History of Blood Donation Movement in India

After the war, this blood bank was handed over to the State Govt and transferred to Calcutta Medical College campus. Nobody thought o' motivating and recruiting voluntary blood donors during peace time Professional blood sellers were accepted as the main source of blood to meet the need of the day. Blood banks were established in metropolita11) cities of the country in the forties. In the fifties the district blood banks were established. All these blood banks depended on professional sellers. Non- availability of blood in these government blood banks encouraged a number of doctors to establish commercial blood banks throughout the country. In 1954, the son of Mrs. Leela Moolgaoker, housewife of the Tata family met with a road accident in Bombay while travelling on a motor cycle. He was taken to St. Georges Hospital near VT Railway station. Blood was needed to save his life. Hospital employees and the employees of House came forward to donate blood. The life was saved. But this incident tiggered off the need of organising blood donation drives in the mind of Mrs Leela Moolgaoker. Mrs Moolgoker carried on her mission till her last day in 1992. Under the leadership of Dr H M Bhatia and Dr Z S Rharucha, Federation of Bombay Blood Banks was founded.

In 1962, Dr V G Mavahnkar an eminent surgeon of Ahmedabad, finding difficulty in getting right type of blood at the right time took up the cause of promotion of voluntary blood donation under the umbrella of Red Cross along with Dr Van; and carried on his self-assigned task till his death in 1984.

Led by Dr Triguna Sen, then Rector of Jadavpur University, students and teachers organised first blood collection drive during peace time in West Bengal on August 4, 1962. In a month long daily blood collection drive, 301 students and teachers donated blood. Some of the donors of this camp initiated the move to set up the Association of Voluntary Blood Donors, West Bengal in 1980 with eminent doctor and social worker Dr Labanya Kumar Ganguli as the president and established professional engineer Arunabha Chattopadhyay as the secretary to build up voluntary blood donation movement by involving the community and by using various innovative techniques. Voluntary organisations in the districts and subdivisions of the state were established and voluntary blood donation in the state became a statewide people's movement At the moment, there are forty voluntary organisations working exclusively on blood donor motivation, recruitment and retention for the fifty eight government blood banks of the state.

In 1962 Dr.M.L. Gupta Director Indian Red Cross Society Blood Bank, Delhi initiated voluntary blood donation movement in Delhi by bringing in other voluntary organisations.

In 1964 at Chandigarh, led by a housewife Mrs K Swaroop Krishen and supported by the then in-charge of the blood bank at P G I Chandigarh UrJ G Jolly, the Chandigarh Blood Bank Society was established to recruit voluntary blood donors. From Chandigarh at their initiative Indian Society Blood Transfusion and Immunohaematology (ISBTI) was established on October 22, 1971. This organisation introduced All India Voluntary Donation Day on October 1 in 1975. Since then, the day is being observed throughout the country. National AIDS Control Organisation came forward to support the observance of this day from 1996. ISBTI has chapters in some states of the country. In 1967, patronised by the Tata House, Jamshedpur Blood Bank was established to recruit voluntary blood donors and collect, store and distribute blood. In 1985, Voluntary Blood Donors Association, Jamshedpur, BiharJ was established to work from outside the blood bank to motivate and recruit blood donors.

In 1970, the students of Madurai Medical College, with the inspiration from their teachers Dr S A Kabir, Dr T Dorairajan and Dr T Chelliah set up Madurai Blood Donors Club to organise voluntary blood collection drive for the hospitals of the city. In 1974, Dr T Subramanian took over the charge and the club could do away with the professional blood sellers from the medical college hospital in 1983.

In 1975, Mrs Shanti Ranganathan, a housewife of the TTK family, established the Madras Voluntary Blood Bank to spread the message of voluntary blood donation in the state. Subsequently, led by R Rajkumar, a bank employee, the Association of Voluntary Blood Donors Tamil Nadu was established in 1991 to function from the same premises to work for the same cause for the whole state.

In 1985, the First National Seminar and Workshop exclusively on blood donor motivation took place at Calcutta. This three-day meet enabled field workers and the organisers working in the country to meet and share their experiences and inter state contacts and communications were established. The meeting after a whole night session, formulated a draft National Policy on Blood Transfusion, which was printed and circulated. The proceedings of the said meet served as the hand book on blood donor motivation for quite sometime. This prompted the Government of India to constitute a working group and organise workshops and the National Guidebook On Blood Donor Motivation came out in June 1990.

On the basis of the recommendations of the first-ever national meet on blood donor motivation, a link quarterly bulletin "Gift of Blood" came to be published regularly from Calcutta from October 1985. The bulletin has now completed its eighteen years.

National meets on donor motivation were subsequently organised by different organisations in Mumbai, Chennai, Chandigarh, Indore, Pune, Jaipur, Tamluk, Bhavnagar at regular intervals. Even two International meetings on donor motivation and recruitment were hosted at Calcutta in 1990 and 1995.

