As winds of doubts loom large when it comes to transfusion of safe blood. R N Makroo, Director & Sr Consultant, Department Of Transfusion Medicine Transplant Immunology & Molecular Biology, Apollo Hospitals, Delhi lists out the efforts required to streamline the blood banking sector and imbibe safe transfusion practices, while in conversation with Prathiba Raju for Elets News Network (ENN)
Can you give an overview of the current status of the blood bank industry in India?
We have roughly 2,650 licensed blood banks in the country, which are working under various controls viz under government, charitable organisations and hos- pital based. As per National Aids Control Organisation (NACO) 70 per cent of the blood is collected via volun- tary blood donors (VBD) but unfortunately majority of them are one time donors. The concept of regular repeat VBD is very little, only four to five per cent do the dona- tion repeatedly. The blood transfusion services in India is primarily hospital based transmission services.
Why does the country face a dearth in VBD?
The concept of regular VBD is not growing up like the developed world. In West, people feel respon- sible for there fellow human beings. Many feel that nobody is doing it then why should I do it. But our country fellow man are good in responding on crisis situation may be it’s a earthquake or calamity thou- sands of people come forward to donate blood but it doesn’t work like that. Blood has its own shelf life it can be stored only 42 days with latest technologies. We need regular, replenishing blood. Some of the blood components like platelets can be stored for a week; plasma can be stored for a year.
What are the challenges in the blood banks sector?
A wide gap prevails in the demand and supply of blood. Our country faces high disease burden that is 2.5 million with HIV, 15 million HCV and 43 million HBV. With miniscule repeated voluntary do- nors, disintegrated blood transfusion centres, testing technologies like im- munohaematology, infectious markers, low blood component preparation, lack of trained manpower are major chal- lenges. Moreover there is no haemov- igilance – how safe is the blood trans- fused. Blood is not a tonic there are risks attached to it and before transfu- sion there should be a tracking system. Transfusion is a vital services in the healthcare delivery system. A success- ful blood transfusion depends on many factors a cohesive and comprehensive national policy is necessary.
Providing safe blood transfusion where does India fall?
Safe blood donation consists of three factors safe blood donors, safe trans- fusion practices and rational use of blood. For safe blood donors we need voluntary blood donors, where we have a huge gap. Testing technologies means not just testing for infectious markers. Presently many hospitals just carry ELISA screening test. But we have to do Nucleic Acid Test (NAT) for HIV/ HBV and HCV. Both tests are com- plimentary to each other to improve the blood safety. As of now only one million blood units undergo NAT out of the nine million units collected.
At each and every step a set of safety assurance needs to be done for blood transfusion. Technology would be a helping hand in this foray
Although our country has a national pol- icy for the blood banking sector in place there is a need to have the amendments of the drug and cosmetics to be in place. The government should also make sure that all the blood transfusion, which takes place are done in a safe manner. Among the various states the Karnata- ka is the only state, which has made the NAT testing compulsory. Hope others fol- low it as safe blood is a concern for all.
How can technology like bar coding, scanning technology, deep freezers help the sector? How far would web based blood banks information management systems help?
Implementation of various technology in the sector is necessary. Actually for every unit of the blood transfused from one vein to another vein there is a need to access the quality. At each and every step a set of safety assurance needs to be done and the technologies definitely helps to track them along with appropri- ate donor selection. Few measures like the donors being grouped and patient’s screening for red cell antibodies before the transfusion is a must. In case if some patient has red cell antibodies which is clinically significant then we need to pro- vide an antigen negative blood for those patients so it will prevent transfusion re- actions. Especially for patients who need multiple transfusions like thalassaemics and haemophiliacs.
How has the transfusion and blood banking evolved in Apollo Hospital and its uniqueness in this platform?
Apollo hosptials has been a forerun- ner in the quality of blood transfused. We were one of the first centres in the country to start the Hepatitis C antibiotic screening and Hepatitis B core antibiotic testing in 1996 and the test for Hepatitis C testing be- came mandatory in 2000. We started to do one leukoreduction in 1998 and we started doing three lock leukore- duction 2006 onwards. NAT testing for each unit of blood was started in the same year. We have 100 per cent blood components.