Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : EC27 - EC31 Full Version

Approach for Safe Transfusion Practices during COVID-19 Pandemic: Observation of an Indian Rural Blood Bank


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51927.16348
Nikhil, Subhashish Das, A Hemalatha, R Kalyani

1. Postgraduate, Department of Pathology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, Karnataka, India. 2. Professor, Department of Pathology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, Karnataka, India. 3. Professor, Department of Pathology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, Karnataka, India. 4. Professor, Department of Pathology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, Karnataka, India.

Correspondence Address :
Subhashish Das,
Professor, Second Floor, Department of Pathology, SDUMC, Kolar, Karnataka, India.
E-mail: daspathology@gmail.com

Abstract

Introduction: Focus of blood transfusion services is continuous, judicious and well-timed supply of safe blood. The Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) pandemic has caused the major disruption throughout the world and declaration of nationwide lockdown by Government of India from 25th March 2020 to 31st May 2020 to halt the spread of virus has afflicted the blood bank services enormously.

Aim: To keep the focal point on approaches implemented for safe blood transfusion services during Coronavirus Disease-2019 (COVID-19) pandemic in rural blood bank and to observe how COVID-19 pandemic has affected blood transfusion services in year 2020 with regards to blood collection, supply and organisation of camps as compared to year 2019.

Materials and Methods: A retrospective study was done in the Blood Bank in a rural tertiary care hospital in Southern India, from January 2019 to December 2020. Various measures were implemented to increase the donor safety and prevention of spread to community and to increase the number of voluntary donors. Statistical analysis performed using Statistical Package for Social Sciences (SPSS) software version 21.0. All data was entered and tabulated in excel sheet. A two sided t-test was utilised for comparing dual variables and one sided Analysis of Variance (ANOVA) for multiple variables. The p-value <0.05 was considered significant.

Results: Mean number of units received during pre-COVID-19 year were significantly higher (4468±4127.2) as compared to COVID-19 year 2020 (2282±1856.4) with significant p-value <0.001. Overall utilisation of Packed Red Blood Cell (PRBC) (0.001), Human Platelets (Single Donor Platelets (SDP)/Random Donor platelets (RDP)) p-value 0.003, Fresh Frozen Plasma) FFP (p-value 0.001) was significantly higher in pre-COVID-19 year as compared to COVID-19 year 2020. Total number of camps conducted in pre-COVID-19 year was 41 as compared to 23 in COVID-19 year 2020. Patients deferred for blood donation were much higher in COVID-19 year 2020 (n=400) with maximum (32.5%) under category of self-deferral due to clinical illness as compared to year 2019 (n=200).

Conclusion: As a result of our strict and effective implementation of COVID-19 safety protocols, no donor had complained of post donation COVID related symptoms and none of our blood bank staff had developed any COVID-19 related illness. Hence during the COVID-19 pandemic, our blood bank maintained 100% attendance (with staggered duty hours).

Keywords

Blood components, Blood donation, Coronavirus disease-2019, Donor safety, Voluntary donors

The goal of Blood Transfusion Services (BTS) is prompt and continuous supply of safe blood (1). The continuing COVID-19 pandemic, attributable to Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2), is causing major disruption throughout the world. Nationwide lockdown was declared by Government of India from 25th March 2020 to 31st May 2020 to halt the spread of virus, affected blood bank services extensively (2). Decrease in blood donations due to scarcity of outdoor blood donation camps, restricted social gatherings and stringent social distancing policies in accordance to guidelines laid by the government of India caused paucity of blood. Other reasons which affected blood bank services were sickness of essential staff and sickness in community due to COVID-19 infection. A crucial pursuit for transfusion organisations during this period of pandemic, either in a hospital or separate BTS, is to assess the demand and supply for maintaining adequate blood stocks during critical situations for instances such as major trauma.

