Blood Transfusion Service Director Dr. Lakshman Edirisinghe says
By Dinitha Rathnayake The importance of blood in the sustenance of life cannot in any way be overstated. However, recently, the public was alarmed by an incident reported from Morupala, where a blood donor tested positive for Covid-19 some time after she donated blood at the National Blood Transfusion Service (NBTS). The Morning spoke to NBTS Director Dr. Lakshman Edirisinghe in this for clarification on the issue as well as to gain insights into other related matters faced by the NBTS during this time of a global pandemic. Below are excerpts of the interview. [caption id="attachment_113402" align="alignright" width="537"]
NBTS Director Dr. Lakshman Edirisinghe[/caption]
Could you explain what happened with the blood donor who tested positive for Covid from Morupala?
I can’t divulge too much information about this incident. The lady came to us to donate blood and then left after donating. Thereafter, a friend of hers had contacted her to inform that the friend had tested positive and that our donor should do a precautionary PCR test to determine if she too was Covid-positive. Based on this advice, she went through a rapid antigen test which confirmed that she was indeed Covid-positive. Thereafter, she contacted us to inform us about her antigen test result. We immediately took steps to destroy the blood donated by her.
Why was not the donor not tested before taking blood?
There is no established clinical evidence that Covid-19 is transmitted through blood and blood products. In general, respiratory viruses are not known to be transmitted by blood transfusion, and there have been no reported cases of transfusion-transmitted coronavirus. Therefore, we do not test blood donors for Covid-19.
What are the challenges the NBTS has encountered due to the Covid-19 pandemic?
The blood component collection requirement of Sri Lanka per year is around 450,000 units. Before the pandemic hit Sri Lanka, in February 2020, the daily supply requirement of red cell concentrate (RCC) was around 1,500 packs and the platelet requirement was 800 packs per day. The Covid-19 pandemic was a huge challenge for us where we could not collect blood.
During the lockdown period where many of the patient visits were restricted, and with no road accidents taking place and no planned surgeries being performed, the minimum requirement of RCC was 600 packs per day and the platelet requirement was a minimum of 400 units per day. We found it really difficult to secure this amount of blood required. Even now, despite existing restrictions, 1,000 RCC packs per day are required. The platelet requirement is still around 650 units, which has become a national norm now. Therefore, it is not easy.
So, how was the required amount of blood collected during that period?
We get our blood through 100% voluntary, non-remunerated blood donations, mainly from mobile camps. A total of 85% came from the organised mobile camps conducted among the general public, while 15% come from voluntary walk-in donations. Due to the Covid-19 pandemic, it was difficult for us to manage this through mobile camps. Therefore, we had to depend on the tri-forces for a certain period and we had to rely on public mobilisation.
Normally, mobile camps are organised in religious places like Buddhist temples, Christian churches, and Hindu kovils by voluntary organisers and non-governmental organisations (NGOs). If someone requests to conduct a camp, the NBTS is always ready to consider that according to the health guidelines. Generally, after informing this to us, we have a standard way to approach this where our public health inspector (PHI) pays a visit to the specific location to conduct an inspection and to discuss with the organisers to ensure that everything is ready for the blood bank.
However, during the Covid-19 period, since our PHIs were busy, they couldn’t physically attend but precautionary measures were taken during the Covid-19 pandemic period as well. Even though we could not physically attend, we made sure that everything was co-ordinated and everyone was informed.
What has been the procedure for donating after the first Covid surge in March 2020?
The NBTS has a centrally co-ordinated blood transfusion system. In other countries, this system is only co-ordinated by hospitals where they have their own blood bank controlled by the hospital, and there is no co-ordination with other blood banks in the country. However, according to our system, all blood banks are co-ordinated and policy decisions are being controlled by the NBTS.
We have around 105 centres around the country. These centres are clustered and demarcated into 24 for the convenience of administration. One cluster is being headed by a cluster consultant and this is the administrative structure. We have introduced a 24-hour hotline (0112369931-4) where the donor can make a pre-booked appointment with limited interactions where they can come to their closest centre and donate blood during 8 a.m. and 4 p.m.
During the Covid-19 period, the donor received a text message (SMS) regarding the appointment to their phone, which they can show to the security officials. However, after donating blood, the SMS automatically disappears so that there will be no misuse. Currently, we use the same hotline and a policy of having mobile camps which are limited in terms of the number of persons involved, under strict guidelines. I was able to have a discussion with mobile camp organisers and agree on special measures like having two on-the-spot screenings, checking the temperature, making sure all locations are sanitised, and not keeping the donor waiting for a long time.
In Sri Lanka, the child birth delivery record is around 350,000 deliveries per year and 1,000 per day. So, even if it is a normal vaginal delivery, we should keep the blood reservation for the mother and the child. In addition, keeping blood for leukaemia, cancer, and thalassemia patients is also a must. Therefore, when the Government announced high-risk areas, we had to divert our mobile camps to the less risky areas. Thus, we considered far remote and less risky areas like Polonnaruwa, Hambantota, and Ampara.
How do you ensure the blood you collect is safe?
There is a misconception that after collecting blood from the donor, it is directly taken and given to the patient. Maybe people think this is something that is done for free and that there is no cost involved. A huge cost is involved before and after collecting blood.
Before collection, the cost includes human resources, transportation, containers which maintain the temperature, blood bags, etc. After collection, the cost includes the screening where the blood is tested for five transfusion transmissible diseases like hepatitis A and B, the human immunodeficiency virus, syphilis, and malaria. This is a thorough screening process.
However, the blood that we collect will be quarantined for 24 hours where we screen it for diseases and information about ineligibility. If there is any confirmation about these factors, the blood samples will be discarded. This will also feed into the system where such will be categorised as “lifelong ineligibility” and donors with such ineligibilities will be detected even prior to the collection of blood at the point of donation.
What do you expect from the public who are keen on donating blood?
Be faithful to the system and be genuine like the lady from Morapala. She was honest enough to inform us about her testing positive, which helped us. During our two screenings, we are able to find people who have ineligibilities, but we also expect the public to be faithful enough to give us the right information.