Blood transfusion: how to make it safe
Dr Amarjit Kaur

Unsafe blood transfusion has not received much attention despite its posing a big threat to the future of the country.

In India, blood transfusion services infrastructure is highly decentralised and lacks many critical resources, mainly trained people, equipment and financial support.

In the early days of blood transfusion therapy, the risks of transfusion-transmitted diseases were high and a multitude of infections could be transmitted. The introduction of a closed collection system, improved sterilisation techniques and refrigerated storage of red blood cell components has dramatically reduced the risk of bacterial contamination of blood.

Three main pillars of blood safety are the selection of donors, the selection of donations and adherence to good manufacturing practices (GMPs). Developed countries have decreased the risk of transmissible infections to close to zero-due to total dependence on voluntary blood donors.

The proportion of blood collected from voluntary donors in India still remains low. The requirement of blood greatly exceeds the availability, and this has led to the mushrooming of commercial blood banks. The professional blood donors should, however, be strictly avoided as directed by Supreme Court of India. The Strategies developed at the state/district level to educate and motivate people about voluntary blood donation need strict enforcement to decrease the deficit of blood.

As per legislation, all blood units collected are screened for HIV, hepatitis B, hepatitis C, VDRL and malarial parasite. However, there are many other infections (viral, bacterial and parasitic) which are not screened because of their low incidence and high cost of testing. This further strengthens the role of voluntary blood donation. In such a scenario, a high degree of awareness about the hazards of unsafe blood transfusion is required. With this little effort, the risk of disease transmissions can be reduced to a minimum.

The use of fresh whole blood is more likely to transmit infection and also increases the risk of graft versus host disease. It should be avoided. To economise on the blood, only the required blood component should be administered, which will also avoid circulatory overload with its resultant ill effects.

For the laboratory personnel working with blood and blood products, vaccination against hepatitis B is a must along with the maintenance of a high degree of personal hygiene.

Preventing disability and death is the objective of all safety programmes and must become a primary goal of every hospital team with a adequate contribution from the general public.

The writer is Associate Professor and Head, Deptt. of Transfusion Medicine, Dayanand Medical College and Hospital, Ludhiana.

Deep and slow breathing helps in keeping fit
Dr Ravinder Chadha

We breathe automatically and spontaneously and are not aware of this phenomenon. Most of the time our breathing is either too quick or too shallow which results in an inadequate intake of oxygen and elimination of sufficient carbon dioxide. As a result, oxygen becomes deficient in our body. As every cell in the body requires oxygen, it affects the health of the person concerned.

The most common reason for our fast breathing is that we are in a hurry most of the time. With the advancement in technology, our working is indoors and our physical activity has decreased. As a result, our breathing has also become shallow, leading to insufficient intake of oxygen. Above all, stress of modern times makes a person breathe more quickly and less deeply.

The result of shallow breathing is a reduction in vitality, as oxygen is essential for the production of energy in the body. Since oxygen is essential for healthy cells, our immune system is affected, leading to many diseases.

The correct way of breathing is to breathe slowly and deeply so as to avoid oxygen starvation. It is advisable to inhale air through the nose. Your nose prevents impurities and excessive cold from entering the body. The hair in nose the traps dust and other small particles, which can cause injury in the respiratory passage.

Breathing exercises are important as they improve the capacity of the lungs. There is always shortness of breath during the period of exercise and one tends to blow the air out of the mouth.

This is a quick and easy way to improve the breathing pattern. Breathing exercises are particularly useful for people having sedentary jobs, spending most of their time in offices. Breathing exercises also improve the elasticity of the lungs and the rib cage.

Here are some of these exercises:

Diaphragm breathing: In this exercise, the diaphragm is efficiently used for improving the breathing pattern.

Lie on your back in a bed with the knees in a bending position. Place one hand on your abdomen and the other hand on the upper chest. As you inhale through your nose, move your stomach out but the chest should not move. As you exhale through the lips, let your stomach fall inward but your hand on the chest should still remain there during the entire procedure.

Breathing exercise for good posture: This exercise is useful for persons having a weak back or stooped shoulders. In the modern times when all the work is done on the computer, this exercise is very helpful as it counteracts the tendency for unhealthy postures.

Stand straight with your feet together, put your hands on your back and interlock the fingers with the palms upwards. Turn the palms around by a twisting movement of your elbows.

Inhale deeply and bend forward while exhaling and at the same time raise the arms until they are stretched out without bending the elbows. Remain in this position for some time, then slowly return to the original position. Repeat the exercise three or five times. This exercise can also be done in a kneeling position.

Kapalabhat: “Kapala” means skull and “Bhati” means lightness. It is a breathing technique wherein a person deliberately breathes faster, using only the abdominal muscles. In this technique, breath is rapid and strong. The lungs act as a pump, creating so much pressure that all the foreign bodies, waste, etc, are cleared from the air passage.

Pursed-lip breathing: In this exercise the air left in the lungs is thrown out which allows more air to get into the lungs. It improves ventilation and the breathing pattern and causes general relaxation.

Sit down with your back relaxed and straight, breath in through your nose and breath out through the lips like you are whistling. Practice this position for two-three times a day.

Deep breathing exercises: Normally in deep breathing, one uses the upper part of the lungs by lifting the upper chest and raising the shoulder.

If we use the diaphragm, the lower abdomen will expand with air, leaving the low back unprotected. In this exercise, use the thoracic and back muscles to breathe.

Hold a towel around your ribs, cross it over at the front.

Breath in and feel the towel expanding.

Gently squeeze the towel as you breathe out.

Breathing in and out can be practised without the towel by placing ones arms on the sides of the lower rib cage.

Breathing for relaxation: Most of the yoga exercises bring relaxation. “Listen to your breathing” till you feel that fatigue is a simple method of relaxation. Efforts should be made to prolong this exercise as it can decrease anxiety.

In a nutshell, correct breathing can lead to a high vitality level, long life and greater resistance to diseases.

Physiotherapy ‘ineffective’ for back pain

LONDON: Physiotherapy for back pain is no more effective than simple advice to stay active, according to a study which found that almost all treatment offered by National Health Service physiotherapists each year to the 1.3 million patients with back pain is useless.

Back pain is one of the most common reasons for a patient to consult a GP, but one of the hardest to treat. Doctors can prescribe painkillers and anti-inflammatories but are often unable to offer any further advice.

Referral for physiotherapy is a popular option because GPs feel they are doing something positive and patients feel their problems are being taken seriously.

Researchers from the University of Warwick found this brought little benefit. They studied 286 patients who had suffered back pain for at least six weeks, half of whom were given regular physiotherapy and half simple advice.

Patients in the therapy group underwent examination by a physiotherapist who nominated a treatment strategy including joint mobilisation and manipulation, stretching and heat or cold treatment.

The advice group had a single session, lasting up to an hour, with the physiotherapist who carried out a physical examination and gave general advice to remain active. After 12 months, there was no difference in disability between the two groups. But patients who had received regular sessions of physiotherapy said they felt better. The researchers concluded: “Routine physiotherapy for mild to moderate low back pain generally practised in the UK is no more effective than a session with a physiotherapist that includes advice to remain active.”

They said research suggested programmes to improve cardiovascular or muscular strength were more beneficial than the routine physiotherapy commonly used in the UK. — The Independent