In a resource constraint rural set-up like ours significant challenges encountered were recruitment of healthy blood donors, ensuring safety of staff, maintenance of blood stock and management of consumables. In this study, evaluation was done to observe how COVID-19 pandemic affected the BTS from January 2019 to December 2020 in regard to supply of blood, blood collection with organisation of voluntary blood donation camps in a rural setup located in Karnataka state in India. So, policies were strategised for prioritising the patients in the event of expected shortage.

Surveillance of demand and supply was done to sustain adequate blood stocks to aid during emergency situations (1). The present study was conducted with the aim to keep the focal point on approaches for safe BTS during COVID-19 pandemic in rural blood bank and to observe how COVID-19 pandemic has affected BTS in year 2020 with regards to blood collection, supply and organisation of camps as compared to year 2019.

Material and Methods

The present retrospective study was conducted at RLJH blood bank, Department of Pathology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, Karnataka, India, for two years from January 2019 to December 2020. The study has been carried out as per ethical guidelines of the institute with IEC NO: DMC/KLR/IEC/46/2021-2022. Data related to issue of blood/blood components which were affected in the COVID-19 pandemic was retrieved, analysed from January 2019 to December 2020. Collection of data was done from the RLJH hospital Blood transfusion registers. Study data was retrieved for the following blood components issued to the patients: Packed Red Blood Cells (PRBCs), Random Donor Platelets (RDPs), Single Donor Platelets (SDPs) and fresh frozen plasma (FFPs).

Inclusion criteria: All these blood components have been included based on their respective clinical requirements and the respective components fulfilling the quality criterias as per Directorate General of Health Services (DGHS) standard (3).

Exclusion criteria: Whole blood and cryoprecipitate issued were excluded from the study as they were very few in number in comparison to other components.

Study Procedure

Donor Selection criteria was strictly followed and in any suspicious case blood was not collected for processing and was advised to go for voluntary deferral. As per Standard Operating Procedure (SOP), all Whole Blood (WB) units was separated into blood components that included PRBC, FFP, RDP.

General measures implemented in present study as approach for safe transfusion practices during COVID-19 pandemic:

1. Measures to increase safety of donors.
2. Measures executed to increase the number of voluntary blood donors.
3. Decrease spread to community and management of staff.
4. Maintenance of blood stock.
5. Management of consumables.

Measures to increase safety of donors: Strict donor only policy was applied to decrease the crowding around the blood donor area. Donors were examined for body temperature by a handheld infrared thermometer before entering into the blood donor area. Rearrangement of waiting area as coloured circles were drawn or fixed on floor which helped to maintain social distancing more effectively. Alternate seats/donor beds were kept vacant with proper signage in understandable languages for maintaining social distance protocol (Table/Fig 1). Donors were kept at a distance of atleast one meter in respective blood bank couches. Each donor was provided with hand-rub sanitiser and a face mask, if they were not wearing. Utilisation of additional COVID-19 related donor health questionnaire as per National Blood Transfusion Council (NBTC) protocol (4). The supplement consisted of questions related to donors and their close contacts, symptoms of active infection, history of travel to abroad (especially to china, South-east Asia, history of travel from the neighboring states (Kerala), history of contact with case suspicious of COVID-19 or with confirmed case of COVID-19) and COVID-19 vaccination status.

Donors with positive history, history of travel to abroad or neighboring states or with donor with symptoms was deferred and followed by referral to medicine clinic. The BTS staff was enlightened about COVID-19 crisis and its vital preventive measures for example hand hygiene, cough etiquette, social distancing etc. All donors were educated and advised to contact the BTS in case of any postdonation illness including signs and symptoms of COVID-19 or in case of close contact with COVID-19. To enhance blood safety all blood donors on the 14th day of donation were personally contacted over telephone asking their well-being and health status. All such communication was documented in the donor card and signed by the BTS doctors. The BTS Staff members were advocated to follow the World Health Organisation (WHO) document regarding the safety of the healthcare personnel’s (5). The Voluntary Blood Donor Organisers (VBDOs) were advocated to ensure self-deferral of any donor with symptoms of fever, cough or cold or deferral for donors who were in close contact with the person having these symptoms or who had a history of travel abroad within the last 28 days. Donors with age group more than 55 years accompanied by underlying medical condition for example diabetes or hypertension was advocated to elude blood donations.

