the “Replacement Donors” is the
lack of a proper donor friendly infrastructure in our blood centres.
In Islamabad, except for Sundas Foundation Thalassaemia Centre and Pakistan Red
Crescent Society, all the remaining blood banks are housed within the premises of
hospitals of various size. These hospital premises are invariably congested and crowded.
And the blood banks functioning within these settings also have similar issues. The young
and healthy people, the potential voluntary donors, are not inclined to visit such settings
unless their family member or a friend requires blood. We thus have a situation where the
potential voluntary donors invariably present to the system as “Replacement Donors”. As
37
these blood banks have basically evolved as “blood manufacturing units” so due attention
is not paid to the needs of the blood donors, the most important element of the transfusion
chain. Therefore, in the absence of donor friendly environment and conditions, the
experience of the individual donors is often not very pleasant. However, under compelling
circumstances, the “Replacement Donors”, accept these inconveniences. But the net result
of the prevailing poor conditions for the blood donors in our blood bank settings is that we
lose out on the opportunity to convert the suitable “Replacement Donors” into regular
voluntary non-remunerated blood donors.
Some ICT blood banks, however, do rely very significantly on VNRBDs, e.g. Sundas
Foundation Pakistan Thalassaemia Centre and PRCS Blood Donor Centre. Due to its
conventional and historical role, the PRCS has a particularly strong background of
mobilizing voluntary donors. But almost all their donors are first time donors as most of
their blood donations take place in mobile blood camps in universities and colleges where
the student population is not static. In the other centres also the voluntary donors are first
time donors who are as safe or unsafe as the family replacement donors. The safest
voluntary donors are the regular donors who donate blood two or three or more times a
year and are screened for suitability each time through behavioural, physical and
serological screening. The regular voluntary donors are thus the safest donors.
Unfortunately, the number of such donors in Islamabad is still very small.
Islamabad, a comparatively small city, has a large number of universities which have a
huge combined enrolment. All these universities as well as many colleges have their own
blood donor organizations (BDOs), which organize mobile blood camps infrequently often
in collaboration with a blood bank. Collectively these BDOs are the single largest source
of voluntary blood donors in Islamabad. The same pattern is evident in the rest of the
country. Until recently all these BDOs worked in complete isolation and without proper
technical guidance or supervision. The true potential of these youth organizations thus
remained locked. Recently, the SBTP formed an Association of the blood transfusion
stakeholders including BDOs called “PakBLOOD” which aims to bring all the BDOs on a
single platform, build their capacity and strengthen them to become the main force to
mobilize voluntary blood donors in their respective areas. These efforts have yielded
promising results and sporadic increase in voluntary blood donations have been witnessed
through donations in mobile and blood bank settings. The strategy however needs to be
institutionalized to wean away the blood bank’s dependence from the patients’ families to
the voluntary donors.
One of the main barriers in the promotion of voluntary blood donations remains the
absence of dedicated blood centres where lines do not cross between the patients and the
healthy voluntary blood donors. This issue is being addressed in the country with the
development of a network of modern Regional Blood Centres which are independent of
hospitals. Such a Centre for Islamabad with a capacity of more than 50,000 donations per
year will be developed in third quarter of 2020 and should be able to cater to the needs of
all the blood banks in Islamabad. The Regional Blood Centre and attached Hospital Blood
Banks will be obliged to build a network with BDO’s and all partners involved in voluntary
blood donation. Within this network, common activities to inform broader parts of the
population about blood and blood donation and to promote VNRBD will be tuned. A donor
management strategy including a registry of Blood Donors will be implemented through the
Islamabad Regional Blood Centre.
38
10.5 Component Preparation
In 2019, 71,591 (95.01%) blood collections in ICT were processed into at least three blood
components, i.e. Red Cell Concentrates (RCC), Fresh Frozen Plasma (FFP) and Platelet
Concentrates (Figure 10.4).
Components
Not
Prepared
4.99%
Components
Prepared
95.01%
Figure 10.4: Components Preparation
Out of 21 ICT blood banks, 19 blood banks reported nearly or more than 95% component
preparation rate in ICT. The remaining two blood banks prepare components variably from
45% to 70% mostly due to lack of awareness among the hospital’s clinicians about
component therapy.
When the revived IBTA initiated the regulation work in Islamabad in the last quarter of
2013, the situation regarding blood component preparation was very unsatisfactory and
only a few blood banks processed the whole blood donations into blood components. Many
blood banks did not even have the required equipment and facilities. However, the situation
has improved considerably since then due to the IBTA advocacy and capacity building of
the management and technical leadership of the blood banks. Facilities for component
production and storage are now a mandatory requirement for licensing. During the initial
phase of licensing many blood banks had to make substantial investments in their centres
to procure ultra-centrifuges, freezers, incubators and other essential equipment to prepare
and store blood components. However, there are still a few blood banks which keep
substantial percentage of their collections as whole blood. The reason is mainly the
pressure from clinicians to issue whole blood or extremely low workload and absence of
demand of blood components by clinicians. Formation of effective hospital transfusion
committees are expected to improve this situation. Steps to promote rationale use of blood
and component therapy needs to be taken for the benefit of the hospitals where the
clinicians still prefer whole blood transfusions.
The common reason cited by the blood banks for not preparing blood components is lack
of demand for blood components by the clinicians and wastage particularly of the platelet
concentrates. IBTA advocates collaboration between blood banks to share the surplus
components prepared with the other licensed blood banks where there is shortage. Such
collaborations now exist between PIMS and Pakistan Thalassaemia Centre and PIMS and
39
PRC Blood Centre. In Pakistan Thalassaemia Centre, FFPs and platelets are usually not
required. These two components are thus provided to PIMS Blood Bank. PRC Blood
Centre shares its inventory with the PIMS Blood Bank and PIMS patients are directed to
the PRCS to get blood components. These patients are provided components by PRCS
free of cost if they are Zakat entitled or on nominal charges. PIMS is the largest tertiary
care hospital in ICT and routinely faces component shortage as the PIMS clinicians
practice component therapy. Therefore, partnerships with PRCS and PTC have
considerably improved the component supplies in PIMS especially for the platelet
concentrates.
10.6 Donations Screened for Transfusion Transmissible Infections

