India’s decision to launch the Sickle Cell Anemia Mission addresses a key ailment that disproportionately affects the poor and marginalised, particularly in the most underdeveloped parts of the country. A year into the programme’s launch, with over 3 crore people screened, it is the right strategy and time to link some of the pressing public health issues into the structure of the programme to derive maximum benefit.
One such critical issue is India’s persistent blood shortage to meet the various needs of individuals, particularly in areas where the population is disproportionately affected by Sickle Cell Disease (SCD). In these areas, the lack of available blood has significant implications for treatment options, making it essential to consider effective management strategies. Individuals suffering from SCD can benefit greatly from Red Cell Exchange (RBCx) therapy, a treatment that enhances their quality of life.
However, safe and adequate blood supply is essential and a critical need in their ongoing care. To improve screening, voluntary blood donation and treatment linkages, behavioural nudges can be leveraged, through the dissemination of localised content such as comic books as undertaken by the Government of Meghalaya to improve voluntary blood donation rates and collections across blood donation drives
A unique opportunity
On National Voluntary Blood Donation Day, while ongoing efforts to encourage voluntary blood donations (VBD) remain crucial, a key opportunity lies in tackling the country’s chronic blood shortage. Despite having a potential donor base of 402 million people, India consistently falls short of the World Health Organization’s recommendation that 1 per cent of the population donate blood. With the country needing 14.6 million units of blood annually and facing a deficit of around 1 million units, there is a significant need to boost voluntary donations.
One effective strategy to confront this shortage is to integrate blood donation initiatives into existing SCD screening programmes. Currently, the SCD screening initiative primarily focuses on preventing intermarriage between carriers by identifying their genetic risks. However, this young, screened population represents a prime audience for promoting voluntary blood donation as individuals who test negative for SCD are in a unique position to contribute to the blood supply.
By motivating these individuals to donate blood, we can significantly alleviate the pressing need for a steady and sufficient blood supply. Moreover, as the demand for blood continues to rise, the extensive reach of these SCD screening programmes provides an invaluable opportunity to effectively address this issue. These programmes already engage a large segment of the population, making it easier to reach potential donors who can help meet the increasing needs of patients requiring transfusions. Thus, by linking blood donation initiatives with SCD screening efforts, we can create a sustainable solution that not only enhances patient care for those with SCD but also helps alleviate India’s persistent blood shortages.
Empowering ASHAs for dual impact
Effective execution of the strategy outlined above requires empowering frontline workers like Accredited Social Health Activists (ASHAs), who already screen patients for SCD and are ideally positioned to further raise awareness about blood donation. By equipping them with localised educational materials, we can empower them to address the limited availability of blood in tribal regions, where both blood shortages and SCD prevalence are high.
A successful example of this approach is seen in the initiative of the Government of Meghalaya which introduced multilingual comic books tailored to resonate with local populations. These efforts significantly boosted awareness and participation by educating communities in culturally relevant ways. A similar approach could be adopted nationwide to promote blood donation, especially in regions heavily affected by SCD.
Charting effective treatment pathways
Building on the awareness generated by ASHAs, it is essential to examine the treatment pathways available for patients diagnosed with SCD to reinforce the critical need for voluntary blood donations. Once individuals undergo screening and receive a diagnosis, they often face a multitude of serious health challenges that require comprehensive treatment strategies, with blood transfusions serving as a fundamental aspect of their care.
Given that SCD patients frequently suffer from complications like acute pain crises, severe anaemia, and an increased risk of stroke, timely blood transfusions become not just important, but essential for their survival and quality of life. The integration of Automated Red Cell Exchange (RBCx) therapy into the treatment framework emerges as a vital option for managing SCD. This innovative and proven procedure involves the removal of sickle-shaped red blood cells from a patient’s bloodstream and replacing them with healthy donor cells.
By significantly reducing the frequency of painful crises and lowering the risk of severe complications, such as stroke and acute chest syndrome, Automated RBCx therapy greatly enhances the quality of life for SCD patients. It also reduces the frequency and duration of exchange procedures and addresses complications associated with traditional transfusions, such as iron overload, thereby minimising the need for chelation therapy.
As more cases of SCD are identified through screening, incorporating RBCx therapy into treatment pathways becomes essential to ensure patients receive comprehensive care. However, the effectiveness of this approach is contingent upon a stable and sufficient blood supply to meet the growing demands of SCD patients. Thus, by emphasising the connection between voluntary blood donations and the treatment process, communities can be motivated to engage in blood donation drives. In this way, a seamless pathway from diagnosis to treatment not only addresses the immediate medical needs of individuals with SCD but also cultivates a culture of voluntary blood donation that enhances public health outcomes.
The writer is Senior Vice President and General Manager, Global Blood Solutions at Terumo Blood and Cell Technologies
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