Ankit (name changed) is standing in front of the desk of a popular city hospital. His nephew has been involved in a serious car accident, and the doctors have ordered for three units of blood in preparation for the operation. Standing in queue with him are two of his friends. They are waiting so that they can donate their blood, in exchange for the three units of B+ blood the patient needs. In automation, the nurses whisk them to the 'bleeding tables', measure their blood pressure, and ask them whether they have imbibed alcohol in the last two to three days.
While this process is going on, the attendant readies the needle, eases it in, and makes sure the blood is flowing into the empty sachets. As the donors talk quietly amongst themselves, the next lot is brought in. Within 15 to 20 minutes, the whole process is done, the needles are taken out, the sachets are sealed, and the befuddled donors are herded out of the room, without so much as a glass of water.
Of all the activities conducted in an hospital in the name of Hippocrates, the blood bank and its role is probably one of the most hustled ones. Like the Emergency Ward, anyone in need of blood is in distress, and is scarcely bothered to note his rights and rules at that moment. Also, the operations of the blood bank are the most closely-guarded secrets of the hospital.
Gurgaon has its share of accidents and emergency cases. Almost every major hospital has a blood bank, and they remain busy day in and out. What is unique about blood banks is the fact that blood (and its components) is among the few things that cannot be manufactured. ‘Captive conception’ (a process in which minor blood components are manufactured in laboratories) is a very little used concept, and not in force with regard to blood and its components (whole blood, red blood cells, granulocyte concentrate, fresh frozen plasma, and platelets). In almost all the cases somebody has to give blood so that another in need can have it. Therefore, the need for donors cannot be stressed more.
Also, you cannot buy blood outright (except in a few cases); there is a replacement policy which the hospitals follow with religious zeal.
Shortage In A Snap
“If there were a citywide calamity, and even a tenth of the populace needed blood, it would be a disaster,” says a government medical official calmly. The country is anyway short of blood donors, and Gurgaon is no exception. In all, there are no more than a floating figure of 5,000 to 10,000 units of blood in all the City’s hospitals. The Civil Hospital, which caters to the masses, has 300-500 units of blood as of now. And it is disheartening to know that the Blood Bank in the Civil Hospital is the only government blood bank in Gurgaon.
There is no clear-cut solution in sight, because the problem is in the product, the supply, the demand and the people. “Blood cannot be stored indefinitely. The shelf life is limited, which poses the biggest problem,” says a blood bank official. Except for umbilical cord blood, which can be cryo-frozen up to two decades, the maximum shelf life for a unit of blood is one month. Whether it is whole blood or its component, the shelf life is the greatest restriction for any blood bank. The NACO guidelines state that if cryogenic freezing is used, then packed RBCs can be stored for up to a decade. This technology would stretch the shelf-life of the blood by years, instead of days. But it would entail storage of blood and its components in constant and uninterrupted minus 30 to minus 198 degrees Celsius environment – which is currently unavailable in the City. The power cuts ensure that even the normal shelf-life of a month is shortened to nothing.
The infrastructure needed to set up a blood bank is so prohibitively expensive that only the government-funded and the well-off hospitals can afford to have them. Each of the machines needed in a blood bank costs over a lakh, needs constant climate control and optimal working temperature, and needs to be handled by a trained professional. Only international non-profit organisations like Rotary and Lions have their blood banks. The Indian Red Cross organises blood donation camps in tandem with the Civil Hospitals of the City.
A blood bank official says, “The biggest problem facing any blood bank is that, on a day to day basis, any blood type can fall short. A patient can have a requirement for A- blood, which we can provide. But there is no guarantee that we will receive A- blood in replacement. It can be AB+, or B-, or whatever the replacement donor’s blood type is. A surplus of B+ blood will not save the day when three patients demand AB+ blood type.” In case of Below Poverty Line (BPL) patients, the blood is provided free of cost, provided documentation is provided. And in some cases, even replacement is not asked for.
Medical Grey Areas?
Dr. Saurabh Sharma, a medical investigator, unveils the murky aspects of the blood banks across the City. “It is a little-known fact that when a patient who had needed blood dies, they drain his body of almost five to six units of blood. ‘It’s there in the rules’ the attendants tell the relatives, asking them to allow the process for a good cause. Also, there is no governing body, or a government watchdog organisation, that can check the different blood banks of the City for proper functioning.”
The Civil Surgeon of Gurgaon is the top official in this matter. But there have been no surprise inspections of blood banks, or even private hospitals, in recent memory. “How will the people be saved from rapacious dealing of the hospitals?” he asks. Technically, the blood is given free of cost, or replaced by the patient’s family. But hospitals have started milking people under the innocuous pretext of ‘processing fees’. “The hospitals observe the rule that the blood, or its components, cannot be sold. But processing fees of lab testing the blood, and extracting its components, are not covered under the Drugs and Cosmetics Act – and is therefore a grey area,” says Dr. Sharma. Many hospitals, including private ones, charge anywhere between Rs. 300 to Rs. 1,000 from the patients, besides getting replacement from the patient’s family.