All 21 ICT blood banks reported 100% (n=75,348) testing for HIV, HBV, HCV, Malaria and
Syphilis (Figure 10.5). The blood screening for five TTI markers, i.e. HIV, HBV, HCV,
Syphilis and Malaria are mandatory under the clause 10, section (d) of the Islamabad Safe
Blood Ordinance, 2002. In 2014, 100% donations were screened for HIV, HBV and HCV
but about 25% of the total donations were screened for Syphilis and Malaria. This rate
increased to about 46% in 2015, 60% in 2016, 77% in 2017 and 100% in 2018 and 2019,
because of continuous advocacy and effective regulation by IBTA.
100% 100% 100% 100% 100%
HBV HCV HIV Malaria Syphilis
10.7 Donations Reactive for Transfusion Transmissible Infections
Among the five TTIs tested, 70 (0.09%) were reactive for HIV, 807 (1.07%) for HBV and 941
(1.24%) were reactive for HCV. 0.02% (n=19) were reactive for Malaria and 0.76% (n=576) for
Syphilis (Figure 10.6).
1.24%
1.07%
0.76%
0.09% 0.02
HBV HCV HIV Malaria Syphilis
Figure 10.6: Donations Reactive for TTIs
40
The reactivity for all TTI markers decreased in 2019 from the previous year. Only malaria
reactivity is almost same as the previous year. The collective TTIs prevalence is still high
and unacceptable and needs to be curtailed through more effective behavioural and
physical screening of the blood donors.
10.8 Screening Techniques for Transfusion Transmissible Infections.
In 2019, for HBV and HIV screening, 85.01% of the total donations were screened by CLIA
and 14.99% of the total donations were screened by ELISA. In addition, 18.02% of the total
donations were further screened by NAT while only 0.4% of the total donations were
screened using manual kits. For HCV screening, 69% of the total donations were screened
by CLIA, 31% of the total donations were screened by ELISA, 18% of the total donations
were screened by NAT while only 0.4% of the total donations were screened using manual
kits. For screening against Malaria, 16.4% of the total donations were screened by CLIA
and 83.6% of the total donations were screened using manual kits. For Syphilis, 27.8% of
the total donations were screened by CLIA, 1% of the total donations were screened by
ELISA and 71.2% of the total donations were screened using manual kits.
IBTA strongly recommend the use of automated serological screening and use of quality
kits recommended by WHO or EU or approved by FDA. The IBTA Advisory Board has
recommended the use of TPHA or anti-TP (ELISA/CLIA) for syphilis screening. The rapid
devices are used for the screening of HIV, HBV and HCV in one centre as compared to 6
centres in 2014. SIH is screening all its donations by two technologies,
Chemiluminescence followed by pooled NAT screening of the non-reactive samples. The
application of advanced technology and internationally certified kits for serological
screening in blood centres in ICT augurs well for blood safety for the residents of
Islamabad.
10.9 Data Management Methodology
Out of the 21 ICT licensed blood banks, nine blood banks use a computerized data
management system which collect about 75% of the total blood donations in Islamabad
Capital Territory (Figure 10.7). The remaining 12 blood centres have manual system and
collect about 25% of blood donations.
14
12
12
10 9
0
Figure 10.7: Data Management
MIS Methodology used by Manual
number of Blood Banks
41
10.10 Haemovigilance
In 2019, 283 Adverse Events (AE) in donors were reported in the 75,348 blood donations.
Most common events were Vasovagal 112 (39.5%), hypotension 91 (32.1%), and
haematoma 21 (7.42%). (Figure 10.8).
A total of 49 Adverse Reactions (AR) in patients were reported including 27 (55.10%)

