Blood Transfusion service and its future in Manipur

Dr L Dorendro Singh *

Blood Donation at The Great June Uprising Observation at Kekrupat on June 18 2013 :: Pix - Deepak Oinam

Any Blood Transfusion service has to depend on voluntary, non-remunerated repeat blood donors to provide adequate, safe blood supply round the clock, throughout the year. In our state where comprehensive laboratory tests are neither possible nor pragmatic, the risk of TTIs remains a problem in family/replacement donors. Hence, voluntary blood collection is always better. This concept comes as safety of transfusion is in jeopardy in todays’ transfusion practice.

In Manipur voluntary blood donation rate is still trailing the other states like Tripura, Arunachal Pradesh, Tamil Nadu,Karnataka and Punjab. Some of the states in the North eastern India, they have achieved almost 100% voluntary blood donation (VBD).To mention some of the states Arunachal Pradesh, Tripura, have almost achieved this target. As per WHO estimates, a country’s need for blood and blood products is 1% of the population and our state needs 28 thousands of blood unit annuallyapproximately. However, our annual collection is hardly 18 to 20 thousands, a shortage of 8 to 10 thousands is still making a constant problem in blood transfusion service in Manipur.

Some organisations are pioneering in blood donation movement in different parts of Manipur but their support for the requirement of blood are still insufficient thereby compelling the blood banking services to depend on replacement type of blood donation which is discouraged nowadays due to high rate TTI among the donors of this kind. There are four government blood banks giving blood transfusion services in Manipur.Two blood banks already started supplying components to the patients whereas another two blood banks still depend on whole blood,prescription of which is discouraged except in few conditions.

Currently, in this scenario, the gravity of anxiety of undue pressures of the public as well as blood user people to the blood bankers for not storing enough blood need to be addressed properly. To achieve the target of voluntary blood donation in our state, we can analyse it from different perspectives of our Manipuri society. Our society,if we looked up in historical characteristic of running a family indicated that man most of the time engaged in outdoor manual works; even in kings’ time most of the male were engaged in battle field. They needed a lot of stamina and strength to do duties assigned to them.

Among the tribal people donation of blood as I experienced so far is comparatively very low, it may be implicated with the theory that male a blood donating section of the society for running the family need stamina and strength which they presumed that it shared directly with blood. If they donate blood their strength and stamina will be reduced, a saga running deep in the mind of people. I am recollecting here a story as I was told by one of my friend very recently, in a part of Chandel District a group of people were motivated well by a motivator who was assigned for the same in the community and one of them donated blood on the same day as he was convinced enough that donation of one unit of blood every three months with the weight and haemoglobin level he had is very safe.

He came back home with high spirit of altruisms and conveyed to his wife at home how he had donated blood with a high esteem of doing something good to the society.His wife was not happy instead started throwing volley of unwanted words towards her husband. In the evening the wife along with some of her friends went to the motivators’ house and argued why and how her husband was instigated to donate blood without their knowledge and started dismantling his house in a raise of anger. It reminds me that among the tribals and also among the illiterate people in the valley, this phobia of letting out bloods runs deep rooted. These incidences might be due to lack of knowledge of blood donation and age old wrong concept that has been imbibed in the community.

This may also be one of the factors of lower level of voluntary donation among the tribal community. Today, though our society, we have transformed a lot in different ways, we have to see changes-in their mind set,their way of life and practices regarding blood donation. I would like to bring about here the misconception and myths regarding blood donation in Manipuri society. I am neither defending non blood donors nor encouraging these people rather I would like to dig the factors hindering the blood donation movement in Manipur.

While discussing these factors we can debate here from two aspects technical as well as blood donors and people involved in blood donation movements. Technical aspects here I mean the people with the expertise in blood banking services .These people are trained with modern technology to collect, store and supply safe adequate blood after processing under a series of standing operative procedures.Todays’ blood banking is not limited to the blood banking of those days when it was under department of Pathology in a corner of the department with minimum man power and little scope of the subject.

Nowadays, they are competent in the field of manufacture, storage of blood and blood products in different environmental conditions. Their expertise covers much larger areas of haemotherapy, organ transplant, genetic engineering, cellular therapy and many research works in the field.So their ultimate aims and objectives in the field are not restricted only to collection of blood and supply of adequate and safe blood to the needy patients.As per Drugs and Cosmetic Acts 1940, collected blood, prepared and stored in a blood bank are categorised as Drugs and it passed a series of stringent processing to transfuse to a recipient finally. These people have been directly associated in the processing of these drugs with great accountabilities towards the medical science and the society. Blood transfusion services nowadays are specialised pharmaceutical producers which are closely linked to the clinical application of their products. Modern clinical transfusion medicine and haemotherapy are essential parts of today’s medicine.

