|Year : 2020 | Volume
| Issue : 1 | Page : 51-53
Bulk transfer of blood and its component: A single-center experience after 2 years of its implementation
Blood Bank Department, I/C Blood Bank, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
|Date of Submission||01-Feb-2020|
|Date of Decision||25-Feb-2020|
|Date of Acceptance||28-Feb-2020|
|Date of Web Publication||17-Apr-2020|
Blood Bank Department, I/C Blood Bank, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
Background and Objectives: BTS in India is highly decentralized and lack many vital resources. National blood policy also depicted safe and adequate blood supply. An Important initiative that can lead to increased efficiency of blood transfusion services (BTS) in our country namely bulk transfer of blood permitting the exchange of blood among licensed blood bank was taken by NACO in the year 2015. In this study we tried to understand the impact of bulk transfer policy in bridging the gap between demand and supply and also prevent the wastages of precious blood resources. Material and Methods: Retrospective analysis of demand-supply of PCV and PC was done for the year 2016-2017. The same done again after implementation of bulk transfer policy for the year 2017-2018 just starting phase (few blood banks adopted) and for the year 2018-2019 after many blood banks taken up bulk transfer. Results: Before implementation of bulk transfer policy only 54.63% patients got red cell concentrate for transfusion and 38.35% patients got platelet concentrate. Supply increases to 68.31% and 69.41% respectively and hence reduces the wastage. Conclusion: Bulk transfer amendment is of great help to prevent wastages of precious blood resources, and hence can win the trust of society and increase voluntary blood donation.
Keywords: Blood transfusion services, bulk transfer, NACO, National Blood Transfusion Council
|How to cite this article:|
Kusumgar R. Bulk transfer of blood and its component: A single-center experience after 2 years of its implementation. Glob J Transfus Med 2020;5:51-3
|How to cite this URL:|
Kusumgar R. Bulk transfer of blood and its component: A single-center experience after 2 years of its implementation. Glob J Transfus Med [serial online] 2020 [cited 2020 May 25];5:51-3. Available from: http://www.gjtmonline.com/text.asp?2020/5/1/51/282746
| Introduction|| |
Blood transfusion services (BTS) in India are highly decentralized and lack many vital resources.
The National Blood Policy also aims at providing safe and adequate blood supply. An important initiative that can lead to an increase in the efficiency of BTS in our country, namely “bulk transfer of blood,” permitting the exchange of blood among licensed blood banks was taken by National AIDS Control Organisation (NACO). This was the result of an expert group recommendation that was subsequently approved by the National Blood Transfusion Council. This new initiative, namely bulk transfer of blood was ratified by the Health Ministry and the new amendments to the Drugs and Cosmetics Act, 1940, came into effect from April 2017, allowing the transfer of human blood and blood components, under prescribed storage conditions from one blood bank to another.
Bulk transfer is one of the most patient-friendly measures introduced by the government as this enables the patients' need to be met from other blood banks when the required group is not available in one's blood bank and also when one blood bank is having excess stock and other blood bank is in crisis.
Aims and objectives
This study aimed to study the impact of the amendment in bridging the gap between demand and supply following the introduction of a bulk transfer of blood and its component and also prevent the wastages of precious resource.
| Materials and Methods|| |
Ethics: Consent for transfer of blood from one blood center to another formed a part of the blood donor consent form. The study was undertaken after the Institutional Ethics Committee approval vide letter no. IRC/2020/P-03, dated January 18, 2020.
Bulk transfer of blood necessitates the following guidelines:>
- Request letter as per the NACO guidelines (http://nbtc.naco.gov.in/assets/resources/orders/Doc-8.pdf) should mention the required details such as ID, type of component, collection, expiry date, and segment number
- Memorandum of understanding (MOU) with the partner blood banks is desirable but not essential.
Retrospective analysis of demand versus supply of Red Cell Concentrate (RCC) and platelet concentrates (PC) was done for the year 2016–2017. The same was done again after the implementation of bulk transfer policy for the year 2017–2018 during initial phase (few blood banks adopted) and for the year 2018–2019 after many blood banks had taken up bulk transfer.
Blood bags were transferred as per the MOU and sometimes with the mutual understanding of blood banks with cold chain maintenance statistics. The receiver blood bank gave a unique identity number to each received bag as per the standard operating procedure using the software (Infohematica 2.1 Ms Soft Corner, Ahmedabad, Gujarat, India). All the details of the recipient of blood remain with the receiving blood bank, which can be used in the near future if the need arises.
