Recently, the Drug Comptroller General of India (DCGI) issued guidelines on the preservation of blood and blood products by storing them at intended temperatures. Newly introduced guidelines suggest that, as of October 2022, all blood bank cold chain devices must be certified medical grade and class B. To deliberate on how reliable cold chain infrastructure can ensure efficient blood management In India, B Medical Systems India Pvt. Ltd. in association with ETHealthworld brought together several domain experts for a webinar. Speakers for the discussion were Dr Rema Menon, Medical Officer, IMA Blood Centre, Kochi, Dr Nidhi Bhatnagar, Director and Lecturer (IHBT), BJ Medical College, Ahmedabad, Dr Varun Capoor, Consultant and Medical Officer Transfusion Medicine, Paras Hospitals, Gurgaon, Dr Rajesh Sawant, Consultant, Transfusion Medicine and Histocompatibility and Immunogenetics, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Dr Sumathi Hiregoudar, Associate Professor, Department of Transfusion Medicine and Blood Centre, Tata Memorial Center—Centre for Advanced Cancer Treatment and Research and Education, Navi Mumbai, Dr. Abhik Banerjee, Zonal Technical Chief, Eastern Zone, Apollo Diagnostic, Apollo Health & Lifestyle Ltd Unit, Kolkata. The session was moderated by Prabhat Prakash, ETHealthworld’s Senior Digital Content Creator.
During the webinar, the experts addressed a number of pertinent issues disrupting the cold chain infrastructure in the country, including making blood management systems in India more efficient using innovative technologies, addressing the challenges of waste of blood, improving the quality of plasma with specialized instruments such as contact freezers and many more.
Responding to the absolute need for an efficient cold chain system and the importance of a correct blood storagesaid Dr. Menon, “Blood transfusion it is an essential part of modern medical care. And if used correctly, it improves health and saves lives.”
Dr. Menon defined this as a therapeutic intervention. It could lead to acute or late complications that carry the risk of morbidity and mortality. Transfusion-transmissible infections are one of the most common complications associated with blood transfusions.
“For safe and effective transfusion, we need to look at coding and we need to implement certain strategies for blood safety,” Dr. Menon continued, noting that safe blood transfusion strategies have been defined by the World Health Organization. ( WHO), which include the establishment of well-organized and coordinated blood transfusion services at the national level with quality systems in all areas. Blood collection should be from voluntary, unpaid, repeat blood donors to ensure safety. There is a need for a testing program as directed by regulatory authorities for all units of blood to prevent transmission of communicable infections and reduce unnecessary transfusions through effective patient blood management protocols available to national and international level.
Dr. Bhatnagar explained the nuances and role of multi-stakeholder training and skills development in cold chain management. He emphasized specialized training of personnel with medical and paramedical backgrounds in the handling and storage of blood and various blood components.
“It is essential to train the work staff, and we are handling these blood products, perhaps outdoors blood donation camps, when blood is coming at every step. At this point, there is a lack of training in cold chain maintenance, equipment that is required for cold chain maintenance, and monitoring of temperature management,” added Dr. Bhatnagar.
Dr. Capoor raised the need to focus on blood waste on the patient side. Recounting incidents where blood was found near the patient’s bedside and proper conditions were not followed, resulting in blood wastage, Dr. Capoor explained, “We need training of nurses in proper handling of blood and blood products, as well as the training of our young residents and doctors, surgeons and doctors as well, mainly because many times they are not aware of the correct storage of these blood products”.
Dr. Bhatnagar stressed that building the capacity of blood transport boxes is the need of the hour and explained that they are a vital part of any blood center that needs to be lightweight for transportation and shipping purposes. “Ideally, there should be a digital display that shows the temperature inside, and it should be secured and locked.” He further added that the reservation period for transport boxes must be a minimum of 12 hours.
Underscoring that it is important to maintain temperature during storage, transport or even routine processing, Dr. Sawant shared: “The most common problem is that once the blood is collected, while it is waiting for the components to separate temperature should be in an air-conditioned room temperature around 22-24 degrees C. Room temperature and humidity may not be controlled in many centers, affecting blood quality and blood components.
Dr. Sawant noted that in India, the temperature during the summer could be a challenging factor. It is a well-known problem that during the component separation process, inventory is left out as labeling progresses, and according to Dr. Sawant, if the product is not held at the required temperature for more than 30 minutes, then the chances of quality being affected are higher.
In addition to installing quality management systems so that patients receive safer products in terms of stem cell therapy efficacy, Dr. Hiregoudar discussed comprehensive cold chain solutions, he said. cryopreservation It acts as a cell biopreserver, which allows its subsequent use as required.
“We have temperature-controlled devices where cells can be transported across distances and where cells are required at the patient’s bedside, and we have temperature recorders that are used to keep track of the cold chain. These containers are very important to manage the viability of the cells,” reported Dr. Hiregoudar.
Commenting on the importance of an efficient supply chain in diagnostics, Dr. Banerjee commented: “Today, more than 70 percent of therapeutic decisions are made on the basis of laboratory reports alone, so it is very important when doing patient management, precision and laboratory precision matter a lot.
Dr. Banerjee raised an important point: Historically, more than 70 percent of laboratory errors occur due to preanalytical errors, which means identical variables. And temperature drift or cold chain breaking is one of the major practical challenges faced by all laboratories across the globe including India.
“In India, as the diagnostic sector is largely fragmented and disorganized when we consider that there are more than one lakh labs present, very few labs maintain that kind of quality. So you can consider the scale of this problem to be huge,” said Dr. Banerjee.
On top of that, Dr. Banerjee clarified the daily operational challenges faced for proper analysis of blood samples. He expressed concern about delays in sample collection or logistics service from the initial sample collection. Sample results can vary according to Dr. Banerjee if proper cold chain processes are not maintained. Speaking about logistics, Dr. Banerjee highlighted the importance of special shipping boxes with ice packs provided and proper sampling policies or procedures for preservation purposes.
After entering the laboratory, the quotient of the samples should be kept until it reaches the technicians and should also be kept according to the policy of the quality management system of the laboratory. Dr. Banerjee said that in his experience, complaints or concerns about sample review are sometimes raised, which he says can only be possible if blood samples are properly stored in a refrigerated room or private refrigerator.
The discussion brought up common problems with the lack of transport protocols. The supply chain requires strict attention and guidelines, awareness and training as it is a neglected area so far. Participants concluded the webinar on an optimistic note. With the rise and prominence of technological innovations in the Indian healthcare sector, experts believe that the ramifications of such innovations will be amplified for blood supply and administration systems as well.
(Brand Connection Initiative)