Measures executed to augment the number of voluntary blood donors: Regarding logistical issues, police and local civil authorities were approached and blood donor movement pass were issued mentioning the date of the donation for smooth commutation of blood donors. Prior donor appointment was made and transport was arranged by us without violating COVID-19 protocol and ensuring donor safety. To alleviate the apprehensions in the rural population with respect to process of blood donation was a challenging scenario for that Information Technology (IT) services was utilised for creating Whatsapp group, Short Message Service (SMS) were delivered to various local Non-Governmental Organisation (NGO) requesting for donor motivation. Our donor outreach program with help of local NGO’s was successful and satisfactory donor response was noted inspite of Kolar being rural and backward area. Responding to our messages, donor came to donate blood. No insistence or compulsion was utilised for the blood donation.

Decrease spread to community and management of staff: Blood banks have to decrease staff, sustain hygiene of the areas. Forefront blood bank staff and volunteers were provided with basic Personal Protective Equipment (PPE). The BTS staff was told to continuously sanitise and wash hands. Staggering of duties for the BTS Staff was implemented: a weekly roster was prepared to keep only half of the staff for continuous duties for seven days, then to isolate them at home for the sequential seven days. For commutation arrangement of special bus was done by the administrative officials. The staff was advocated to get homemade food. Staff members were requested to avoid overcrowding and maintaining social distancing during lunch hour.

Indian way of greeting (Namaste) was the preferred mode of greetings instead of using handshake. Maintenance of social distance while at blood donations. The grouping of donors was avoided, eluding over four donors at a time, was executed in consultation with the VBDOs. Donor area sanitisation was done for atleast four times in a day after every three hours and flowing water availability, sanitiser, hand soap and colour coded dustbins according to biomedical waste management guidelines were made accessible in blood bank for proper and efficient disposal of COVID-19 specified consumables. After every blood donation, couches were cleaned utilising a 1% sodium hypochlorite solution. All the door handles/knobs in the blood bank were cleaned daily after every one hour. We advised the blood bank staff including doctors as well as technicians to be updated regarding recent norms for COVID-19 from WHO (5).

Maintenance of blood stock: In view of countrywide lockdown due to COVID-19 pandemic and consequently decrease in voluntary blood donors hospital administration was requested for:

a) Postponement of elective surgeries;
b) Requested for performing only emergency surgeries;
c) Using the social platform (whatsapp): Bharat scouts, National Service Scheme (NSS and other NGO were contacted to come forward by prior appointment;
d) More in-house blood donation drives were conducted on a weekly basis ensuring COVID-19 safety protocols.

Management of consumables: For management of consumables, following approaches were implemented:

a) Sharing of near expiry reagents (ABO Blood grouping) with other blood banks as exchange mechanism to minimise wastage;
b) Placing of indent for consumables including reagents at weekly intervals;
c) Maintaining regular contact with vendors so that extra reagents if needed can be procured at a short notice. Whole exercise was designed to maintain a satisfactory level of buffer stock of blood bags, masks, gloves, donor refreshments, donor certificates so that any exigencies can be met.

Statistical Analysis

All data obtained was entered, segregated and tabulated in micro excel software as per mentioned variables. Statistical analysis was performed using SPSS software version 21.0 for windows. Tables were prepared in Microsoft excel sheet. A independent t-test was utilised to assess the difference in mean and Standard Deviation (SD) between Pre-COVID-19 year (2019) and Post COVID-19 year (2020). The p-value <0.05 was considered as significant.

