25-Oct-2023-Special-Article

BLOOD TRANSFUSION IN INDIA – BLOODY MESS

The recent revelation of HIV and hepatitis infections among thalassemia patients receiving blood transfusions in a Kanpur government hospital highlights a grave issue within India’s healthcare system. With the country having the world’s largest number of children with thalassemia, the preventable nature of these infections underscores the urgent need for reform in the management of blood transfusions.

What is Blood Transfusion?

Blood transfusion, as defined by the American Red Cross Society, is generally the intravenous process of receiving blood or blood products. It is a medical procedure employed to replace lost components of the blood.

System of Blood Transfusion in India

The system of blood transfusion in India is intricately structured and regulated to guarantee the safety, quality, and accessibility of blood and its components for those in medical need.

NACO’s Role:

Key Player: The National AIDS Control Organization (NACO) has played a pivotal role since 1992 in ensuring the provision of safe blood throughout the country.

Network of Blood Banks:

India boasts a network of 1131 blood banks, strategically distributed across over 600 districts, primarily supported and coordinated by NACO.

National Blood Policy:

• The Government of India introduced the National Blood Policy in April 2002.
• Aim: The policy’s primary objective is to ensure easy access to sufficient, safe, and high-quality blood for medical purposes.

Regulatory Body – National Blood Transfusion Council (NBTC):

• Established in response to a Supreme Court mandate in 1996.
• Apex Policy-Making Body: Serves as the apex authority for formulating policies concerning blood and plasma-related issues.

Modernization and Quality Control by NACO:

• NACO has undertaken several initiatives to modernize blood banks, ensuring that the country’s blood supply remains secure.
• These efforts are directed at maintaining the safety and quality of the nation’s blood supply.

Transfusion-Related Infections in Thalassemia Patients

Prevalence: Among 14 thalassemia patients in Kanpur, 2 are now HIV-infected, 7 have Hepatitis B, and 5 have Hepatitis C due to receiving infected blood during transfusions.

Scale of Thalassemia in India: India bears the burden of 1-1.5 lakh children with thalassemia, with an annual addition of 10,000-15,000 new cases. A lifelong reliance on blood transfusions makes this population highly vulnerable to transfusion-transmissible infections.

Blood Transfusions in Chronic Conditions

Critical Role in Treatment: Patients with chronic conditions like cancer depend on blood transfusions as a crucial component of their treatment.

Invisible Crisis: Despite being a constant health emergency for many families, the demand for blood often goes unnoticed. Complications from malnutrition, anaemia, and pregnancy contribute to the high demand, and studies reveal that 25% of maternal deaths result from haemorrhaging.

Mismanagement of Blood Resources

1. Poor Supply Chain Management: The mismanagement of both whole blood and its components is evident throughout the supply chain. From collection to distribution, safety to storage, and accessibility for patients, critical resources are chronically misregulated.
2. Regulatory Gaps: Although regulations for testing and screening exist, monitoring is insufficient. Unscrupulous “blood banks” with outdated facilities exploit patients, and a thriving grey market in blood further exacerbates the problem.

Urgent Need for Reform

Haemovigilance Programme:

While the haemovigilance program promises to investigate the Kanpur case, it lacks the authority to penalize or correct systemic issues.

Investment and Collaboration:

States and authorities must invest more funds and collaborate to empower the National AIDS Control Organisation (NACO). NACO should mandate audits, establish strict standards, and procedures for blood banks and hospitals.

Empowerment of NACO:

Crucially, NACO should be granted the authority to penalize blood banks and hospitals, ensuring accountability and preventing future tragedies.

Conclusion

The distressing incident in Kanpur serves as a stark reminder of the urgent need to address the mismanagement and lack of accountability in India’s blood transfusion system. With the highest number of thalassemic children globally and a growing population with chronic conditions, systemic reforms, increased investment, and collaborative efforts are imperative to prevent further tragedies and ensure the safety of patients relying on blood transfusions across the nation.

Mains Question:

1. Discuss the multifaceted challenges in India’s blood transfusion system as highlighted by the Kanpur incident, emphasizing the role of NACO, the regulatory framework, and the need for comprehensive reforms. Propose policy measures that can address the mismanagement and lack of accountability, ensuring the safety and accessibility of blood for patients across the nation. (250 words)