Febrile Non Haemolytic Transfusion Reaction (FNHTR), 10 (20.4%) Anaphylactic/Allergic
reactions, 2 (4.08%) transfusion associated circulatory overload and 10 (20.40%) other
reactions (Figure 10.9).
The IBTA introduced internationally recommended AE and AR reporting system in late

2016. The blood banks were not familiar with the new system and thus failed to properly
report the adverse events. IBTA in collaboration with SBTP has updated the National
Quality Control Guidelines (3rd Ed. 2020) and the new reporting forms have also been
added to these guidelines which will be distributed among the blood banks and trainings
will be conducted on the new reporting system. It is thus expected that improved quality of
data will be generated in 2020. Currently, the haemovigilance data is grossly under-
reported due to various reasons; lack of recognition of signs and symptoms, over-burdened
staff, poor data management etc.
The IBTA strongly advocates haemovigilance practices in its licensed blood banks to
promote transfusion safety. The Authority strongly highlighted the significance of this
surveillance work. Training workshops organized for the capacity building of the blood
banks comprehensively covered haemovigilance and guidance was provided to the blood
bank management to initiate this practice in the blood banks and hospitals. A precondition
of blood bank licensing was establishment of a Hospital Transfusion Committee (HTC) with
representation of the senior management of the hospital and medical and surgical
specialist as well as the nursing staff.
Citrate ReactionAllergic Reactions

1% 1%
Vasovagal without Haemotoma

(LOC) 7.42%
37.4%
Others
Vasovagal with
40%
LOC
2.1%
Allergic Reactions Citrate Reaction Haemotoma

