March 1 Picture this an emergency situation in a nursing home somewhere in the interiors of Punjab. The patient urgently requires blood transfusion. The doctor tells the relatives that the only way to save patients life is an immediate blood transfusion. The relatives agree. Within minutes a donor appears. After the basic formality of matching the group, he is taken to an adjoining room serving as a blood bank and he donates the urgently needed life saving fluid. A recent notification by the Union Ministry of Health and Family Welfare to Drug Controller General of India makes Hepatitis C Virus (HCV) testing mandatory for the blood banks and hospitals which will come in force from June 1, 2001. However, the experts lament that with most blood banks operating, at times from a room adjoining nursing homes in Punjab, Haryana, Himachal Pradesh and Jammu and Kashmir, the donated blood was not even tested for HIV hepatitis-b, VDRL and Malaria at times. The HCV testing may, thus, have to wait for the time being.
Certainly not surprising since more than 50 per cent of the blood banks in the region are functioning without even a licence. Experts add that in the entire region, private nursing homes continue to rely on their own blood banks where even the most basic requirements of drug control are being flouted. And that most of the blood transfusions are, in fact, shots of disease rather than of life.
According to Prof J.G. Jolly, Emeritus Professor, PGI, and founder of the Blood Transfusion Department in the institute, unless the licensing authorities were alert and testing of blood was monitored, dreams of safe blood would very well remain a distant dream.
The Drug Controller General, he adds , has laid down certain norms for issuing a licence to a blood bank. There are specifications which include the space required to set up a blood bank, which is 1,000 sq ft with seven rooms each for a specific purpose. Specifications also include directions on the number of trained persons, doctors, technicians, equipment and reagents for handling the blood. Basic infrastructure including air conditioners , refrigeration and centrifuges are also mandatory for any laboratory. But, flouting these rules and regulations, most of the blood banks in the region operate under most primitive conditions with the professional donor continuing to be professional, adds Prof Jolly.
Interestingly, many government hospitals in the region also depend upon private blood banks for their needs. Besides, courier services are also operating from Delhi which supply the life saving blood to nursing homes in the border areas of Haryana, needless to say, without observing the prerequisite quality control essentials.
Gravity of the situation could be realised only if there was a meticulous system of monitoring the patients who receive these transfusions, says Prof Jolly. Under the present circumstances it is almost impossible to highlight the extend to which transfusion contributes to the spread of serious diseases among the recipients. Health authorities may have made HIV, hepatitis-b, VDRL for testing syphilis, Malaria mandatory and more recently also HCV, however, unless this aspect is taken care of there can be no hope for any improvement, he adds.
Prof Jolly, who has extensively inspected operations of the blood banks in the region says barring a few centres in these states, most of them function in a very primitive way. Neither do they give due consideration to quality control nor are the norms vital for ensuring safety of blood adhered to.
Incidentally, there is National Blood Transfusion Council under which there are state blood transfusion councils, which are academic bodies responsible for guiding the operation of blood banks. Licensing is done by the Drug Controller General.
Licensing alone is not the only solution, says Prof Jolly. After directives of the Supreme Court, the Drug Controller General, has started licensing blood banks more enthusiastically. But this has not made any impact on improving the technological operations of the blood centres. And this is true for the majority of blood centres whether in public or private sector, he adds.
Most unfortunate is the fact that by and large trading and commercialisation was still rampant in most of the northern states. Actually the fact that the country annually requires eight million units of blood but procures just 3,5 million is another reason for flourishing business of the private blood banks.
Annually there is a deficit of 4.5 million units. So when a doctor says that the only way to save the life is blood transfusion, the relatives have no option but to turn to private blood banks.
The answer to this is the judicious use of whole blood, says Prof Jolly.
All emergencies do not require whole blood transfusion. Which is why in a country where demand of safe blood is far more than the supply, judicious use of specific components makes a sense. A unit of 450 cc of blood can be used for many patients. For leukemia patients, platelets, anaemic and thalasaemia, Red Blood Corpuscles (RBCs), plasma for operative bleeding disorders.
Most centres operate for whole blood and at very few places the facilities for economising blood into its components exist. These include PGI and Government Medical College and Hospital, Sector 32, Chandigarh, CMC and DMC Medical College, Ludhiana, and the medical colleges in Rohtak, Jammu and Srinagar, are perhaps the only centres using blood components, says Prof Jolly.
A major factor that hampers the development of blood centres had been the non-availability of trained personnel available in the programme. Unless this aspect was dealt on a war footing by training medical and paramedical personnel safe blood would remain a distant dream.
