India has one of the largest Blood Transfusion Service (BTS) in the world, with more than 4300 blood centres, about 26% of which are in the public sector, through which more than 14.6 million units were collected in 2024-25. There is a spectrum of blood centres, with majority still collecting and transfusing whole blood. With more than 70-% voluntary blood donations, there are several lacunae that need to be addressed to improve blood safety.
The National Blood Policy (2003) envisages continuous adoption of technology to ensure safety, quality and blood security. The modernization of the Indian blood banking system through automation is no longer a luxury but a necessity for public health resilience. In a nation where a significant proportion of blood collection occurs in urban and semi-urban centres and blood donor camps, that lack standardised digital systems, reliance on manual registers and fragmented tracking often leads to inefficiencies. Besides affecting operations, this increases risks associated with donor identification and traceability of donated blood its components.
The system needs a comprehensive approach which begins with meaningful digitalisation. An ERP system addressing operational requirements should form the core, allowing data collection at each point of contact rather than relying on the traditional “data entry operator” model with redundant data capture. Intricately linked to this is the need for robust identity management system for blood donors. Development of donor cohorts as in Denmark helps track donors, ensure authentication, enhance donors experience and monitor health. Such longitudinal engagement enables better donor tracking and generates evidence to guide policy decisions. Making donor authentication mandatory through government-issued ID and linked biometric data could also reduce the presence of paid donors in the system. Regular data reporting to authorities should occur through computer interfaces rather than manual reports.
The next step is automation in laboratories where screening for transfusion transmissible infections (TTIs), blood grouping, antibody screening, and crossmatching are performed. Except in large centres, these tests are still largely conducted manually or on semi-automated platforms. Advanced testing methods now allow earlier detection of viral RNA or DNA, significantly reducing the likelihood of TTIs. Additionally, emerging technologies can inactivate bacteria and certain viruses in collected blood using specialized molecules and light exposure, without significant damage to blood cells.
{{/usCountry}}The next step is automation in laboratories where screening for transfusion transmissible infections (TTIs), blood grouping, antibody screening, and crossmatching are performed. Except in large centres, these tests are still largely conducted manually or on semi-automated platforms. Advanced testing methods now allow earlier detection of viral RNA or DNA, significantly reducing the likelihood of TTIs. Additionally, emerging technologies can inactivate bacteria and certain viruses in collected blood using specialized molecules and light exposure, without significant damage to blood cells.
{{/usCountry}}In the traditional model of component production, blood bags are processed in refrigerated centrifuges and manually separated based on density. This is a tedious process requiring multiple timed manual interventions and focused attention, often taking more than an hour for a batch of eight units. This process improved somewhat with the semi-automated systems. However, automation in component preparation changed significantly with the introduction of fully automated blood component separators, in India in 2020.
These devices bring comprehensive automation to the final stage of blood centre operations. The integrates a refrigerated centrifuge and separator controlled by microprocessors. Blood collected in specially designed bags is directly inserted into the device, and up to four units can be processed simultaneously. This machine centrifuges the blood and automatically separates components according to pre-set protocols. The entire process takes about 22 minutes. At completion, three components can be removed, ready for storage. When required, the system can also produce leukocyte reduced red blood cells using appropriate kit. Besides producing standardised component volumes, these systems may also slightly increase plasma recovery. The entire process is digitally monitored, generating outputs useful for maintaining records conducting quality audits.
Since most of blood centres are located in urban areas, patients in rural regions often struggle to access timely supplies. Modern automation powered by Artificial Intelligence (AI) and Internet of Things (IoT), can address both scarcity and wastage. Greater production of standardised components improves inventory management and product quality within the health care system. Blood and components are often discarded after reaching the end of their shelf life. Automated inventory systems can help solve reduce this mismatch through predictive analytics that forecast seasonal spikes and implement First-In-First-Out (FIFO) distribution.
The implementation of machine-readable barcode systems for samples and the ISBT128© barcoding for labelling the blood units ensures seamless information flow across the system. Bedside verification using barcodes or RFID tags on patients and blood bags can further strengthen “vein-to-vein” safety.
While these technologies have become ubiquitous, efficiencies can only be achieved through large scale operations, on the production side, since setting up these systems can be expensive. Hence it is essential to explore the possibility of hub-and-spoke operations that only the BTS and the regulatory authorities working in tandem can design and test.
It is, therefore, imperative that the BTS should initiate such efforts to model the implementation of such comprehensive information management systems and automation on a regional basis. While doing so, we must also ensure that systems that cater to rural areas that are geographically challenging terrains should be maintained with out compromise.
India should move towards implementing automation in a planned and systematic manner while ensuring blood security and safety for all.
(The views expressed are personal)
This article is authored by Dr Joy John Mammen, professor, Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore.