The prolonged lockdown has thrown up a new challenge for hospitals and blood banks across the country as blood donations are drying up.
Blood banks have been reporting a sharp fall in voluntary and replacement donations. Most of the blood banks in the country are dependent on voluntary donors for their supply, for which donation camps are arranged daily.
“We have been unable to hold blood donation camps because of restrictions on the movement of people,” said R Vijayalakshmi, former president of Rotary Club of Hyderabad.
The donors are hesitant to visit hospitals or blood banks for fear of contracting Covid-19 disease, she said.
As a result, patients suffering from thalassemia, cancer patients and those who need platelet infusion and blood transfusion are facing severe problem.
Though hospitals have postponed all elective surgeries, there is still routine requirement for blood for thalassemia and haemophilia patients, oncology patients, cardiac surgeries, accident victims and cancer patients undergoing chemotherapy.
“We have several patients with thalassemia, sickle cell and aplastic anaemia, and blood cancer, who need blood every day,” said a senior surgeon at Apollo Hospital in Hyderabad.
Moreover, blood has a shelf life. While the donations have dried up, stock is expiring daily and hospitals are dipping into their reserves. The blood platelets have a shelf life of only seven days. In absence of a continuous supply, the reserves are bound to dip.
“The requirement of blood in hospitals could also rise if there is a surge in COVID-19 cases,” said Dr P Sharatchandra Reddy at the government-run Gandhi Hospital in Hyderabad which has now been converted into an exclusive facility to treat COVID-19 patients.
The COVID-19 patients in critical condition would need platelet-rich concentrates (PRCs) and fresh frozen plasmas (FFPs).
The World Health Organization (WHO) estimates that blood donation by 1% of the population is generally the minimum needed to meet a nation’s most basic requirements for blood. However, the average donation rate is 15 times lower in developing countries, including India, than in developed countries.
Most countries with low rates of blood donation are largely dependent on blood provided by the families or friends of patients who require transfusion.
The experts believe that as per the WHO standards, India is already far behind while the lockdown has made it even worse.
According to an estimate made in 2018, India was short of 1.9 million units of blood a year. The experts say this is because India does not have a proper system to manage blood banks and not many people donate, unless someone in their family needs it.
“In India, there is no culture of altruistic donation. Blood donation happens only when asked for,” lamented a healthcare activist S Ramakrishna.
Most of the blood donation in India is “replacement” blood donation, which means that if one is admitted to hospital and gets a blood transfusion from the blood bank, they must replace the same amount by asking someone else to donate.
According to the information tabled in the Parliament, as of December 2019, India had 3,321 blood banks – 2.45 blood banks per million people – and had collected 12.5 million units of blood in 2018-19.
An online database, E-RAKTKOSH, was established in 2016 to provide a digital, centralised blood inventory management system. However, there is widespread criticism that it is not comprehensive.
As per the government data available on the National Blood Transfusion Council’s website, the total donated blood has dropped from 38,189 units in February to 26,741 units in March.
Further, only 3,037 units have been received in the first 10 days of April. The number of blood donation camps have also come down from 473 in February to 46 in April.
“The voluntary donations have gone drastically. We receive about a million blood units a year from 89 centers in the country. Of these 52 are voluntary based donation centers, and there has been no procurement of blood,” said Vanashree Singh, the director of Indian Red Cross Society.
Even the in-house replacement donations have reduced by almost 50 percent.
The blood donation in India is seasonal, with fewer donations during vacations, says Suryaprabha Sadasivan, the lead for healthcare practice at Chase India, a Delhi-based public policy research and advocacy firm.
India can learn from African countries that conduct sensitisation workshops in schools and colleges to make children aware of the vital need of blood donation, said Sadasivan. It creates a cultural shift and convinces people to start donating early, she said, adding that companies could provide non-monetary incentives for employees to donate blood.
Plasma can be stored for up to a year and platelets for just five days. If blood camps and banks are not organised well, a lot of blood could also be wasted, the experts warn. For instance, between 2014-15 and 2016-17, over 1 million units of blood were wasted every year, according to the information tabled in the Rajya Sabha in 2017.
Though the National Blood Transfusion Council has laid down guidelines for blood banks on reducing the wastage of blood, not many of them follow the guidelines, Sadasivan said.
There is lack of coordination among blood banks run by state governments, private companies and non-profit organisations.
As a result, even if one blood bank has more units than it needs, it may not be willing share with other banks.
In Hyderabad, blood banks are rationing the supply even to thalassemia patients and insisting that patients bring volunteers with required blood group as they are unable to replacement donation. The donors struggle to reach blood banks in view of the police imposing restrictions on travel and non-availability of public transport.