BLOODLINE©

Vinod A. IyengarNew Delhi, December 17, 2013

(Email: viyengar@sify.com; Mob: +91-98-18-434418; Tel: (11) 2223-8880/1/2)A-505 & 506, UNESCO Apt.; 55, I. P. Extension; New Delhi – 110 092 (India)

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Blood facts - 1

• THERE IS NO SUBSTITUTE FOR HUMAN BLOOD• Blood saves the lives of acutely anaemic pregnant women, accident

victims, thalassaemia, haemophilia and blood cancer patients, some malaria and dengue patients, and those undergoing surgeries

• Red blood cells carry oxygen and are needed by surgical patients or to treat those with anaemia, e.g., pregnant women, cancer patients, etc.

• Platelet concentrates are fragile blood cells used to control bleeding in the treatment of dengue, malaria, leukaemia and other forms of cancer

• Plasma restores fluid volume in patients who have suffered from shock and provides a source of clotting proteins that stop bleeding

• Cryoprecipitate is a part of plasma that contains clotting factors and is used to treat clotting deficiencies in people with haemophilia, etc.

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Blood facts - 2

• Life-span of blood components– Red cells: 80-120 days– Platelets: 9-10 days– White cells: days to weeks– Plasma: 1 year (-12 to -30oC)NB: Blood banks in India currently store blood

at ~ 4oC as only plasma can be frozen, not whole blood since red cells break at freezing temperatures

• Blood Groups– Depend on antigens present on red

cell membrane and/or plasma– Eight blood groups:

A+, A-, B+, B-,

AB+, AB-, O+, O-

O; 35%

B; 35%

A; 20%

AB; 10%

Blood Group as % (age) of Population

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Blood facts - 3

Group O

Group B

Group A

Group AB

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5

Rh+Rh-

(million units in 2011)

RAREB- & O-

RARERA-

RAREST AB-

Rh+: 95% of all blood types; Rh-: 5%December 2013

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Blood facts - 4

Donation between groups Rh factor in donation/transfusion• People with blood group 0 Rh- are

called "universal donors“• Those with blood group AB

Rh+ are called "universal receivers”

• Rh+ blood can never be given to someone with Rh- blood(e.g., 0 Rh+ blood can not be given to someone with the blood type AB Rh-)

• But Rh- blood can be given to those with Rh+ blood

December 2013

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Blood collection & supply in the West

December 2013

Blood Database

Blood Helpline

Blood processing & separation unit

Patients

HOSPITAL

Patients

HOSPITAL

Refrigerated transport

Collection Unit

Storage Unit

Collection Unit

Storage Unit

Collection Unit

Storage Unit

Collection Unit

Storage Unit

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Blood collection & delivery in India

Voluntary donations(Students and others)

Replacement donations(Patients’ well-wishers)

Separation units Blood banks

Hospitals PatientsDecember 2013

NB: Big hospitals usually have in-house blood banks and separation units

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Sourcing & usage of blood in India

December 2013

42%

14%

44%

Students Others Replacement

35%

65%

Components Whole blood

Blood sources Blood usage

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Demand & supply of blood in India

Sale price: blood components Rs. 350 - 850/- per unit(Processing cost: Rs. 300 – 650/- per unit)

December 2013

2011 2013 2015 2017 2019 20210

2

4

6

8

10

12

14

16

Minimum stock Collection

Year

Mill

ion

units

(as per WHO guidelines)

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Problem areas

• Chronic blood shortage• Indifferent blood quality• Wastage• Absence of centralised data

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Main causes of shortage

• Increasing demand due to several Central and State health insurance schemes, especially for the poor

• Low voluntary blood donation rate (India: 8 donors per 1,000 people, western countries 50/1,000)

• Seasonal fluctuations (drastic fall in collection during Summer and Rains)

• Non-availability of trained blood collection teams • Few blood component separation units• Wastage/injudicious usage

December 2013

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Main causes of indifferent quality

• Inadequate infrastructure & hygiene in blood banks• Poorly trained/sensitised nurses, technical and

processing staff• Poor blood safety while handling/storage/transport• Lack of dedicated blood transportation vehicles• Inadequate monitoring by Central Drug Standard

Control Organisation and State health agencies• Malpractices due to insistence on replacement donation• Poor quality of testing (so high percentage of

transfusion transmitted diseases)

