It's always a challenge to make available adequate quantity of rare blood groups. Whenever there is request for Bombay blood group, our emergency team explores all alternatives to blood transfusion before proceeding to organise for blood donations. The medical condition, the alternatives for transfusions which fit into the scenario and whether or not any alternative was used eventually is documented for each request. We recently analysed 40 of the Bombay blood group requests the organisation received last year. One of the very impressive outcome was the use of erythropoietin(EPO) as an alternative to transfusions.
Whenever we got a request in which EPO could be used as an alternative to transfusion our volunteers requested the doctors to consider the same. Of the 40 requests we analysed from last year, EPO was eventually used in 14 blood requests. There were 7 more blood requests where based upon the information available on the patient's condition, EPO was an appropriate option but was not used. This is very encouraging because each time EPO is used, it reduces the demand for 1 to 3 blood units depending upon the specifics of the case. Our findings suggest that EPO could be used as an alternative to transfusion in one out of every two requests and infact it was actually used in one out of every three requests.
This is very promising. Not only did EPO contribute to easing the pressure to get rare blood groups donated, it is also a safer, more convenient and maybe even cheaper alternative to organising for blood. Imagine what this could imply if EPO is used in management of mainstream blood requests judiciously.
Safe and rational use of blood has been identified as a priority area not only by WHO, but also by national health services across the developed world. The concept si well known in India as well but the grass root implementation is far from desirable. We use the unique opportunity and necessity posed by the need to organise for adequate quantity of rare blood groups to apply the principles to reduce use of allogeneic blood. EPO is just one of the many options. While we struggle to increase voluntary blood donation, an alternate, cost effective and safer approach to reduce the gap between demand and supply is to focus upon rational use of blood.
Know more about erythropoietin (EPO)
What WHO Says
Data on the use of blood products are limited, but studies suggest that blood products are often overprescribed in both developed and developing countries.
WHO recommends for the safe and rational use of blood to reduce unnecessary and unsafe transfusions and to improve patient outcomes and safety, thus minimizing the risk of adverse events including errors, transfusion reactions and transmission of infections.
These strategies should include:
- Prevention, early diagnosis and effective treatment of conditions that could result in the need for transfusion (through health promotion, disease control and screening for early detection);
- Optimal patient management and rational use of blood products (evidence-based use of transfusion for the treatment of conditions that could not be managed by alternative treatment modalities to blood transfusion including the use of pharmaceuticals, medical devices, good surgical and anaesthetic techniques);
- Safe clinical transfusion processes for ensuring patient safety.