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BLOODLINE© Vinod A. Iyengar New Delhi, December 17, 2013 ( Mob: +91-98-18-434418; Tel: (11) 2223-8880/1/2) A-505 & 506, UNESCO.

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Presentation on theme: "BLOODLINE© Vinod A. Iyengar New Delhi, December 17, 2013 ( Mob: +91-98-18-434418; Tel: (11) 2223-8880/1/2) A-505 & 506, UNESCO."— Presentation transcript:

1 BLOODLINE© Vinod A. Iyengar New Delhi, December 17, 2013 (Email:; Mob: +91-98-18-434418; Tel: (11) 2223-8880/1/2) A-505 & 506, UNESCO Apt.; 55, I. P. Extension; New Delhi – 110 092 (India)

2 Blood facts - 1 THERE IS NO SUBSTITUTE FOR HUMAN BLOOD Blood saves the lives of acutely anaemic pregnant women, accident victims, thalassaemia, haemophilia and blood cancer patients, some malaria and dengue patients, and those undergoing surgeries Red blood cells carry oxygen and are needed by surgical patients or to treat those with anaemia, e.g., pregnant women, cancer patients, etc. Platelet concentrates are fragile blood cells used to control bleeding in the treatment of dengue, malaria, leukaemia and other forms of cancer Plasma restores fluid volume in patients who have suffered from shock and provides a source of clotting proteins that stop bleeding Cryoprecipitate is a part of plasma that contains clotting factors and is used to treat clotting deficiencies in people with haemophilia, etc. December 2013Vinod A. Iyengar2

3 Blood facts - 2 Life-span of blood components – Red cells: 80-120 days – Platelets: 9-10 days – White cells: days to weeks – Plasma: 1 year (-12 to -30 o C) NB: Blood banks in India currently store blood at ~ 4 o C as only plasma can be frozen, not whole blood since red cells break at freezing temperatures Blood Groups – Depend on antigens present on red cell membrane and/or plasma – Eight blood groups: A+, A-, B+, B-, AB+,AB-, O+, O- December 2013Vinod A. Iyengar3

4 Blood facts - 3 RARER A- RAREST AB- Rh+: 95% of all blood types; Rh-: 5% December 2013Vinod A. Iyengar4

5 Blood facts - 4 Donation between groupsRh factor in donation/transfusion People with blood group 0 Rh- are called "universal donors Those with blood group AB Rh+ are called "universal receivers Rh+ blood can never be given to someone with Rh- blood (e.g., 0 Rh+ blood can not be given to someone with the blood type AB Rh-) But Rh- blood can be given to those with Rh+ blood December 2013Vinod A. Iyengar5

6 Blood collection & supply in the West December 2013Vinod A. Iyengar6 Blood Database Blood Helpline Blood processing & separation unit Patients HOSPITAL Patients HOSPITAL Refrigerated transport Collection Unit Storage Unit Collection Unit Storage Unit Collection Unit Storage Unit Collection Unit Storage Unit

7 Blood collection & delivery in India Voluntary donations (Students and others) Replacement donations (Patients well-wishers) Separation units Blood banks Hospitals Patients December 2013Vinod A. Iyengar7 NB: Big hospitals usually have in-house blood banks and separation units

8 Sourcing & usage of blood in India December 2013Vinod A. Iyengar8 Blood sourcesBlood usage

9 Demand & supply of blood in India Sale price: blood components Rs. 350 - 850/- per unit (Processing cost: Rs. 300 – 650/- per unit) December 2013Vinod A. Iyengar9 (as per WHO guidelines)

10 Problem areas Chronic blood shortage Indifferent blood quality Wastage Absence of centralised data December 2013Vinod A. Iyengar10

11 Main causes of shortage Increasing demand due to several Central and State health insurance schemes, especially for the poor Low voluntary blood donation rate (India: 8 donors per 1,000 people, western countries 50/1,000) Seasonal fluctuations (drastic fall in collection during Summer and Rains) Non-availability of trained blood collection teams Few blood component separation units Wastage/injudicious usage December 2013Vinod A. Iyengar11

12 Main causes of indifferent quality Inadequate infrastructure & hygiene in blood banks Poorly trained/sensitised nurses, technical and processing staff Poor blood safety while handling/storage/transport Lack of dedicated blood transportation vehicles Inadequate monitoring by Central Drug Standard Control Organisation and State health agencies Malpractices due to insistence on replacement donation Poor quality of testing (so high percentage of transfusion transmitted diseases) December 2013Vinod A. Iyengar12

