Blood banks meet to enhance quality of drives

In the summer months from March to July, Sankalp India Foundation organised for close to 5000 units being collected over the state in voluntary blood donation drives. While the collection of all these units did ease the burden on a large number of patients, it was felt that some finer aspects of quality in these drives needed a relook.

 

Consider the following situations. All of these are real situations. Since Sankalp aims at analysing a problem and finding the right solution for the same, names of institutions/individuals have not been mentioned. 

 

 

Hb analysis is an important step in blood donation. While most blood banks dont deny it's importance, most of them do not necessarily practice the right standards. Here are few cases of things going wrong due to Hb analysis.

 

a. 1/3rd of donors in a blood donation drive had vasovagal reactions of various degrees. On further investigation it was found that the calibration of copper sulphate used for Hb analysis was incorrect. CBC results showed that donors with Hb in the range of 10-12.5 were also allowed to donate

 

b. At a blood donation drive in a boys degree college, initially all boys coming in to donate were rejected due to low Hb. Since the necessary infrastructure was available, the camp was restarted by Hb determination via calorimetry. Then a lot of the boys rejected earlier were eligible.

 

c. In a blood donation drive with 2 blood banks, there were 42 rejections. 36 rejections came from one blood bank. Further analysis showed that the calibration of the meter used for Hb analysis was incorrect. In another drive, the meter showed up a constant reading of 17/18

 

d. In blood donation drives with more than 100-120 donations, the Copper Sulphate solution is badly soiled and there have been examples of results of Hb test being not very correct for donors who come in later halves of the drive

 

 

Untrained staff and doctors has a direct impact on the quality of the drive. Poor screening and pricking means more chances of severe discomfort post donation. This creates a psychological impact on minds of donors, derailing the chances of them being motivated for further blood donations.

 

a. In a blood donation drive held for the 6th time with Sankalp at an institution, donors complained of severe pain in the arm after donation, not experienced in previous 5 drives. A strong written feedback was given by the institution. Further analysis showed that most technicians involved in phlebotomy were untrained

 

b. One doctor in a blood donation drive was unmoved when people fainted after blood donation fainted due to a vasovagal reactions. After several reminders and arguements, the doctor decided to look into the cases.

 

c. In one instance, the doctor in the blood donation drive was not aware what questions to ask donors. This was the doctors first blood donation drive and she had no formal training/orientation. Throughout the drive, the donors were required to be screened by the doctor, Sankalp volunteers and technicians. 

 

 

It is often seen that different blood banks follow different standards when it comes to screening. This is especially true in cases of

a) Hypertension

b) Diabetes

c) Hormonal problems

d) Vaccinations

 

This leaves some donors complaining. They would have donated in an earlier drive with a different blood bank and would have now been rejected or vice versa. Sankalp patrika has on several ocasssions tried to address this point by publishing detailed articles by experts on such contentious topics.

 

 

Of the 5000 who donated in Sankalp drives in the last quarter, 3-4% donors experienced adverse reactions of various degrees. This is quite a significant number.  Blood donors, camp organisers tend to draw a very dangerous picture of voluntary blood donation drives by looking at such things.

 

Not just that, we had the following 4 extreme situations

 

a. A lady donor was treated for an adverse reaction for close to 2 hours at the camp site. Despite multiple attempts from the blood bank to revive her condition, she was losing conciousness every few minutes. Medical staff from the organisation also came in to administer treatment. After a lot of treatment, she was declared to be fine

 

b. One lady donor fainted an hour after donation at her workplace. She was at the 4th floor and the drive was at the ground floor. Since the blood bank did not have a splint board, she had to be carried by 4 male members to the donation area which was an uncomfortable situation for all. She took several minutes to be normal

 

c. One male donor faced severe pain in the arm. He took an off from work for 3-4 days. By the time Sankalp could locate him and take relevant steps, he had developed a swelling and the bruise was very severe. This was a very severe case of hematoma

 

d. In one organisation, 3 donors had a bruise and painful arm even 4 days after the drive. They reported the matter to the senior management of the organisation who informed Sankalp. The management was not convinced if they should consider doing blood donation drives in future. Several meetings and assurances later, things were ironed out.

 

 

There have been situations where donors who have tested positive for any of HIV. Hepatitis B/C, have been called and directly informed of the same. This creates a panic in the mind of the donor and can escalate to a big tension. A real life situation where this lead to the management of the institution even blaming the blood bank and Sankalp for creating this extreme situation was shared.

 

 

Something had to be done to discuss these matters in detail. Blood donation drives are places where people walk in to do something really special. He/She must never be put through any hassle. On Saturday 17 August 2013, Sankalp India Foundation organised a blood bank meet @ NIMHANS to try and address the situation.

 

29 representatives including doctors, blood bank technicians and other staff from the floowing blood banks were present in the event

 

1. NIMHANS Blood Bank

2. Rashtrothana Blood Bank

3. Victoria Hospial Blood Bank

4. Bowring Hospital Blood Bank

5. IGICH Blood Bank

6. ESI Blood Bank

7. St Johns Hospital Blood Bank

 

Rich debates and discussions were held on these topics. The meet gave a platform for Sankalp and the blood bank to share common complaints in organising drives. Few positive decisions were taken with quality as the central focus.

 

The meet had a dedicated section on reaction handling. In the first place, an important reaction handling strategy was presented to the blood banks. Steps on prevention, management and documentation of reactions were discussed. A copy of the new Adverse Reaction Handling Protocol, reviewed by Dr Sundar P, Asst Professor and Blood Bank Medical Officer, NIMHANS was circulated among the blood banks for their analysis and review. Dr Bardi Narayan, a senior anesthetist from NIMHANS also educated people about CPR.

 

Finalisation and implementation of the protocol will be done from September onwards.