Every year, World Blood Donor Day is celebrated on June 14 to raise awareness about the need of safe blood and blood products and to thank voluntary, unpaid blood donors for their service. This year, 'Give blood and keep the world beating' is the theme announced by the World Health Organization (WHO) for the day.
While, shortage of blood is already acute in developing countries, COVID-19 added to the problem and the second wave of cases in 2021 made it worse. India already suffered from blood shortage before the pandemic. According to an article published in the Lancet Haematology journal in 2019, India had the largest absolute shortage of blood supply, being nearly 41 million units in 2017. This means against a need of 52.5 million, only 11.3 million was supplied.
The WHO estimates that blood donation by 1% of the population is the minimum need to meet a nation's most basic requirement of blood. Developed countries have higher requirements due to advanced health care systems. However, the average donation rate is 15 times lower in the developing countries than developed countries.
The lock down induced by the raging wave of COVID-19 in India has severely affected blood donation drives. Although elective surgeries are postponed due to increased attention to treating COVID patients, but patients suffering from diseases like Thalassemia or cancer, pregnant women, those who suffered road accidents and those on dialysis, have a recurring need of blood.
"Till February 2021 we could still manage blood and other components for those in need. The crisis escalated after that. Every state in the country is facing an acute shortage, especially from the second wave. After the recent decrease in COVID-19 cases, we may see donors voluntarily coming forward," Dr P Ravindran, chief pathologist at Indian Red Cross Blood Bank, Chennai, told FactChecker.
Crisis Compounded By COVID
While the National Blood Transfusion Council, at the early stage of the pandemic, released a set of guidelines to ensure supplies of safe blood continue to be maintained at licensed blood centres, various factors originating from COVID-19 have led to shortage in supply of blood. Here are four of them.
First, working professionals and students who form the bulk of blood donors, through donation camps, are no longer easily accessible as colleges are closed and people are working from home. Also, there are instances of donors testing positive for COVID-19. Owing to increase in infection rate, blood donation drives in large numbers have reduced.
"There is acute shortage of blood in the blood banks in Bengaluru. No volunteers are interested in donating blood and blood donation camps could not be arranged since colleges are shut and offices have moved to work-from-home mode. During the first wave, blood supply chain was functioning well but with the second wave the situation worsened," Mahadevan, a worker at the Indian Red Cross blood bank's Bengaluru branch, told FactChecker.
Camps conducted at the blood banks too are not getting many donors. "Although we have been conducting blood donation camps in our blood bank itself, we are getting very few donors. We did not conduct any camps outside and the ones held at the blood bank building with proper sanitization and all Covid protocols saw a very low turnout," said Dr Gigyasha Kanda, nodal officer, Indian Red Cross blood bank, Durg in Chhattisgarh.
While seconding Dr Kanda, Dr Vamsi Krishna, a junior resident doctor and specialist in general surgery, Gandhi Hospital, Hyderabad, explained, "Despite staff at blood banks motivating people to volunteer, donors are not turning up in large numbers. In case of emergency, patients are asking their relatives and friends to donate. Also, the RH negative blood groups like B negative or O negative are even more scarce in supply at the blood bank."
In the pandemic, relying on private blood banks is also not an option doctors are left with since they too are facing acute shortage. "There are also myths and false beliefs among people that they might be infected with some diseases if they donate blood. That contributes all the more to the shortage of blood," added Dr Krishna.
Second, earlier in March, National Blood Transfusion Council issued an order where a donor has to wait for 28 days after getting the second dose of the vaccine. This has just aggravated the scarcity.
"Since the order by NBTC has caused a problem with blood supply, we are asking people to volunteer to donate blood before going for vaccination since we cannot keep waiting in case of emergencies in the hospital," said Dr Saikam Bhargavi, a resident doctor and a specialist in gynecology and obstetrics at Gandhi Hospital, Hyderabad.
Third, in India anyone above 18 years can donate blood as long as they fulfil certain health criteria. Men can donate blood every 3 months, women can every 4 months. But more than half the women in India are anaemic, according to a report by Anadolu Agency.
"During major surgeries like intestinal obstruction and others, patients need intra-operative transfusion. In a lot of cases many patients are also anaemic so while operating those cases we are facing shortage of blood. More than any other patient, surgeries related to gynecology and obstetrics are facing greater challenges with shortage in blood supply since most of the pregnant women are anaemic," said Dr Krishna.
"The need for blood transfusion is generally higher among women and the demand remains unchanged even during the pandemic. Moreover, blood loss during delivery or post-partum hemorrhage are other aspects that demand immediate blood transfusion," added Dr Bhargavi.
Fourth, apart from reasons induced by COVID-19 pandemic, issues related to blood wastage are also an all-time cause of concern. On an average, 6.5 lakh units of blood and blood components are wasted in India before reaching the needy on time, according to a response to an RTI query filed by Chetan Kothari.
In the reply, National AIDS Control Organisation mentioned that in 2016, 6.57 lakh units of blood and its components were discarded out of which 50% of wasted units were plasma which has a longer shelf life of one year than red blood cells or whole blood which need to be used within 35 days.
Confusion On Plasma Therapy
During the second wave, several social organisations and youth groups had been creating awareness on plasma donation and managed to stock plasma in various blood banks. But in May, the Indian Council of Medical Research dropped plasma therapy from COVID-19 treatment guidelines. This created an atmosphere of confusion not only among doctors and health experts, but also among others on the stocked plasma getting wasted.
Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) had come up with this as 'off-label' treatment for patients suffering from COVID-19. And, during the first wave, usage of convalescent plasma was considered to have provided therapeutic treatment against Covid-19 and received a go ahead by ICMR.
"There is no evidence of universal effectiveness of plasma transfusion among COVID patients. And also, we do not know if plasma transfused to COVID patients produces sufficient or low amount of antibodies. At times it is also seen that by the time plasma is injected in to a patient, the antibodies have already faded away since no one knows for how long the antibodies last," concluded Dr Bhargavi.