While Sri Lanka is still recovering from the Covid-19 pandemic that gripped the entire country from April this year, causing most services to grind to a halt temporarily, the National Blood Transfusion Service ( NBTS) must be commended for continuing its history of unbroken service to the nation by ensuring that its banks never ran short of blood supplies even in an emergency.
Director, National Blood Transfusion Service, Dr Lakshman Edirisinghe this week fields questions from Sunday Observer readers on who can donate blood, how often and how the bank ensures that all donations are 100 percent safe and uncontaminated. He debunks myths regarding blood donations and unveils future plans for the service.
Following are excerpts …
Q. As the apex agency for blood supply in the country, can you tell us how much blood the bank requires per day to meet the requirements of hospitals?
A. In routine circumstances, the country requires 1,200 blood (Red cell) 600 platelet units and around 400 units of plasma per day.
Q. Are there certain months when there is an increase in the demand for blood supply? E.g. during festive seasons when more road accidents are reported?
A. There is no significant difference in blood demand throughout the year. However, the number of blood donations is markedly dropped during festive seasons as the focus of the public is deviated on celebrations. Hence, meeting the national blood requirement becomes a challenge.
Q. How prepared is the NBTS to meet this extra demand for blood on an island wide basis?
A. There are some regular blood donation organisers who support the NBTS during these periods. Shraddha TV is one of these organisers who conduct blood donations throughout April. The NBTS reminds blood donors through public media announcements whenever blood requirement is rising.
Q. How many blood banks do you have around the country?
A. There are blood banks in all teaching hospitals, provincial general hospitals, district general hospitals and Type A base hospitals. The entire system comprises 102 blood banks.
Q. How do you ensure they all have sufficient blood supplies? Do you have a central monitoring system and a proper feedback system?
A. Yes. The NBTS is a centrally coordinated national service. The National Blood Centre (NBC) at Narahenpita functions as the headquarters of the system. The 102 blood banks of NBTS are affiliated to 24 regional blood centres, based on their locations. The NBC monitors the stock availability of all regional blood centres to ensure availability of blood in all hospital blood banks.
Q. How quickly is it possible to replenish depleted stocks? What kind of transport is available to carry stocks of fresh blood to their destinations? (helicopter? Ambulances?)
A. Adequate blood stocks are made available in all 24 regional centres. If there is any depletion of stocks at hospital blood banks the nearest regional blood centre, to which the blood bank is affiliated, can send the required stock within a few minutes via an ambulance.
Q. Is all the blood received by NBTS donated voluntarily?
A. Yes. In 2014, the NBTS declared self-sufficiency in blood supplies from 100% voluntary non-remunerated blood donations. We are continuing this standard successfully.
Q. How do you ensure that the blood donated is hundred percent free of any infection?
A. The NBTS ensures the safety of blood adhering to stringent quality control measures. This is a long process which starts with safe blood donor selection, blood collection adhering to biosafety techniques, blood transportation, processing and storage in appropriate temperatures in closed systems and testing of donated blood for transfusion transmissible infections (HIV, Hepatitis B and C, Syphilis and Malaria). The NBTS adheres to international standards in all these procedures.
Q. Can a person with a sexually transmitted disease such as HIV, AIDs or gonorrhea donate blood?
A. Persons with a sexually transmitted disease are not allowed to donate blood. According to the Penal Code, it is a punitive offence to donate blood knowing that he/she has a sexually transmitted disease.
Q. What about persons with preexisting conditions such as, diabetes and heart diseases?
A. If the person’s blood sugar levels are controlled by diet only, without any medicine, he/she can donate blood provided all other requirements are fulfilled. Persons with heart diseases are not allowed to donate blood.
Q. Do you follow the WHO guidelines for blood donations? According to the guidelines who is eligible to donate blood?
A. The NBTS has adopted a national guideline for blood donor selection based on WHO blood donor selection criteria. All healthy people aged between18-55 can donate blood. If previously donated, one can donate until 60 years, if he is otherwise healthy.
Q. How often should a normal healthy person donate blood?
A. A normal healthy person can donate blood at 120-day intervals.
Q. What are the health benefits of donating blood?
A. Although not proven by meta-analysis, certain health benefits of blood donations are evident. Improving cardiovascular health and reduced certain cancer risks are among them. Mostly, blood donations improve emotional wellbeing and help to get rid of negative feelings.
Q. In various reports in newspapers, we have seen schoolchildren being encouraged to donate blood. Is this a good thing?
A. Yes. It is a very good thing. Schoolchildren are the future blood donors. By encouraging them to donate blood, students will identify their social responsibilities as citizens. It also inculcates good qualities such as, teamwork, sharing, empathising and leadership.
