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More blood, more life

Dr Poonam Khetrapal Singh : Blood saves lives and improves health. It is the most precious and unique gift from one human being to another. In the developed world, much of the blood goes to the treatment of older patients. In the developing world most of the blood is utilized to treat younger patients: infants and children with anaemia due to malaria, victims of trauma; and mothers with blood loss due to childbirth. WHO estimates that more than half a million women die every year during pregnancy, 99% of them in the developing world. Blood saves life but unsafe blood is a potent vehicle for transmission of several dreadful diseases including HIV, hepatitis B, hepatitis C, malaria and syphilis, to name a few. WHO estimates that the lack of effective screening results in up to 16 million new infections with hepatitis B, 5 million new infections with hepatitis C, and 160 000 cases of HIV infection every year. It is estimated that 5-10% of HIV transmissions worldwide are through transfusion of contaminated blood. No perfect method is available to fully eliminate the risk of transfusion transmissible infections. Hence, multi-pronged strategy is needed to reduce transmission of these pathogens through blood. The health systems need to assure highest degree of quality assured screening of every unit of donated blood, preferably collected from healthy individuals who decide to donate voluntarily, to guarantee its freedom from infectious marker to the extent the current technology permits. In recent past, screening of donated blood for HIV has averted every year more than 25,000 new cases of HIV in the South-East Asia Region. The need for safe blood is universal; however, a major imbalance between developing and developed countries in the level of access to safe blood exists. Millions of patients needing transfusion do not have timely access to safe blood. This is primarily because of two reasons: inability of science to artificially manufacture this life saving fluid and hesitation on the part of only reservoir of these product i.e. human beings to donate blood voluntarily and regularly. Around 93 million blood units are donated annually all over the world; 50% of these are collected in developed countries, home to 16% of the world's population. The average donation rate in developed countries is 45.4 donations per 1000 population. In Member States of WHO South-East Asia Region, this rate is 6.7 per 1000 population. If 1% of a country's population donates blood, it would be sufficient to meet the country's basic requirements for blood for transfusion. But donation rates are still less than 1% of the population in 77 countries including Bangladesh where it is still less than 0.5%. Around 362,000 units of blood were collected in Bangladesh in 2009 of which only 29% were from voluntary donors. Bangladesh is the only Member State of WHO South-East Asia Region that allows paid blood donations and obtains around 10% of its annual collection of blood from these high risk donors. There is clearly a need to accelerate the education of communities on blood donation, recruitment of voluntary blood donors and retaining them to assure regular supply of blood. Several myths prevent healthy people from coming forward to voluntarily donate blood. The safest blood comes from unpaid donors who donate for altruistic reasons. In this group, the prevalence of HIV, hepatitis infection, and other blood-borne pathogens is lowest. Infection rates are higher among replacement donors who donate to replace blood used by a patient. Infection rates among paid donors are highest. Social scientists need to study influence of human behaviour vis a vis blood donation. While during major disasters, thousands of people voluntarily reach blood banks to donate blood. Their number invariably exceeds the capacity of blood centre to collect, store and utilize their blood. However, in normal times when the need for blood continues to be huge, people in developing countries find it difficult to come forward to donate a unit of blood that can save lives of several patients. It is indeed a challenge to present the human needs regularly and clearly to the communities. This can only come through motivational methods and community based networks. West Bengal (India) and Nepal have shown the power of these NGOs and there is a need to learn from their success stories and their replication across developing countries to assure a sustained supply of safe blood to everyone.