A strong and comprehensive health infrastructure includes a well-maintained and efficient network of human blood banks that collect, test, store and distribute blood to meet the transfusion needs of the local population. Blood transfusion is required in cases of blood loss due to accidents, injuries, surgeries, etc.
For some blood-related diseases, such as thalassemia, regular blood transfusions are necessary. Patients undergoing certain cancer treatments also need to supplement blood or blood components when platelets, hemoglobin, etc. decrease sharply.
The National Blood Policy was adopted in 2002. The focus is on adequate voluntary blood collection, blood safety to prevent transfusion-borne infections, and nationwide access to safe blood. The establishment of national and state blood transfusion committees and a network of blood banks and blood storage centers using a hub-and-spoke model is envisaged. Blood is considered a drug under the Drugs and Cosmetics Act 1940.
Therefore, around 4,000 blood banks in India are licensed and regulated under the Act. We estimate the annual demand for blood to be approximately 15 million units, of which we meet nearly 85%. Our goal is to donate blood voluntarily rather than obtain replacement blood from relatives of patients. In terms of macro management, E-Raktkosh is operational, although not all blood banks report regularly to this Kosh yet. Mandatory testing of transfused blood for hepatitis B and C, HIV, malaria and syphilis. However, nucleic acid amplification testing (NAAT) methods have advantages in terms of a shorter window of undetected hepatitis/HIV infection but have not yet been mandated mainly due to cost and infrastructure considerations.
While we have achieved considerable success in the field of blood transfusion, we need to step up our efforts to provide world-class health services.
policy steps
The statutory framework of the Drugs and Cosmetics Act, 1940 is inadequate to regulate and promote blood banks and related issues. We need a concrete central legislation to look at blood collection, testing, storage, distribution, access and related matters. The legislation will make it mandatory for states/Union Territories, blood banks, hospitals, storage centres, etc. to adopt uniform standards and impose penalties for non-compliance.
The hub-and-spoke model of blood collection, testing, storage, and distribution must become a vibrant reality. This will reduce infrastructure investment requirements, allow central aggregation of blood units, facilitate pre-transfusion blood testing, and facilitate efficient management of blood banks.
In this social media era, we must use the influence of social media to effectively promote voluntary blood donation.
At the same time, more attention needs to be paid to blood safety. Mandatory NAAT testing for hepatitis B, hepatitis C and HIV should become the norm. Although NAAT technology is expensive, we can work to reduce the unit cost of NAAT testing. India has one of the largest blood banks in the world. We should use our quantity advantage to get lower prices.
One issue that already exists in our blood policy but deserves more attention is making the best use of the blood we collect. To do this, we have to separate the blood components (packed red blood cells, fresh frozen plasma, platelets) and use whatever the patient needs. The remaining plasma is used in various products such as albumin, immunoglobulins, etc.
Patients with blood-related disorders deserve special attention. Some of these conditions, such as thalassemia, can be found when tested at the right time before delivery.
Our blood banks and transfusion industry are ripe for a major leap forward. We should turn opportunities into reality.
The author is a former Secretary to the Government of India
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