Other voluntary organisations to recruit blood donors were established in Tripura, Assam, Madhya Pradesh, Orissa and Punjab between eighties and till this date.

On a public interest litigation, the Supreme Court directed the Union Government on January 4, 1996 to abolish buying blood from sellers with effect from January 1, 1998 and asked the Government to constitute National and State Blood Transfusion Councils to promote voluntary blood donation.

National AIDS Control Organisation established, in 1992, under its Blood Safety Programme has been supporting voluntary blood donation of the country.

National and State Blood Councils were set up in July 1996 under the direction of the Supreme Court. The portions of the Drug Rules under the Drugs and Cosmetics Act related to blood banking were thoroughly revised and came into force from April 5, 1999 and subsequently modified thrice. National Blood Policy, after processing through all levels, was released on April 2002. The Action Plan for Blood Safety was released by NACO in May 2003.

NACO had his first phase of programme between 1992-99 and entered in its second phase of the programme on November 9, 1999. The second phase would continue upto 2004. Thirty percent of the project cost is focussed on Blood Safety. The project finances HIV and other test kits, technical assistance on blood safety, and upgradation of equipment in government blood banking facilities. It also sponsors information, education and communication (IEC) campaign at both national and state level to generate awareness of potential danger of unsafe blood from unlicensed blood banks and professional sellers, and promotes the voluntary blood donation movement.

Every year, exercise by way of workshops, seminars, conferences are being organised by National AIDS Control Organisation (NACO), World Health Organisation (WHO), Department of Science, Technology, Government of India (DST) and voluntary organisations to train up the blood donor motivators to embark upon a journey to achieve total voluntary blood programme for the country. WHAT IS BLOOD?

Human Blood is actually a liquid connective tissue made of mainly plasma and more 3 important components like the red blood cells, the white blood cells and the platelets.

WHAT IS THE MAIN FUNTION OF BLOOD?

The main functions of blood are:

  2. Maintain the body immunity.

  Furthermore, blood helps in healing of wounds and also keeps our body temperature steady.

  WHAT ARE THE MAIN COMPONENTS OF THE LIQUID?

  Blood is mainly made of about 22% solids and 78 % water. The components of human blood are:

• Plasma

• Red blood cells (RBC)

• White blood cells (WBC)

• Platelets

• Fat globules

• Chemical substances including carbohydrate, hormones, electrolytes, proteins.

• Gases like oxygen & carbon di oxide.

PLASMA: This is a straw colored liquid with 92% composed of water. However, the remaining 8 % of this liquid contains more than 200 substances, including minerals, vitamins, proteins, sugar, fats and some other minerals acting as chemical messengers and help fight diseases. As more than the half of blood is made of this circulating liquid, the RBCs, WBCs, and Platelets as well as other components of blood move throughout the system remaining suspended in plasma. Generally, average adult body contains six pints of plasma out of 10 –12 of pints of blood. Plasma carries nutrients to all parts of the human body and carries off waste products to the excretory organs.

 RED BLOOD CELLS (RBC): This component makes up 40-50%of total blood volume and is responsible for providing the red color to the blood due to the oxygenated haemoglobin present in it. As it contains the iron containing protein haemogloobin, which is very much essential component helping in carrying of oxygen from lungs to the entire body cells and at the some time it picks up carbon dioxide and carries it back to the lungs to be exhaled, serves the most impotent function of blood to keep life possible. The oxygen released by the red cells help in the conversion of nutrients in food such as milk, red meat and green vegetables into energy. The RBCs (erythrocytes) are disc shaped, round and tiny microscopic cells without nuclei. These red cells are produced in bone marrow at a rate of 2-3 million per second from the stem cells by hematopoiesis. Each red cell contains about 270,000,000 iron-rich hemoglobin molecules.

WHITE BLOOD CELLS (WBC):Only 1% of total blood is composed of WBCs or leucocytes of variable number and types. Normally these are produced by the same hematopoiesis process in the bone marrow, and in some cases in the thymus gland. Other than blood, lymphocytes also occur in the spleen, liver and lymph glands. There are many specialized sub types of the cells that take vital part in our immune system. Among them the 5 main sub types are lymphocytes, monocytes (both agranular), basophils, neutrophils and eosinophils (all 3 are granular).

 •Lymphocytes (20-25%) - recognize surface markers on cells and targets them for destruction if foreign to the body;

•Monocytes (3-8%) - formed in bone marrow, monocytes migrate into connective tissue and become macrophages; •Basophils (5-1%) - acts on smooth muscle and Blood cell walls;

•Eosinophils (60-70%) - acts against infestations of parasitic lar

•Neutrophils (2-4%) - the first line of defense, 100 billion mature neutrophils are released into the body everyday.

  The primary function that white blood cells, or leukocytes, play is to fight against various bacterial, viral, fungi, and parasitic infections.

 • WBCs help in healing of wounds not only by fighting infection but also by ingesting matter such as tissue debris, dead cells and old erythrocytes.

