Blood management is in dire need of tech transfusion

Chetan Makam | Updated on November 22, 2020

A hub-and-spoke model will go a long way in reducing blood wastage and enable larger volumes of blood to be processed

Donate Blood, Save a Life’ is a frequently heard clarion call to encourage voluntary blood donations. The most important element of blood transfusion is the safe collection, testing and distribution of blood and blood components to those in need. However, currently, around 40 per cent of all blood collected globally is in developed countries, which are home to just 16 per cent of the world’s population.

More populous developing countries, on the other hand, suffer from an acute shortage of safe, timely available blood. One reason for this is that nearly four-fifths of high-income countries have a dedicated national blood policy/legislation. In contrast, less than two-fifths of developing countries have similar policies in place.

India currently faces the world’s largest shortage of blood. The country needs an estimated 26.4 million units of blood annually, while the supply is just 13.5 million units. Much of this overwhelming shortfall of nearly 13 million units can be attributed to an unstructured and inefficient blood collection system. The Covid-19 related lockdowns have further aggravated blood shortages across the country. There is an urgent need to legislate into effect a comprehensive policy framework for efficient management of the blood banking system.

The consequences of a lack of safe and accessible blood supply are significant. For example, postpartum haemorrhage (PPH) — excessive bleeding after childbirth accounts for about 30 per cent of all maternal deaths in India and the replacement of blood and blood products is critical in managing PPH and saving maternal lives.

Today, in India, we have more than 3,000 blood banks of varying sizes and capabilities when it comes to testing, storage, and distribution. Many experts have already been talking about the adoption of the Hub-and-Spoke model, in which local centres are connected to a regional hub which hosts advanced technologies and skilled manpower.

Economies of scale

It can then leverage economies of scale to reduce costs and ensure quality via standardisation of blood/blood components. At a functional level, the model involves the centralisation of blood collection processing and then the transport of blood/blood components to regional hubs for storage.

Such a Hub-and-Spoke model, if supported with demand mapping and inventory management, helps reduce the wastage of blood. It would allow for larger volumes of blood to be processed. It must be combined with a similarly organised testing lab model so that all blood can be tested on world-class criteria.

Smaller blood banks can be converted into collection centres at the front end and storage centres for distribution as well. Given the enormity of the need in India, it is crucial for us to adopt advanced technology solutions for the collection and delivery of safe blood.

Leveraging technology in the collection of blood and its separation into blood components (red cells, white blood cells, platelets, and plasma) can help scale its collection and efficient use. Depending on the situation, either whole blood or blood components are used for chronic transfusion needs such as thalassemia, emergency needs like trauma and accidents, scheduled surgeries, and to manage haemorrhages during childbirth. Platelets are used commonly in oncology and for treatment and management of dengue and other viral infections.

Plasma, the most voluminous component of blood carries antibodies and other proteins. It has been used in several life-saving medical procedures for more than a century now. In fact, even in the context of Covid-19, a recent study conducted by the Mayo Clinic, USA, suggests that convalescent plasma has beneficial application for reducing mortality and improving patient recovery rates.

As per the findings of the study, “seven-day mortality rates declined to 8.6 per cent compared to 12 per cent in a previous safety study of the first 5,000 transfused patients. Serious adverse events continued to be less than one per cent.”

Technological advancement is a necessity to modernise our health systems, including blood banking. We can draw inspiration from the fact that India has often leapfrogged an entire generation of technology to adopt the next generation of technology.

We can and must replicate the same for blood systems as well, bring our blood management systems on par with developed nations and ensure that every single Indian has access to safe blood whenever the need arises.

The writer is Managing Director of Terumo Penpol

Published on November 22, 2020

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