Delivering the Jeevan oration Dr.
Neelam Marwaha, Head, Department of Transfusion Medicine, Post Graduate
Institute of Medical Education and Research (PGIMER), Chandigarh, stressed the
need to launch awareness programs for blood banking services including donor
motivation so as to ensure adequate voluntary donation. Discussing the
risks of infected blood transfusion, Dr. Neelam said it was possible for an
infected donor to transmit the infection to 4 patients and the infection could
move into families and spread into the community. The list of possible Transfusion
Transmitted Infections (TTI) is endless, including viral infections such as HIV,
Hepatitis B and Hepatitis C, Bacterial infections such as syphilis and others,
Parasitic infections such as malaria, Chagas disease and transfusion
related acute lung injury. Chagas disease is peculiar to South American
countries but with cross migration happening in today's world that is more of a
global village, it is likely that newer infections are transmitted through
blood transfusion across countries. Advanced countries have reached the maximum
level of safety in the procurement, storage and transfusion of safe blood. In a country like India where there is less
voluntary donation and more paid donation our prime focus should be on shortening
the Window period to ensure safe blood transfusion.
Presenting the case for the
efficacy of 4th generation Elisa Test in developing countries like
India that is only short of the high cost nucleic acid test NAT, Dr. Neelam
said it was important to ask the donor about recent fevers, GI infections etc
to further rule out possible collection of infected blood samples.
Commending the industry's role in
effecting safe blood transfusion, Dr. Neelam mentioned the blood bag with
diversion pouch which was simple, inexpensive, yet an effective way in which
contaminants stay behind in the pouch without entering the blood bag.
Discussing Blood Component Preparation and Special Screening, Dr. Neelam
suggested that though Apheresis platelet concentrate is costly,
it should be a doctor's first choice if the patient can afford it.
Dr. Neelam also dispelled the myth
that fresh whole blood transfused within 24 hours is the safest blood for
transfusion and said Transfusion Medicine is not given enough importance in
medical education in India. More education on Appropriate Clinical Use and Safe
Bedside Transfusion Practice would reduce the friction between
clinicians and blood bankers and ensure safe blood transfusion to the patient.
Discussing hemovigilance and the
need for a comprehensive quality control system in the entire transfusion
process, Dr. Neelam said it was about time the outdated term blood banking was
changed to something more comprehensive to meet the rising challenges in the
fast evolving field of Transfusion Medicine.
Dr. Saranya Narayan,
Medical Director, Jeevan Blood Bank, Chennai spoke on Making Blood Safer -The Indian
Context, tracing the incidence of TTI trend from 1995 to 2010 with
statistics from Jeevan Blood Bank. Discussing
the current scenario, Dr. Saranya said, in 2009 majority of hospital donors
were NOT from truly voluntary blood donors and elaborated on the huge risks
posed by directed blood donation.The talk addressed concerns on transport
of collected blood such as timing, temperature maintained and the need
for additional trips when required. Dr. Saranya argued the case for the cost
effective fourth generation Elisa test's efficacy vis-à-vis NAT and said that
until a centralized screening happened in India, fourth generation Elisa test
should do fine in the Indian context. Dr. Saranya stressed on stringent
screening of donors, the need for more interaction between clinicians and the
blood bank, discouraged fresh warm whole blood single unit transfusion and
asked medical professionals to avoid transfusion wherever it was unnecessary..
Dr. Dolly Daniel,
Professor, Department of Transfusion Medicine, CMC, Vellore took the audience Beyond
A, B, O, Rh and discussed problems related to Red Cell antibodies in
the context of adverse reactions after blood transfusion. The talk dwelt on
antigen characteristics and antibody characteristics, outlined the laboratory
hints of Clinical Significance, the need to perform antibody screening versus
cross match and cited examples from data collected at CMC, Vellore. Dr. Dolly
discussed febrile hemolytic transfusion reactions and severe anaphylactic
reaction and management.
The next paper elaborated on standard operating procedures and touched upon safety procedures
in blood transfusion. The paper on Impact of Accreditation on Safe Transfusion was presented by Dr. Neelam Marwaha.
The PowerPoint discussed Quality Management System (QMS) at
every step in the transfusion chain and the relevance of clear-cut Standard
Operating Procedures (SOPs) to maintain quality in testing blood.
In the Panel discussion that
followed, P.V. Vijayalakshmi, Asst Director, Drugs Control, Tamil Nadu raised
questions on the precautions taken by blood banks to ensure that blood is
transported safely and maintained at the desired temperature until it is
transfused in a patient. Dr. Usha from Frontier Lifeline Hospital wanted to
know if blood banks had post donation counseling when a donor tested positive
for infections. Dr. Prabakar from Vijaya Hospital asked if stem cell research
could yield safe blood components going by the recent media reports. Dr, Neelam
responded that it was a currently a very costly exercise and how much of it is
going to be translated into clinical use is a moot question.
Summing up the day's proceedings and thanking the
speakers and audience, Dr. Srinivasan, Chairman, Jeevan Blood Bank said careful
documentation and sharing of observations, constant training and upgrading for
all involved in blood transfusion was imperative to step up safety measures in
the field. Likewise, when blood transfusion specialists meet, share and discuss
newer trends in the field of Transfusion Medicine as often as possible, there
is a maximum guarantee that safer blood transfusion is possible in