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Monday, March 5, 2012

Blood donations critically below par in China


NEW YORK — Every year, blood transfusions save millions of lives, but still millions of patients needing transfusion do not have access to safe blood because of insufficient donations. Among the countries suffering this problem is China, where insufficient amounts of donated blood continue being a problem despite efforts to raise people's awareness about this need.

The problem in China will be solved not only when technical issues are addressed, but when people's cultural beliefs are also taken into consideration.

In spite of the fact that China's Blood Donation Law was enacted in 1998, encouraging all citizens between the age of 18 and 55 to donate blood, only 84 out of 10,000 people donate blood in China. This is far below the 454 people out of every 10,000 people who donate blood in high-income countries.

Hospitals in Beijing, and in the provinces of Shandong, Shanxi, Yunnan and Jiangxi suffer from acute blood shortages which provokes delays in surgical procedures.

The concept of blood (xue) as it is used in traditional Chinese medicine (TCM) is different from that of the commonly used term in Western medicine. According to Chinese medicine, blood is a dense form of body fluids that has been energized by Qi, and has a synergistic relationship with it.

That is why the "Suwen," also known as "Basic Questions," a text that covers the theoretical foundation of Chinese medicine and its diagnostic method, states, "Blood and Qi are the spirits of man." This is one of the reasons that explain why many people in China are reluctant to donate blood.

According to TCM, one can donate blood once every two years without adverse effects, and this may even enhance the body's ability to produce more blood.

According to Western medicine theory, however, a person can donate blood every 56 days without fear of adverse effects. The blood lost can be completely recovered 10 days after the transfusion.

In addition to the belief that donating blood may drain a person's energy, other misunderstandings related to blood donation are that it can undermine men's fertility, lead to weight gain or result in dangerous changes in blood pressure. None of these beliefs has been proven true. The only drawback in blood donation is that if proper precautions are not taken, it may lead to the recipient's acquiring infections from the donor's blood.

Fear of transfusion transmissible infection, notably HIV, is one of the biggest factors discouraging people from donating blood. Many people remember the spread of HIV by contaminated blood in Henan province. It is estimated that, in central Henan province alone, more than 1 million people contracted HIV from selling their blood in unsanitary collection stations.

To overcome the problem of contaminated blood transfusions, the World Health Organization (WHO) recommends that, at a minimum, blood should be screened for HIV, hepatitis B, hepatitis C and syphilis.

Because of public concern of the risk of infection from donations, it is still necessary to overcome the popular fear that donating blood is deleterious to a person's health. According to some researchers, in one region in Western China, almost 70 percent of the people who were interviewed, said that fear of transmitted infections (TTIs) prevented them from donating blood.

A complicating factor in the need for donated blood is that several studies have shown that blood transfusions are often given when there is no urgent need — when simpler, less expensive treatments can provide equal or greater benefit. The need for more blood donations, however, is critical in China, which has made considerable progress in convincing many Chinese to eliminate blood selling and increase voluntary blood donation as a way of stemming transmission of TTIs.

During a couple of visits I made to China's rural areas in the 1990s, I was able to assess the greater needs of populations in the urban areas. More information and resources should be brought to those and to marginal areas in the big cities.

The World Health Organization lists five basic conditions to increase access to blood transfusions and to promote safety: (1) establishment of a nationally coordinated blood transfusion service, (2) (3) collection of blood from exclusively voluntary donors in low-risk populations, (4) testing of all blood for compatibility and TTIs, and (5) reducing all unnecessary transfusions.

In addition, it is important to secure the government's commitment and support for the national blood program and to continue public health campaigns aimed at educating the population, particularly in poor, marginal and rural areas. Blood is a gift of life, and should be treated as such.

Cesar Chelala, M.D., is an international public health consultant.


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