|LETTER TO EDITOR
|Ahead of print publication
Can blood collection and transport vehicles be feasible supplements to conventional blood collection strategies?
Soumee Banerjee, HM Ashok
Indian Red Cross Society Blood Centre, State Branch, Bengaluru, Karnataka, India
|Date of Submission||17-Dec-2022|
|Date of Acceptance||11-Jan-2023|
|Date of Web Publication||23-Mar-2023|
Indian Red Cross Society Blood Centre, State Branch, Esteem Arcade, Race Course Road, Bengaluru - 560 001, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this URL:|
Banerjee S, Ashok H M. Can blood collection and transport vehicles be feasible supplements to conventional blood collection strategies?. Iraqi J Hematol [Epub ahead of print] [cited 2023 Jun 9]. Available from: https://www.ijhonline.org/preprintarticle.asp?id=372378
COVID-19 and subsequent lockdowns impacted blood collection severely all over the world., Despite minimizing elective needs, a baseline demand for blood remained due to emergent and unavoidable cases. Therefore, it was necessary to find a feasible adjunct to conventional blood donation camps in order to meet these needs. Blood collection and transport vehicles (BCTVs), vehicles refurbished to include donor couch (es), storage areas, screening desks, and whole blood and reagent storage facilities, could serve this purpose. There is a dearth of literature on the effect of BCTVs on blood inventories across the country, especially in the context of the pandemic. This standalone South Indian blood center has three BCTVs, the details of which are summarized in [Table 1]. The inside of a BCTV is shown in [Figure 1].
|Table 1: Details of blood collection and transport vehicles used by the blood center|
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|Figure 1: Inside structure of a BCTV. 1: Overhead storage, 2: Air conditioning, 3: Driver area, 4: Predonation counseling and examination area, 5: Refreshment area, 6: Donation couch, 7: Entrance, 8: Whole blood storage unit, 9: Bottom storage, 10: Way to exit, handwash area, and refreshment storage area. BCTV = Blood collection and transport vehicle|
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BCTVs can tap into a valuable pool of donors who can be motivated on the spot. However, apprehensions about blood collected from BCTVs include need for impeccable screening to minimize the risk of transfusion-transmitted infections (TTIs), avoidance and management of adverse donor reactions (ADRs), bureaucratic red tape in acquiring BCTVs, and their cost-effectiveness. In the 24 months of this study, the TTI reactivity and ADRs in donors donating in BCTVs have been lower than the overall rates in total units collected by the center. It is crucial to formulate and adhere to standard operating procedures (SOPs) in these regards. Measures such as stocking and regular review of the inventory of emergency medicines onboard, additional duration of postdonation observation, staff training and re-training, and knowledge of nearby hospitals in the route to be taken each day go a long way in avoiding and managing ADRs when they do happen. Regular assessment of knowledge and practice among the staff is also paramount. Aid from government or private organizations can help blood centers acquire BCTVs, and assessment of cost-effectiveness for every camp needs to be handled by the center. Alternatives must absolutely be kept at hand in case of BCTV breakdowns, repairs, and maintenance when no collections can be done on those days in them.
These BCTVs are used by this center for roadside “camps” as well as for venues of camps arranged by third-party organizations. The thorough records of all camps and in-house collections that are maintained at the center were used to tabulate monthly number of camps, number of collections, number of TTI reactive donors, and number of ADRs between March 2020 and February 2022, with special focus on the months when the lockdowns were in full swing and are compiled in [Table 2]. All these parameters among BCTV donors are also expressed as percentages of the total numbers of the center as a whole. It is novel because extremely limited literature exists on this topic in the context of India, even less so during the pandemic.
|Table 2: Bimonthly overall and blood collection and transport vehicle collections and transfusion-transmitted infection reactivity during March 2020-February 2022|
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Owing to the pandemic, special COVID-19 preventive measures were taken at the BCTVs. SOPs were laid down, staff were trained, and compliance of the same was evaluated monthly. Temperature check and hand sanitization were offered at the entrance, the vehicle was operated with 2–4 staff members as per the size of the vehicle, special attention was given to ensuring good ventilation in the vehicle, masks were made mandatory for both donors and staff at all times, surface sanitization was insisted upon, and before each donor occupied a couch, a paper cover was placed on it which was discarded after him to allow for a fresh one for the next donor. The donor questionnaire had to be modified as per evolving national guidelines to allow for deferral based on symptoms, contact history, and vaccination status.
Details of TTI and ADRs are included as parameters of efficacy of existing SOPs for donor screening and management. Between March 2020 and February 2022, the total number of units collected by the center was 36,412. BCTV collection was 12,846 (35.2% of total collection) in 526 camps.
Between April and June 2020, 27 camps and 710 collections (12.7% of total collections) were done in the BCTV. Between July 2020 and February 2021, the BCTV contributed 108 camps and 3547 units (30.4% of total collections).
During the second wave of rise of COVID-19 cases, varying degrees of lockdown were imposed between March and June 2021. In these 4 months, BCTVs contributed 62 camps and 1480 units (36.8% of total collections). Between July and December 2021, 230 camps and 5088 units (44% of total collections) were done in the BCTVs.
In the third wave between January and February 2022, 99 camps and 2021 collections (56% of total collections) were in BCTVs.
As shown in [Table 2], the overall TTI reactivity in the center between March 2020 and February 2022 was 0.94%, and among the BCTV collected units, this percentage has been 0.87%. BCTV collected reactive units made up 0.3% of total units collected during these 24 months. 32.7% of the total reactive units were collected in BCTVs. Between March 2020 and February 2021, the TTI numbers were hepatitis C virus (HCV) (BCTV –14, total –49), Hepatitis B virus (HBV) (BCTV –11, total –64), HIV (BCTV –2, total –5), and syphilis (BCTV – 18, total –55). Between March 2021 and February 2022, they were HCV (BCTV –23, total –55), HBV (BCTV –19, total –56), HIV (BCTV –3, total –6), and syphilis (BCTV –23, total –65). There were no reported cases of malaria in the donors. The numbers mentioned above were the donors deemed reactive by one test of the primary method of screening at this center (chemiluminescence-based assay for viral markers and rapid plasma reagin for syphilis), which lead to the discard of the units collected from these donors. Subsequent test protocols for donor counseling and notification are beyond the scope of this text, and the numbers in those categories have not been enumerated.
ADR in the center between March 2020 and February 2022 was 0.7% (254 out of 36,412), and among the BCTV collected units, this percentage has been 0.65% (84 out of 12846). The majority of those reactions were postdonation giddiness (226 in total, 72 in BCTV), with local swelling and hematoma formation comprising the rest. All of them were managed at the vehicle with the emergency medicine kits onboard. Only one donor required further management at a nearby government hospital emergency room to stitch up a laceration he had sustained due to a fall from feeling giddy after donation. The expenses were paid for by the center with a follow-up call the next day to check on his recovery.
Despite all their concerns, the contribution by BCTVs to the blood collection attempts of the center during the COVID-19 pandemic was invaluable. It rose from 30.6% through 36.8% to 44% between July 2020 and February 2022. However, as is evident, the major part of collections, even during the peak periods of the pandemic, were from in-house and fixed venue camps. This goes to show that even though BCTVs can be good supplements to conventional methods of blood collection, there is no substitute for an efficiently run blood center with a motivated donor pool supporting it, even in unforeseen circumstances.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]