Results

(Table/Fig 2) demonstrates comparative evaluation of total blood collection month wise during Pre-COVID-19 year 2019 and COVID-19 year 2020 along with gender distribution. A total of 53,625 units were collected during the pre-COVID-19 year 2019 whereas 27,384 units were collected during COVID-19 year 2020. Mean number of units received during pre-COVID-19 year were significantly higher (4468±4127.2) as compared to COVID-19 year 2020 (2282±1856.4) with significant p-value <0.05 (0.001). As seen commonly in the developing countries, 90% of donation is by male. Male donation is common in the developing societies including India because of various socio-economic and socio-cultural factors. In India most of females have low haemoglobin, are underweight and undernourished, undergo multiple pregnancies along with pregnancy related complications. The present study reflects same underlying conditions and hence female constituted 1.24% and 1.5% of donation in year 2019 and year 2020 respectively (Table/Fig 2).

Overall utilisation of PRBC, Human Platelets (RDP/SDP) and FFP was significantly higher in pre-COVID-19 year as compared to COVID-19 year 2020 with significant p-values (<0.05). p-values noted were 0.001, 0.003, 0.001 for PRBC, RDP/SDP and FFP respectively (Table/Fig 3). A comparative evaluation of transfusion details across the various hospital departments shows a marked decrease and this reflects the sincere efforts of blood bank staff to communicate and convince the various clinicians including the physicians, surgeons and pediatrician to postpone all elective surgeries and therefore perform only emergency surgeries and to promote use of various alternatives of blood and blood components. During the pandemic our Hospital Transfusion Committee (HTC) was very active and initiated several measures including few innovative measures as Maximum Surgeries Blood Ordering Schedule (MSBOS), Patient Blood Management (PBM) and performing transfusion audit at regular intervals along with sensitisation of medical/paramedical staff regarding judicious use of blood and blood components. The results of all such efforts are fruitful as reflected in the present study results as mentioned in (Table/Fig 3). Unnecessary transfusion, performing only emergency surgeries which is based on avoiding and postponement of elective surgeries as a consequence of the co-ordinated efforts of blood bank staff and clinicians as a result we could meet the challenge successfully. Comparative evaluation of blood camps in pre-COVID-19 year 2019 and COVID-19 year 2020 is reflected in (Table/Fig 4).

Total number of camps conducted in pre-COVID-19 year was 41 as compared to 23 in COVID-19 year 2020. Marked reduction in camps in COVID-19 year was noted due to various reasons as national lockdown, public fear, lack of transport and communication etc. So, blood bank under guidance of HTC took certain special initiatives to mitigate the challenge and fulfill the demand for blood requirement. Special initiatives included: walk-in donations, donation by appointment by utilising social media network and services of local NGO’s. Comparative evaluation of donor deferred along with the causes in pre-COVID-19 year 2019 and COVID-19 year 2020 is discussed in (Table/Fig 5). The reasons for deferral in pre-COVID-19 year 2019 were history of underlying medical condition (diabetes): 60 cases(30%) followed by history of drug intake 50 cases (25%) followed by history of tattooing (15%), history of epilepsy (10%), history of endoscopy (10%), history of dental extraction (5%) and immunisation (5%). Reason for deferral in COVID-19 year 2020 included maximum cases of self-deferral if suspicious of COVID-19 130 cases (32.5%), followed by diabetes 84 cases (21%), history of travel to abroad/neighboring states 70 cases (17.5%), history of drug intake (10%), history of tattooing (7.5%), history of immunisation (5%), history of endoscopy (2.5%), history of epilepsy and dental extraction (2%).

