India is striving to achieve the target of 100% voluntary blood donation by 2020. National Blood Transfusion Council, National AIDS Control Organisation, Federation of Indian Blood Donation Organisations and all other stakeholders agree to the goal. The primary focus appears to increase voluntary blood donation to meet the ever growing demand for blood in the country. Is increasing supply to meet the demand the only way?
World-over there is acknowledgment of the need to make more judicious use of blood. The WHO manual on clinical use of blood states “The appropriate use of blood means the transfusion of safe blood products only to treat a condition leading to significant morbidity or mortality that cannot be prevented or managed effectively by other means.” No large scale randomised study has been done in India on the subject so far. However, numerous studies from individual institutions have shown that there is wide scope to rationalise the use of blood in our setup.
In last few years, researchers worldwide have agreed that by making use of blood in a more conservative manner, better outcomes are achieved than with liberal use of blood. Borrowing from Evidence Based Medicine Save blood, save lives “Between 2007 and 2014, at least six more large, randomized trials were published, each comparing restrictive guidelines to liberal ones. These trials enrolled patients with a wide variety of conditions septic shock, traumatic brain injuries, gastrointestinal bleeding as well as children in intensive care, adults undergoing cardiac surgery and older adults having hip surgery. All six studies revealed that patients fare just as well, and sometimes better, when doctors use lower haemoglobin thresholds.”
Yet, in our setup we continue irrational use of blood even for situations like management of anaemia in strict contradiction of the international and national guidelines. Our setup continues to ignore the simple strategies to limit blood use like the correction of anaemia and the replacement of depleted iron stores before planned surgery. There is also very limited use of simple alternatives to transfusion, such as intravenous replacement fluids, which are safer, less expensive and may be equally effective. The opportunity to reduce the inappropriate use of blood in our country is huge.
Backed by solid evidence from multi-disciplinary randomised controlled trials, the developed world has taken note of the importance to work towards making judicious and rational use of blood. Consider this. Blood transfusions have been on a decline in USA since 2009. “Transfusions are down almost one-third over the last five years, to about 11 million units last year from about 15 million units, according to the American Red Cross,” .
"The fact that we are struggling to match our blood demand, the fact that the medical outcome is better with rational blood use, the fact that the several developed countries have already established the need to reduce blood transfusions and have started making progress on this goal together point to the need for our nation to take immediate note of this and work towards rationalising blood use."
While we strive to increase the donation of blood, we must also start discussing the need for safe and appropriate use of blood. We request people involved in blood banking to give this a thought and participate in building a momentum. It is also an opportune moment for hospital based blood banks to study the utilisation of the blood they issue. Sankalp India Foundation will be happy to provide the necessary support for the same. Let us continue to remind ourselves that the way forwards to achieve safe blood for all is also to work towards judicious use of blood.
- 1. Anthes E. Evidence-based medicine: Save blood, save lives. Nature 2015;520(7545):246.
- 2. WALD ML. Blood Industry Shrinks as Transfusions Decline. N Y Tiimes [Internet] 2014;Available from: http://www.nytimes.com /2014/08/23/business/blood-industry-hurt-by-surplus.html