Hypotension Other Vasovagal with LOC
Vasovagal without (LOC)
Figure 10.8: Adverse Events in Blood Donors
42
Others Allergy
20.4% 20.4%
TACO 4.08%
FNHTR 55%
FNHTR
Anaphylaxis/ Hypersensitivity
Immunological Haemolysis due to ABO Incompatibility
Others
Figure 10.9: Adverse Reactions in Recipients
The HTC is responsible for ensuring blood safety standards and monitoring the
haemovigilance system. The blood banks were advised to conduct at least three HTC
meetings every year and share minutes of the meeting with IBTA. One of the IBTA licensed
public sector blood bank (KRL Hospital) has developed a model system for
Haemovigilance and conducts HTC meetings regularly. Even the complete blood request
form is sent through the MIS based system to the blood bank for cross-match and issuance.
Over the past few years, IBTA has made significant progress in promoting the culture of
donor and patient vigilance. This has enabled IBTA to collect Haemovigilance data from
all the licensed blood banks. The annual data generated provides very useful information.
The information gained from the investigations and analysis of haemovigilance facilitate
corrective and preventive actions to be taken to minimize the potential risks associated
with safety and quality in blood processing and transfusion for donors, patients and staff.
Each and every incidence reported must be investigated fully to ensure that lessons are
learned and shared with all to avoid repetition of the errors. It is expected that with the
passage of time the HTC functioning would improve and along with it the standard of
reporting of adverse events. Currently, it appears that the adverse events are under-
reported mainly due to the fear of reprisals and lack of recognition of adverse signs and
symptoms. A landmark achievement in many blood banks is the return of empty blood bag
after the transfusion.
The objective of donor haemovigilance (DHV) is to continuously improve donor safety and
satisfaction through monitoring, analyzing, and researching adverse events associated
with blood donation just prior to, during, and after the donation event. The activities of
prospective and continuous surveillance of donation related complications are largely
voluntary in Pakistan but are mandated in the ICT through the ICT Blood Safety Ordinance.
The donor haemovigilance data of 2019 indicated that majority of the AE were vasovagal.
43
These events are often avoidable, provided trained, vigilant and committed staff is
available. Such vigilance systems allow monitoring of donor safety and assessment of the
success of interventions designed to further improve donor safety. It is crucial that all blood
banks adopt a systematic approach to monitor the rates of donor adverse reactions.
Recording of these events and their analysis and corrective measures will ensure that the
donor experience in the blood centre improves. This practice is likely to increase the trend
of voluntary blood donations.
The patient haemovigilance data showed very low number of immediate adverse events if
compared with anecdotal evidence from other developing countries. No haemolytic
transfusion reaction and delayed transfusion reaction took place during the reporting period
in ICT. Majority of the reactions were febrile, anaphylactic/ hypersensitivity allergic
reactions. This is probably due to under reporting because of fear of reprisal or lack of
awareness about the signs and symptoms of transfusion reactions. The figure may rise
with more stringent follow up from individual blood banks with the transfusion wards.
10.12 Reason for Discard of Blood
Out of 75,348 blood collections in 2019, 7,041 blood units were discarded. About 2,501
(35.52%) blood units were discarded due to TTI positivity, 3,427 (48.67%) blood
components discarded due to expiry date and 1,113 (15.80%)due to other miscellaneous
causes.
The question was not properly phrased in the questionnaire due to which clear response
could not be received. The discard of blood components was not requested separately due
to which a mix discard of RCC, FFPs and Platelets is provided by some blood banks in the
expiry section. The percentage of blood being discarded due to expiry is very high in some
small-sized blood banks due to insufficient demand in their hospitals. Wastage of the
scarce blood resource can be avoided by centralization and better coordination with large
centres.
TTI Positivity
35.52%
Expiry
48.67%
Misc
15.80%
Figure 10.10: Reason for Discard of Blood/Components
44
10.13 Cross-Match Technology
Out of the 21 ICT blood banks, manual cross-matching is done in nine blood banks while
12 perform cross-match through semiautomatic or automatic Gel-Card technology (Figure
10.11). Use of Gel Card technology is recommended especially in the larger blood banks
where the existing workforce cannot possibly manage this work manually. In addition,
permanent record is also maintained with this technology and quality of work assured.
12
Gelcard Manual
Figure 10.11: Cross-Match Technology in ICT Blood Banks
10.14 Donor Deferral

4,871 blood donors were deferred from donating blood in the 21 lCT blood banks in 2019.
Out of these 4,055 (83.25%) were deferred temporarily and 816 (16.75%) were deferred
permanently (Figure 10.12). List of the deferral reasons is given in the Table 6 which
indicates highest number of deferrals 1,523 (37.55%) due to anaemia followed by 660
(16.27%) due to low body weight. During donor assessment the blood donors may be
deferred from donating blood for many reasons, either permanently or temporarily.
Knowledge of the reasons for donor deferral can help in planning more effective
recruitment and retention campaigns aimed at the availability of safe donors. Blood donor
deferral leads to loss of available blood units for transfusion. The credible scientific data of
donor deferral generated by IBTA indicates that about 6.46% of the blood donors who
presented for blood donations were unfit for donations temporarily or permanently. This
underlines the need to focus on retention of suitable voluntary as well as replacement
donors in addition to further strengthening donor management systems.
Permanently
Deffered
16.75%
Temporary
Deffered
83.25%
Figure 10.12: Temporary and Permanent Donor Deferral
45
Table 10.6: Reasons for Donor Deferral
Causes Number Percentage
Anaemia 1,523 37.55%
Underweight 660 16.27%
Inappropriate height weight 86 2.12%

