Our study of complications related to blood donation being published in Asian Journal for Transfusion Science

What do we do as a voluntary organisation when we confront with a problem that affects the donors and the interest of voluntary blood donation as a whole? There are choices. There is the choice to create awareness about the problem and hope that someone will take notice and solve it. The other option is to petition the Government and other stakeholders to try and take the problem up and find answers. Then there is the approach that we took. We decided to own the problem and commit ourselves to finding the root cause of it, explore what can be done to mitigate the problem and help shape a solution to it. It is this drive and intent which pushed Sankalp India Foundation to work upon the problems faced by voluntary blood donors post their donations. We chose a blend of common knowledge, best available guidelines and technology to create a system with which we could observe, measure and understand complications associated with blood donation. The intention was very simple – “to make blood donation safer". We studied the existing practices in the blood donation camps, relooked at our own experience and realised that common definitions and structure was essential to do any meaningful assessment. Fortunately, the pinnacle of blood transfusion medicine, International Society of Blood Transfusion Working Party on Haemovigilance together with European Haemovigilance Network had setup a working group on Complications Related to Blood Donation in 2008. The outcome of this group was an internationally acceptable standard for “Surveillance of Complications Related to Blood Donation”. This document gave the definitions and the interpretations which would make it possible to harmonise various organisations. We also organised necessary consultation and trainings to be able to systematically study every single complication which was observed in our drives. Sankalp recognises the power that information technology brings to the forefront. We also augmented our already powerful blood donation camp management software with tools to be able to capture and analyse all aspects of complications. With everything in place, the challenge of implementing the whole things lay before us. In general, our society trains us to ignore problems instead of confronting them. The dismissive attitude towards complications was so deep rooted in the blood banking setup that in order to get the teams to start calling a spade as a spade was an enormous task in itself. The bigger challenge was to convince people that rather than looking at it at a very personal level, rather than looking at it from a mistake and punishment kind of logic, they had to embrace this as a genuine attempt to find the root causes and participate in addressing the problems. The initial few months were tempestuous. But with the will to secure the best interest of the donors and with the strong support of the advisors and guides of the organisation we were able to regularise the process of donor side hemovigilance – the process of assessing donor complications. Three and a half years and one hundred and eighty one blood donation camps later we decided to consolidate our findings. The summary was named – Complications related to blood donation: A multicenter study of the prevalence and influencing factors in voluntary blood donation camps in Karnataka, India”. The time spent and the experience gained had already convinced us as on organisation that donor side hemovigilance would continue to be an inseparable part of each of our blood donation drives. Our findings not only put a quantum to the problem, not only helped understand the contributing factors but also laid out clear path ahead for mitigation. The mission seemed successful. However, one step remained. Quoting from an article “Knowledge, Open Access and Us” from Sankalp Patrika May 2015, Vol 5, Issue 5 (http://goo.gl/hKw5jF) – “Let us commit ourselves to do pioneering, original and insightful work nothing short of the best in the world and then share it. We in India have a unique position of opportunity and scale. This puts us in a far better position to do original work. We need to think forward and go beyond the tendency to see compliance to the standards laid out by the West as our further most limits. We need to start innovating while maintaining (or even surpassing) the most stringent levels of scientific scrutiny and evidence based approach. We need to get more comfortable and in tune to large studies carried out with strict commitment to quality and standards across multiple institutions in a way that enhances the confidence to the research. There is a need to replace the 'me' with the 'we'. There is a need to start looking at the benefits more from a 'global' than a 'personal' point of view.” In-line with this spirit and intent, we subjected out findings to scientific scrutiny and requested for to be accepted for publication in one of the most reputed open-access journal in the field of blood transfusion medicine – “The Asian Journal of Transfusion Medicine (AJTS)”. The journal accepted our publication for review. What came as a delight were the encouraging comments of the reviewers. After ascertaining that our findings were sufficiently novel, worth sharing and of interest to the larger audience, AJTS accepted our work for publication as original article. This publication is unique in a manner that it assesses the full spectrum of complications across multiple institutions (blood banks) and for a huge number of donors and complications(30,298 and 995 respectively). For the very first time we have data which explains the problem at a more systemic level. Now we know what to expect, what is contributing to what is happening and what is likely to control it. Donor side hemovigilance has been implemented, demonstrated and proven in the reality and scale of our country. So, does the journey, at least as far as complications is concerned, complete for the organisation? Of course not. Now is the time to use the findings and make blood donation safer for donors. Now is the time to have wider adoption of the best practices and most importantly stop the dismissive attitude towards donor discomfort. We are both open to and very welcoming of collaboration and knowledge sharing. We welcome blood banks, medical staff and institutions in general to participate with us in the joint mission to make blood donation camps safer. We are grateful to the blood bank teams which understood the intent of the whole program and participated in making the whole program possible. We would like to thank Dr Sundar Periyavan, (Department of Neuropathology, Transfusion Medicine Center, National Institute of Mental Health and Neurosciences, Bengaluru) whose participation and guidance strengthened and enabled the whole program. Of course the technology made available by Jagriti Innovations provided the backbone for this work. Most organisations where we organised blood donation drives are concerned about adverse events. It is quite clear to them that nearly 3-5% donors may face a complication of some sort. However, many of them have expressed confidence and satisfaction at the way it is managed. Hence we also gained the confidence of donors and organisers which quietly contributed to the successful implementation of the protocol. It was important and imperative for us look at all stakeholders and place our proposition well. The protocol in itself (on the basis of which the scientific paper was based) is a journey towards something unique and looks to address 4 crucial aspects related to complications: Identification, Prevention, Management and Documentation. Over the years, after the blood donation drive blood banks have come back with various arguments claiming classification of complications have been incorrect. The only answer we have is the protocol. Then there is acceptance. We strongly recommend using this protocol as an integral part of blood donation drives. Introduction: Complications associated with blood donation significantly lower odds of subsequent donations. The aim of the study is to assess the prevalence of complications related to blood donation, identify the influencing factors, and come up with suggestions for minimizing discomfort to donors and making outdoor voluntary blood donation camps safer. Materials and Methods: This study covered 181 blood donation camps organized by Sankalp India Foundation where 16 blood banks participated from 01-04-2011 to 01-08-2014 in Karnataka. Uniform protocols for donor selection, predonation preparation, counseling, postdonation care, and refreshments were used. The postdonation complications were recorded on a form immediately, after they were observed. Results: We observed 995 (3.2%) complications in 30,928 whole blood donations. Of these 884 (2.86%) mild, 77 (0.25%) moderate, and 5 (0.02%) severe complications were observed. Local symptoms (blood outside vessels, pain, and allergy) contributed 1.0%, and generalized symptoms (vasovagal reaction) contributed 2.2% to all the complications. Conclusion: We observed 322 complications for every 10,000 donations. Since 27 out of every 10000 experience moderate and severe complication, the readiness to manage complications is crucial. Women donors, young donors, and donors with a lower weight are at a significantly greater risk of experiencing complications, highlighting the need for specific guidelines for the management of higher risk donor groups. Complications varied significantly between various blood banks. Predonation hydration was effective in limiting complications with generalized symptoms. We recommend a robust donor hemovigilance program for voluntary blood donation for monitoring complications and enable assessment of effectiveness and implementation of appropriate interventions.