Preventing wastage of donors' blood
Dr. Dharmakanta Kumbhakar
(The writer can be reached at drkdharmakanta@yahoo.com)
On an average, every year, about 6.5 lakh units of blood and blood components are wasted in India before reaching the needy on time. In response to an RTI application filed by Mumbai-based activist Chetan Kothari in 2017, the National Aids Control Organization revealed that over 2.8 million units of blood and its components were discarded by blood banks across India between 2012 and 2016. In 2016 alone, over 6.57 lakh units of blood and its components were discarded across India. The worrying part is that 50% of the wasted units were plasma that has a longer shelf life of one year as compared to whole blood and red blood cells that have to be used within 35 days. The RTI revealed that States like Maharashtra, Uttar Pradesh, Karnataka and Tamil Nadu were among the worst offenders, discarding not just whole blood but even red blood cells, platelets and plasma. The data for Assam is not available. According to the Union Health Ministry data, placed in a Parliament session in 2018, the reasons for this wastage were primarily because of deterioration during storage and expiry due to outdating. Specifically blood units get spoiled due to bacterial contamination, infections, haemolysis, discolouration, not meeting quality parameters and other factors. This exposes the serious loopholes in the nation's blood banking system.
Blood is considered to be wasted when it cannot be transfused to a patient for technical reasons which include faults in storage or expiration. This excludes the discarded seropositive blood screened for transfusion transmitted infection. Many factors lead to wastage of blood and its components in India like broken bag, broken seal, burst packs, contaminated packs, under donations, clotted donations, delays to conduct tests, problems with manufacturing and testing of blood components, lack of proper storage, expired units, over-ordering, improper transport, returned after 30 minutes, etc. Most of them happen due to lack of proper knowledge and awareness. Care must be taken in storage, transportation, and manufacturing and testing of blood components to reduce blood wastage. Proper additive solutions should be added to enhance shelf life and reduce wastage. The blood bank staff should issue the short expiry blood products first to reduce expiry rate. Mega blood donation camps should be avoided to minimize blood wastage. A collection of up to 500 units of blood in a camp is acceptable and manageable. Where is the place to store so much blood, if more than 2000 units of blood are collected in a mega camp? It is estimated that 10 to 20 per cent of the blood collected in such donation camps are wasted because of deficiency in storage facilities. Instead of organizing mega donation camps, the blood banks should maintain a list of blood donors and call them to donate blood when necessary to fill up the gap between demand and supply.
The hospital blood transfusion committees should monitor and record the wastage of blood and its components. Reviewing the wastage data, the committees should take proper donor blood management and patient blood management to reduce blood wastage. It is seen that blood products are often ordered but not used. To reduce blood wastage, the treating doctors should decrease over-ordering, encourage rational blood transfusion and instead of keeping the blood products in wards or ICUs, it should be returned to blood bank within half an hour if not used.
Whole blood continues to be the most widely used blood product in India. Whole blood is a source of red blood cells, and this leads to wastage of other components such as plasma and platelets. We should develop a zero tolerance for whole blood except in special situations and work toward 100% components. There are only around 40% blood banks in India having such component separation facilities. Around 19.2% blood banks in Assam have blood component separation facility, which is indicative of its outdated blood banking methods. The sooner blood component separation facilities are installed by all blood banks in India, the lesser will be the wastage of blood.
Lack of synergy between donors, blood banks, regulators, hospitals and receivers is leading to wastage of blood in India. On this front, the launching of the e-blood bank software in Assam by the State Health Minister in 2015 has promised to bring about this synergy. We have the online system where all the blood banks are supposed to update their stock status in real time so that those in need of blood can contact the respective blood bank and blood is used before its expiry, but this system has been underutilized. Lack of exchanged blood and blood components amongst hospitals also affect proper utilisation. The new amendments in the Drugs and Cosmetic Act, 1940, brought into effect from April 3, 2017, allow the transfer of human blood and its components under prescribed storage conditions from one blood bank to another. The amendments were recommended by the National Blood Transfusion Council in 2015. This will allow sharing the excess units of blood and its components with other blood banks; this will reduce blood wastage.
Blood is a valuable resource and blood wastage could make a very serious impact on the healthcare system of the country. Ideally in a proper setting, outdating and wastage of blood and its components would never occur. Due to the inherent need to have blood stocks at all times and also often unpredictable demands on the inventory, a very limited and inevitable outdating of blood and its components in blood bank is accepted. The institutional blood and its components wastage should be less than 1% of the units issued. But, India wasted about 6.5% of the blood and its components issued in 2016. The figure is alarming because blood shortage is a chronic problem in India. Every year India needs an estimated 14 million units of blood, but collects barely 9.9 million units. Every two seconds, somebody needs blood in India. In many cases, people lose their lives because of lack of donors' blood. All hospitals, private and public, blood banks and government authorities should implement proper regulations to prevent such blood wastage in the future.