ratio
Mensuration 141 3.47%
Low blood Pressure 197 4.85%
Taking Medicine 97 2.39%
History of fainting / vertogo 42 1.03%
Recent Vaccination 28 0.69%
Recent blood donation 203 5.0%
Underage/Vertigo 205 5.05%
Flu/respiratory tract infection 18 0.44%
Gastroenteritis 2 0.04%
Typhoid 15 0.36%
Chest Pain 2 0.04%
Difficult vein/Obesity 41 1.01%
Blood phobia 24 0.59
Fever 55 1.35%
Fasting 18 0.44%
Fear of needle 48 1.18%
Asthmatics 8 0.19%
High blood pressure 40 0.98%
Any Other 602 14.84%
46
11. NATIONAL GUIDELINES – QUALITY

CONTROL IN TRANSFUSION MEDICINE
SBTP has published the third edition of the
National Guidelines for Quality Control in
Transfusion Medicine. The first edition of the
document was formulated by the National
AIDS Control Programme in 2007. The second
edition developed in 2017 by the Safe Blood
Transfusion Programme with significant
revisions and additions of new chapters. The
second edition was disseminated to all national
stakeholders in capacity building workshops
across the country by the SBTP team. The
implementation of the document was made
mandatory, through the Islamabad Blood
Transfusion Authority, and a prerequisite for
licensing in the Islamabad Capital Territory.
With the practical implementation of these
guidelines in the blood centres the need for a
revision was felt by many eminent national
experts who provided valuable input that was
incorporated in the second edition. The second
edition of the guideline document for Quality Control in Transfusion Medicine was therefore
revised and a third edition is being published in an effort to ensure the maximum safety of
all procedures for donors, recipients and staff in transfusion services. Blood transfusion is
an excellent therapeutic intervention for patients provided stringent yet simple quality
control measures are followed thoroughly in order to ensure transfusion efficacy and
safety, and so to protect the donor and the patient against the possible risks. A quality
system is a documented system. Written procedures and records, checked at planned
intervals with proper auditing, provide evidence that quality requirements have been met
and the blood is safe. This is why documentation is so important, it is a health care issue,
it is not an administrative question.
The Programme is also very fortunate to avail the professional guidance and expertise of
eminent national and international experts who have contributed effectively in reviewing this
document. The document has been edited by Prof. Hasan A. Zaheer, Dr. Saeed Ahmed, Dr.
Usman Waheed and Akhlaaq Wazeer.
The document is available on SBTP and IBTA websites.
47
12. FUNCTIONAL BRIEF FOR BLOOD

TRANSFUSION AUTHORITY
To support the provincial blood transfusion
authorities in operationalization, the IBTA
and Safe Blood Transfusion Programme
through technical assistance from the GIZ
Health Programme, developed a handbook
for the Blood Transfusion Authority.
The handbook describes (1) the roles and

responsibilities, including registration,
inspection and licensing, the establishment of
a haemovigilance system, as well as
reporting requirements; (2) it provides basic
organizational chart and explains which
resources are required; (3) it details the
requirements of data management (data on
blood establishments as well as data related
to blood safety and haemovigilance, which
are collected from Blood Establishments or
Hospital Transfusion Committees); (4) tools
and forms required for its different tasks and
responsibilities; and, finally, (5) an initial
operational plan which helps to structure the
work approach.
The Functional Brief provides guidelines for the functioning of BTA as regulators of a modern
Blood Transfusion System as sanctioned by the new Safe Blood Transfusion Law and may be
used as a communication tool with the Health Department to explain which resources are
required to conduct the actions defined. This would include the identification of BTA staff
requirements, the elaboration of registration documents to be filled by all Blood Establishments
operating in the province/state/ICT and the mapping of all these facilities. On the basis of this
first overall data collection BTA and DOH will have more clarity about expected workloads and
the resources to be allocated.
48
14. FIELD MANUAL FOR BLOOD BANK

