Backdrop
Every time someone faces any kind of discomfort in a blood donation drive, the Sankalp volunteer in-charge of the drive is trained to take all possible steps to:
- Provide immediate relief to the person
- Figure out what could have triggered the reaction
- Ensure that the incidence is properly documented so that corrective action can be taken
On a weekly basis the volunteers exchange their experiences and discuss the reasons and the possible preventive strategies. This is a long standing protocol. When it was introduced first, the volunteers had a tough time convincing the blood banks that a post donation reaction was indeed a reaction. There was reluctance on part of the medical officers to call the post donation reactions anything but minor discomfort which sometimes happen. We even got to hear reasons like current lifestyle, consumption of Maggi and pizza, and so on being associated with the 'discomfort'. Gradually things improved and after a meeting at NIMHANS where the definitions set up by the 'Working Group on Complications Related to Blood Donation' of the International Society of Blood Transfusion were accepted as the norms for capturing and recording reactions for future drives. At this stage the recording of hematomas, incidences of delayed bleedings, mild vasovagal reactions etc. became a routine. However, what came as a shock to the volunteers was the abnormally high rate of reactions when compared to the studies done in various parts of the world. Strong attempts were made to bring in every possible strategy to reduce the chances of reactions. Better donor selection, preparing donors for better donation experience and better selection of venue for the blood donation drive was introduced leading to tremendous drop in the rate of reactions. For a while the volunteers thought that they had eventually managed to bell the cat.
And then one day
In the weekly review meeting one of the volunteers who had recently overseen a blood donation drive reported 8 reactions in about 100 donations. Volunteers were alarmed. They drilled the volunteer to understand if the protocols were stuck to. Everything seemed to be right on spot. Very minor deviations were observed but nothing which could explain the sudden increase in the reactions. Since the event was over and there was little left to look back at and study, the volunteers were cautioned to follow all protocols by the book and things proceeded. Within a week, in another blood donation drive, the volunteer in-charge began observing the same pattern. Extremely high rate of reactions were observed. While all was done to take adequate care of donors and even prevent reactions from turning into moderate and serious ones by early detection, it came as a shock.
This time however, every little bit of information at the camp site was carefully scrutinized. Towards the end of the drive when the volunteer wanted to know how many people were deferred because of low hemoglobin - he was not expecting the answer he got. Having attended drives regularly, he was anticipating a lot many more deferrals because of low hemoglobin. So, now there were 2 things that happened abnormally:
- High rate of vasovagal reactions
- Abnormally low rate of deferral.
There was all the reason to probe the correlation and hence he requested all the blood samples to be put up for CBC. The CBC was done immediately on arrival at the blood bank. The results - SHOCKING!
It was observed that 40% of the donors who got an opportunity to donate blood that day had a hemoglobin count less than 12.5 gm/dl. What was worst is that 2 of them had a hemoglobin less than 10 gm/dl. It was a situation that nobody who goes motivates people to donate blood wants to confront.
From the organiser of a blood donation drive point of view, Sankalp puts in a lot of effort to ensure that only those blood banks come to collect blood in blood donation drives who:
- Make no compromises on the safety of the donor
- Impartially issue tested blood units to needy (at justifiable rates).
In-spite of that we had a situation where it was identified and concluded that the person who was in-charge of the standardization of the CuSo4 (Copper Sulphate) solution which was used for hemoglobin test had pain scant regard to quality and safety. The solution had a specific gravity way below the prescribed mark. How could a very prominent blood bank equipped with state of the art equipment make such a terrible mistake? Could it be possible that more people were doing the same mistake? With almost no blood bank tracking post donation complications systematically there is all the reason to believe that even if there are problems with the processes that are being followed they may go unnoticed.
Scientifically speaking, though a correlation between the increased rate of reaction and the improper screening of donors could be well established that day, it is hard to be sure of this relationship unless proper control is put in place. There are more factors associated with the working of the blood bank in question which are believed to have played a role in the incidence. However, negligence of this kind could have very serious consequences on the voluntary blood donation program in general and more importantly to the safety of the donor. Few years back a donor who donated in a blood donation drive had to be admitted because of complications to a hospital. The hemoglobin was tested to be 6 gm/dl. The donor remained admitted in the hospital for 6 days. With connected community of the kind we have today, any adverse event may quickly find a lot of publicity and reach the nook and corner of our society. This will undo the years of effort that have gone in from numerous stakeholders to bring the voluntary blood donation movement in the country to life. Sankalp appeals to the blood banks to take this incidence as a wake up call and plug the loop holes that may have crept into our systems silently. Prevention is the best strategy.
We appeal to the blood banks to be open to periodic comprehensive audits and checks of all the processes, people and equipment not from a compliance perspective alone but from the perspective of genuinely ensuring quality and safety. We also request the blood banking fraternity to engage in open debates on these matters without the tendency to finger point and victimize any individual or institution. This will ensure that we as a whole firstly identify, then rectify and finally keep reconfirming that any loopholes in our working are plugged. With proactive steps we can ensure that blood donation is both safe and happy for the blood donors.
As you read this articles, several blood banks in Bangalore are taking steps to ensure that they never face a day when they face a similar situation.