Sharing Resources: Coordination Between Hospitals
It is mandatory that if there is a shortage of blood, the hospital should ask other premises for replenishments. But that does not take place in Gurgaon hospitals. – though officials do say that they arrange for blood from other hospitals in the case of BPL emergencies. But patients do not share the same story. Vishal Rao says, “My friend had gone to a big hospital a few days ago, to donate blood for his relative who needed AB+ blood. As he was being bled, the attendants were talking to another patient who was trying to arrange blood for another operation. Since the hospital was out of that particular blood type, they were attempting to get blood from another hospital. The ‘fix’ was that he had to shell out a few thousand rupees extra for the ‘transportation and handling charges’.
Even between sister hospitals, there is constant friction over sharing blood supplies. An ESIC Hospital worker says that they had to ask the patients to arrange for blood, as the Civil Hospital had ‘issues’ with providing it to ESIC.
Donation, Donation, and Donation
The only way to replenish blood supplies in blood banks happens through blood donation drives, or through replacement. And the biggest source of donations are the youth, who sign up in droves. Right now, the summer vacations have put the brakes on the collection spree.
“We collaborate with the Indian Red Cross to set up blood donation camps across the City periodically,” says a government blood bank worker.
In this aspect, private NGOs score better. A Rotary spokesperson says that they have plenty of blood supply in the NCR region. They conduct blood camps every week, and usually 50-70 units are harvested per sitting. “All a patient needs to do is to come to us with a doctor’s prescription, saying which blood type is needed. That is all the documentation we need.”
The Indian Red Cross also organises blood donation camps to replenish blood supplies, but on a more infrequent basis. The majority of the collections go to the government hospitals, since the Red Cross does not have a blood bank of its own.
Technology Comes To Help
Technology can build bridges when everything else fails. Seeing the dire need for blood donation, storage, and the woeful database, the Indian Society of Blood Transfusion and Immunohaematology (ISBTI) has recently decided to adopt a successful Pune model, in which an index of voluntary blood donors is kept online. At the time of registration, all the relevant details of the volunteer are collected and saved. Whenever a patient finds himself in need of blood, all he needs to do is to call the number, search the list for a particular blood type, and ask the volunteers for help. Already getting past the 5,000 mark in Pune, the model is to be replicated across India. Besides that, there are a number of online support sites where lists of blood donors are updated.
Indians have always been a little shy of donating their blood. Even in a modern, cosmopolitan city like Gurgaon, officials still have to depend on donation drives, to accrue enough blood for day to day operations. According to officials, there are hardly any walk-in donors in hospitals across the City. “We have to set up special drives, and cry ourselves hoarse, before an uninvited passer-by drops in and says he wants to donate blood on his own volition,” says a Red Cross official. People are not willing to part with their blood unless it is an emergency – and that too for a close friend or family.
It is clear that the blood banks of the City are not geared up to handle a sudden calamity. Apart from the ‘short supply’, a stress point is the low number of blood banks (mainly the major hospitals), and the lack of communication and co-ordination between them regarding blood supplies. Finally, there is a lack of a modern set-up, in which blood can be stored for longer periods, reducing the need for donor dependency. The government needs to pitch in, for setting up of cryogenic storages, in which life-saving blood supplies can be stored for years – rather than facing a day when there is blood everywhere except in the blood bags.
Conditions for donation of blood:
No person shall donate blood, and no blood bank shall draw blood from a person, more than once in three months. The donor shall be in good health, mentally alert and physically fit – and shall not be an inmate of jail, having multiple sex partners, and a drug-addict. The donors shall fulfill the following requirements, namely :-
Σ The donor shall be in the age group of 18 to 60 years.
Σ The donor shall not be less than 45 kilograms;
Σ Temperature and Pulse of the donor shall be normal;
Σ The systolic and diastolic blood pressures are within normal
limits, without medication;
Σ Haemoglobin which shall not be less than 12.5 grams;
Σ The donor shall be free from acute respiratory diseases;
Σ The donor shall be free from any skin diseases at the site of phlebotomy ;
Σ The donor shall be free from any disease transmissible by blood transfusion, insofar as can be determined by history and examination indicated above;
Σ The arms and forearms of the donor shall be free from skin punctures or scars – indicative of professional blood donors, or addiction of self-injected narcotics
No person shall donate blood, and no blood bank shall draw blood, from a person suffering from any of the following diseases –
Cancer, Heart disease, Abnormal bleeding tendencies, Unexplained weight loss, Diabetes-controlled on Insulin, Hepatitis infection, Chronic nephritis, Signs and symptoms suggestive of AIDS, Liver disease, Tuberculosis, Polycythemia Vera, Asthma, Epilepsy, Leprosy, Schizophrenia, Endocrine disorders.
Deferment Of Blood Donation
CONDITIONS PERIOD OF DEFERMENT
(a) Abortions 6 months
(b) History of Blood transfusion 6 months
(c) Surgery 12 months
(d) Typhoid 12 months after recovery
(e) History of Malaria 3 months (endemic) and 3 years (non endemic area)
(f) Tattoo 6 months
(h) Breast feeding 12 months after delivery
(i) Immunization (Cholera,
Typhoid, Diphtheria, Tetanus,
Plague, Gammaglobulin) 15 days
(j) Rabies vaccination 1 year after vaccination
(k) History of Hepatitis in 12 months
family or close contact
(l) Immunoglobulin 12 months
Σ Text BRAVO BLDDNR to +919246356765