INSPECTORS
The provincial Health Departments have
made efforts to strengthen the regulation of
the blood banks. In 2015, the Punjab and
Sindh BTAs organized training workshops
for the blood bank inspectors which were
facilitated by the SBTP Technical Expert
from Romania. The trainings were first of its
kind in Pakistan and will go a long way in
strengthening the regulatory arm of the
blood transfusion services. During the
trainings, a need was felt to develop a
technical document to guide the blood bank
inspectors in their field visits. Thus the IBTA
and the Safe Blood Transfusion Programme
through technical assistance from the GIZ
Health Programme, developed “Field
Manual for Blood Bank Inspectors”.
The blood transfusion inspector who is

directly involved in ensuring compliance of a
blood establishment is not only expected to
be well versed with vein to vein transfusion
processes but should also have some awareness about the regulatory and organizational
aspect of blood transfusion services. Therefore, the main intention of developing the Inspection
Manual is to outline the role of an inspector within blood transfusion service organization.
The document is divided into sections providing the reader a clear and comprehensive
knowledge of regulatory framework of BTS, the structure and functioning of BTA, and the step
by step approach in registration and licensing of a blood establishment and management of
post inspection data. The inspection checklist is elaborated in such a way that the inspector
knows the significance of each question and how each question should be presented during
inspection in order to get maximum and relevant information from the blood establishment
Therefore it will serve as a useful tool for guiding blood transfusion inspectors in conducting
inspection of Blood Establishments in a systematic manner.
This book also gives the inspector an insight on their rights and responsibilities which
accompany their optimal training. Well trained inspectors are the backbone of safe blood
transfusion practice in the country and ensure progress of blood safety.
49
15. STANDARD OPERATING PROCEDURES FOR

BLOOD TRANSFUSION SERVICES
This collection of Standard Operating
Procedures is a remarkable achievement.
It has been elaborated in continuation of
previous efforts under the National AIDS
Control Programme, undertaken with the
objective to improve blood safety and to
curb the transmission of TTIs. These SOPs
will close an important safety gap in the
blood transfusion system by helping to
standardize laboratory practices and by
providing concise guidance to the
laboratory staff. These have been
developed in collaboration with the GIZ
Health Programme. Recently, as part of the
SBTP-JHPIEGO collaboration, this
document has now been translated in Urdu.
The document has been used for trainings
to the blood bank personnel in interior
Sindh and also in rest of the country.
These SOPs are a step forward, as they

deliver a comprehensive list of procedures
required in the vein to vein transfusion chain, from donor management to compatibility testing
and issuance of blood. These SOPs are also remarkable for the methodology under which they
were developed. The 12 sections addressed were distributed to specific working groups
carefully identified and brought together to draw on the best professional competence in
Pakistan.
50
16. HANDBOOK OF CLINICAL TRANSFUSION

