Blood Banks & India

According to the World Health Organisation South Eastern Asia's estimated blood requirement is about 15 million units, but collects annually about 9 million units, leaving a gap of 6 million. India with its huge population is lagging behing in blood collection. India has 2,433 blood banks that requires 9 million units of blood annually, but collects only 7 million.

With 909 government promoted blood banks, 362 voluntary organisations, 684 blood banks associated with private hospitals and 500 blood banks owned by private charity organisation, the blood bank services sector is highly fragmented in the country. Relatively smaller countries like Singapore, Thailand or Sri Lanka blood transfusion services are centrally coordinated and doing best job. Most of the hospital based blood banks in India often force the patient relatives to replace blood unit. Though the voluntary donations are increasing (45% in2002 to 53% in 2008) this is very common in hospital based government and private blood banks leading to all sort of malpractices. Many blood banks show replacement donations as voluntary donations on record. It is difficult to track later.

In India, the ratio of use of blood components to whole blood is 15:85, while globally it is 90:10. This shows how poorly equipped we are. Many blood banks in India still not equipped to make components. They also try to malign the one those who seperate components attaching relegious values. Most of the blood banks issue whole blood. Even mejority doctors prescribe whole blood, without understanding advancement in transfusion medicine. As a result they contribute to shortage of blood in the country and also overburden the patient unnecessarily causing harm at times. Blood Transfusion reactions are common in whole blood transfusions.

Many government and private blood banks are very poorly equipped posing threat to the health care system. At present, India follows a procedure of mandatory licensing under the Drugs and Cosmetics Rules for blood banks. According to Gupta of NACO, only 500 blood banks in India can be termed as “big banks” because they collect more than 10,000 units annually. Nearly 600 of the rest are “small banks” that collect a paltry amount of 1,000 units a year. Most of the 2,433 blood banks are moderate — they collect 3,000-5,000 units of blood a year. “Probably, 90% of Indian blood banks still do not have the first level quality documents like quality policy and quality manual probably because it is not mandatory under drugs and cosmetics Act in India”[1]. says Dr.N.Chowdury from a reputed blood bank.

There is always shortage of blood in blood banks not because there are not enough donors but because the blood banks faile to organise voluntary blood donation camps and just depend on replacement donations. As a result there is always pressure on patient to procure blood when needed. This is one of the worst condition in Indian health care system. According to the protocol specified by National AIDS Control Organisation, 25% of all blood collected by a blood bank has to be kept aside as buffer stock, to be used only in case of an emergency.[2] “Of India’s 2,433 blood banks, only 20% maintain the buffer stock. The majority are so small that they don’t even know how to handle an emergency…”said Debashish Gupta of NACO. According to Gupta, "AB+ plasma, O+ and O- blood stocks are vital in case of a terrorist attack when lot of patients require blood. O- is given to children and women of child-bearing age while O+ is given to men and women in menopausal age".

What needed is concerted action by blood donors and patients. Patients should refuse to replace blood with the blood bank if it demands replacement. It is the duty of blood bank to manage blood. However mobilising voluntary blood units is difficult job involving intensive campaign, motivation and spending considerable resources on it. As a result some blood banks try to get it from replacement system. But those who can not manage a blood donor for replacement depend on touts soliciting to help at a cost. The Lucknow incendent is reflection of blood banking in India where a mediator started selling spurious blood collected from drug edicts and animals. On the other hand some political entities to get name and fame force donors to donate blood in camps. Rajasthan school blood donation incendence reveals such attempts. Here I am not talking about exceptions but trying to understand general scenario. The net result is many poor patients still depend on touts outside some hospitals selling blood at Rs.300. The scenario must change and good quality and safe blood banking should evolve in India.

[1] 02,Feb 09, Indian Express. ‘7blood banks to get quality certification’ Sandip Das etl.

[2] 27^th May 08, Indian Health News. Medindia. ‘Shortage of blood in India…’