In the wake of the COVID-19 pandemic, everything from education to health services has been affected to some degree, and while some of these disruptions may not have lasting consequences, others may impact our most crucial right—the right to life.
One grave fallout of the pandemic has been the unprecedented decline in blood donations. Even after the lifting of lockdown, donations have not increased to pre-COVID-19 levels, as people remain wary of going to hospitals and blood banks for fear of contracting infection.
Blood is the lifeline of our public health system and, even with elective procedures being postponed, remains crucial for time-sensitive procedures like childbirth and emergency surgeries. Even before COVID-19 hit, India’s blood collection was insufficient to cater to the country’s needs. Owing to the country’s vast geographic spread and population, access to safe blood has remained a challenge, and on an average, less than 1 unit of blood was being collected per 100 population, resulting in a shortfall of approximately 1.9 million units across the country.
While the overall shortage of blood is unfortunately an ever-present issue, plasma collection, a subset of the problem, has risen to prominence in the present times. Plasma is the component that lends blood its liquid volume and carries precious antibodies that can help recipients ward off infections. In the absence of reliable treatments for COVID-19, hospitals across the world have found that plasma from convalescent (recovered) patients increases the recovery rate of other affected patients. In late June, the Union Health Ministry approved use of plasma therapy in COVID-19 patients not responding or poorly responding to other treatment modalities.
Indian states, too, have found merit in using convalescent plasma in the treatment and management of moderate or critical COVID-19 patients, and have been taking steps to encourage recovered patients to come forward to donate plasma. With over 6.5 lakh recoveries in India so far, one would imagine plasma banks overflowing, but instead the real situation is grim. While Delhi and Maharashtra have fared okay, states like Karnataka and Assam haven’t had much luck, as only a small percentage of recovered patients came forward to donate plasma.
Why, one may ask, is it so difficult to convince people to donate blood or plasma? Pandemic aside, many people still believe that donating blood causes physical weakness, while others remain in the dark about the pressing need for this life-saving liquid. In truth, however, the amount of blood one person can donate at a time is strictly capped and the body replenishes it quickly.
Need for new-age technologies for component collection
In a country where blood shortage is a reality, post-collection separation of blood components (plasma, red and white blood cells, platelets) through centrifugation has overcome the shortages to a great extent. However, the quantity of these components generated through one unit may not be sufficient to treat a patient. Instead, blood collection technologies like apheresis (plateletpheresis or plasmapheresis or erythrocytapheresis) allow a single donor to donate either platelets or plasma or red cells in sufficient quantities (equivalent to 2-6 donors), while the remaining components are filtered and returned back to the donor.
Typically, donors can donate whole blood only once in 90 (for males) or 120 (for females) days but can donate plasma as frequently as twice a week (capped at 24 times a year). This becomes particularly crucial in the case of COVID-19, where the pool of COVID -19 recovered patients coming forward as voluntary convalescent plasma donors are limited. Awareness programmes should be implemented to motivate these individuals to come forward and play a crucial role in the fight against COVID-19.
Despite their obvious merits, the adoption of apheresis and plasmapheresis technologies has remained low in India primarily owing to their cost. In public health emergencies like the COVID-19 crisis, however, the investment has more than proven its worth. Delhi’s Chief Minister Arvind Kejriwal, who has opened three plasma banks in the state, recently announced that plasma has been one of the reasons behind the declining COVID-19 death rate in Delhi.
Besides its use in infections, plasma plays a crucial role in the management of auto-immune and clotting disorders like haemophilia, in addition to everyday emergencies like shock, burn, trauma or accident cases. Even after the decline of the present pandemic, blood components will be needed to treat other conditions and potentially even future health crises, and the adoption of new technologies will remain key to the advancement of healthcare.
However, while the government does its part, until access to a safe and adequate blood supply can be guaranteed for all, it is the duty of every Indian to voluntarily donate blood/components on a regular basis.
Gupta is professor & head, department of transfusion medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram
The opinions expressed in this article are those of the author's and do not purport to reflect the opinions or views of THE WEEK