Blood donation is a generous donation

Blood is crucial for the survival of patients undergoing surgeries, cancer treatments, managing chronic illnesses, and recovering from traumatic injuries. The provision of this life-saving care begins with a single individual making a selfless contribution. Read why blood donation is important...

Last Updated on June 14, 2023 by Neelam Singh

Dr Shamee Shastry

Dr Shamee C Shastry is a transfusion medicine specialist, Professor and head of department of immunohematology and blood transfusion in Kasturba Medical College, Manipal. With 17 years of experience in the field of transfusion medicine and more than 130 published research papers to her credit, she is a trusted name in the field of transfusion medicine. In a discussion with THIP Media, she talks about the importance of blood donation.

What is the eligibility criteria to donate blood?

As per the drug controllers’ guidelines, there are some basic eligibility criteria that we look into. We speak to the donor and review their medical history and then do some minor health checkup to determine whether the person is eligible to donate blood or not. First of all, the person should be healthy. A healthy person within the age bracket of 18 to 65 years can donate blood. The weight should be more than 45 kgs. Blood pressure should be normal, pulse rate, temperature should be normal and haemoglobin should be more than 12.5 grams per deciliter (g/dL) of blood. In addition to that, we do ask about the blood donation interval. If it’s a male donor, then he shouldn’t have donated within the last three months, and for females it’s four months.

Who is not eligible to donate blood or to receive blood from a donor?

Unfortunately many people, though they are willing to donate, do not fulfil eligibility criteria for blood donation. There is are some temporary and permanent deferral criteria that are well established. They are safety of the donor, the safety of the patient who is receiving these blood components and the quality of the product. Based on these three factors, we determine these deferral criteria for blood donation. So, anyone with cardiac disease or some endocrine disorders and chronic infection is not eligible to donate. If they have hepatitis then they are permanently deferred. If they are on some medications like antibiotics then they should not donate for 7 days. If they are on pain killers then they cannot donate for 3 days. Generally, during menstruation women are not supposed to donate blood.

Can cancer patients donate blood?

No, cancer patients cannot donate blood, because though they are cured of cancer, some of the genetic abnormality may be present in the cells. So, when we transduce it should not cause any problem to the patients and we are worried about the health and the health requirement of the donor as well. So, they are not allowed to donate blood.

How does one convince people to donate blood for the rare blood groups? And how do you manage the demand supply ratio?

First of all, there is a lack of awareness among people regarding the demand for blood and the need for the rare blood types for example even RH negative. People do not come on their own to donate blood unless they see blood donation drive announcement flyers or some motivating ads. So, awareness programs need to be promoted well. For rare blood types donation, we call the donors whenever we require and take the help of social media. We have donor groups and student groups who organise blood donation drives. So we put the messages to call for donors of specific blood groups in these groups. Social media really plays a great role in mobilising donors. Though there are many misconceptions regarding blood donation as well. We try to clarify a lot of misconceptions with the help of social media and through discussions to motivate people to donate blood.

What are the repercussions of incompatible blood transfusion?

Incompatible blood transfusion is fatal if it is a major ABO incompatible transfusion. But almost all the blood centres have several checkpoints to prevent this kind of reaction. Unless it is a technical error or some clerical error, it generally doesn’t happen and it’s rare. ABO incompatibility is a major incompatible reaction that is fatal and one can have hemolytic transmission reactions. Whereas minor blood group incompatibility can be there. Generally, we do not match for minor RBC antigens and if there is minor blood group incompatibility, patients can also have immunisation and they can develop some sort of antibodies against minor blood growths. So, when we do cross match, the patient’s serum is mixed with donor cells and if there is a logical reaction, we call it incompatibility. But there are conditions like patients with autoantibodies, autoimmune, hemolytic, it’s very difficult to get compatible blood. In such patients, to help them especially when their haemoglobin is very low, less than 5 grams per deal, then we may have to give best match or least incompatible blood. So, in that situation it is lifesaving. It depends on what kind of incompatibility is present in that scenario.

What are the unmet challenges within blood transfusion therapies and how can these be addressed realistically?

The major challenge is the gap between the demand and supply. Another is regarding the quality and safety of the blood products. So, we have the skills, we have the equipment to improve the quality and safety of blood products but it always comes with a cost. As we use better materials, the high end equipment and good quality reagents, good quality materials to process blood and blood components, then definitely it adds on to the cost. So, the quality comes at a cost and balancing the two is also a major challenge.

Apart from that, in our day-to-day practice, we do get some of the challenging cases. For example, a person with rare blood phenotype or a person with multiple antibodies, sometimes a massively bleeding case with the coagulopathy and DIC established. So, in such cases it’s quite challenging to support them.

Share some information about your research around penal blood groups and challenges associated with anti PP10PP antibodies.

Once we had a patient with a penal phenotype. It was really a nightmare situation for us. He was a 45-year-old male with a road accident and had a fractured femur. He was admitted to trauma. We received a request for blood transfusion and his haemoglobin was quite low and he was bleeding profusely. Doctors wanted to operate on him, so they requested for two units of RBC. We started with blood grouping and cross matching. We do antibody screening for all the patients and while doing antibody screening, we noted that he has got some unexpected antibody. So, as it was an emergency situation, we had to further investigate and support him with the blood components. We did antibody identification; we have three cell and cell panels even for immunohematology workup. And unfortunately, we could not identify initially because that particular antibody was reacting with all the cell panels and all the donors whom we have tested. Further, we cross matched with eighty blood units that we had in our inventory. And every unit was showing a strong incompatible reaction. So that’s how we could not support that patient at that time and doctors had to postpone the surgery.

So how did we manage this case? We sent his sample to a reference lab which is IBGRL in the UK. They did extensive workup and showed that it’s a penal phenotype and it is one of the rare phenotypes. In India, we have the Bombay phenotype, and Indra, INB negative, similarly penal is one of them. Such patients will have antibodies that react with almost all the donor units. So it becomes challenging for blood bankers to give a compatibility unit.

What we did next? First of all, whenever we have a rare blood phenotype and with antibody against the normal donor units, we need to do some sort of work where we call their family members. It’s very likely that one of the family members can have that rare phenotype. But unfortunately, in this case we didn’t have anyone with the penal in his family.

So, this particular patient we manage conservatively. We gave him erythropoietin hematinics. Built up his haemoglobin and did his surgery. Now since he is a healthy person, he is willing to donate blood for other patients with penal. So, this was a kind of inspiration for us to start initiating a regional rare donor registry in this part of the country. Hope that soon we will have a nationwide rare donor registry in India. ICMR NIIX centre in Mumbai has already started working towards it and there are few more regional rare donor registries in India. So definitely with networking and better collaboration work, we will have a nationwide rare donor registry in our country very soon.

I would like to take this platform to thank all the blood donors for giving the gift of life and for taking this initiative to create awareness among people on voluntary blood donation.

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