Safer Blood Transfusion Symposium in India: Highlights
Safe blood transfusion procedures need to be constantly reviewed, especially in a country like India where the demand for safe blood far outstrips the supply. The Symposium on 'Making Transfusion Safer' organized on Sunday at Chennai, South India by Jeevan Blood bank and Research Center, was designed to focus on the manner and method of ensuring safe blood transfusion in India vis-à-vis other countries in the world.
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 India.