Safety of Blood Transfusions
By Dr Tapti Mohapatra, Consultant and Head - Transfusion Medicine, Fortis Hospital, Bannerghatta Road, Bengaluru
Blood transfusion has become a major lifesaving measure in modern medicine. The constant and dependable supply of blood donation is of utmost importance. Blood transfusions are indicated in instances of substantial blood loss during surgical procedures, emergencies, complications in childbirth, and management of long-term diseases such as thalassemia and anemia, to name a few. The blood supply's safety and the sufficiency of blood supply for treatment purposes need very well-organized systems that ensure blood collection, testing, processing, storage, and even administration are all done in the right way.
Poorly tested and transfused blood can spread Transfusion-transmitted infections (TTIs), among which viruses (HIV, hepatitis B, and C) are the most common, while bacteria and parasites also being main sources, therefore, presenting a very serious threat. The World Health Organization (WHO) has stated that no unit of blood donated can be released for clinical use until it is screened for infectious markers. The scenario, however, in the case of some low and middle-income countries and in specific areas of India, is still quite difficult. Some blood banks indeed apply very high-standard quality protocols, but the rest are using outdated tests or subject to irregular screening practices.
What Makes Transfusion Safe?
Voluntary and Well-Screened Donors: The very-first step that blood transfusion-safety-reliability is built upon is the confirmation of blood being from such voluntary, non-remunerated donors who can generally be considered the safest group. To be certain about this, such donors are put under very detailed screening which is not only the collection of medical history but also assessing the risks coming from one's lifestyle, recent illnesses, travels, and other factors that might make one more prone to infections. It is mainly the screening of donors who engage in high-risk behaviors that helps one reduce the risk of disease transmission through blood to a great extent. Consequently, the donor selection process is identified as the first and most important factor in the safe transfusion assurance procedure.
Infections Testing for Blood Units: The blood drawn from the donors is regularly tested for various infections that can be transmitted through blood, such as HIV, Hepatitis B, Hepatitis C, Syphilis, and malaria. Some blood banks do perform even stricter tests, i.e., Nucleic Acid Testing (NAT), which is the most sensitive method of the regular tests. It can detect the presence of the virus at the very early stage when antibodies have not yet been produced, which is called the "window period".
Accurate Blood Grouping and Cross-Matching: Blood typing and cross-matching done with the utmost precision are vital to the process of accepting the donor’s blood as being totally compatible with the recipient's blood. A very tiny discrepancy can cause very serious transfusion reactions, even death. To establish the ABO and Rh blood groups, labs perform certain procedures and then conduct cross-matching tests to reveal the presence of antibodies that might create problems. Blood compatibility verifications have been an extremely trustworthy measure against harmful reactions.
Quality-Controlled Storage and Handling: The blood supply chain in the blood center has to ensure proper storage at the right conditions and with strict monitoring in order to maintain the safety and efficacy of the blood and its components. Clear labeling for traceability is one of the procedures in place along with setting right temperatures, using sterile equipment and preventing breakage or contamination. Besides, regular quality checks cut down the chances of bacteria production, blood unit quality deterioration, or wrong mixing of blood units. Correct blood storage and handling activities reduce the likelihood of transfusion errors leading to complications.
Hemovigilance: It is a set of procedures that monitors and improves all aspects of the blood transfusion process from “vein to vein “, that is from collection to use.
Clinical Oversight during Transfusion: Safe transfusion also relies on the proficiency of the healthcare team administering it. To begin with, the doctors must figure out whether the patient really needs a transfusion, because unnecessary ones not only add risk but also do not provide any benefit. The nurses keep a close watch on the patient throughout the entire transfusion for any adverse reactions, For example, fever, rash, or blood pressure changes, which may come up. Transfusion monitoring also helps to identify delayed reactions. With clinical care, the situation is such that if any complication occurs, it will be identified and treated immediately.
What Health Systems Must Commit To?
In order for blood transfusions in India to be an absolutely safe and reliable practice, health systems need to enhance the various elements of the blood safety system. They need to commence by ensuring that all licensed blood banks adhere to universal screening guidelines very strictly and also, where applicable, employing modern techniques such as Nucleic Acid Testing (NAT). Taking voluntary, non-remunerated participation in blood donation further through awareness campaigns that are conducted over a long period of time, ensures a dependable and low-risk donor pool. Modern infrastructures, trained personnel, quality control, formation of a transfusion committee, participation in hemovigilance reporting, rational use of blood and blood products accreditation through the national regulatory bodies, are some of the processes that ensure high quality standards of a hospital blood center and ensures patient safety.
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