Our guidelines are comparable to global standards; however, we fall short when it comes to good monitoring mechanisms. We also see a huge disparity between blood banks in the urban areas and those at district levels. Laws regarding blood transfusion services are part of Drugs and Cosmetics Act. Blood is under the regulatory control of Drug Controller (General) of India, the central licensing authority which is assisted by the State Drug Controllers. The National Blood Transfusion Council (NBTC) and State Blood Transfusion Councils (SBTC) are advisory in nature. Despite availability of consensus guidelines, inappropriate blood transfusions happen and not all collected units are converted into components, reporting of adverse events after transfusion is poor and donor deferral system is practically nonexistent. So, despite multiple agencies there is poor monitoring and control. We should consider a single autonomous agency manned by people with experience in transfusion medicine.
Role of technology
Transfusion medicine is a branch which has benefited tremendously from technological advances. This is evident as far as blood safety is concerned. Nucleic acid test (NAT) testing has increased the sensitivity of detecting transfusion transmitted diseases and cut down the window period. Complete automation in red cell serology and interface with computers has cut down chances of human errors. Viral inactivation of blood and its components (there may still be few undetected and unknown viruses) by heating, ultraviolet irradiation, and use of alkylating agents and solvent detergents can further increase blood safety.
Software-based blood bank management systems though not much in use now are the way forward. It will help with quick communication with donors, thus helping in increasing repeat voluntary donations. It can give stock updates ensuring utilisation of near expiry stocks. It also can make monitoring and auditing easier.
In the future if we have a centralised distribution system, RFID technology can be used to track blood bags.
Challenges to be conquered
The biggest challenge is a steady supply of safe blood. Also, recruitment of voluntary donors who are committed and will be repeat donors. Information, communication, and education to first time donors, so that they overcome their fears and prejudices cost a lot in terms of time, effort and funds, which are often scarce.
There is unfortunately no centralised system to co-ordinate services and stocks so the deficit can be anywhere between 20-40 per cent. It also leads to wastage of blood or components in a few setups.
The control on pricing deters the industry from implementing latest technologies as the cost implications would be high.
We also need to find ways to increase longevity of blood and at the same time ensure that the clinicians are willing to accept that blood.
The future path
Transfusion medicine would evolve into transplant immunology centres, which would test for HLA antigens and provide cross-matching facilities prior to transplant. Stem cell registries, cord blood banking, and tissue banking could be the way forward. Haematopoetic stem cells for bone marrow transplantation can be obtained from peripheral blood by apharesis.
– Dr Charu Pamnani, Head – Laboratory Medicine and Quality, Wockhardt Hospital
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