Q. Following the outbreak of the Covid-19 pandemic in Sri Lanka, the National Blood Bank was faced with the challenge of ensuring that the NBTS had sufficient blood to meet any possible crisis. During the crisis did you run out of blood as the numbers began to rise unexpectedly? How did you deal with the situation as you had to supply the entire country?
A. Blood donation in Sri Lanka was highly affected with the imposed restrictions on public gatherings. Since the NBTS depends mainly on community-based mobile blood collection, the system faced a significant reduction in blood collection. The mode of blood collection had to undergo a rapid change to face the pandemic situation. Blood donors were invited to blood banks to donate blood adhering to safety precautions. The Covid-19 situation of the country was reviewed daily at the NBC and the at-risk areas identified and avoided from the blood collection plan.
The areas unaffected from the pandemic were identified for blood collection and blood components were distributed under central monitoring, to ensure the availability of blood at island wide blood banks. The contribution by the Tri-forces, Sri Lanka Police and civil security defence during the curfew is commendable. Issuing a special curfew pass for blood donors to attend the blood banks was a remarkable support for maintaining adequate blood supplies. Promotions carried out via social media campaigns were also immensely helpful.
Q. At present we have controlled the spread of Covid-19 and it is still in the first wave of transmission. If there is a second wave how prepared are you?
A. The NBTS developed guidelines for ‘donating blood adapting to the new normal’ The main focus is to strengthen in-house blood donations. An online blood donor registration system is established to facilitate blood donors to take appointments for donating blood at island-wide blood banks at their convenient time schedules. A pre-donation screening questionnaire is adopted to identify blood donors who are at risk of contracting the infection and to exclude them from blood donations to ensure blood donor and staff safety. Donors are informed of the importance of self-deferral if they feel unwell.
Q. What precautions do you have for health workers, nurses and doctors involved in blood donations?
A. In addition to the said precautions, all health staff of NBTS are provided with adequate amounts of personal protective equipment (PPE). Hand sanitisation/ hand washing facilities are provided in all blood banks and mobile centres to ensure staff and donor safety.
Q. The recently concluded parliamentary elections gave you a valuable experience in handling various situations with regard to blood distribution and other health related issues. Briefly tell us how it will help to shape your plans for the future?
A. NBTS has successfully maintained adequate blood supplies for the nation for more than five decades, under more challenging circumstances. However, ensuring blood supplies amid the combination of a pandemic and a general election was a novel challenge. Stringent monitoring of blood stock levels and planning the island-wide blood collection, processing and distribution were the key factors for the successful maintenance of adequate blood supplies. This experience disclosed the resilience of the NBTS in facing any challenge.
Q. What is your goal for sustaining blood and creating a disease-free blood zone?
A. Sri Lanka achieved a 100% voluntary donor base in 2014. Thus, we have achieved the mandatory step towards assuring safe blood supplies. In addition, NBTS is adhering to all best practices in blood donation testing, processing and storage. The goal is to maintain the current good standards while expanding the system with cellular-therapy and transplant facilities.
Q. How has the NBTS carried the message on the importance of blood donations to the public, youth, schoolchildren and parents in general?
A. In this technological era, the social media has become the most popular mode of communication worldwide. The NBTS could approach the youth through Facebook and other social media very effectively. The involvement of mass media, print media and school education programs were invaluable in conveying the message on the importance of safe blood donations.
Q. Any gaps you like to see filled in the present delivery of safe blood in the country? e.g. do all hospitals in remote areas have refrigerators to store blood? How close are they to the community?
A. Having an absolutely perfect infrastructure is not possible even in the most developed part of the world. Hence, this is not an exception for the NBTS Sri Lanka. Expanding the storage capacity, improving transportation facilities and human resource are prioritised in the future plans of the NBTS.
Q. Prejudices in certain communities and myths about blood donations?
A. There are many myths among the public on blood donations. The NBTS addresses these myths with correct facts through developing IEC (Information, Education, Communication) materials and public awareness programs.
Q. Your message to the public?
A. Almost 90% of blood supplies are collected from mobile blood donation campaigns conducted by volunteer blood campaign organisers.
However, in a situation like a pandemic this system is challenged by restrictions imposed on social gatherings. Hence, we wish to address the grassroots, that is the individual blood donors to walk-in to the nearest government hospital blood bank and donate blood. We invite the youth in social media groups to join the NBTS and donate blood at regional blood centres.