Preventing wastage of donated blood

Prof. (Dr.) Dharmakanta Kumbhakar

(drkdharmakanta1@gmail.com) 

 Blood is considered to be an essential element and the living force of human life, with no substitute. Nothing is comparable to the preciousness of human blood. Safe blood/blood component transfusions are an important component of the modern healthcare system and, most of the time, a life-saving one. Every two seconds, someone in India needs a blood or blood component transfusion. In many cases, people lose their lives because of the non-availability of quality blood and blood components. India’s estimated annual blood requirement is nearly 15 million units, but only 11 to 12 million units are collected. While this is one side of the coin, the other side indicates that, on average, every year, many blood/blood component units are wasted in India before reaching the needy on time. The worrying part is that about 50 percent of the wasted units are plasma, which has a shelf life of one year as compared to whole blood and red blood cells, which have to be used within 35 days. This exposes the serious loopholes in the nation’s blood banking system. The blood banking systems are in need of an overhaul in most places in India.

Blood is considered to be wasted when it cannot be transferred to a patient for technical reasons, which include faults in storage or date expiration. This excludes the discarded seropositive blood screened for transfusion-transmitted infection. Many factors lead to wastage of blood and its components in India, like broken bags, broken seals, burst packs, contaminated packs, under-donations, clotted donations, delay in conducting tests, problems with manufacturing and testing of blood components, lack of proper storage, expired units, over-ordering, improper transport, unused returns after 30 minutes, etc. Most of these factors happen due to a lack of proper knowledge and awareness. Care must be taken in the storage, transportation, manufacturing, and testing of blood components to reduce blood waste. Proper additive solutions should be added to enhance shelf life and reduce waste. The blood bank staff should issue the short-expiry blood products first to reduce the expiration rate.

Mega blood donation camps should be avoided to minimise blood waste. A collection of up to 500 units of blood at a camp is acceptable and manageable. Where is the place to store so much blood if more than 2000 units of blood are collected at a megacamp? It is estimated that 10 to 20 percent of the blood collected at such donation camps is wasted because of a deficiency in storage facilities. It is crucial to ensure that collection and distribution are equitable. India needs a sustained blood donation campaign. We need to create noise about blood donation, but all year long. Instead of organising mega blood donation camps, frequent and small blood donation camps should be organised at regular intervals, depending on demand. Moreover, the blood banks should maintain a list of blood donors (donor database) and call on them to donate blood when necessary to fill up the gap between demand and supply.

The hospital blood transfusion committees should monitor and record the wastage of blood and its components. After reviewing the waste data, the committees should take proper measures for donor blood management and patient blood management to reduce blood waste. It is seen that blood products are often ordered but not used. To reduce blood wastage, the treating doctors should decrease overordering, encourage rational blood transfusion, and instead of keeping the blood products in wards or ICUs, should return them to the blood bank within half an hour if not used.

Whole blood continues to be the most widely used blood product in India. Whole blood is a source of red blood cells, and this leads to the waste of other components such as plasma and platelets. We should develop a zero tolerance for whole blood except in special situations and work towards 100 percent components. There are only around 40 percent of blood banks in India with such component separation facilities. Around 25 percent of blood banks in Assam have blood component separation facilities, which is indicative of their outdated blood banking methods. The sooner blood component separation facilities are installed by all blood banks in India, the lesser will be the wastage of blood.

Lack of synergy between donors, blood banks, regulators, hospitals, and receivers is leading to the wastage of blood in India. Assam has an online system (e-blood bank software) to bring synergy in this regard where the blood banks are supposed to update their stock status in real time so that those in need of blood can contact the respective blood banks and the blood is used before its expiry, but this system has been underutilized. Lack of exchanged blood and blood components amongst hospitals also affects proper utilisation. The new amendments in the Drugs and Cosmetic Act, 1940, brought into effect on April 3, 2017, allow the transfer of human blood and its components under prescribed storage conditions from one blood bank to another. The amendments were recommended by the National Blood Transfusion Council in 2015. This will allow sharing the excess units of blood and its components with other blood banks; this will reduce blood wastage.

Blood is a valuable resource, and its wastage could have a very serious impact on the healthcare system of the country. Ideally, in a proper setting, outdating and wastage of blood and its components would never occur. Due to the inherent need to have blood stocks at all times and the often unpredictable demands on the inventory, a very limited and inevitable outdating of blood and its components in the blood bank is accepted. The institutional blood and its components waste should be less than 1.0 percent of the units issued. But India wastes about 5.4 to 5.9 percent of the blood and its components every year. The figure is alarming because blood shortages are a chronic problem in India.

All hospitals, private and public, blood banks, and government authorities should implement proper regulations to prevent such blood wastage in the future.