A robust and comprehensive health infrastructure includes a well maintained and efficient network of human blood banks for collection, testing, storage, and distribution of blood to meet the transfusion requirements of the local population. Blood transfusion is needed in situations of loss of blood due to accidents, injuries, in surgical procedures etc.
Transfusion on a regular basis is necessary for some blood related disorders (e.g., thalassemia). Patients undergoing treatment in certain types of cancer, cases of rapid fall in platelets, haemoglobin etc.., also need supplement of blood or blood components.
The National Blood Policy was adopted in 2002. The focus was on sufficient voluntary blood collection, blood safety to prevent transfusion transmissible infections and access to safe blood across the country. National and State Blood Transfusion Councils were envisaged along with a network of blood banks and blood storage centres in a hub and spoke model. Blood is considered as a drug under the Drugs and Cosmetics Act,1940.
Hence licensing and regulation of approximately 4,000 blood banks in India is undertaken under this Act. Of our estimated blood requirement of about 15 million units per annum, we meet nearly 85 per cent of the demand. Our goal is voluntary blood donation rather than replacement blood sourced from relatives of patients. For macro management, E-Raktkosh is in operation, though all blood banks do not, as yet, regularly report to this Kosh. Mandatory testing of blood to be transfused is done for Hepatitis B and C, HIV, Malaria and Syphilis. However, Nucleic Acid Amplification Testing (NAAT) method, which is superior in terms shorter window for undetected Hepatitis/HIV infection, is not yet made mandatory largely on cost and infrastructure considerations.
While we have achieved considerable success in the realm of blood availability for transfusion, we need to step up efforts in providing world class health services.
Policy steps
The statutory framework of Drugs and Cosmetics Act,1940 is not sufficient for regulation and promotion of blood banking and related issues. We need a specific central legislation to focus on blood collection, testing, storage, distribution, access and related matters. This legislation will mandate adoption of uniform standards in every State/UT, Blood bank, hospital, storage centre etc., along with penalties for violations.
The hub and spoke model for blood collection, testing, storage and distribution must become a vibrant reality. This will reduce infrastructure investment requirements, permit aggregation of blood units at hubs, facilitate testing of blood prior to transfusion and promote efficient management of blood banks.
In this age of social media, we must leverage the social media reach and influence, to effectively promote voluntary blood donation.
Simultaneously, blood safety focus needs to be escalated. Mandatory NAAT testing for Hepatitis B, C and HIV should be the norm. While NAAT technology is expensive, we can work to reduce the per unit cost of NAAT testing. India has one of the largest numbers of blood banks in the world. We should use our strength of numbers to get lower prices.
An issue which is already in our Blood Policy but merits more attention, is utilising in full the blood which we collect. For this, we must segregate the blood components (packed red cells, fresh frozen plasma, platelets) and use whichever component is required for the patient. Surplus plasma is used for various products like albumin, immunoglobulins etc.
Patients with blood related disorders deserve special attention. Testing prior to childbirth at the appropriate time can detect some of these disorders such as Thalassemia.
Time is now ripe for a big leap in our blood banks and blood transfusion sector. We should convert the opportunity into reality.
The writer is Former Secretary, Government of India