Initially, around 7–8 blood banks started the bulk transfer and later on 10 more blood banks in the state embraced the policy during the study period.
The data, regarding the number of blood bags received from various blood banks, were collected from the Informatica software version 2.1 and analyzed.
| Results|| |
Blood Bank received the blood and its component in the prescribed format from various blood banks of our state as shown in [Table 1].
The data in [Table 2] and [Table 3] shows that the gap between demand and supply has decreased significantly.
|Table 2: Comparative table for demand supply gap for red cell concentrate|
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|Table 3: Comparative table for demand supply gap for platelet concentrate|
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| Discussion|| |
In the present study, we have identified bulk transfer of blood as a great initiative from NACO in favor of better BTS has benefitted a lot by means of reduced wastages and better utilization of blood. Most of the blood we received was in the last week of their expiry. All the red cell concentrate (RCC) were checked for any color change or hemolysis and then issued to the needy patient after crossmatching. Only one allergic reaction was reported to date, which was taken care of. Bulk transfer helped to bring down the gap between the demand and supply in the year 2018–2019 (See [Table 2] and [Table 3]).
Initially, the acceptance was slow but as soon as most of the blood banks adopted the policy, the impact was very positive. In our blood bank, we could reduce the demand-supply gap significantly. Before the implementation of bulk transfer policy in the year 2016–2017, we were able to cater to the need of around 54.63% in the case of RCC and only 38% of PC. Around 90% of our patients have been given blood free of cost under various government schemes. Hence, the unavailability of blood or its component costs them a lot if they have to purchase it from another blood bank. After many blood banks adopted the policy, we were able to fulfill the RCC demand of 68.31% of patients and 69.41% of PC, which shows a significant reduction in the gap of demand and supply. As more and more blood banks take on this policy, this gap will be reduced further.
This is the first study of such kind; hence, comparison with other studies is not possible.
Experts recommend bulk transfer due to various reasons. It helps better distribution of blood collected in large centers to their satellite centers. It helps to reach out to patients in remote and rural areas.
In the absence of bulk transfer, blood could be brought from another blood bank and used for the intended recipient only or else it had to be discarded. Permission for bulk transfer of blood has eased out the process.
In many hospitals, such as in trauma centers, cancer units, the number of units of blood transfused per patient is very high. Approximately 8–10 units of blood are often needed. In the case of stem cell or organ transplantation, approximately 30–40 units of blood are required. In such situations where large quantities of blood are needed over a short time, bulk transfer is very helpful. Blood can be shifted from one center to another quickly to tide over the crisis.
The bulk transfer also paves the way for better utilization of blood collected in mega blood donation camps. Excess blood collected can be distributed to other centers, which need that blood, without disappointing the donors and turning them back.
In our institute treating more than 400,000 cancer patients in a year, many patients do not get blood due to shortages. PCs are needed in large numbers for the treatment of leukemia and bone marrow transplant recipient. Most blood banks in the city having a component license can prepare PC, but do not do so due to lack of demand at their centers. Bulk transfer to needy blood banks will help in better utilization of such scarce and precious resources. The implementation of bulk transfer helped to bring down the demand-supply gap significantly.
It is concluded from just 2 years of our study span that better understanding among partner blood banks can reduce an estimated wastage of 15,000 units of red cells and around 25,000 units of PC per annum. This can be made available to needy patients.
The challenges in bulk transfer of blood may be related to cold chain maintenance during transport, logistics and handling of adverse transfusion reactions due to blood brought from partner blood bank. However, we faced no serious issues on this account.
In future, all blood banks can adopt this policy and we can improve still on supply, and hence, gap can be narrowed down to near zero.
| Conclusion|| |
Amendment to drugs and cosmetic act permitting bulk transfer of blood is useful to prevent the wastages of precious blood resources which in turn reduce the demand and supply gap of blood and its component. This way every unit of blood can be made available to the patient, preventing their wastage, ensuring equitable distribution, and consequently win the confidence of the donors and the community through better blood management.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bharucha ZS. Standards for Blood Bank and Transfusion Services. 1st
ed. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India; 2007.
National Blood Policy. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India; 2007.
Kang NS. Document 8: Guidelines for Bulk Transfer. Govt. of India, Ministry of health and Family Welfare, NACO; 2015.
Ministry of Health and Family Welfare. The Drugs and Cosmetics Rules, Latest amendment FDCA 1940. Ministry of Health and Family Welfare; 3 April, 2017.
[Table 1], [Table 2], [Table 3]