Mumbai: “I have been on the phone talking to people for the last two days. I have barely gotten any sleep or had a proper meal,” said 27-year-old Shreya Mitra, a social media executive from Kolkata. Mitra, who has thalassemia, a blood disorder in which the body produces less haemoglobin, needs a blood transfusion every 14-16 days. It took her four days to arrange the one unit of blood (500-600 ml) she needed for her April 1 transfusion, she said.
“For the last 26 years, this has been my drill,” Mitra said, adding, however, that the lockdown has made things worse. After the area blood bank informed her transfusion centre it could not provide blood because of the lockdown, the centre held an emergency blood donation camp, but few donors came forward, Mitra told IndiaSpend.
The World Health Organization recommends that the blood requirement of 1% of a country’s population be used as an estimate of its blood needs. By this measure, India was short of 1.9 million units of blood a year, according to an IndiaSpend article published in June 2018. Experts said this is because India does not have a system to manage blood banks and not many people donate, unless someone in their family needs it.
The situation has worsened during the lockdown--hospitals are making do with fewer staff, and fewer donors are coming forward due to restrictions on people’s movement and the fear of contracting COVID-19 at a hospital or clinic, our reporting found.
Even before the 21-day lockdown began on March 25, the Maharashtra health minister had announced on March 23 that there was a shortage of blood and appealed to more people to come forward and donate. Since the lockdown, a similar situation has been reported from West Bengal and Odisha.
Few volunteers, restricted movement
Rajiv Chibber, a public health specialist, has been trying to arrange a donor for his 12-year-old son for the past three days. His son has thalassemia and needs a transfusion every 15-18 days, depending on his haemoglobin level, he told IndiaSpend.
Before the lockdown, Chibber would ask students and staff from his previous workplaces to donate, but people are now scared to come to the hospital, he said.
People do not want to go to blood banks, and especially blood banks within hospitals, because of the fear of getting infected with COVID-19, said Zarin Bharucha, a pathologist and chairperson of the Federation of Bombay Blood Banks.
The lockdown has restricted movement, so regular donors living far from a hospital or blood bank cannot donate, and finding new donors in nearby areas is a challenge, said Kavita Sassane, a social worker at Mumbai’s King Edward Memorial (KEM) hospital.
Chibber, whose son needs a transfusion, said a donor was ready to come to Indirapuram in Ghaziabad--which lies in Delhi-NCR but falls under the state boundary of Uttar Pradesh--while Chibber is across the border in Delhi. “It is very difficult for people to cross state borders due to constant police checking and lack of public transport to get around,” he said.
Even when people come, doctors will have to be careful about who is donating blood. Donors will have to be asked questions about travel history or contact with anyone who has travelled abroad, Bharucha said.
The other issue is a lack of staff, said Sassane of KEM in Mumbai. “Even if we find a donor, we do not have staff on call”, as many live in Nalasopara or Virar, at least an hour from the hospital, she said.
“We ask the patient's healthy relatives to donate blood for them,” Sassane said, of patients who are admitted. “But with the lockdown, the canteens and eateries around the hospitals are shut and these relatives have not eaten, and it would not be good practice to take blood from them.”
Elective surgeries on hold
This blood shortage exists despite most government hospitals putting all elective surgeries on hold. “We have patients with thalassemia, sickle cell and aplastic anaemia, and blood cancer, who need blood everyday, despite cutting down on all non-essential surgeries,” Sassane said.
Some 10-15 donors are coming each day, when the need is for 150-170, she added.
A similar situation exists in other hospitals. For instance, Chibber said, Indraprastha Apollo hospital in New Delhi, where his son would usually go for transfusions, has only 10 donors coming daily, down from the 200-250 before the lockdown. “The hospital has requested us (parents and relatives of the patients) to get at least five-six donors each,” he said.
Usually, Mumbai’s Jamshedjee Jeejeebhoy Hospital has a stock of blood to last a month, but they are currently down to 12 days’ stock, said Sadhana Tayade, the director of health services at the hospital, on March 26.
The situation is worse because there were almost no blood donation camps between January and March 2020 in Maharashtra because of the fear that blood might be COVID-19 contaminated, said Tayade. Emergency donation camps are happening now, she said, with special precautions.
Bharucha of the Federation of Bombay Blood Banks said they are making special provisions for blood collection camps with only five people present at any given time in order to ensure social distancing. The camp will provide sanitisers, dispose of waste carefully, and take all infection control precautions, she added.
Blood donation in India is seasonal, with fewer donations during vacations, said Suryaprabha Sadasivan, the lead for healthcare practice at Chase India, a Delhi-based public policy research and advocacy firm. Most of the blood donation in India is “replacement” blood donation, which means that if one is admitted to hospital and gets a blood transfusion from the blood bank, they must replace the same amount by asking someone else to donate, she said. “In India, there is no culture of altruistic donation,” she said. “Blood donation happens only when asked for.”
India can learn from African countries that conduct sensitisation workshops in schools and colleges to make children aware of the vital need of blood donation, said Sadasivan. It creates a cultural shift and convinces people to start donating early, she explained, adding that companies could provide non-monetary incentives for employees to donate blood.
Centralised planning, waste reduction
As of December 2019, India had 3,321 blood banks (2.45 blood banks per million people) and had collected 12.5 million units of blood in 2018-19, according to replies to questions in the Rajya Sabha and the Lok Sabha.
Blood usually expires in one month, and some cases in 45 days, Bharucha said. Plasma can be stored for up to a year and platelets for just five days.
If blood camps and banks are not organised well, a lot of blood could also be wasted, experts said. For instance, between 2014-15 and 2016-17, over 1 million units of blood were wasted every year, according to this reply in the Rajya Sabha from August 2017.
The National Blood Transfusion Council has guidelines on blood banks for reducing wastage of blood, which lay down rules to transfer blood between licensed blood banks. But as there is no centralised mechanism, not every blood bank follows these guidelines, said Sadasivan.
Various blood banks are owned by the government, private companies and nonprofits, which makes any coordination across blood banks difficult. So even if one blood bank has more units than they need, they might not be sharing the excess with a blood bank that has too few, she said.
To aid the process of transfer of blood, the Drug Controller General of India passed the Drugs and Cosmetics Amendment Act in 2016, allowing blood banks to send blood in bulk to other blood banks if they are not going to use it, said Bharucha. She suggests a hub-and-spoke model in which a centralised blood transfusion service would connect all blood collection centres and fill the gaps between supply and demand. This hub would transport the blood to different storage centres, or spokes, aided by digital tracking.
India already has an online database, E-RAKTKOSH, since 2016, which tries to reduce blood shortages through a digital, centralised blood inventory management system, but this system is currently not comprehensive, Sadasivan said.
Meanwhile, Mitra in Kolkata has found a donor for herself for April 1, 2020. But the entire process of looking for a donor has re-started as she prepares for her next transfusion on April 16, 2020, just a day after the lockdown is scheduled to lift.
(Salve is an IndiaSpend contributor.)
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