December 2013

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Main causes for wastage

• Many doctors prescribe blood transfusion at platelet levels of even 40,000, whereas it is required only at levels around 20,000

• Use of whole blood in majority of cases(dengue and malaria patients need only platelets; burn cases need plasma, and cancer patients and pregnant women mainly need RBCs)

• Doctors insistence on having more blood than necessary, even for low-risk surgeries

• Expiry of blood due to hoarding in hospitals/blood banks• Absence of centralised data and poor information exchange between

different hospitals and blood banks• Poor inventory management in blood banks/hospitals• Lack of dedicated blood transportation vehicles

(currently, blood transported by patients’ well-wishers in ice-packs, which keeps blood safe only for about two hours)

December 2013

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Consequences of blood shortage

• Declarations of blood emergencies(During 2011-12, two state governments declared blood emergencies and one requested its police force for donations)

• Ordeal for patients & well-wishers(People have to run from pillar to post for finding blood bank storing required blood type or arrange replacement donors)

• Illegal activities(Despite ban on ‘paid’ donations and rules mandating 3-month interval between donations, blood taken from drug addicts and very poor people - sometimes for as little as Rs. 100 every fifteenth day)

• Indifferent quality and poor blood safety(Disregard of safety procedures during collection, testing, transportation, storage and transfusion. Transfusion associated Hepatitis-B estimated at 0.36% and Hepatitis-C at 1.2% per unit of blood)

December 2013

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Dealing with the challenge

• Boosting blood collection:– Identify, track and cultivate healthy donors– Escalate awareness drives– Widen voluntary donor base by approaching non-conventional donors– Increase number of blood collection teams– Improve communication between donors, blood banks, hospitals and patients

• Reducing wastage and injudicious usage:– Advanced training for doctors, nurses and technicians dealing with blood– Develop dedicated blood transport systems– Modernize blood storage structures– Augment component separation units

• Improve blood safety:– Ensure sanitized conditions in blood donation camps, blood banks, hospitals, etc.– Increase awareness & training programs for improved hygiene in banks and hospitals – Modernize blood testing systems

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Possible interventions - 1

• Fostering coalitions and networks between organisations involved in blood donation activities (e.g., the Indian Red Cross Society, Sankalp India Foundation, Rotary and Lions’ clubs) to:– Influence policy and legislation

– Change organisational practices vis-à-vis hygiene, blood safety, wastage, etc.

– Promote education & training to strengthen individual knowledge and skills of doctors, nurses, technicians, etc.

– Design and develop literature, media clips, etc.

– Create and implement voluntary blood donor motivation, recognition and reward programs

December 2013

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Possible interventions - 2

• Installing and managing dedicated voluntary blood donation and blood safety awareness programs to:– Increase awareness in local communities– Identify and motivate non-conventional donors– Leverage CSR obligations of companies to widen voluntary blood

donor base– Initiate voluntary blood donation drives– Create databases and telephone-based blood information helpline to:

• Identify and track healthy blood donors• Coordinate/manage inventory in blood banks, hospitals, etc.• Provide information/assistance on blood types, quantity and

location to concerned citizens, blood banks and hospitals

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Possible interventions - 3

• Creating and operating safe blood transportation system– Based on suitably modified

refrigerated vehicles– Blood transportation

between blood donation camps, banks and hospitals

– Connected to blood helpline (if any) to ensure blood reaches its destination in time

Refrigerated NHS (UK) blood transport vehicle(Source: www.flickr.com/photos/nick19/5534468319)

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Recommended ‘Bloodline’ model

Blood Helpline

Blood Database

Blood Banks Hospitals

Separation Units

Replacement Donors

Patients/Well-wishers

Voluntary Donors

Oth

ers

Corp

orat

es

Char

ities

NG

Os

Red

Cros

s

Refrigerated transportation Blood donation campsDecember 2013

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Project requirements

• Baseline study• Dedicated teams for:– Blood donation and safety awareness program– Voluntary blood donation drives– Data collection from hospitals and blood banks– Blood information helpline

• Office-cum-Call Centre on rent• Personnel training• Refrigerated blood collection vehiclesDecember 2013

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Blood information helpline costs

Item Rs. 'lakhs RemarksCAPEX 43 @ Rs. 7.20 lakhs/seatOPEX per annum 36 @ Rs. 6.00 lakhs/seat

December 2013