With vast 39 years of experience as Head of Department, Pathology, in various army hospitals, Dr (Brig) Anil Khetarpal, Director- Blood and Transfusion Medicine, Artemis Medicare Services Limited, believes that India needs a central top of the knot regulatory body for the blood banks. In conversation with Ekta Srivastava, ENN
Could you please give us the brief overview of the status of the blood bank industry in India?
The blood bank industry in India is growing in a fast pace. Today people and society are aware of the fact that one can donate the blood if he is healthy and it will not cause you any harm.
Secondly, India is a country where the longevity of the people are increasing , means that they are living for about 80-90 years of age, giving rise to lot of age related problems. Like Bypass surgery, lots of joint replacements, liver transplants and other things that happened in that age group, increasing the requirement for more and more blood. Now, beyond age group of 60 nobody can donate, but they are the main user of this. Cancer patients who are under chemotherapy also need a lot of blood. Every year we get outbreak of dengue patients where we need a huge amount of platelets. Ultimately, this consumption of the blood needs to get fulfilled by the society either voluntarily or by replacement to tackle such demand.
Illegal blood trading is also rising around the country in a big way. How do you think we can tackle this?
We had a Supreme Court ruling in 1996, where it was decided that blood from the professional donor will not be taken. And that is what we are sought of trying to aim at. When the donors come to us, we do lots of counseling, pre counseling before the blood is taken, to ensure that he is a healthy donor and genuine one. We thoroughly screen the donors, so illegal thing is the story of the past.
Few months back, during my some investigation I found these professional donors lying outside the government hospitals in Delhi and they are selling the blood say in `3000 and `3500 for a unit.
These people will always make an attempt but it is up to the people taking care of the blood bank to ensure that these people do not become part of your donation process. This is what we are here to see. If you got stringent criteria of donor selection, there is no way that you will get mugged up by such people. Even if they try to come they will get rejected because the moment you start asking them question there will be the deviant. I think this is what all the blood banks should do; a perfect screening of the donors.
If a patient is a regular donor and suppose he suffered from some mis-happening, so still he/ she need a replacement donor?
If he is a regular donor and he has donated it voluntarily. He is entitled to one unit of blood but if he has done replacement for somebody not donated then he needs to have replacement donor. There are two ways of getting blood either through voluntary donation or replacement donation. We are getting voluntary donation but majority are replacement donation.
What are the major challenges that blood bank industry is facing in India?
One is the cost factor because once you have to increase the safety of the blood then you have to send it through various test processes. Certain people do only rapid test, which is less expensive, some are doing Enzyme Linked Immuno-Sorbent Assay (ELISA) which is more expensive then there is National Association of Community Health Centers (NACHC) testing where each NACHC testing cause additionally `1000. The more you try to improve the quality standard, more cost will be added. Same time, blood is something with which you cannot take chance, as you cannot afford to give infection to your own patients. This is a major problem with stand alone blood bank, which do not able to seek out to take care of the equality to that extent.
Then there are three different agencies which are working for the blood banking management. First is Drug controller, which takes care of the licensing, second is the National Blood Transfusion Council under which there are many state blood councils, they provide the policies to the blood banking and tickle it down to the states. Third is NACO, which looks after the blood safety procedures. Now, issue with India is that we have very decentralized system, there is no one agency at the top who can take care of all the things. The reason you can see the mis- management in some of the periphery and stand alone blood banks. These Drug controller people are so over bounded with their work, they are not able to go and look after this wide area. Though there are rules and regulations given by the Drug controller but people are just following their own methods, making quality control different from one blood bank to other.
In last five years we have done almost 25,000 to 30,000 collections where only 2 samples are seen positive, these are the kind of screening we are doing
Please tell us the latest technology solution that the hospital has adopted .In what way they are helping in increasing the betterment of patients?
Off late we have started with bone marrow transplantation and in last six months we have done more than 22 transplants. Previously, we took bone marrow from the bone but now we take it from the peripheral blood by apheresis, we have a cell separation machine where donor is attached to the machine, which is a six hour process. Then we are also in a position to give blood to the fetus, which is inside the mother’s womb. Sometimes this fetus become anemic due to RH disease, we provide the specialized kind of blood for such cases. This can be given under ultrasound guided manner.
Other than that we are doing liver transplant especially for the patients of medical tourism. Then anti-body screening that goes for grouping and cross matching, that we grouped the blood and cross match to the patient’s requirement. The benefit of this screening is that once you are undergone with this test then at the time of emergency, it just takes two minutes to give you the proper cross matched blood which will not get anti-body reaction from your body. Though it adds to the cost but we are doing this for the betterment of the patient’s life. Other then we are planning to use stem cell for regenerating in patients who have say liver sclerosis, chronic kidney disease, and respiratory problem, ulcers which are not healing and eye disease (which are age related) .