Dr. Zarin Bharucha explains the nuances of a blood bank
M3 India Newsdesk Jun 14, 2018
On World Blood Donors Day, Dr. Zarin Bharucha, Chairperson, Federation of Bombay Blood Banks writes about how a full blood bank is not just the doctor's or hospital's but a community responsibility.
Every year, on 14th June, countries around the world celebrate World Blood Donors Day to thank voluntary non-remunerated blood donors for their life-saving gifts and to raise awareness of the need for regular blood donations to ensure quality, safety and availability of blood and blood products for patients in need.
The theme for this year’s World Blood Donor Day,
“Be there for someone else. Give blood. Share life.”
This theme encourages people to care for one another motivating regular blood donors to continue giving blood, and to motivate young people in good health who have never given blood, to begin doing so, and generate social ties and promote community cohesion.
The blood donor
Any healthy individual between the ages of 18 to 65 years can donate blood. A medical history and a medical checkup is a routine procedure before blood is collected.
Voluntary non-remunerated blood donors provide the safe blood for transfusion as they are well informed and give correct answers to the questions asked regarding their medical and lifestyle history. The regular blood donors who donate every 3 months are safer as their blood is tested every 3 months.
All the blood collected is tested for HIV, Hepatitis B &C, syphilis and malaria. There is a window period which spans between the infection and the test becoming positive.
There are ways of reducing the window period by use of more sensitive tests which all blood banks are now expected to use. There are also DNA/RNA based tests which reduce the window period further but it does not bring the risk to zero level and at the same time these are extremely expensive and may raise the cost of one unit of blood by almost Rs. 1200.
Media reports on infection transmissions are not entirely true
Many times the media reports an unusual number of HIV transmission through blood. This is not always correct. It is likely that an individual tested positive at referral centers (ICTC) is asked about his lifestyle. Many of these individuals due to the worry of getting stigmatised provide false background information and wrong history and prefer to say they had taken a transfusion earlier rather than telling they had visited CSW or are drug abusers. Such stories often get picked up quickly by the media, and people begin to view blood transfusion from anonymous donors as unsafe and blood banks as infection transmission zones.
Due to false reporting, doctors too face questions about the possibility of receiving infected blood from donors. During such times, doctors should take a stand and counsel and provide complete information about the blood donation-testing-transfusion process, and talk about the protocols and guidelines followed so as to negate any possible fear of transfusions in the patient.
Doctors face queries on transfusion costs
Many doctors are faced with a common question from patients’ families that if blood is donated freely why should a blood bank charge the patient?
The charge is a processing cost. The blood collection bag, tests done, storage, transport and maintaining the blood bank operations do cost and hence the charge.
While government and NGO blood banks supported by NACO charge less but the private blood banks carry out other add on tests and processes are allowed to charge more. However, thalassemia, sickle cell anemia, hemophilia and other patients below poverty lines are provided free blood.
One unit of blood saves 3 lives. The blood bank separates red cells, platelets, and plasma. The platelets are used for leukemia and other cancers, and also for dengue patients, the requirement be especially high during dengue season.
Platelets can be collected in a larger amount from one donor using a machine called cell separator, when the rest of the blood components are returned back to the donor. This procedure is called apheresis and the product is called single donor platelets which is equivalent to six units of platelets recovered from whole blood donations. Doctors must always mention this to voluntary blood donors during blood drives and camps. A regular apheresis donor can donate every 3-4 days. But a person who has donated blood can donate again only after 3 months either whole blood or single donor platelets. Doctors must always be sure to mention both donor options to anyone donating blood. People may be more encouraged to donate platelets too.
Plasma is used for some surgical patients and the rest can be used for preparing products such as albumin, globulin or coagulation factors, again important for therapeutic use in some patients. These plasma derived medicinal products are manufactured at plasma fractionation centers using pharmaceutical process.
Currently we have 5 such centers in the country and they need to get enough plasma, otherwise we need to spend a lot of money for importing these products.
India's stand on blood donation
The average blood donation rate in India is 0.8, according to NBTC press release in 2017, which is lower than WHO suggested 1% to meet the nation’s basic blood requirement.
According to SBTC (MS) at present 60 blood banks are functioning in Mumbai which collected 2,95,795 lakh units of blood in 2017. Though the voluntary blood donation is increasing, the rate of regular blood donation is much lower. More often the blood is donated by relatives and friends when there is a need. Blood should be waiting for the patient and not the patient for blood as at times it may be too late before you find a donor to donate blood.
Keeping the blood banks full all the time is the blood bank doctor’s and hospital’s responsibility. We still have epidemics of blood shortage especially during March to July when there are exams followed by vacations and the number of voluntary donors and blood donation camps decrease in number.
At many hospitals replacement is asked for when a patient requires blood. But this is not right. Hospitals and physicians should educate patients and families that a blood bank is not like a money bank. A blood bank will accept donors, not depositors who need to withdraw when the need arises. Blood is donated by donors and will only be used per storage basis. So no patient can play the relative card, or ask for free blood on the pretext of having donated blood earlier or even request for ‘new’ just-donated blood.
India is prepared to reach towards the WHO goal of 100% self-sufficiency for Blood and Blood Products and is also focusing its efforts towards reaching 100% Voluntary Blood Donation by 2020.
Voluntary blood donation is perhaps one of the most perfect examples of altruism in action. It is the highest form of charity and a grand gesture - the greatest gift any person can give or receive.
All healthy individuals in the age group of 18 to 65 should enroll as a regular blood donor …say yes to be a hero! Remember - There is no substitute!
Disclaimer- The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of M3 India.
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