World Patient Safety Day: How safe is blood transfusion?

New Delhi: On the occasion of World Patient Safety Day observed on 17th September, Thalassemia Patients Advocacy Group (TPAG) has stressed on the importance of safe blood transfusion for everyone and more so for thalassemics, cancer patients, dialysis recipients, etc who are regular recipients of blood and run the risk of even losing their lives if exposed to transfusion-transmissible infections (TTIs).

“Thalassemics India is extremely proud to have undertaken the pioneering initiative of creating a body like TPAG. In doing this, we have fully empowered qualified and informed patient advocates to take forward the journey of not only protecting the interests of thalassemics but also of establishing the importance of patient participation in policy making. We stand right behind them in their path breaking efforts related to patient safety.” said Deepak Chopra, Co-Founder & President, Thalassemics India.

A recent report released by NACO reveals that 14,474 cases of HIV have been caused due to unsafe blood transfusion in India.  Being a vital healthcare resource, blood is routinely used in a broad range of hospital procedures and therefore, such TTIs can happen to anyone who, for some medical reason, undergoes a blood transfusion. It may be possible for an otherwise normal mother to come back home with a TTI like HCV, HBV or HIV after delivering a baby, just because she had to undergo a transfusion around the delivery time.

 “Safe blood is one of our focus areas and we are committed to partnering policy makers in propagating, implementing and advocating best practices related to blood in India. To achieve the objective, all aspects of blood safety, including blood donation, transfusion, and screening technology will need to be covered. In our efforts, we will try to address some difficult questions- what it costs to prevent a TTI in comparison to treating one (and, TTIs like HIV are incurable!)?; Can a patient getting transfusion in Jharkhand get a different quality of blood than one sitting in Bengaluru? Is there a golden standard for blood screening across India or a mechanism that allows one blood bank to pick a screening method different from another blood bank and do blood banks need to keep in mind repeat recipients of blood while making these choices? And, should patients move from a safer technology to a less safe technology due to compulsions of Covid-19? said Anubha Taneja-Mukherjee, a legal & policy advocacy professional and Member Secretary of TPAG.

On the point of repeat recipients and on the occasion of World Patient Safety Day, Dr R N Makroo, President Indian Society of Transfusion Medicine Regional Director Transfusion Medicine Medeor Group of Hospitals Delhi NCR commented, “Blood Transfusion is lifeline for Thalassemia patients and accordingly they should receive the safest possible Blood. Although there is no Zero risk blood but by adopting best transfusion strategies which includes provision of blood from regular repeat voluntary non remunerated blood donors. Latest and best testing technologies for infectious marker screening (HIV,HBV& HCV)Including NAT testing to narrow the window period transmissions of these infections. Type & Screen Policy including provision of red cell antibody Screening & identifications If antibody screen is positive then provision to provide red cell antigen negative blood. In order to have safe blood of uniform standards for all patients the Country needs Centralized blood collection & testing”

Voluntary blood donation is the first step to ensure safe blood. India currently has over 2800 blood banks in the private and public sector. In the past few years, India has seen an increase in blood collection (from 9.8 million units in 2012-12 to 11.45 million in 2017-18). However, India still has blood shortage of ~ 1.95 million units. As per the WHO recommendation, blood requirement should be between 1%-3% of a country’s population. Voluntary blood donation, therefore, clearly requires a boosted dose. And, blood shortage during Covid-19 has made this fact even more pronounced. E-Rakt Kosh launched by MoHFW is a great step in the direction.

Voluntary blood donation must be ably supported by other recommended practices and tests in order for blood to be safe. It is understood that, while practices like patient counseling may just need stricter implementation, screening may need a much deeper assessment, to prevent deaths by Transfusion Transmitted Infections (HCV, HIV, HBV, etc). India needs to assess the superiority of Nucleic Acid Testing technology (NAT) method as a safe option for blood screening since it ensures 99.99% blood safety.

The focus of the government on TTIs is clear through the National Viral Hepatitis Control Programme, which is in line with the Sustainable Goals. Moving towards “zero-risk” transfusion of blood is critical for the success of the Programme. Stringent testing guidelines and monitoring of policy implementation is required in this regard. This, in turn, requires consolidated data-driven impact assessment of various clinical test combinations, algorithms and thorough cost-benefit analysis to arrive at a combination suitable and practical for India. It may just be the case that we are spending more on the treatment of TTIs (not that all can be treated) when it is possible to prevent them by strict implementation of guidelines related to blood transfusion and by further harmonizing and mandating uniform screening methodologies across India. It may be time for #OneIndiaOneBlood!