Editorial: The virtues of fractionating blood
Published in The Hindu on November 8, 2005
Approximately seven million units of human blood are needed in India every year for transfusion purposes but only 4.5 million units are available, according to the Union Health Minister. The way available blood is being used becomes a key medical and social issue. Blood availability through voluntary donation is rising but no serious effort is made to maximise the use of every unit of blood procured by blood banks. One practical way of using blood effectively is to separate its various constituents — red blood concentrates, fresh frozen plasma, cryoprecipitates, and platelet concentrates. When separated, a unit of blood will meet the requirements of more than one patient. Many ailments call for the transfusion of only specific components, not whole blood. There are other advantages of separation, such as the extended shelf life of components. While blood component therapy has nearly replaced whole blood transfusion in most developed countries, the practice is yet to take off in India.
What is worrying is not so much the low awareness of component therapy among the lay public as the lack of knowledge among doctors and their unwillingness to use components even when they are aware of the virtues of such use. Nearly 80 per cent of the blood collected is transfused as whole blood. There is an urgent need to sensitise doctors to the value of blood component therapy. The higher cost of blood components and the medical need to use more than one component at times are often cited by doctors as reasons for shying away from this therapy, especially during surgery. The separation of blood components has other advantages as well. Plasma separated from blood can be further fractionated to produce many useful life-saving components such as Factor VIII, fibrinogen, albumin, and gamma globulin. India now imports every year fractionated components valued at more than Rs. 50 crore. The only plasma fractionation facility in the country, the KEM Hospital in Mumbai, has not been operational for more than three years. The assurance by the Union Health Minister that the Government will revive the KEM facility has not come a day too soon. In some countries, the plasma for fractionation is obtained from paid donors. Altruism or “the gift relationship” (to use the title of Richard M. Titmuss’ classic work on voluntary blood donation and social policy) is the cornerstone of blood donation in India. Blood banks must make it their mission to mobilise more donors and go in for component separation as a clear social priority.
