All That Looks Red Is Not Blood!

Blood is the savior of life. But for that it has to come from a good source. Availability of blood is a well discussed and is debated often. However, do we ever stop and think about another very important aspect of it—the quality? Disease, often life threatening can be transfused along with the blood, especially when hardly any efforts are taken to understand and negate them. Doctors today are involving more concerted efforts to better the quality aspect of blood. Some methods used are adhering to safe and sophisticated methods to utilize and optimize the usage while diminishing any accidents and to find out newer and modern ways to tackle the same. But the doctors we spoke to are trying to hit at the roots of the problem.
Manipal Hospitals’ blood bank doctors, Dr. Shivaram and Dr. Ambuja, have initiated Donor Counseling, an unique way to enhance the effectiveness of blood safety by ten times than even the latest technologies like the Enzyme-Linked Immunosorbent Assay (ELISA) or Nucleic Acid Amplification Testing (NAT) to ensure the right quality of blood. Both the doctors introduce us to the very important aspects of purity of blood and the importance of it in all its form and dimensions. They highlight not only things like, the quality of the blood bag but also the various ways that are intrinsically involved in the entire process of blood collection, storage and usage of it.
Talking about their initiative in India, Dr. Shivaram says, “A very important factor that should be kept in mind during any act of blood donation to ensure blood safety is effective counseling of the blood donor in a confidential manner. This ensures that the blood donation is really a voluntary/selfless act and not driven by any peer or family pressure. At Manipal we have a dedicated blood donor counselor and a confidential counseling area to ask sensitive questions relating to sexual behavior of the donor which is one of the ways of ensuring blood safety.”
While most blood banks do ELISA for testing of blood which delays diagnosis of HIV or Hepatitis by 4-6 weeks, only some blood banks do NAT, which helps in early diagnosis.

But Doctor Ambuja warns, “More important than NAT are simple steps like conquering bacteria. We certainly don’t want our patients to come for heart surgery or organ transplant and die of bacterial infection or septicemia through tested blood. The quality of the blood bag, the quality of phlebotomy-meaning the way your skin is cleaned –is it with unsterile cotton or sterile gauze swabs, the direction of cleaning and the way the bag is stored and transported all play a vital role in ensuring quality in transfusion service.”
Dr. Shivaram adds, “The quality of blood depends on various things like the community of blood donors, effectiveness of donor counseling, the testing methodology used; the infrastructure available and the competency of the blood bank personnel. In addition, the type of bag used, the method used for collection of blood, its transport and storage, timing of component separation, all play a vital role in ensuring that the blood served really saves your life. There is no role for the whole blood in modern medical practice.”
According to Dr. Ambuja, “Blood bag is not just any plastic bag to store milk or water; it has live cells within and needs to be of top class quality to ensure viability of the cells. If not, you may have the best donor, and the best training and the best testing methodology but all this is worth zero, if the quality of bag is not good enough for optimum storage. While all blood bags and all blood banks are licensed there is a world of difference between them. Just like there is wide variation in the quality and price of vegetables in the vegetable market so also there is an even bigger variation in the quality of blood from one blood bank to another.”

An attempt by the Government to reduce this inherent variation and bring blood banks on par with minimum standards is accreditation of blood banks. KMC Mangalore was the first NABH accredited Blood Bank in Karnataka followed by Manipal Hospital Bangalore and Rotary –TTK.
Finally the onus of using the right component of blood in the right dose rests with the treating physician.
This article was previously published in Eve’s Times magazine and has been reproduced here with the permission of the editor, Swati Amar.