Sri Lanka is currently undergoing a rise in the demand for blood transfusions which have escalated due to the spiralling number of patients – from those afflicted by Chronic Diseases and Malignancies with their newest treatment modalities to the frightening increase in road and rail accidents on a daily basis.
As such our country is in constant need of voluntary blood donations from healthy Sri Lankans whose ages range from eighteen years to sixty years.
While the country has recorded a reduction in the demand for the blood due to the reduction of road accidents following the current lock down resulting in less road accidents there are still a number of challenges that confront the National Blood Transfusion Service (NBTS).
Yet despite these challenges, the National Blood Transfusion Service has succeeded in maintaining its supply for all needy patients throughout the island.
The Sunday Observer spoke to the Director National Blood Transfusion Service Sri Lanka, Dr. Lakshman Edirisinghe on how the National Blood Transfusion Service has been able to perform so well under trying circumstances escalated by the Covid-19 pandemic and rise in Dengue cases due to the onset of the monsoon.
Excerpts from the interview
Q. Sri Lanka is a country which requires blood for a variety of reasons ranging from patients undergoing surgical procedures to Thalassaemia patients. Even with the Covid-19 pandemic the continued demand for blood transfusions is still present. My question is does the NBTS have enough stocks at present to meet this demand for blood?
A. We always maintain adequate stocks to cater to our patients’ requirements under any circumstance. However, with the prevailing situation in the country, especially the Covid pandemic, it has become a challenging task to sustain the minimum requirement. It needs an extra effort with quite an additional work to keep the balance between supply and demand.
Q. What is the estimated number of donors you have at present?
A. Around 300,000
Q. Are they all voluntary donations?
A. Yes all are voluntary, non-remunerated donors
Q. In normal circumstances, what is the average amount of blood that hospitals need per day or month?
A. Island-wide details in normal circumstances
RCC 1000 to 1200 units per day
Platelets 500 to 600 units per day.
However, today, the situation has changed.
RCC 750 to 850 units per day
Platelets 350 to 450 units per day.
Q. If the pandemic worsens as it is likely by the large number of new cases being detected daily, and the rapid rise in road and rail accidents also on a sharp upward curve, do you see a rise in demand doubling or trebling in the near future?
A. Actually the reality is just the opposite.
With the imposition of travel restrictions RTAs, routine surgeries and normal patient visits to hospitals have come down significantly. So the demand is less.
Q. So what are the problems the Bank faces?
A. Blood collection which is usually achieved by mobile blood campaigns have decreased due to cancellation of mobiles due to lockdown and travel restrictions. Due to this, maintaining blood stocks to satisfy the demand is challenging.
Q. We are now in the midst of an extended lock down. As such, is the National Blood Transfusion Service ready with enough stocks and storage equipment to deliver blood to hospitals in different parts of the country within the required time?
A. Yes. Right now we are doing it.
Since the gatherings are restricted as a preventive measure of Covid-19 spread, the blood collections are affected from mobile blood campaigns.
We have already taken measures to increase the in-house blood collections on appointment basis with an on-line donor pre-registration system in the National Blood Transfusion Service website (website link: www.nbts.health)
There is no issue whatsoever to maintain our supplies to any corner of the country.
Q. How much blood can a person give in a single donation? Does it depend on his/her age, health status etc?
A. 450ml the standard volume.
Q. Does it depend on his/her age, health status etc?
A. It is the respective age and health status.
Q. So does that mean someone with underlying chronic diseases like diabetes, hypertension, cholesterol and heart ailments will not be allowed to donate blood?
A. Yes.
Q. Do blood donations require hospital settings? Or can they be given in mobile clinics and makeshift tents as long as they are done in sterile conditions?
A. No. Hospital conditions are not required. More than 80 percent of our routine collections are done through outreach mobile camps as stated above.
Q. Are these donations done under medical supervision?
A. Definitely yes.
Q. Are preliminary investigations required before you donate your blood? If so, what are they?
A. It is only the Haemoglobin (Hb) check, No blood tests are done before the collection. However, they will be given a questionnaire which will have to be filled; counselling based on the completed questionnaire and a simple medical examination will be done to ensure the donors and donation safety.
Q. How do you know the blood donated is safe? What are the tests that are done to ensure this and where?
A. The first safety measure is taken at the counselling with the selection of donors. Here two aspects; the donor safety to undergo the donation process and the donation safety to the recipients.
