KOCHI: It all started in 1665 when a British doctor Richard Lower drew blood from a canine and transfused it to another. The success of the process paved the way for the method to be replicated among humans, and soon blood transfusion became one of the mandatory procedures of modern healthcare.
Centuries later, in 2005, the World Health Assembly decreed that June 14 be observed every year as World Blood Donor Day. This year the theme, as per the WHO website, is ‘20 years of celebrating giving: thank you blood donors’. The expression of gratitude also comes with the need for safety precautions in the collection and transfusion process, as well as ensuring better accessibility.
Voluntary blood donors form a major chunk of the collection drive, and India seems to have a slump in voluntary donation, suggests a 2023 Union Health Ministry report that records a 1 million unit shortage.
Voluntary blood donation (VBD) has registered only a slight increase in Kerala too. As per the Kerala State Aids Control Society report, in the 2023-2024 period, VBD in the state registered just a 1.04% increase in 2023-24. In Ernakulam, the VBD saw a dip — 69,316 units in 2023-24 as against 72,787 in 2022-23. In Thiruvananthapuram, there was just a slight increase from 59,032 units in 2022-23 to 60,265.
The total blood collection scenario too has not seen much of a jump. According to the data from Kerala State Blood Transfusion Council (KSBTC), presently there are 189 licensed blood centres in the state out of which 42 are in the government sector and the rest are owned by private entities, cooperatives, and charitable organisations. A total of 5,90,726 units of blood were procured in 2023-2024 as against 5,86,788 in 2022-23.
‘Not alarming’
But the drop is not alarming, instead, data suggests a change for the better, says Sinu Kadakamapally, assistant director of KSBTC. “The priority should always be whether we have adequate blood units to meet the requirement and ensure the donated blood is safe. The figure also reflects that our requirement for blood transfusion is not too high and that we have a healthier society. Unless and until it is absolutely necessary, don’t go for a transfusion, that’s our policy.”
Current treatment procedures, hence, insist on exploring other alternatives before deciding on the need for blood transfusion. For example, in cases where an anaemic condition is diagnosed that can be corrected with the use of medications or lifestyle, doctors encourage patients to do so rather than go for a blood transfusion that may bring faster remedy.
Also, voluntary blood donors are less hesitant to donate blood and better aware now of the importance of the act, and hence follow a safe lifestyle, says Rema Menon, medical officer at Indian Medical Association (IMA) Blood Bank. “This is largely due to awareness campaigns. The IMA Blood Centre in Ernakulam attends at least three camps each week, with an average of 25-30 donors per camp. Various NGOs, organisations, colleges, and political parties conduct these camps. Our list includes at least 60 organisations in the district that regularly hold monthly camps,” says Dr M I Junaid Rahman, secretary of IMA Blood Centre, Ernakulam.
People between 18 and 65 years can donate blood and according to experts, some second-generation and third-generation also sign up. More awareness camps in educational institutions seem to have brought many youth into the donor fold, according to National Service Scheme (NSS) coordinators in Thiruvananthapuram and Ernakulam. In addition, resident associations also help blood centres stock up.
Frequent donation
Though there is an optimistic air, coordinators of Blood Association Forums are doubtful of steady participation from the youngsters. “When camps are conducted, the young often participate and sometimes donate, but they do not donate regularly. Men should donate every three months, while women should donate every four months,” says Rajeev Menon, president of Cochin Blood Donors Forum.
The idea then should be to catch the donors young. “If youngsters donate when they are between 18 and 25, chances of them continuing the habit is higher,” says Dr Junaid. This thought probably prompted the KSBTC to work with the higher secondary department to increase awareness. Though they cannot donate now, KSBTC officials feel the exposure could guide them as adults in the future.
This has prompted 28-year-old Vishnu Raj K R to donate blood frequently. “It wasn’t a planned decision,” he recalls. “My blood group is A negative, which is quite rare. A nurse at the hospital where I was admitted a few years ago suggested I start donating. That’s how it all began.”
He soon learned that because of the rarity of his blood type, it wasn’t advisable to donate every three months. “Most blood centres aren’t directly associated with hospitals, so I decided to donate only when there’s a specific need,” he explains. Inspired by Vishnu’s commitment, his friends have also started donating blood. “Though they’re not regular donors, they step up whenever there’s a need,” says the IT professional.
Yet, between February and May, the collection sees a dip because of exams and vacations making the students at institutions unavailable.
“Vacations pose a challenge as donation camps will not be viable in colleges. Moreover, with the increasing trend of work-from-home, difficulties have arisen in mass procurement from spaces like Technopark,” says a blood centre official in Thiruvananthapuram who wishes to remain anonymous.
Thanks to these moves, it is possible for medical institutions to store adequate blood. “Even during emergency situations like childbirth, road traffic accidents, liver transplantation, and diseases that demand blood transfusions like Thalassaemia, there is immediate access to blood units from hospitals and blood units,” says Rema.
The process of blood donation has also seen several changes as per the KSBTC. Over the last decade, there has been progress in the collection and checking process, and more women also come forth for donations. “Our priority is on bringing down whole blood consumption by focusing on component separation therapy and apheresis procedure,” Sinu says.
In the apheresis procedure, components are extracted from the donor’s blood while returning the rest to the donor. This helps in the faster replenishment of blood components in donors, enabling them to donate more frequently. Moreover, this targeted approach benefits patients too, as it considers their specific requirement. As of now, all 14 districts of the state have Blood Component Separation Units.
“It was in 2013 that the component separation unit in General Hospital, Thiruvananthapuram, began. We collect the whole blood that gets screened for mainly five diseases. Once the safety of the blood is ensured, it undergoes component separations,” says an official from General Hospital.
Rejection and checking
Not all are eligible to donate blood, all the time. Donors complete a questionnaire to assess their social life, and the likelihood of infections is then analysed based on their responses to ascertain their qualifications.
“Any recent surgeries, body piercing, tattoos, all of these have a probability of acquiring infections. A person who has done tattooing and body piercing can donate after six months,” says Rema.
In addition to the screening process serology, most blood centres and hospitals in the district also do a nucleic acid amplification test to flag any components. “Screening of the donated blood is done to identify Hepatitis B, C, HIV, Malaria and syphilis,” says Athulya Satheesh, consultant pathologist at Renai.
A recent media report on drug usage in Kozhikode created a buzz in the blood donation circle. “There have been instances of deferring donors who have disclosed the usage of drugs or alcohol,” says Deepa Shenoy, head of the department of transfusion medicine at Amrita Hospital. These high-risk groups are later linked to KSBTC’s Targeted Intervention programmes, where counselling and other health services are provided to them, says Sinu.
But the identification of drug usage or alcohol cannot be found during any screening process, and it is usually during counselling that such habits are flagged, say experts. However, Athulya says there is no test to determine the presence of drugs in donated blood.
“With the introduction of NAAT testing, patients incur a slightly higher cost. Adding other toxicology tests would further increase expenses,” says Athulya. She adds that there haven’t been many studies to understand whether the presence of drugs in donor blood will impact the patient or how it will impact. “Only founding is that, there can be possibilities of Hepatitis and HIV infections when the donor is an IV drug user,” she says.