15 days, 6 requests, 4 transfers: Examples to emulate for rational use and power of collaboration

Bombay blood group transfers

We share the story of 6 blood requests which were handled between 17th Jan and 2nd Feb 2020 by Sankalp's Emergency Team.

17 Jan 2020 Rational blood use averts unnecessary donation for delivery in Bangalore:  We received a request for Bombay blood type for a pregnant lady due to deliver at Rajarajeshwari Hospital, Bangalore. She had a hemoglobin of 12gm/dl. In spite of healthy Hb count, the treating doctors insisted on having one unit ready on the shelf considering the rare blood type. One unit was available in K R Hospital, Mysore which we recommended to be transferred (blood bank to blood bank transfer). The treating doctors instead advised the family to shift the lady to KR hospital. The family did not agree to transferring to Mysore. Fortunately, the family was acquainted with a known specialist who spoke to our team. The specialist confirmed that with the hemoglobin on 12 gm/dl the chances of needing the transfusion are remote. The family is now all set for delivery together with the medical team and for now no one is insisting on the unit being made available on the shelf.

17 Jan 2020 Teamwork and planning avert needless donation in Ananthpur : Bombay blood type was requested from Snehalatha hospital, Ananthpur for a lady with gynaecological complications with a hemoglobin of 5 gm/dl. The doctors informed that they anticipated getting one unit from Ananthpur and one more donor may be coming in to donate. We requested the team to keep the donor on hold unless the situation was very critical and instead transfer the unit from Guntur. They transfused one unit and thankfully kept the donor on hold. The patient improved and neither more donation nor blood transfer was needed.

21 Jan 2020 Blood unit from Guntur transferred as backup for delivery in Chennai: A pregnant lady, due for delivery, admitted in Egmore Hospital - Chennai was detected with Bombay Blood type and a low hemoglobin. The treating doctors insist on having a blood unit on the shelf. Meanwhile Platelets donors club Chennai also came across the request and with their local support things became more manageable. It was a requirement to be "on a safer side" and hence we suggested that the ready unit on shelf in Guntur which was collected on 5th Jan 2020 be transferred (blood bank to blood bank transfer). Platelets club Chennai could locate a person traveling from Guntur who helped transfer the unit from Manipal Hospital Guntur to Egmore Hospital Blood Bank. The lady was not transfused and had a safe delivery. NOw the unit is reserved for a kid who is being treated in the same hospital with a hemoglobin less than 5 gm/dl.

22 Jan 2020 Unit from Mysore and Mumbai come in for surgery in Bangalore: A request for Bombay blood type was made from St John’s Hospital Bangalore for a patient who was due to undergo amputation with a hemoglobin of 10 gm/dl. We recommended that the available unit from K R Hospital Mysore be transferred. For some time there was some confusion over whether the medical team would accept a unit from K R Hospital Mysore. On 29th Jan 2020, the unit was collected to be used for this patient and the surgery happened. Post-surgery, one more unit was requested for which we recommended that a unit which is available in Mumbai be transferred in. On 2nd Feb 2020, the unit was also transferred from Sion Hospital Blood Bank – Mumbai, with the help of Team Sankalp - Mumbai and Think Foundation.

23 Jan 2020 Unit donated even though another one was available on the shelves: We received a request for a Bombay blood type from District Hospital Dharwad for a patient who was bleeding with a hemoglobin of 5.5 gm/dl. A unit which was available at Janakalyan Blood Bank, Nasik was recommended to be used for this patient. The medical team sought some time to confirm that they were willing to accept the transferred unit. After our discussion the medical team became unresponsive. They were apprehensive about the transferring blood unit. Later we realized that they found a donor from Gadag who donated. Patient has received the transfusion and is said to need no more units.

26 Jan 2020 Unit from Nasik makes its way to Madurai: We received a request for multiple units of Bombay blood type for a patient being treated at Velammal Medical College Madurai. The patient was reported to have a hemoglobin of 4.5 gm/dl through Platelets donors club - Chennai. At the same time, we had 2 requests for Bombay blood type for 2 patients in Bangalore with one unit available on the shelf in Mysore. There was another patient in Coimbatore who requested for at least 2 units. Family was screened and there were no donors found. At the same time there were units reported from Mumbai and Nasik on shelf. One unit was donated locally. Decision was taken to transfer the unit available with Janakalyan Blood Bank - Nasik with interim help of Samarpan Blood Bank - Mumbai to maintain the cold chain. It helped since we had Sankalp associates on ground in both the cities. There were logistics issues in using air connectivity to Madurai and hence the unit was shipped to Coimbatore on 30 Jan 2020 where a volunteer of Platelets club collected it and transferred to Madurai with reinforced cold chain. 

While these requests were being addressed there were 3 other requests which came in with partial information and no clear contact points, which we could not do much about. Gradually improving networking for rare blood types has vastly improved the collective ability to ensure right blood is available to the right patient irrespective of the regional limitations and challenges. The direction of work we have chosen is to rationalising blood use and collaborate and this seems to be paying rich dividends.

Structurally within team Sankalp we are happy that now we have multiple fully acquainted people specializing in managing rare blood type requests. This enhances our capability to ensure timely and appropriate steps are taken for each request. Additionally, the presence of on-ground Sankalp associates and partner institutions across several different cities in the country adds to our intrinsic capacity to get things done.

We would like to thank all the involved blood banks, medical teams, patient families, logistics providers, Platelets Club Chennai and Sankalp friends who worked together to let better sense prevail and continue to ensure rational use of rare blood types.

#RationalBloodUse #InterBloodBankBloodTransfer

Sankalp Unit
Patrika Section