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One of the most important essential first
move for blood donor recruitment is establishing clear goals by estimating pragmatically
the blood need of the Country/State/Region/ Blood Bank. For a well established transfusion
service, with a long history of success, knowledge of current patterns of blood
usage and data of changes from year to year, it is a straightforward matter to project
need into the future, to plan blood collection and recruit donors accordingly.The
process is much more difficult at the beginning in regions or states where no data
is available for any estimation at all. It is, therefore, quite natural that maiden
attempts of donor recruitment may result in insufficient blood collection in reality.
Surrounding every mountain peak, there are valleys and into these valleys one must
go before climbing the peak. There are joys. There are disappointments. There will
be success and there will be failure. Blood donor motivators should have a mental
makeup to accept both the rough and the smooth. The journey of a thousand miles
begins with the first step. And, a beginning has to be made.There may be three principal
reasons for failure in the first venture:
- Immature organisation
- Lack of clear goals
- Underestimation of blood need.
When there is no blood, suppressed
need of blood would not come to the surface. Blood need will increase with the availability
of blood. Even donor awareness campaigns may inculcate the sense of need of blood
in the minds of the clinicians and surgeons resulting in irrational use of blood.
That should be taken care of when blood would become easily available from the blood
banks.There may be a number of approaches for the estimation of blood need. Some
are simple and some are complex in character. Some may give an approximate idea
and some may give a fairly accurate target. To start with a goal, however approximate,
a target is badly needed to set the ball rolling.There are four approaches to estimate
how much blood is needed:
- In relation to hospital beds
- In relation to total population
- In relation to medical facility available
in the region
- In relation to past blood usage.
Ideally, if 2% of population donates
blood, it will be more than sufficient to meet the need of a country like
India
. For a population of 100 crores (1000 million), 2 crores (20 million) of intending
blood donor would be more than sufficient for the country by taking into consideration
all possible allowances. The present estimated blood need of
India
is 80 lakh (8 million) units. In the first method the need of blood can be calculated
as 3 to 15 units per hospital bed per year. It may also be calculated as 7 to 20
units per acute hospital bed per year. In the primary health centres, the need may
be 3 units per bed per year, while at a super speciality surgical hospital the need
may be as high as 25 - 30 units /bed /year. The golden mean may be worked out. With
the introduction of open heart surgeries, liver transplants and treatment for oncological
disorders in the country, the need of blood in different regions have increased.
The table below indicates the enormous
variations of blood donor per 1000 population between different countries.
Switzerland
113
Japan
70
Australia
58
New Zealand 56
Canada
55
UK
40
Greece
33
Singapore
24
Macao
23
Hongkong
27
Korea
22
Spain
21
Jordan
17 Malaysia
13
Zimbabwe 10
Mexico
10
New Guinea
9
Fiji
9
Philippines
7
China
4
Brazil
2
Vietnam
2
Sudan
2
Ethiopia
0.4
In India, this figure at the moment is 4 per thousand population
with some regions/states at a higher than the national average and some below the
national average.If this national average can be raised to 8 voluntary blood donor
per 1000 population, there would not be any shortage of blood for the country and
none would die for want of blood for transfusion.
The ideal simple method of estimating blood need at the beginning
would be to make a list of hospitals together with the details of bed strength of
a region for which a particular blood bank or transfusion service is supposed to
cater. This data is available with the health authority of the state. From this
data, by counting the actual bed or acute bed, by using rule of thumb, blood need
can be calculated by multiplying by the appropriate factor between 3 and 20
depending upon the standard of the health service. Another method may be to collect
data about the requisitions received and served by the blood bank / transfusion
service over a period of not less than three months. If such study had been conducted
in the past, the results should also be studied. While computing such data, care
should be taken pragmatically to:
- Express all data on annual basis
(if information availability covers only three months, it should be multiplied by
four).
- If data are not up-to-date, there
should be interpolation and or extrapolation to allow for changes during the intervening
period.
- It should be ascertained that information
collected is, in fact complete.
- Inconsistency between blood collection
and blood usage should resolved before interpretation.
It will be difficult to get data in
many states due to poor documentation and improper record keeping system. Still
a survey has to be undertaken. The survey may be based on the following questionnaires
- How many units of blood are collected
by the hospital in day/ week/month/year?(any one)
- How many requisitions are received
in a day/week/ month/year? (any one)
- How many units are asked for on an
average per requisition?
- Whether blood for the patients are
obtained from other sources?
- If so, what is the quantum?
With these data, blood need can be
estimated for the state/region/ blood bank for the year.The motivators have to collect
another set of data i.e. actual storage capacity of blood bank(s) or transfusion
service for which blood donor recruitment is being planned.
The blood donor motivators should remember that the donor recruitment target should
always be higher than the estimated blood need.
The reasons are :
- Recruited donor may not turn up on
the day of blood collection.
- Intending donor may be temporarily
deferred on medical reasons at the time of actual blood collection.
- Collected blood after testing may
be discarded for containing blood communicable parasite/virus.
Further, to meet each and every blood
need, the services will have to stock blood more than the estimated requirement.
As it is not known from which blood group patients would come, blood of all groups
including rare groups is to be adequately stocked. There may be some marginal periodic
so-called ‘wastage’ due to out dating of blood of some groups. A question can be
raised: which is better, some one dying for want
of right group of blood or some blood bags being discarded after the prescribed
expiry period for want of requisition of that particular group?
How do we feel if the unfortunate
victim, whose blood need could not be met, is our near and dear one?
A small portion of the collected blood, about 5%, may be outdated, another portion
of about 1% may be discarded after testing, for various reasons. Some of the intending
donors may be deferred on medical reasons; some intending donors may not turn up
on the date and time of blood collection. Considering all these allowances and adding
a blanket allowance of further 10%, the target of donor recruitment may be planned
for the year and computed for month or week.
Target of donor recruitment, annually, monthly or weekly should be at the finger
tip of donor recruiters. A portion of blood would be collected in the blood bank
but a goal has to be set. The goal should be pragmatic Estimation of blood need
and planning the target of blood donor recruitment are the initial steps to identify
the goal. The donor motivators/recruiters should assess, review and reset the goal
from time to time by generating data from different sources.
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