ISBTI Karnataka organised the annual CME at VIMS Bellary on 23-34 February 2013. Sankalp India Foundation was invited to give a talk on "Our Experience With Bombay Blood Group". The CME coincided with the first ever international transfer of Bombay Blood Group organised by the organisation. The CME gave the organisation an opportunity to share with the blood banking community of Karnataka, the work done, the essential learning and the roadmap to take care of Bombay Blood Group need in specific and rare blood groups in general.
The organisation shared the fact that within this (financial) year the organisation had taken up 50 blood requests totaling to 101 units till the date of the presentation.
With most of the donors and the needy coming from the Southern states, the current estimates of the prevalence of Bombay Blood Group (1 in 17,000) don't seem accurate. The number of requests has risen multi-fold in last few years. This clearly indicates that in the last few years there is a good reason to believe that there were fewer detection of the cases where Bombay Blood Group was needed. Sankalp also shared the story of the child who is thalassemia and for whom blood is being organised since last 2 years.
Situation and Detection
Based upon the findings during the process of handling the blood requests the organisation made the following observations:
- We are not detecting as many BBG as we should. The number of requests simply indicate that we must have more people with Bombay blood group getting detected in regular screening.
- Not everyone is doing enough Bombay Blood Group(BBG) tests. There were several instances when blood banks read BBG as O+ve as issued blood leading to severe hemolytic reactions. Several regular Bombay Blood Group donors shared the fact that they had donated blood several times before the blood banks discovered and communicated to them that their blood group was Bombay blood group. This clearly indicates that several individuals with BBG are going undetected.
- Testing at time of issue it is futile as it leads to wastage. Several units of BBG expired because they were detected to be BBG at the time of issue, leaving a very short window for proper utilisation of the units.
False Detection
False detection and improper transfusion has been a major problem with BBG. Not only centres in low resource areas but also in prominent centres have been wrongly detecting blood groups.
- Within 2012-13 we have had 5 instances of incorrect detection of blood group followed by wrong transfusions causing severe haemolytic reaction and more complications.
- The patient ended up needing more units of blood than what would have been required initially.
Problems with Availability
With 10 units required each month Sankalp pushed the limits to ensure that each willing donor and each donated unit was used optimally. Following issues were observed:
- Several small lists of Bombay Blood Group donors were being maintained. Sub-critical mass leading to staggered availability.
- There were attempts to reserve the donors for donations for specific institutions.
- The good donors, who donated regularly were being called by everyone – emotional blackmail was rampant! They were sometimes donating in less than 90 days simply because of the pressure.
- Remaining units post procedures were not being utilised and reported proactively.
Management
- Educate, motivate and encourage. Sankalp has been persistently working to increase the general level of awareness about matters relating to rare blood groups among all stakeholders.
- Sankalp is promoting regular testing for Bombay Blood Group right when O group get's detected.
- BBG screening is done for all donors who donate blood in camps organised by Sankalp
- Sankalp Patrika regularly stresses the need for regular BBG screening.
- Ensure networking and easy information flow between blood banks about need and collection of Bombay Blood Group. Helpline numbers 9880132850 / 9886064563 / 9900161551 are being promoted so that the blood banks can exchange information about BBG.
- Get all the donors together to form a larger pool. BombayBloodGroup.Org has become the common platform for all individuals with BBG.
- Setup effective cold chain to enable long distance transfer of units
- Aggressive usage of methods to minimise blood usage
Cold Chain and Logistics
Minimum discomfort to donor. Minimum cost to patients
The following is required and is being worked upon to ensure proper availability of blood across the geographies.
- Temperature controlled logistics for 4, 4-12, and more than 12 hours is being put to use.
- Resolution of regulatory and legal requirements for transfer
- Liaison with airlines and blood banks nationally.
- Consideration for poor patients to make blood available without additional costs.
- Crisis management protocols well understood by volunteers and organisations to handle difficult situations.
Aggressive use of alternatives and managing with lesser blood
Sankalp is promoting the use of blood alternatives aggressively to reduce the number of BBG that are required.
- Family screening for all eligible and non-eligible family members is being organised
- Use of EPO(erythropoietin)
- Autologous donations wherever applicable
- Intra-operative blood salvage
- Double red cell donations (apheresis)
- Move to better centres – conservative procedures and better equipment
Recommendations: Blood Banks
- Do BBG test at time of collection
- Communicate collection of BBG immediately
- If unutilised intimate network
- Share donor details
- Learn proper packaging and transportation essentials
Recommendations: Donors
- Connect and network
- Keep hemoglobin high
- Screen all family members – whether they can donate or not!
Recommendation: Authorities
- Make Bombay Blood Group screening at time of collection mandatory.
- Make it mandatory for airlines to transport Bombay Blood Group Units – Possibly free of charge.
- Come up with a clear policy for national and international transfer of blood and leave regulation in the hands of just 1 department.
- Provide facility for cryopreservation – But . . do we have enough units to be able to spare some for cryopreservation?
From the trends, the demand and the difficulty in organising for each unit it clearly looks like the journey for BBG in specific and rare units in general has just begun.