It has been 200 years since the first human-to-human blood transfusion was carried out on a man suffering from carcinoma. From storing blood in glass bottles to plastic pouches and discovering compatibility with blood groups to testing for infections, blood transfusion has evolved significantly. Yet, the life saving medical procedure ails from the lack of a system in place, say experts.
It was on December 22, 1818, when obstetrician James Blundell carried out the first human-to-human blood transfusion. While the patient who received the blood succumbed 56 hours later after showing initial improvement, Dr. Blundell’s first successful case of blood transfusion in a woman was recorded in The Lancet in 1829. “We have come a long way. But even today, lives are put at risk by transmission of infections. This is happening only because the government has made zero efforts to put a system in place”, says Dr. Zarin Bharucha, chairperson of the Federation of Bombay Blood Banks and Red Cross Mumbai’s blood transfusion committee.
Mushrooming of blood banks
Too many blood banks in the country is the biggest problem, said Dr. Bharucha, who has been working in the field since 1966. “For a lay man, this looks like a good thing. But there is no one to monitor the blood banks. We don’t know if they are following all testing and storage protocols. The Food and Drugs Administration (FDA) is a regulatory body but it is always short staffed and cannot tab all the blood banks,” she said. The country has more than 3,000 blood banks including over 60 in Mumbai. These are run by the government, municipal corporations, NGOs, politicians and hospitals.
“We should have only four to five blood centers to supply blood to hospitals. The hospitals can then only have storage facilities like most developed countries do,” Dr. Bharucha said. She referred to the recent case in Tamil Nadu where a 23-year-old woman tested positive for HIV after being transfused with infected blood in a government-run hospital in Sattur as an example. “Why should a small hospital in Sattur have a blood bank? Who has monitored whether the blood bank followed all protocols?" she asked.
Replacement blood donation
Experts also point out that dependence on replacement donation due to low social awareness is another big problem. “Voluntary blood donation is the safest way of donating blood. The hospitals have to take responsibility of arranging blood for patients and it should not be the other way around,” said Vinay Shetty from the Mumbai-based Think Foundation, which organises blood donation camps. “It is only in our country that patients and relatives are made to arrange for replacement blood. It is heartless and criminal,” Mr. Shetty said.
When people donate voluntarily, they are more likely to give a truthful self-history. When relatives, friends and unknown individuals are brought in as replacement donors, they are more likely to hide their history as they may not be prepared to talk about it.
“When it comes to blood donation, a lot of things matter. One’s sexual history, involvement with multiple partners, illnesses, drug use and so on. Choosing the right blood donor is important to avoid getting infected blood into the cycle,” explained Dr. Bharucha, who feels that mass blood donation camps also need to be closely monitored to check if they are following protocols like taking history, counselling donors etc.
According to the State Blood Transfusion Council in Maharashtra, merely 2.4% of the total collected blood in 2017 was of replacement donors. However, activists have criticised these figures, saying that replacement blood donation is rampant.
Lack of legislation
Dr. Bharucha said that lack of legislation further damages the blood transfusion cycle. “India has a National Blood Transfusion Council but it is a toothless body. There are so many things going wrong when it comes to blood donation and transfusion but there is no authority that can take action,” she said, adding that the World Health Organization demands that all countries should legislate their policies on blood transfusion.
“If the government fails to implement the required measures, we will only be staring at more cases like the one in Tamil Nadu,” Dr. Bharucha said.
First human-to-human transfusion
On December 22, 1818, James Blundell, a noted physician, physiologist and obstetrician carried out the first human to human blood transfusion. Blundell with the help of surgeon Henry Crine Noyes, his niece’s husband, transfused a 35-year-old man with what would now be called gastric carcinoma, but was then described as ‘scirrhosity of the phylorus’. Approximately 14 ounces of blood were administered by syringe in small amounts, from several donors, at intervals of 5-6 minutes. Despite temporary improvement in the condition, the patient died 56 hours later.
Between 1818 to 1829, Blundell and his colleagues performed ten transfusions using human blood. The first successful transfusion was of a woman who recovered from severe post-partum hemorrhage after receiving eight ounces of blood from Blundell’s assistant during the course of three hours. The case was published in The Lancet in 1829.
(Source: Blood Transfusion in History by Dr. Abdul Nasser Kaadan and Dr. Mahmud Angrini)
