June 14 is celebrated as World Blood Donors Day. It is the birthday anniversary of Austrian biologist and physician Karl Landsteiner, who won the Nobel Prize for discovering the ABO blood group system. The first World Blood Donor Day was observed by WHO in 2004. This year the slogan is ‘Donating blood is an act of solidarity, join the effort and save lives’.
The aim is to raise global awareness of the need for safe blood and blood products for patients and highlight the contribution of voluntary unpaid donors. According to WHO, some European countries have 100 per cent of their blood supply from voluntary non remunerated blood donors. India is also hoping to achieve this target. There are certain things which money cannot buy; one such thing is the happiness you get when you save one life. So, donate blood and enjoy the happiness as one donation helps save three lives.
We need not be a superhero to save people’s lives. All it requires is a small act — blood donation.
Patients suffering from anaemia, thalassemia, haemophilia, sickle cell disease, kidney disease etc usually require blood transfusion. Patients on chemotherapy, undergoing major surgeries, pregnant women, patients with postpartum haemorrhages, road accidents and trauma patients also require a blood transfusion. As these kinds of incidences keep on increasing day by day, blood has become a valuable resource for managing patients.
Various types of blood donations
In-house donation — the blood donor has to come to the blood bank and donate Outdoor camps — collecting blood from donation camps in colleges etc Mobile blood donation centre — blood is collected in a bus which has got all the facilities
Who can donate blood
Any person who is more than 18 years and less than 65 years, weighs at least 55 kilograms (450ml for components) or 45kilograms (350ml as whole blood) and is mentally and physically fit can donate. Men can donate every three months and women every four months.
What does a blood bank do
The main function of a blood bank is to give quality blood in the right amount to a patient who needs it. The most important requirement is ‘a voluntary, non-remunerated repeat blood donor’, who donates blood at regular intervals of three or four months.
The donor who comes to a blood bank first undergoes counselling where his/her health status and life habits are identified. It is to make sure he or she is fully fit for blood donation. The haemoglobin level of the blood donor is also checked to make sure that the donor has more than 12.5 grams per deciliter of haemoglobin.
Different types of blood collection
There are mainly three kinds of collections whole blood, component and apheresis collection. Most blood banks carry out the component collection. A 450 ml of blood is collected from a donor and is separated into three main components packed red cells, fresh frozen plasma (FFP) and platelets. Each of these components is stored at different temperatures for different storage periods. We also test for five transfusion-transmitted infections (TTI).
They are HIV, Hepatitis C, Hepatitis B, syphilis and malaria. There will also be various immuno-haematological testing like blood grouping, antibody screening and cross-matching to make sure the receiver is safe and not likely to have any reactions. According to different case scenarios, there will be various tests like antibody identification, antigen phenotyping, Indirect Coombs Test (ICT), Direct Coombs Test (DCT), cold agglutinin test and antibody titre estimation.
NAT testing
Nucleic Acid Amplification Testing is the most modern testing platform for infectious disease screening. Here the window period is significantly less compared to other traditional testing platforms. Normally we screen for infectious diseases by platforms like Enzyme-Linked Immunosorbent Assay (ELISA) or chemiluminescence. One of the disadvantages of the above-mentioned platforms is the high window period. The window period is the time gap between the entrance of the virus into the body and the detection of its presence by a testing platform.
The window period for detecting HIV, Hepatitis B and Hepatitis C by ELISA is 15 days, 38 days and 58 days, respectively. Whereas in NAT these are 5, 15 and 3 days, respectively. The window for Hepatitis C has been reduced drastically from 58 days to just 3 days. This helps us in providing the blood transfusion service safer than before.
Apheresis blood collection
In this type of blood collection, the blood from the donor is collected into equipment and is centrifuged and separated into the required component. The remaining part is transfused back to the blood donor. The whole process takes less than two hours.
This helps us to reduce exposing multiple donors to a patient and reduce the chance of adverse reactions. Apheresis collection also helps us to collect the desired component in higher quantity and quality.
Challenges faced
The primary challenge is to maintain adequate inventory, especially in the case of negative blood groups. It is here the importance of voluntary blood donors comes in. Also, blood banks find difficulties in maintaining stocks of platelet units, especially during the rainy months of June and July when dengue cases fly high.
Another challenging situation is massive transfusion scenarios where numerous blood units have to be transfused for patients presenting with postpartum haemorrhage and road traffic accidents. Patients who have rare blood groups like Bombay and Para-Bombay and incompatible cross matches also pose a threat. The only solution is to have a pool of voluntary regular blood donors.
Maintaining a donor pool
A blood bank needs to have a pool of voluntary repeat blood donors as this mitigates the risk of patients procuring TTIs like Hepatitis B, Hepatitis C, HIV, malaria and Syphilis. It also helps in emergencies as patients’ relatives may not be able to find adequate numbers and suitable donors at the right time. It is vital for a health care system to guarantee the provision of affordable, appropriate, adequate, safe and quality blood and blood products to all who require a transfusion. For this, the blood transfusion services (BTS) of a country need to know the quantum of blood requirements for their population. Maintaining an adequate supply of safe blood and ensuring their appropriate use has been a great challenge for developing countries like India.
According to WHO, the blood donation by 1 per cent of the population is generally taken as the minimum need to meet a nation’s basic requirements. As per the above norm, India’s demand for blood is around 14 million units. A study conducted by NACO (National AIDS Control Organisation) found that India needs to collect 26.4 million units of blood to address the need for blood and components in the country. The supply was found to be 13.5 million, which means there is a deficiency of 11 million units of blood.
Benefits of regular blood donor
The blood donor gets a mini health check-up, including recording body weight, testing blood pressure, pulse, body temperature, haemoglobin level and a thorough physical examination. If any of these tests reveal a problem, the person will not be able to donate blood.
Apart from these check-ups, the donor’s blood sample is also tested for five infectious diseases. The results could be a first step toward seeking treatment. Blood donation centres need to weigh people before they give blood, this could help identify people with obesity and offer them help to manage their weight and any related health problems. It is claimed that giving blood burns 650 calories. However, there does not appear to be any scientific evidence to prove this. Various studies have concluded that blood donation offers a long-term protective effect against cardiovascular disease and also helps reduce blood pressure.
Dr Antonio Paul