 • Gives us protections from foreign bodies such as allergens that enter the blood stream.

 • Also protects against mutated cells, such as cancer.

BLOOD TYPING

Discovery of blood groups:

  People were familiar with transfusion of blood for so many years before the discovery of blood groups, though sometimes that resulted to death. It was 1901,when the Austrian Karl Landsteiner first described about blood grouping that made blood transfusion far more safer.

Transfusion of blood between two individuals can lead to blood clumping or agglutination as well as some toxic reactions that may be fatal for the patient sometime leading to death. That blood clumping is an immunological reaction of antigen antibody interaction was first discovered by him, who later made the typing of blood possible and thus made blood transfusion more scientific. For this discovery Karl Landsteiner was awarded with the Nobel Prize in 1930.

Different blood groups:

Our Blood types is determined by the specific types of antigens (relatively large protein molecules) present on our red blood cells. There are 27 known human blood groups, for which each of us can be typed. As a result, there is one or more antigens for each of these blood groups. Since many of these blood systems also are found in apes and monkeys, it is likely that they evolved prior to the time that we became a separate species.

The 27 known human blood groups:

The antigens are located on the surface of the red blood cells and in the blood plasma there are antibodies, which distinguish particular antigens from others, causing bursting or agglutination of the red cells when foreign antigens are found by binding to the antigens. Individuals have different types and combinations of these molecules. The blood group we belong to depends on what we have inherited from your parents.

The AB0 and Rh systems are the most important ones used for blood transfusions. Not all blood groups are compatible with each other. Mixing incompatible blood groups leads to blood clumping or agglutination, which is dangerous for individuals.

The ABO blood typing:

There are four different kinds of blood types: A, B, AB and 0 (null), according to the AB0 blood typing system.

Type A blood group contain type A antigen on the RBC cell, and type B contain type B antigen.AB type blood have both the antigens on the RBC. The designation of O was supposed to mean that no antigen, i.e. no A or B type antigen was present on the red blood cells. Later it was discovered that the type O cells actually had another antigen which was named H (for "human").

Blood type is determined by the "alleles"(different possible types of a particular gene, in this case the gene(s) controlling our Blood type) which we inherit from our parents. There are three common Blood type alleles: A, B, and O. Everybody has two alleles, one inherited from each parent. The possible combinations of the three alleles are: OO; AO; BO; AB; AA; BB

Blood types A and B are known to be "codominant" alleles (in our genetic Blood make-up both of them have important controlling influence), while O is "recessive." A codominant allele is apparent, or dominant, even if only one is present; a recessive allele is apparent only if two recessive alleles are present. Since Blood type O is recessive, it is not apparent if the person inherits an A or B allele along with it.

Therefore, there are certain possible allele combinations in a particular Blood type:

(1) OO = Blood type O; (4) AB = Blood type AB;

(2) AO = Blood type A; (5) AA = Blood type A;

(3) BO = Blood type B; (6) BB = Blood type B.

Blood transfusion will be successful if the person going to receive blood has a blood group that doesn't contain any antibodies against the donor blood's antigens. But if the person going to receive blood has antibodies matching the donor blood's antigens, the red blood cells in the donated blood will result to clumping.

Rh –factor blood grouping:

Further typing as (+) or (-) is based on the Rhesus factor (Rh antigen) present on the red blood cells. People having Rh antigens on RBC are Rh positive (+) & who lack the factor are Rh negative (-). However, most people are Rh positive.

The +ve or -ve characterization depends on the presence or absence of two Rhesus genes called the D or d, inherited from each parent. A person is Rh (D) -ve if he/she has inherited a d gene from each parent making them d/d. In case of a person being Rh(D) +ve there may be three genetic combinations possible, like the offspring has got D gene from each parent making them 1)D/D or a D and d from the parents (either ones) making them 2)D/d or 3)d/D.

Thus it is possible to have an Rh (D) -ve offspring from a father who is Rh (D) +ve and mother who is Rh (D) –ve and vice versa. If one of the parent (Rh (D) +ve) has both a D and d gene and the other is Rh (D) -ve; the offspring may be Rh (D)-ve if he /she inherits the d gene from his (Rh (D) +ve) parent. The child from a D/D father and D/d or d/d mother or vice versa will always be Rh(D) +ve since it will get a D from one of his parent and either a D or a d from the other. So, what is relevant here is the presence or absence of the D gene that makes a person Rh (D) +ve or Rh (D) -ve.

…Now, the problem is that the D antigen present in the Rh (D) +ve blood stimulates the Rh (D) -ve blood into producing antibodies against it. Whereas Rh (D) +ve blood does not produce antibody against a Rh(D) –ve blood group , as +ve blood does not produce `anti-d` - there is no anti-Rh(d). However the problem comes as the Rh (D) -ve blood produces antibody against Rh (D) +ve.

According to above blood grouping systems there are 8 following blood groups.