PRACTICE
Blood transfusion is an essential part of modern

health care. Used correctly, it can save life and
improve health. However, the transmission of
infectious agents by blood and blood products
has focused particular attention on the potential
risks of transfusion. The World Health
Organization (WHO) has developed an
integrated strategy to promote global blood
safety and minimize the risks associated with
transfusion. A key component of this strategy is
reduction in unnecessary transfusions through
the appropriate clinical use of blood and blood
products, and the use of simple alternatives to
transfusion, wherever possible. Accordingly,
the WHO developed a bedside transfusion
handbook ‘The Clinical Use of Blood’ to provide
a set of comprehensive learning materials that
can be used by individual clinicians and blood
transfusion specialists. The materials have
been written by an international team of clinical
and blood transfusion specialists and have been reviewed by a wide range of specialists
throughout the world. The Safe Blood Transfusion Programme has derived the ‘Handbook
of Clinical Transfusion Practices’ from the WHO’s The Clinical Use of Blood with the
permission of the WHO. The pocket handbook is designed for quick reference to promote
rational use of blood components and avoid unnecessary blood transfusions. The
Handbook is not designed to replace the conventional textbooks or to provide a definitive
text on the clinical use of blood. Rather, its purpose is to provide an easily accessible
learning tool that will assist prescribers of blood to make appropriate clinical decisions on
transfusion and contribute to wider efforts to minimize the unnecessary use of blood and
blood products.
The SBTP appreciates Prof. Syed Muhammad Irfan, Consultant Haematologist, Liaquat
National Hospital and Medical College, Karachi, and Executive Board Member, Pakistan
Society of Haematology, for motivating the Programme to compile this Handbook and also
for reviewing and endorsing the adopted document. The SBTP technical team (Dr. Usman
Waheed, Kaenat Nasir and Saira Tahir) also deserve special acknowledgement for their
tireless efforts to adopt the original WHO document into a Handbook well suited to the
national needs and requirements.
It is expected that the use of this document in the Pakistan healthcare system will
significantly improve the blood transfusion practices in our hospitals. It will also help
overcome to a large extent the chronic shortage of blood and blood components in our
blood centres and promote the rational and judicious use of blood and blood components.
51
17. COMMENTS ON IBTA PERFORMANCE
IBTA is a unique authority that helps the institution in its true spirit
to organize the Blood Banks with excellent quality and efficiency.
I really appreciate and in addition suggest that there is a need for a
hub where blood banks can share their experiences and data and
also that hub can provide information with reference to availability
of products in different blood banks. This can be physical or online.
An online option will be more helpful.
Best wishes for all IBTA team members.
Babar Hameed Awan
Senior Manager Diagnostics, Ali Medical Centre, Islamabad
The IBTA experience is a wonderful addition to our ongoing

interQC management of transfusion services. The valuable and
technical input by IBTA has always opened for us new avenues
for improvement.
Surg. Lt. Cdr. Dr. Mohsin Manzoor, MBBS, FCPS
PNS Hafeez Naval Hospital, Islamabad
The way they inspected is very positive and their suggestions and
recommendations are very encouraging that helped us a lot in
reviewing and upgrading of operational tasks of our blood bank. The
best thing that I felt during the entire inspection process is, there is
no undue pressure of being inspected. I would like to extend my
profound wishes to IBTA team so that their core mission of safe
blood transfusion will come true.
Dr. M. Sharif Astori
Administrator, Federal Government Polyclinic Hospital Blood Bank
Islamabad
During my visit to Pakistan, I was pleased to see the progress made by the
Islamabad Blood Transfusion Authority (IBTA) by implementing the blood
safety legislation inhet Islamabad Capital Territory. The IBTA has developed
a very practical model of regulation suitable for the needs of developing
countries. I appreciate the IBTA team for this endeavor. Best wishes!
Dr. Yetmgeta Abdella, MD, MPH
Medical Officer for Blood and Transfusion Safety
Regional Office for the Eastern Mediterranean, World Health Organization
52
IBTA is a valuable regulatory authority and it is working to provide

safe blood. I suggest that more emphasis should be placed on
continuous medical education of medical and paramedical staff to
develop their capacity.
Muhammad Khalid
Medical Technologist, KRL Hospital Blood Bank, Islamabad
I appreciate the constructive approach of IBTA during the inspections.

Several of our deficiencies have been overcome and our staff receives
regular guidance and technical advice from IBTA team.
Bilal Ahmed Tareen
Manager Blood Bank, Pakistan Institute of Medical Sciences, Islamabad
Islamabad Blood Transfusion Authority inspected blood bank

services at the Medicsi Hospital for the first time in February 2014. It
was definitely a remarkable experience for us. IBTA team cooperated
with us regarding everything in a professional manner. No other way
could be found to guide us in all aspects of blood banking. We are
grateful to the Islamabad Blood Transfusion Authority.
Waqas Khan, MS
Administrator, Medicsi Hospital Blood Bank
This is one of the best transformations in the regulation of blood

transfusion services that I have witnessed.
Dr. Ron Brown, USA
53
18. LIST OF PUBLICATIONS

BY IBTA TEAM
54
SBTP 10

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Zaheer HA, Waheed U, Nasir K, Tahir S. IBTA Annual Report. 1st Ed.