Secondly, highlighting the role of people who are committed to blood donation movement with altruistic spirit in front is utmost importance in blood transfusion service. They are the pillars of blood banking services and safe and adequate blood supply depends on them. Without their contributions to blood transfusion service and to the society, the management of a patient in a clinical set up will never complete. Motivating the potential blood donors, managing the safety and welfare of donors and respecting their altruistic attitudes in the society which enable us to provide a safe, predictable and secure blood supply, are therefore essential cornerstones of tomorrow’s blood transfusion service.

There are some non-government organizations and individuals in Manipur who are showing their philanthropic attitude by donating bloods for the people in need. However, in comparison with states like Tripura, Tamil Nadu and Punjab we have to go a long way to come par with these states. Why are we still trailing of others is a question to be answered only when we come to the front of blood donation movement in Manipur. It is not a competition for higher percentage of achievement with other state but is to satisfy our requirement of blood in clinical practice.

Calculating our blood requirement only from the population as 1% of the population needs blood and blood components may not be correct always, we may sometime need to count exact amount of blood units issued in all the blood banks of Manipur in a year for 5-10 years retrospectively, that may give some idea on the requirement of blood in our state. In places where diagnostic facilities and treatment options are more limited, the requirement of blood is also less whereas in developed and well advanced medical centres or cities use of blood is more. Whatever it may be, WHO stipulates 1% of the population needs blood transfusion and we are yet to fulfill the requirement of the state.

Our ultimate aim and objective is to give safe blood to the patients and to bring closer the gap of demand and supply. Safe blood needs to be defined and someone may ask this question as which blood is safest blood? Blood from a person cannot be defined as safe scientifically while transfusing to a person. It is something foreign to the person or recipient, it is sure to induce some immune modulation to the patient and further risking the life of the recipient. However, blood and blood products processed in the blood banks are certified to be free from certain infections and antibodies and fit for transfusion to a recipient under drug and cosmetic acts. To make available right product at right time to the right person inculcates a lot of intricate processes and it depends exclusively on the transfusion service experts.

Blood transfusion services in Manipur face challenges of ensuring both a sufficient supply and the quality and safety of blood and blood products for patients whose lives and wellbeing depend on blood transfusion. Blood supplies need to be constantly replenished since whole blood and blood components have a limited shelf-life. Transfusion services in Manipur are in a battle to meet current requirements while at the same time responding to increasing clinical demands for blood. What can we do now to make up the requirement of our state? We need a foundation, a foundation of blood donors and its movement in Manipur. To make a farm and permanent foundation of blood donation movement, only motivation and awareness campaign on blood donation may not give much impetus on the blood donors and potential blood donors; we may need to start working right from the policy makers or game changers.

Inclusion of the motivational ideas and knowledge on blood and blood transfusion in the syllabus of the schools especially in the classes of the potential blood donors may be one of the options. For safety of blood transfusion we need to emphasise blood donation on voluntarism and altruisms. As per guidelines of NACO and NBTC, A voluntary non-remunerated blood donor gives blood, plasma or cellular components of his or her own free will and receives no payment, either in the form of cash or in kind which could be considered a substitute for money.

This would include time off work other than that reasonably needed for the donation and travel. Small tokens, refreshments and reimbursements of direct travel costs are compatible with voluntary, non-remunerated donation. Competing among different blood organisations, including private companies which pay for whole blood donations, might damage the altruistic attitude in society and leave us with a blood supply problem. Encouraging use of blood rationally among the blood users in clinical practice is also one option for achieving our target.Many experts are calling for a shift towards bloodless medicine and components.

But most of the practitioners are not aware of the situation we have.Their clinical orientations are not directed to the modern trends in transfusion practices. So there is always conflict of rational while transfusing of blood and blood products. Imparting the basic knowledge of blood transfusion and immunohematology right from the undergraduate medical syllabus during the 5 years UG course may also be one of the options to achieve country’s goal. While the demand for blood products in India is growing, demographic changes will lead to a decrease in the proportion of the young in populations from which most of our current blood donors come.

These demographic changes could lead to a shortage of blood products in the future, if not counteracted by modern donor management, recruitment of healthy people currently not donating blood and attempts to make the optimal use of precious blood donations. Blood substitutes, bioengineering and production of red cells, platelets and granulocytes are currently only feasible on a small-scale. Although it’s a promising field, there is probably still a long way to go and engineered cellular blood components are unlikely to enter into clinical use within the near future. This approach will not, therefore, improve the predicted shortfall in blood component supply in the coming years.

Future of blood banking services still has to depend on voluntary blood donation. Voluntary blood donation thereby is the first and foremost step towards achieving a safe and adequate blood supply. Counselling,IEC activities, personal contacts, group discussions, seminars, workshops, symposia, conferences, awareness programmes in different educational,religious,social organization, poster making competitions and exhibitions, video shows, TV talk show, programmes on AIR, motivational workshops with donor and motivators are some of the means of sensitizing the blood donation movement in Manipur.