Comparative evaluation of units discarded along with their causes in pre-COVID-19 year 2019 and COVID-19 year 2020 is discussed in (Table/Fig 6). The annual discard rate was 2% for pre-COVID-19 year with 1,072 units discarded out of total 53,425 units due to various reasons such as insufficient volume, leakage from bag, breakage from needle, bacterial contamination, short shelf life etc. Maximum discard rate (75%) was noted in platelets due to short shelf life. In COVID-19 year 2020 discard rate was decreased to 1% due to several innovative and proactive measures initiated by blood bank under guidance of HTC with proper emphasis on blood inventory management based on principle of “First-in-First out” along with co-operation and co-ordination of clinicians. In both pre-COVID-19 and COVID-19 years maximum discard rate was of platelets (75%) due to their extremely short shelf life. Hence, efforts must be made to increase the shelf life of platelets. After approaches implemented for safe transfusion practices the results showed no donors had post donation COVID-19 infection, no staff had post donation COVID-19 infection. On analysis of donor feedback form 90-95% of donors were satisfied with the COVID-19 protocols followed for blood donation.

Discussion

Globally, around 19 million cases of COVID-19 have been confirmed and not a single case of transfusion-transmitted COVID-19 has been reported till date however, theoretically there is risk of COVID-19 transmission by blood transfusion (6). Hence, blood bank needs to maintain strict COVID-19 safety protocols Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) is a novel virus, its ability to cause transfusion transmission even by an asymptomatic blood donor is not known (7). Data in present study showed there was substantial reduction in total Blood collection as total of 53,625 units were collected during the pre-COVID-19 year 2019 whereas 27,384 units were collected during COVID-19 year 2020 (Table/Fig 2) and overall utilisation of PRBC, Human Platelets (RDP/SDP) and FFP was significantly higher in pre-COVID-19 year as compared to COVID-19 year 2020 (Table/Fig 3). Total number of camps conducted in pre-COVID-19 year was 41 as compared to 23 in COVID-19 year 2020 (Table/Fig 4). The decline in voluntary donation has been observed globally.

Various strategies were implemented in current study to augment the blood collection. Recruitment of donor was a major challenge. In a rural set-up donors were apprehensive of getting COVID-19 infection from hospital or blood bank. Special measures were implied to motivate donors through social media and telephonically to augment blood donations. In case of blood shortage, donor movement passes were issued for the ease of movement during lockdown. For maintenance of blood stock demand based strategies were implied for collection of blood and appropriate planning was done to elude shortage and to prevent the expiry of the collected blood units. The challenges faced towards maintaining regular uninterrupted blood supply for regular hospital use in Rural Blood Center. As the present blood bank is situated in a rural backward region where ignorance, illiteracy is high so the authors were forced to implement several innovative ways and means to ensure the blood supplies for emergency services are not hampered. Some of the effective measures implemented were: postponement of elective surgeries, performing of only emergency surgeries. Minimising unnecessary blood transfusion in case of borderline anaemia (Haemoglobin 10-12 g/dL) with use of Injection erythropoietin, hematinics wherever feasible. Clinicians were encouraged to practice concept of “Alternative Blood groups” as approved by WHO so that transfusion demands are successfully met without comprising patient safety (5). Performing in few selected cases, autologous blood transfusion (mainly for day care surgeries). The concept of Pharmacy Benefit Managers (PBM) was shared with the surgeons and they were encouraged to minimise transfusion wherever feasible. As a consequence, transfusion threshold for PRBC was decreased for example 6 g/dL for aplastic anaemia and 8 g/dL for chronic anaemia in an effort to have more equitable and judicial distribution of blood products particularly in crisis period (8). So strict observation should be kept on blood stock and its products, in view to take judgment ensuring import of blood and its products in a timely manner.

Measures can be taken to decrease the apprehension, myths about COVID-19 infection especially in rural population by implying awareness activities and blood supply can be maintained by encouraging voluntary blood donors (9). Clinicians were informed about the shortage of blood during pandemic and were told about utilising transfusion alternatives for example: Iron, erythropoietin (EPO), Intravenous immunoglobulin (IVIG), albumin etc., (10). Sharing of consumables which are about to get expired with other blood banks having scarcity of consumables because of lockdown. The National Blood Transfusion Council (NBTC) advocates that blood and its components if they are about to be expired or if particular blood group are in surplus, it is recommended to dispense the blood group units to nearest blood bank with special consent from government authorities to transport the units during lockdown period. For optimum hospital transfusion services during crisis period, blood bank developed a system of “Haemovigilance” where various challenges faced by blood bank were discussed with surgeons, clinicians and other stake holders so that hospital transfusion services are maintained at a optimum level (11). After implementation of these strategies no donor or staff had post donation infection and in case of emergency there was no shortage of blood requirements.