The second safety layer is testing of each pack for five (5) transfused transmissible diseases at selected centres across the country before they are ready to use for patients. I must emphasise that quality and safety of all products are equally maintained throughout the country irrespective of the geographical location.
Q. How long will it take for a person who has donated his blood to recover?
A. On average a person can leave the donation site within 30 minutes of donation without any complication.
Q. How often can a healthy person donate blood?
A. A person can donate blood every four months.
Q. A person is considered completely normal in between except for blood donations. Explain please.
A. The volume depletion occurred during donation is adjusted by 30 minutes and that is why a donor can safely be discharged from the donation site. The complete recovery of the volume depletion ensues by 12- 24 hours of donation. The cellular part (mainly red blood cells) takes about 6 – 8 weeks to come back to the pre-donation state.
Our donor selection criteria are set in such a way that all those who are accepted to donate are healthy and fit enough to withstand above changes.
Q. What is the ideal age group for blood donations?
A. Eighteen years to fifty-five years.
Q. Can children under12 years of age donate blood? If not, why not?
A. No. This is because they are in the growing and development age bracket. Hence, they are not considered physiologically suitable according the standards set for blood donations
Q. What about elders who are healthy?
A. Maximum suitable age considered is 60years.
Q. What are the obstacles that prevent voluntary donations across the country e.g. cultural barriers, and myths?
A. All around the country we have voluntary donations. But in certain areas some extra motivational efforts are needed.
Some believe that after a blood donation, a “Physical weakness” will occur. No such effect is felt by almost all of our blood donors except those who are emotionally susceptible, because we select healthy donors.
Q. What are the benefits of blood donations?
A. To the donor the most powerful health benefit is arguably in the psychological well-being.
Iron stores are regulated and many organs of the body are thus benefited such as liver and heart. Donating blood is good for you, and it’s even better for all the people who desperately need the help.
Many patients need blood to save their lives. Thalassemia, leukaemia, lymphoma and most other cancer patients on various medications need blood and blood products. Pregnant mothers with post-partum haemorrhage, patients in shock following trauma and all patients undergoing major surgeries can be saved with blood transfusions.
Patients with Chronic Kidney Disease and those experiencing severe complications from Dengue can also be saved from a blood transfusion.
Q. How many lives can a single dose of blood save?
A. Two to five.
Q. Which authority is responsible for the overall management of blood donations island wide? What role does it play?
A. The National Blood Transfusion Service.
Q. What role does it play?
A. It is responsible for the development and implementation of Blood Inventory Management Guides & the National Blood policy in Sri Lanka. In addition, it also provides technical and clinical expertise on the subject. It is the apex body overlooking all regulatory matters related to blood and blood products in both public and private sectors in Sri Lanka.
Q. Is blood donations part of a strategic national development plan?
A. Yes, it is a national bio safety requirement for any country in that matter.
Q. What is the goal of the National Blood Transfusion Service in the future?
A. To be the leader and the best service provider in the National Transfusion Services in the Southeast Asian region.
Q. Is there a definite date for achieving your goal?
A. We are on a five-year plan to achieve this height if other conditions in the country are favourable for us to achieve the target.
Q. Do you have a message for our readers with regard to blood donations?
A. The National Blood Centre and each Cluster Blood Centre makes a pre-assumption about the number of mobile blood camps and the number of donors and decides the production of blood components in comparison to the national requirement.
Blood is a precious resource that must be carefully managed to ensure that each donor’s gift provides the greatest benefit to patients. It is essential to increase collections when the demand is high, and it is equally important to limit collections when the blood stocks are adequate, hence preventing wastage of blood.
Once a donation takes place, blood and components have a limited lifespan, and the person is not suitable to donate for another four months. The most important point is that there are no other substitutes for blood. Therefore, the National Blood Transfusion Service of Sri- Lanka is committed to optimise blood collection, production, blood inventory management, provision and transport to meet the statistically and scientifically predicted patient needs while minimising resource wastage.
So do not be disheartened if you are requested to donate on a later date simply due to adequate stocks in hand.
Q. Anything else you wish to add?
A. We also request our readers to communicate with the blood centre nearest to you via our online portal and hotlines to donate as per requirement without violating travel restrictions.
Our hotlines are: 0115332153/54