Saturday, July 8, 2017

Paradigm shift in blood donation

India has huge population of more than 1.3 billion, but is still short of blood by 20-25%. Blood donation is a requirement of the society. All donations should be voluntary.

Blood donation camps are often organized by hospitals and NGOs. But these are whole blood donation camps.

But, now no camp should be organized for ‘whole blood donation’. Instead components-only blood donation camps should be organised. One unit of blood collected can be used to help 3 to 4 patients, instead it is being wasted as whole blood depriving another patient in need. And, voluntary blood donation camps should be now called “blood component donation” camp and not just blood donation camp. So, if the blood being donated is collected in a single bag, do not give blood. Usually two component bags are used. 100 ml bags should be promoted for pediatric use.

People with rare blood groups should not donate in camps. They should instead donate only when needed.

Under the new National Blood Transfusion Council regulations, no blood is to be wasted. The surplus left over plasma is fractionated to manufacture products like albumin and intravenous immunoglobulins (IVIG). The blood that is donated in voluntary blood donation should be maximally utilized.

The tests done are for blood groups (A, B, O) and Rh factor and five transfusion-transmitted infections namely hepatitis B and C viruses, HIV 1 & 2, VDRL and malaria. Tests with the shortest window should be chosen as per affordability.

For safe blood transfusion, tests other than those prescribed by the government should also be available such as minor blood groups, nucleic acid amplification testing (NAT). NAT detects very low levels of viral RNA or DNA that may be present in donated blood and reduces the window period of detection of viruses like hepatitis C, hepatitis B, HIV, which may otherwise be undetected by 3rd generation or even 4th generation ELISA-based tests. The prevalence of hepatitis B, C and HIV is very high in India.

The doctor has a duty to inform the donor that facilities for these other tests are also available and the donor or the recipient should have the right to ask for extra tests. Till they a national policy is formulated in this regard, a doctor can help the donor or the recipient to decide. An informed consent must be taken from the donor or the recipient explaining the risks by not doing these tests, however small and rare they might be. These tests may add to the cost of the blood transfusion, but patient safety is foremost.

The donor’s blood should also be tested for lipids, liver enzymes (SGOT, SGPT), kidney function (creatinine); a complete hemogram can be done, so that the donor gets a comprehensive panel of tests done, when he/she volunteers to donate blood.

Rational blood transfusion is safe blood transfusion… Transfuse blood only when necessary. If only one unit is required, don’t transfuse blood; if two units are required, transfuse one. If hemoglobin is more than 7, give a trial of intravenous iron first. This is also a very important way by which the transfusion-transmitted infections can be reduced. 

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