Limitation(s)

Failure to perform comparative evaluation of various other blood centres regarding their strategies of blood bank management during COVID-19 pandemic along with our non-participation regarding COVID-19 convalescent plasma therapy. The present study was a unicentric study conducted in a rural area with limited donor population and a variable vaccination status. Hence, the authors are constrained to have an elaborate and conclusive opinion regarding blood bank management in pandemic times. However, present study can definitely provide vital inputs for implementing various strategies and measures for blood bank management during COVID-19 pandemic.

Conclusion

As a result of strict and effective implementation of COVID-19 safety protocols, no donor had complained of post donation COVID-19 related symptoms and none of the blood bank staff had developed any COVID-19 related illness. Hence, during the COVID-19 pandemic, present blood bank maintained 100% attendance (with staggered duty hours). Given by the proven track record with regards to COVID-19 safety measures and stringent precautions taken regarding blood bank donation procedure and also as a measure of trust and faith of the general community on the blood bank management, voluntary blood donors from various walks of life came shedding their prejudice and inhibitions to donate blood and helped the blood bank in fulfilling health and societal responsibilities.

References

1.
Sharma S, Bunda S, Malakar PC, Sharma A, Gupta A. comparative study of blood transfusion services before and during COVID-19 pandemic and the challenges faced: Retrospective study done at a tertiary care hospital in North Western India. Int J Community Med Public Health. 2021;8(4):1788-91. [crossref]
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Saran RK Quality assurance in blood transfusion. Transfusion Medicine Technical Manual 2nd ed. New Delhi:Directorate General of Health services 2003. Pp.341-60.
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The National Blood Transfusion Council guidelines, Ministry of health and family welfare, Government of India; 2020. Available from: https://www.mohfw.gov.in/pdf/2ndNBTCGuidanceinLightofCOVID-1919Pandemic.pdf [Last accessed on 26th January 2022].
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WHO Guidance document on coronavirus disease (COVID-19) outbreak; 2020. Available from: https://www.who.int/docs/default-source/coronavirus/whorights-roles-respon-hw-COVID-19.pdf [Last accessed on 26th January 2022].
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The AABB Inter-organisational Task Force Statement on Coronavirus and Blood Donation; 2020. Available from: http://www.aabb.org/advocacy/regulatorygovernment/Pages/Statement-on-Coronavirus-and-Blood-Donation.aspx [Last accessed on 26th January 2022].
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Stanworth SJ, New HV, Apelseth TO, Brunskill S, Cardigan, Doree C. Effects of the COVID-19 pandemic on supply and use of blood for transfusion Lancet Hematol. 2020;7(10):756-64. [crossref]
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Ojha S, Gupta AM, Nagaraju P, Poojary M, Sumathi SH. Challenges in platelet inventory management at a tertiary care oncology center during the novel coronavirus disease (COVID-19) pandemic lockdown in India. Transfus Apher Sci. 2020;59(5):102-08. [crossref] [PubMed]
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Mohammadi S, Tabatabaei Yazdi SM, Eshghi P, Norooznezhad AH. Coronavirus disease 2019 (COVID-19) and decrease in blood donation: Experience of Iranian Blood Transfusion Organisation (IBTO). Vox Sang. 2020;115(7):595-96. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/51927.16348

Date of Submission: Aug 16, 2021
Date of Peer Review: Nov 27, 2021
Date of Acceptance: Mar 02, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 18, 2021
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• iThenticate Software: Feb 28, 2022 (13%)

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