The National Blood Transfusion Committee (NBTC) and Blood Transfusion Services Division of the Directorate General of Health Services published the Transfusion Medicine Technical Manual Third Edition 2023.
The Manual reveals that the World Health Organization (WHO) has emphasised the need for a well-structured national blood system governed by a comprehensive blood policy and legislative framework. This directive aims to promote uniform implementation of standards, ensuring consistency in the quality and safety of blood and blood products across nations.
The WHO highlights that a well-organized and coordinated Blood Transfusion Service (BTS) is essential, and such coordination may occur at either the national or sub-national levels. The primary goal of the BTS is to guarantee that blood and its components, including Whole Blood, Packed Red Cells, Plasma, and Platelets, meet specific criteria:
- Availability: Ensuring adequate blood collection to meet the demand.
- Accessibility: Extending the reach of blood where it is needed.
- Affordability: Providing blood services at reasonable costs.
- Safety: Ensuring that blood transfusion does not cause harm, especially avoiding transfusion-transmitted infections (TTIs).
- Standard Quality: Offering clinical benefits through standardized practices.
To maintain the safety of blood for transfusion, certain fundamental conditions must be met, including:
a) Safe Donor:
- Blood collection from regular, repeat, non-remunerated voluntary blood donors.
- Pre-donation counseling and deferral of individuals with “risk behavior.”
b) Safe Blood/Components:
- Quality testing and processing following Good Laboratory Practice (GLP) and Good Manufacturing Practice (GMP).
- Sensitive screening for TTIs.
- Proper blood component separation and storage.
c) Safe Transfusion:
- Optimum and appropriate transfusion practices using components.
- Proper bedside transfusion practices.
d) Haemovigilance:
- Implementing a look-back system to track donor and transfusion-related adverse reactions.
The Manual also recalls, that a landmark Supreme Court judgment in January 1996 led to the establishment of the National Blood Transfusion Council (NBTC) and State Blood Transfusion Councils (SBTC), the elimination of professional donors, enactment of legislation for controlling blood center operations, and the introduction of mandatory licensing for all blood centers.
Subsequently, the National Blood Policy (NBP) was published in 2002, emphasizing the government’s commitment to safe blood and blood components. In 2007, the Action Plan for Blood Safety proposed centralization of the BTS for improved quality and economy of scale.
The National AIDS Control Organization (NACO) played a pivotal role in improving blood safety until 1992 when the entire BTS was entrusted to NACO as a blood safety program. Licensing of blood centers became mandatory in 1997, and paid blood donors were banned in 1998.
The present structure places blood transfusion services under the purview of the Directorate General of Health Services (DGHS). The NBTC, working under the DGHS, coordinates policy matters at the national level, while at the state level, SBTCs and State AIDS Control Societies (SACs) oversee activities related to blood transfusion services and blood safety.
The current status reflects significant growth in blood transfusion services since 1996. Both government and non-governmental organizations manage blood centers, and the focus is on opening centers at the district level to ensure widespread accessibility. Transfusion medicine has evolved into a medical specialty, with over 50 institutions offering postgraduate courses. The Hemovigilance Programme of India monitors adverse reactions, enhancing patient and donor safety.
The Revised Manual underscores the importance of a well-coordinated national blood system to ensure the safety and accessibility of blood and blood products, aligning with global standards and advancing public health.
