Shilpa Naik clearly remembers how nervousness turned into panic that August night as she began to trawl her phonebook, social media and the Internet for a likely platelet donor. Her daughter Aarohi, 16-month-old then, was fighting a brain tumour and an urgent platelet transfusion was needed to combat the side-effects of chemotherapy. “We realised how few people even know what platelet donation is,” Shilpa recollects. After a 10-month-long struggle, Aarohi passed away on October 28 this year.
It wasn’t platelet unavailability that killed Arohi, but the Naiks will never forget the stress over arranging for this life-saving blood component through the 10-month treatment, the growing dread before every chemotherapy session over whether a donor would be found. Oncologists estimate that the country needs about 70,000 units of platelets annually, though there is no official figure to verify that claim. More tellingly, there is no official national-level registry for platelet donors.\ The National Blood Transfusion Council (NBTC) has admitted that they neither possess any data on yearly requirement of platelets nor on the kind of supply available in the country.
Part I | From native villages to big city footpaths: cancer patients struggle to survive
A single private registry exists in Mumbai, called ‘Save a Life’, run by the Nargis Dutt Cancer Foundation. It has 2,280 registered donors. “That, however, fulfills only 71 per cent of the hospital’s demand. In other cities in India, hospitals have to look for donors as and when the demand arises,” Dr Rajendra Badwe, director of Tata Memorial Hospital, told The Indian Express. Mostly, relatives are requested to step forward when there is need.
Platelets are a life saving blood component, aiding clotting and preventing blood loss. Required for treatment of dengue, malaria, leptospirosis, post-pregnancy complications, bone marrow ailments and cancer, doctors say not enough awareness exists about platelet requirement in cancer treatment. “Everyone knows about platelets due to the rising incidence of dengue, but the larger demand is for cancer treatment,” says Dr Sunil Rajadhyaksha, head of transfusion medicine department at Tata Memorial Hospital (TMH), India’s largest cancer hospital.
Tata Hospital alone has a yearly need of 4,000 units. “Most patients are from West Bengal, Bangladesh, Uttar Pradesh and Bihar. Asking them to arrange for platelets donors in an alien city inhibits them,” admits Shalini Jatia, secretary of ImPaCCT Foundation, which provides aid to young cancer patients.
Parents of two-year-old Geeta Singh (name changed), from a village near Faizabad, have been living with their daughter in Mumbai for the last two months. Diagnosed with Acute B lymphoblastic leukemia, Geeta has already undergone her first chemotherapy cycle and three platelet transfusions of half a unit each time. When Geeta required her first transfusion a day after her hospitalisation, the parents were told to find donors. “We do not know anyone in this city. We did not even know what exactly platelets were,” father Abhijeet Singh (name changed) rues.
Dr Tushar Vora, a paediatric oncologist, says platelets are frequently required for patients of leukemia, lymphoma and brain tumour and for patients undergoing chemotherapy and certain radiation sessions. “A rough estimate will be 20 units of platelet per patient during the entire treatment. One unit of platelet can help build 30,000 platelets per microliter,” says Vora. He adds, “It has never happened that we have enough supply.” Mumbai receives about 60,000 cancer patients every year for treatment, of which 80 per cent are from outside Maharashtra. The private registry’s donor-list is simply not enough.
Former Parliamentarian Priya Dutt, who heads the Nargis Dutt Foundation, admits that low awareness of platelet donation is the prime cause for short supply. Her organisation attempts to visit corporates and colleges seeking prospective donors. “Blood donation is known, accepted. But people are anxious about platelet donation,” she says.
A common misconception is that platelets can be extracted from stored blood. The truth is that blood can be stocked for up to two months, but platelets have a shelf life of barely four days, making it impossible to store. Platelets can be separated from blood only immediately after donation, and to collect one unit of platelets requires over six units of whole blood.
Dr Rajadhyaksha explains that the Random Donor Platelets (RDP) method of extracting platelets by separating blood into different components is insufficient in cancer treatment — a lot of units of blood need to be collected before a sufficient quantity of platelets can be extracted. The second method, Single Donor Platelets (SDP), involves hooking a donor on to an aspheresis machine that extracts blood, separates platelets and then injects blood back into the donor’s body. In this method, one donor can provide one unit of platelets.
Data from the State Blood Transfusion Council (SBTC) shows that Maharashtra has 309 blood banks of which 254 have component separation facility. Only 110 have aspheresis machines (to directly extract platelets from body).
It’s little wonder then that platelet donation faces serious hurdles, crippled by low awareness and worse infrastructure. Of 2,700 blood banks in India, only 700 currently possess a facility to separate blood into various components. “Attempts to streamline the data are underway. We first need to understand the demand of platelets in order to work on how to improve the supply,” an official from NBTC told The Indian Express.
Mehul Doshi, 50, is one of Mumbai’s silent heros, donating platelets once every three weeks or so. As Doshi walks along the narrow passages of Dadar’s Sant Gadge Maharaj Dharamshala where hundreds of outstation cancer patients live every year, or when he ventures into Tata Memorial Hospital, family members of patients approach him with smiles and stories. He stops and listens to each. Doshi is a well known and much revered figure here, having helped save at least 116 lives — the total number of times he has donated his since 2011, roughly abuot 23 times a year.
It was in 2011, having donated blood 68 times previously, that Doshi was approached for platelets. He refused — the procedure of injecting blood back into the body appeared unsafe. When the same patient approached him the second time, Doshi agreed after consulting a doctor. When tests showed that he had a higher platelet count than normal (5 lakh per microliter compared to the normal range of 1.5 to 4 lakh per microliter), he was put on an aspheresis machine for 90 minutes. “When I came out, a woman was standing in the hospital corridor. She was looking for an urgent platelet donor for her 21-year-old daughter Preeti Sahu, from Jhansi. Her husband was not supporting the daughter’s treatment,” Doshi remembers. That girl, suffering from advanced stage blood cancer, changed Doshi’s perspective, leading him to turn a regular donor. Sahu passed away in 2013, but Doshi continued the good work.
Now part of a team attempting to motivate others to donate platelets, Doshi says superstitions ride high and many are unwilling to donate beyond their first attempt. After months of efforts, he succeeded in registering 20 donors. “But the common problem is that when people agree to donate once, they never turn up again. The time to take tests and then extract platelets from blood requires one and a half hours,” he says.
When patients find no donors, the only alternative is to buy platelets. Zahid Khambatti, a social activist and frequent donor, says charges in private hospitals are exorbitant. “They range from Rs 10,000 to Rs 15,000 per unit, as opposed to blood available for Rs 1,250 per unit,” he says.