IBTA Annual Report 2019

ISLAMABAD BLOOD TRANSFUSION AUTHORITY

Copyright © 2019 Islamabad Blood Transfusion Authority

Printed in Islamabad, Pakistan

Abbreviations and Acronyms ................................................................................................................................... i

10.6 Donations Screened for Transfusion Transmissible Infections ................................................................ 40

ABBREVIATIONS AND ACRONYMS

Prof. Hasan Abbas Zaheer

DR. ZAFAR MIRZA

The present PTI government places special emphasis on strengthening of the

to see the progress of the Authority despite administrative challenges. As a result of

DR. ZAFAR MIRZA

The Islamabad BTA conducted annual inspections of Blood Banks in Islamabad in

The documentation standards have improved considerably as a result of the IBTA

The IBTA organized a ceremony to felicitate its Panel of Inspectors. Appreciation

Blood transfusion is an indispensable, potentially life-saving medical intervention.

To achieve regulation and harmonization of blood transfusion services in the country

Figure 1.1: BTS Legal Framework in Pakistan

Figure 1.2: Functions of IBTA

2. IBTA GOVERNING BOARD

Prof. Hasan Abbas Zaheer Maj. Gen. M. Ayyub, H.I. (M)

Prof. Khurshid Ahmed Prof. M. Farooq Khattak

Prof. Khalid Hasan Dr. Huma Qureshi

Prof. Tahira Zafar Prof. Haroon Khan

Dr. Asma Cheema Dr. Syed Imtiaz Hasan

3. IBTA INSPECTORS’ PROFILE

Prof. Dr. Khalid Hasan (MBBS, DCP, MPhil, FCPP) is serving

Brig. (R) Prof. Dr. Javaid Usman (MBBS, MCPS, MPhil,

Brig. (R) Dr. Nadir Ali (MBBS, FCPS, PhD) is working as

Prof. Dr. Haroon Khan (MBBS, MSc, FCPP, PhD) is serving as

Brig. (Retd.) Prof. Nuzhat Salamat, Tamgha-e-Imtiaz (M)

Wg. Cdr. Dr. Kamran Nazir Ahmad (MBBS, FCPS) is working

Dr. Noor e Saba (MBBS, MPH, MPhil Haematology) is working

Dr. Faiza Fahim (MBBS, FCPS) is working as Consultant

Dr. Shawana Kamran (MBBS, FCPS) is an Assistant Professor

4. W.H.O. COUNTRY SUPPORT MISSION ON

5. CEREMONY TO FELICITATE IBTA PANEL OF

6. ORIENTATION SESSION FOR KHYBER

7. IBTA INSPECTIONS WITH THE KHYBER

8. ORIENTATION SESSION FOR BLOOD BANK

automation, rational use of blood, component therapy, haemovigilance, data

9. BLOOD BANK INSPECTIONS

S. No. Blood Bank Inspection Team Date

Wg. Cdr. Dr. Kamran Nazir

Dr. Usman Waheed

Al-Nafees Medical College Dr. Syed Imtiaz Hasan

Dr. Syed Imtiaz Hasan

Wg. Cdr. Dr. Kamran Nazir

9.1 Inspection Photographs

Al-Nafees Medical College Hospital, Lehtrar Road, Farash Town, Islamabad

Ali Medical Centre, F-8 Markaz, Islamabad

PAF Hospital, E-9, Islamabad

Akbar Niazi Teaching Hospital, IMDC, Bhara Kahu, Islamabad

Capital Hospital, G-6/2, Islamabad

Federal General Hospital, NIH, Islamabad

Federal Government Polyclinic Hospital, Islamabad

Social Security Hospital (PESSI), I-12, Islamabad

Medicsi Hospital, F-7, Islamabad

Kulsum International Hospital, Kulsum Plaza, Blue Area, Islamabad

KRL Hospital, G-9/1, Islamabad

Maroof International Hospital, F-10, Islamabad

IMC Nescom Hospital, H-11, Islamabad