There is no mistaking the passion and zeal that Dr. Rema Menon brings to her work as Head, Transfusion Services, Apollo Hospitals, Chennai. But it is so much more than that, the Blood Bank is where she ‘transfuses’ hope to not only patients, but also their families. Before she joined Apollo Hospitals in 2005, she worked in different blood banks including the IMA Blood Bank, Kochi, Kerala that was supported by the community. She witnessed true community spirit here with students contributing money (one rupee each) for the blood mobile. Her sensitivity stems from her work at Kidwai Cancer Institute, Bangalore where she had a baptism by fire seeing leukemic children abandoned by their parents because they were daily wage earners who had to work to provide for the rest of the family.

Talking about the role of the Blood Bank in organ transplantation, Dr. Menon emphasises that it is vital to improving the quality of transplantation since it spans the pre, peri and post-operative period. In fact, it starts with correct blood grouping and Rh typing. It is also important to have an evidence-based blood order schedule for ordering different blood components. In the post-transplant phase, the blood bank is involved in the management of antibody-mediated rejection (therapeutic plasma exchange and adsorption therapy to remove antibodies).

In deceased donation transplantation, the blood bank has to be always prepared for any eventuality. There are no shortcuts here when it comes to giving someone a new lease of life, Dr. Menon says, and adds that in a liver transplantation up to 100 units of blood have been given! The process starts with a minimum stock of blood and blood components being maintained, a quality assurance programme, and staff that is sensitised to the needs of a transplant taking place at short notice.

Blood safety has recently taken centre-stage given the scandals in Tamil Nadu, but way back in 2008 Dr. Menon put in place a number of safety measures including leucodepletion to prevent transmission of CMV infection from blood products and NAT testing (for HIV, HBV and HCV). She adds that while it is known that safe blood and blood products are required for many surgical procedures, it is imperative that the public actually understands the process in ensuring safety and the costs involved. Dr. Menon has seen public perception about blood donation changing over the years with growing volunteerism and enormous support for the cause. Social media has played a key role in spreading the message of blood donation among the youth with online campaigns yielding excellent results. Another positive development is that along with blood donation, organ donation is also being promoted.

A B O I n c o m p a t i b l e t r a n s p l a n t a t i o n is gaining popularity and is another area where blood bank interventions are critical to the process. Dr. Menon elaborates that the antibody titre of the recipient is important. This is evaluated during t h e p r e -t r a n s p l a n t workup. If the antibody titres permit intervention, immu n omo d u l a t i n g drugs are used, and plasma exchange or adsorption is done. Four procedures are carried out pre-operatively. Post-operative procedures depend on the immunosuppression that the recipient is being given.

There is one other cause that is close to Dr. Menon’s heart as Member Secretary of the Institutional Ethics Committee-Clinical Studies of the Apollo Hospitals – the ethics of living organ donation where she seeks to support vulnerable populations, especially women as living donors – wives, mothers, sisters, daughters. She strongly advocates that an independent living donor advocate be made available in all transplant centres to ensure that it really is informed consent. She feels that psychosocial counselling needs to be strengthened and not made too simplistic with more time spent on family counselling. While she quietly goes about her work in the blood bank, she also makes sure that her voice is heard when she talks about living donor care and follow-up...that too is in her blood.

- Dr. Sumana Navin