The Shortage of Blood has been threatening lives - Seeker's Thoughts

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Thursday, 14 February 2019

The Shortage of Blood has been threatening lives

Introduction
India has been facing heavy shortage of safe and sufficient blood for long. In 2105-16, India was 1.1 million units short of its blood requirement.  

Awareness about blood donation in India is sharply skewed. While some states, like Delhi are able accumulate 23% extra blood than what is required, other needy states like Bihar face a deficit of as much as 85%.
There is huge gap in blood availability in both states; the reason behind the difference is lack of knowledge and unfounded myths about blood donation.

There were considerable regional disparities, with 81 districts in the country not having blood bank at all. 
In 2016, in Chhattisgarh’s hospital turned away a woman in dire need of blood as it was unavailable. She died on the way to the nearest blood bank which was few hours away. 


In April 2017, it was reported that blood banks in India had in the last five years discarded a total of 2.8 million units (more than 6 laky litres) of expired, unused blood.

According to the media reports, India has a population of 102 billion people and annually requires over 12 million blood units. However, only nine million units are collected. This means the country faces a shortage of over three million units of blood every year. 

While India has eligible population for blood donation, there will be no shortage of blood and its component in blood banks- if people donate. 
This would mean that a significant number of deaths could be avoided if people donate blood regularly and voluntarily.

Other concerns

The shortage of safe blood particularly impacts children suffering from thalassemia, road accidents and trauma victims, women with complicate pregnancy, cancer patients and those undergoing major surgeries.
Doctors say that a common misconception is that fresh whole blood is required for transfusion. But the fact is that with the availability of blood components such as packed red blood cells, fresh frozen plasma and platelets concentrates, the concept of fresh whole blood has vanished. 
In fact, there is no difference between one-day old and 30-day old, it has been preserved properly.

Blooded is treated like a raw material in Blood Bank

Blood bank keep blood like a raw material and once the sample is collected, it is separated into red blood cells which can be stored up to 42 days, and platelets can be stored up to 5-6 days and plasma which can be stored up to one year.
Technical issues apart, the most important thing which people should understand that blood donation is a very healthy practice. 
Donating blood involves preliminary health check –up, screening for infection markers and blood group and knowledge about the health history of an individual.

Significance of blood donation

Interestingly, blood donation reduces the chances of heart attack because it thins out the blood. Actually, 70-80ml of red blood cell gets destroyed by their own every 120 days, and the bone marrow manufactures new ones. So, donating blood in no way interferes with your body system.
Of course safe and sufficient blood supply is the key for an effective healthcare system. But blood should be used after careful consideration as there are risks associated despite all types of testing.
Nowadays, blood collection banks have introduced integral filters to bring down the possibility of transfusion reactions such as fever and viruses. Also, with better testing and narrowing down the window period for screening different diseases such as hepatitis and HIV, the blood safety has improved significantly. 
Still it’s not possible to detect all infections and care should be taken. That’s the only precaution to be kept in mind.

 Supreme Court directions and weak framework

The regulatory framework which governs the blood transfusion infrastructure in India is scattered across different laws, policies, guidelines and authorities. Blood is considered to be a ‘drug’ under the Drugs & Cosmetics Act, 1940. Therefore, just like any other manufacturer or store of drug, blood banks need to be licensed by the Drug Controller General of India. 

For this, they never meet a series of requirements with respect to the collection, storage, processing and distribution of blood, as specified under the Drugs & Cosmetic Rules, 1945. 

Blood banks are inspected by drug inspectors who are expected by drug inspectors who are expected to check not only the premises and equipment but also various quality and medical aspects such as processing and testing facilities. Their findings lead to the issuance, suspension or cancellation of a licence.
In 1996, the Supreme Court directed the government to establish the National Blood Transfusion Council and state Blood Transfusion Councils. 

The NBTC functions as the apex policy-formulating and expert body for blood transfusion services and includes representation from blood banks. 
However, it lacks statutory backing (unlike the DCGO), and as such, the standards and requirements recommended by it are only in the form of guidelines.

This gives rise to a peculiar situation- the experts blood transfusion body can only issue non- binding guidelines, whereas the general pharmaceutical regulator has the power to license blood bank. This regulatory dissonance creates a serious issue on the ground and results in poor coordination and monitoring.

A Ray of Hope

A collaborative regulator can more effectively, take the lead in facilitating coordination, planning and management. This may reduce the regional disparities in blood supply as well as ensure that the quality of blood does not vary between private, corporate, international, hospital-based, non-governmental organisations and government blood banks.

The aim of the national blood policy formulated by the government back in 2002 was to “ensure easily accessible and adequate supply of safe and quality blood”. To achieve this goal, India should look to reforming its regulatory approach at the earliest.

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