By Dr S V N Vijayendra
Mysuru, July 14:- Blood plays a critical role in the survival of human beings and animals. It carries oxygen to the brain. Human beings need to be injected with blood, a process known as blood transfusion (BT), to save their lives on many occasions. BT is carried out to people suffering from cancer, thalassemia, dengue fever, or whenever the loss of blood occurs like during major surgery, delivery, road accidents, victims of war, major injuries in various accidents, etc. In some patients with blood disorders, BT is required once in 15 days or one month. Delay in BT may lead to an adverse condition in such patients and they become weak immunologically due to a drop in haemoglobin and become vulnerable to diseases like COVID-19 easily and may succumb to their diseases.
Blood donation is considered a sacred service to humankind. Recognising the importance of blood donation, 14th June is dedicated as “World Blood Donor Day.” BT is considered a pillar of modern medicine, and it is saving millions of lives every year. Globally, more than 100 million units of blood are donated every year. However, the first global estimation of demand and supply of blood done by researchers from the University of Washington, USA, in 2019 indicated that there is a shortage of 30 million units (The Lancet Hematology, 2019, doi.org/10.1016/S2352-3026(19)
There is a great demand for blood everywhere, and 119 countries out of 195 surveyed do not have enough blood in their blood banks to meet hospital needs. Many hospital patients in low- and middle-income countries do not have access to the timely and safe supply of blood. There was a shortfall of nearly 41 million units in our country too. The COVID-19 pandemic aggravated the situation further in many countries. The WHO has issued guidelines in March 2020 for safe blood donation and transfusion and to maintain adequate blood supply during the COVID-19 pandemic period. Similar guidelines were also issued by National Blood Transfusion Council, India.
According to experts from the Red Cross, in normal conditions, it is safe to keep a good supply of blood that is enough for four days, and on an average, a region should have a safe supply of about 20% out of its population. In general, regular blood donors required to take a two to three-month break between successive donations.
Though there is no data or precedent describing the impact of COVID-19 on blood safety as of now, all over the world, many countries have faced a shortage in blood supply during the lockdown (period) imposed due to the COVID-19 pandemic. Even after easing the lockdown restrictions, blood donors are fearing to visit blood banks to donate blood because of fear catching the COVID-19. This resulted in a massive demand-supply gap in all major blood banks in many countries, including India and further increased the global blood shortage.
Small blood donation camps
The National Institute of Hematology and Blood transfusion (NIHBT) in Vietnam could collect just 226 blood units in 10 days as against the requirement of 1500 blood units per day. To reduce the supply gap in blood banks in Indonesia, the Red Cross has asked communities to donate blood to ensure a sufficient supply. In the current situation of fear of spreading the virus in large groups, organising small blood donation camps in housing complexes may be safe rather than organising huge blood donation camps in cities. However, both donors and blood bank staff need to wear face masks, and maintaining physical distancing in groups is a must under the present conditions. In some places, patients are advised to bring their own donors.
The shortage of blood in blood banks caused by the pandemic is expected to last for several more weeks or months, depending on the spread of the novel coronavirus. To tide it over, blood donation of the widely compatible A and O blood types are being encouraged in some countries. Some governments have urged the people who have recovered from COVID-19 disease to donate their blood for the treatment of the critically ill coronavirus patients.
Millions of patients are suffering or dying unnecessarily due to the unavailability of blood, and on some occasions, injecting contaminated blood resulted in the death of patients. This has lead to the safety of the blood transfusions. As a remedy to this, the concept of autologous blood transfusion (ABT), also known as or cell salvage, was brought in. In this process, the blood is collected from the patient and re-infused into the same person after treating with ABT (blood washing) devices, which function on cross-flow filtration technique.
These units capture red blood cells and separate them from fluids and other components. This process can be done at the bedside itself with minimum training. The ABT has several benefits, such as no risk of transmission of serious viral infections, reduced risk of adverse transfusion effects, own blood leads to better clinical outcomes, maximal blood type compatibility, reduces the cost of BT, provides a safe option, reduces the pressure on donor blood systems, etc.
(The writer is a regular contributor to City Today and Traffic Warden and member, City Traffic Advisory Committee, Mysuru)