13 Main causes for wastage Many doctors prescribe blood transfusion at platelet levels of even 40,000, whereas it is required only at levels around 20,000 Use of whole blood in majority of cases (dengue and malaria patients need only platelets; burn cases need plasma, and cancer patients and pregnant women mainly need RBCs) Doctors insistence on having more blood than necessary, even for low-risk surgeries Expiry of blood due to hoarding in hospitals/blood banks Absence of centralised data and poor information exchange between different hospitals and blood banks Poor inventory management in blood banks/hospitals Lack of dedicated blood transportation vehicles (currently, blood transported by patients well-wishers in ice-packs, which keeps blood safe only for about two hours) December 2013Vinod A. Iyengar13

14 Consequences of blood shortage Declarations of blood emergencies (During 2011-12, two state governments declared blood emergencies and one requested its police force for donations) Ordeal for patients & well-wishers (People have to run from pillar to post for finding blood bank storing required blood type or arrange replacement donors) Illegal activities (Despite ban on paid donations and rules mandating 3-month interval between donations, blood taken from drug addicts and very poor people - sometimes for as little as Rs. 100 every fifteenth day) Indifferent quality and poor blood safety (Disregard of safety procedures during collection, testing, transportation, storage and transfusion. Transfusion associated Hepatitis-B estimated at 0.36% and Hepatitis-C at 1.2% per unit of blood) December 2013Vinod A. Iyengar14

15 Dealing with the challenge Boosting blood collection: – Identify, track and cultivate healthy donors – Escalate awareness drives – Widen voluntary donor base by approaching non-conventional donors – Increase number of blood collection teams – Improve communication between donors, blood banks, hospitals and patients Reducing wastage and injudicious usage: – Advanced training for doctors, nurses and technicians dealing with blood – Develop dedicated blood transport systems – Modernize blood storage structures – Augment component separation units Improve blood safety: – Ensure sanitized conditions in blood donation camps, blood banks, hospitals, etc. – Increase awareness & training programs for improved hygiene in banks and hospitals – Modernize blood testing systems December 2013Vinod A. Iyengar15

16 Possible interventions - 1 Fostering coalitions and networks between organisations involved in blood donation activities (e.g., the Indian Red Cross Society, Sankalp India Foundation, Rotary and Lions clubs) to: – Influence policy and legislation – Change organisational practices vis-à-vis hygiene, blood safety, wastage, etc. – Promote education & training to strengthen individual knowledge and skills of doctors, nurses, technicians, etc. – Design and develop literature, media clips, etc. – Create and implement voluntary blood donor motivation, recognition and reward programs December 2013Vinod A. Iyengar16

17 Possible interventions - 2 Installing and managing dedicated voluntary blood donation and blood safety awareness programs to : – Increase awareness in local communities – Identify and motivate non-conventional donors – Leverage CSR obligations of companies to widen voluntary blood donor base – Initiate voluntary blood donation drives – Create databases and telephone-based blood information helpline to: Identify and track healthy blood donors Coordinate/manage inventory in blood banks, hospitals, etc. Provide information/assistance on blood types, quantity and location to concerned citizens, blood banks and hospitals December 2013Vinod A. Iyengar17

18 Possible interventions - 3 Creating and operating safe blood transportation system – Based on suitably modified refrigerated vehicles – Blood transportation between blood donation camps, banks and hospitals – Connected to blood helpline (if any) to ensure blood reaches its destination in time Refrigerated NHS (UK) blood transport vehicle (Source: December 2013Vinod A. Iyengar18

19 Recommended Bloodline model Blood Helpline Blood Database Blood Banks Hospitals Separation Units Replacement Donors Patients/Well- wishers Voluntary Donors Others Corporates Charities NGOs Red Cross Refrigerated transportationBlood donation camps December 2013Vinod A. Iyengar19

20 Project requirements Baseline study Dedicated teams for: – Blood donation and safety awareness program – Voluntary blood donation drives – Data collection from hospitals and blood banks – Blood information helpline Office-cum-Call Centre on rent Personnel training Refrigerated blood collection vehicles December 2013Vinod A. Iyengar20

21 Blood information helpline costs ItemRs. 'lakhs Remarks CAPEX 43@ Rs. 7.20 lakhs/seat OPEX per annum 36@ Rs. 6.00 lakhs/seat December 2013Vinod A. Iyengar21

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