Tracking Transfusion Medicine
The scientific foundation and clinical approaches to blood banking have seen tremendous development in the past decade. IMT catches up on these developments and discusses the relevant advances in the field
Blood transfusions, today, are fairly routine and a crucial part of healthcare delivery, saving millions of lives every year. Blood banks contributed to several treatments involving both routines as well as emergency situations. Blood and its components are required for surgeries especially for treatments involving cancer patients, pregnant women, accident cases and other disasters like burn victims. “Blood is a scarce resource which is now available only through donors,” says Dr B Latha, Associate professor, Department of Transfusion medicine, Madras Medical College, Chennai.
The blood Banks have evolved over time. “Blood Bank has come a long way from being just a blood bank
wherein only whole blood was collected and issued, to a Blood Centre or Transfusion Medicine department with all the advanced modern technologies,” explains Dr Anand Deshpande, Consultant Transfusion Medicine &
Hematology, PD Hinduja National Hospital & MRC Mahim, Mumbai.
“Initially only whole blood was issued to the patients, now most of the blood centres are preparing 100 per cent blood components such as Packed Red Blood Cells (PRBC), Random Donor Platelets (RDPs), Fresh Frozen Plasma (FFP), Cryoprecipitate (Cryo) & issuing to different patients as per the clinical requirements. This has led to rational use of blood components optimizing the inventory and minimising the losses,” he further adds. Dr Latha further states, “Usually, one out of seven hospitalised patients require transfusion; so, rational use of blood components should be mandatory. However, at times miscommunication and inadequate information among clinical colleagues and transfusion medicine specialists leads to wastage.”
“The importance of blood donation and appropriate use of this scarce resource should be clearly explained to public as well as clinical colleagues,” she says. According to government figures, there are more than 3108 blood banks across India, among which, 1101 are public and about 2007 in private domains, including those run by charitable trusts. Out of these, about 35 per cent blood banks are in the government sector, five per cent are run by Indian Red Cross Society (IRCS), about 20-25 per cent is run by NGOs and the rest are managed by corporates.
A recent study highlights the demand-supply gap in availability of blood and its components in India. A study called “National estimation blood requirement in India” was done by NACO and its partners to estimate the population need, clinical demand, supply and utilisation of blood in India. The study found that the quantum of blood needed to cater to the entire population was around 26.5 million units, of which medicine accounts for 39.9 per cent of all the need followed by surgery (25 per cent), obstetrics and gynaecology (O&G) (13.8 per cent) and paediatrics (21.3 per cent). Hence the blood transfusion services of the country need to collect
26.5 million units of whole blood in order to address the national need for whole blood and components. However, in 2017, the annual collection of blood in India was 11,094,145 (11million). If this data is assumed as supply, then the actual supply per 1,000 was 26.1 per 1,000 eligible population which indicates a significant gap between demand and supply.
The costs of running the blood bank involve multiple factors. “It includes costs spent on donor safety, blood
collection, blood component preparation, transfusion-transmitted infection testing, immunohematology and other testing, advanced tests like Nucleic acid test (NAT) and a considerable expense on blood storage and issue,” says Dr Mohit Chowdhry, Sr Consultant & Head, Department of Transfusion Medicine, Transplant Immunology & Molecular Biology, Quality Manager- Lab Services, Indraprastha Apollo Hospitals New Delhi.
However, these standards and tests are not uniform (except for the mandatory tests) and therefore cost of establishing may differ from one centre to another The quality and safety of blood is one of the major concerns in transfusion medicine today. In India though, transfusion transmitted infections generally found are of HIV and Hepatitis B & C. According to 2016 NACO report, HIV positivity among blood donors was found to be 0.14 per cent, Hepatitis C 0.34 per cent, Hepatitis-B 0.87 per cent, Syphilis 0.17 per cent and malaria 0.06 per cent.
Nucleic acid amplification test (NAT) was developed to detect infection in blood for these deadly pathogens, but it is an expensive test and not all blood banks use it. Currently, other tests like ELISA based test kits and rapid diagnostic tests are used to screen blood. However, quality of screening tests and methods remains as one of the basic challenges in blood banks. Combine this with the lack of quality reagents and test kits and paucity of adequate training for hospital staff, which makes availability of safe blood very difficult. Poor laboratory procedures, inadequate basic facilities within a majority of blood centres and lack of awareness of safety amongst blood donors and receivers are the other issues that mar the blood banks.
Specialty of Transfusion Medicine
is currently evolving and has a lot of scope for teaching, training and research. “There will be new frontiers
of basic and clinical research in donor and patient care but youngsters need to think out of the box,” says Dr Ratti Ram Sharma, Professor & Head, Department of Transfusion Medicine, PGIMER, Chandigarh. “We need to communicate with our clinical colleagues to understand their concerns and patient requirements to develop innovative ideas for clinical care and research. Similarly, we have to connect with our community and donors to understand them better for their support and develop novel ideas for donor recruitment and retention,” he concludes.