EDITORIAL Voluntary blood donation and safe transfusion Dr Dwijendra Nath Sarma
Service to Mankind is Service to God goes a common saying. A right of service would for example be blood donation. Human life is very precious and to save it we must put in every little effort and contribution whatsoever it may be. Blood donation for example is a small gesture but it has tremendous impact on the welfare of human being. Blood is that precious red coloured fluid in our body which no scientist or laboratory in the world has been able to produce with all its qualities, except for a few chemical compound. Fluro-carbon derivative like flusol for stroma free haemoglobin which when transfused can partly carry the function of blood as a substitute for haemoglobin only. Therefore only one human being can save another.
Voluntary blood donors are those donors who donate blood of his/her free will without distinction of caste, religion, colour and status of the recipient and without compulsion and so not accept any monetary benefit or other incentives/reward at the time of donation or in future.
Assam is still lagging behind in regard to Voluntary Blood Donation. Probably we still lack well trained good motivators. Unawareness remains an added factor. Again the transfusion service in our country is mainly hospital based and poorly organised with a diverse management system. The Non-Government Voluntary organisations (NGO) can ply a vital role in motivating voluntary blood donation by personal contact, group discussion, mass appeal and illustration etc. Education and training programmes are essential for the motivators. In fact, motivation for bloods donation should begin at the school level when the minds of children are still young and can be moulded. Basic blood science e.g. composition, circulation, function, blood grouping, its meaning and use should be discussed in order to make the topic more interesting. If one of us would be able to motivate a single person, the result will be enormous. So let us all participate in this joint venture to improve the concept of Voluntary Blood Donation and to create awareness and motivation among common people to eliminate fear from the minds of the probable donors.
A large quantity of blood is required not only to treat mass casualty during war and natural calamities but blood is required in major surgical operations for treatment of accident cases, women at child birth, blood diseases like anaemia, haemophilia, bum cases and during dialysis for chronic renal failure. Moreover, the introduction of speciality and superspeciality hospitals, arrival and diagnosis of newer diseases has increased the demand for more blood. The day to day requirement of blood in a hospital is generally about 3 per cent of the total hospital bed strength, but over the years it has increased manifold.
In order to meet the increasing demand for blood, movement for voluntary blood donation is necessary by recruitment of donors. Besides voluntary donors mentioned above, donors may be of different types e.g. replacement type directed donors (who usually donate flood for their friends and relatives) and autologous donorwho donates blood prior to his elective (anticipated) surgery and utilised during operation. So far this type of donation is safe as there is no chance of all-immunization. The professional blood donors (sellers) are banned by Supreme Court with effect from January 1, 1998 to sell their blood. In the country after switching from paid professional to voluntary donors the incidence of post transfusion diseases could be remarkably reduced.
The voluntary blood donation movement in Assam was mooted in the wake of Sino-Indian war in 1962. A large number of people all over the country came forward to donate their blood for the wounded jawans in the front. Unfortunately this momentum was lost and it was not utilised by the then Voluntary organisations engage in this field. In order to avoid the professional donors and to cater to the increased demand for adequate quantity of blood, a Voluntary Blood Donors Association was formed in the year 1988 at Guwahati comprising the like minded voluntary organisation like Red Cross Society, Lions Club, Rotary Club, AASU, Nursing association etc. The main purpose of this was to motivate people to voluntarily donate blood and organise such camps and to arrange training course for social workers and technicians. Presently the government and Various NGO have come forward to restart the movement for procuring safe blood for the needy patients but it has not reached to the desired level. The volunteer donor should be explained about the potential health benefits of blood. The chief benefit lies in the satisfaction of selfless concern for the welfare of others. However, two studies suggest that there may be more tangible health benefits, particularly for middle aged men such as lowering the risk of cardiovascular diseases. In the younger age group (18-36 years) when bone marrow remains very active, regeneration and replacement occurs quickly by feed back mechanism, and so this group is able to donate blood every 3 months (i.e. 4 times a year).
The development of blood transfusion service is based upon the recommendation of the International Society of Blood Transfusion and Immunohematology (ISBTI) and the World Health Organisation (WHO). As per recommendation all donors should fulfill certain criteria and all donated blood should be screened for transfusion transmitted diseases, using the most appropriate and effective assays for testing HIV 1 and 2, Hepatitis B and C viruses, Syphilis and Malaria. If these tests are found to be non-reactive, the blood bank staff can go ahead with the processing of blood.
Blood donation has potential medico-legal consequences. If a donor becomes ill shortly after giving blood. The illness may be attributed to blood donation. For this reason among others it is important to ensure that the donors have no history of medical conditions such as diabetes, hypertensiong poorly controlled epilepsy and unstable cardio -pulmonary disease that might be associated with an adverse event following phlebotomy. Donors who become ill within 2 weeks of donation should be encouraged to inform the blood bank which may wish to discard the donated blood. Donors who develop hepatitis or HIV infection within 3-6 months of duration should also inform the blood bank.
In fact there are certain conditions where an individual is permanently deferred from blood donation if he/she has a history of open heart surgery including bypass surgery, any cardiovascular disease, chronic renal failure, chronic liver disease, cancer, endocrine disorder, positive test for Hepatitis B and Hepatitis C and also donors having history of high risk for HIV and symptoms of AIDS. Persons with a history of abnormal bleeding tendency and blood coagulation disorder (Haemophilia) and severe allergic history are also permanently deferred.
Blood banks in India are governed by the Drugs and Cosmetic Act. and accordingly they have to be licensed by the Drug Controller Authority. Blood and its products are defined as Drug under the Drugs and Cosmetic Act. A defective product would make the manufacturer liable.
National AIDS Control Organisation, Ministry of Health and Family Welfare has introduced standards for blood bank and blood transfusion-services. All fransfusion services in the country should follow these standards to ensure safe blood as well as safety to donor, recipient and blood bank personnel.
Modem blood transfusion envisages the optimal use of every donation by way of component therapy. The development of plastic bags with integral tubing, high speed refrigerated centrifuge, deep freezers and cell separator machines have made blood component preparation easier and practical. With the more advanced chemical technique (Plasma fractionation) various plasma derivatives or fractions are also now made available.
Blood component therapy helps in two ways : It leads to economy of blood, as one unit of blood can be separated into different components and used in different patient according to their indication. It also minimies the hazards of whole blood transfusion. (Published on the occasion National Blood Donation Day)
