'A national institute for blood is needed'

. 6.5 per cent of all cancer types in Bangladesh are basically blood cancers. · There are 150 hematology experts in the country. ·  There’s no model integrated treatment center for hematology in the country. · Strategy, animal houses (animals to use for tests), regular funding as well as support or aid are required for basic research on blood.

Md Salahuddin Shah

Hematology expert professor Md Salahuddin Shah is now the chairman of the hematology department at Bangabandhu Sheikh Mujib Medical University. He talked to Prothom Alo about blood, blood disorders, treatment of blood disorders in the country and an action plan for future.

Q :

What is blood and how would you describe blood as a part of the body?

Water makes up 65 to 70 per cent of the human body. A significant amount of this consists of blood. Usually, a person weighing 75 kilograms has 5 to 6 litres of blood in his body.

Blood circulates throughout the body through small and large vessels such as veins and arteries. The heart controls the blood circulation. Blood contains red blood cells (RBC), white blood cells (WBC) and platelets.

These components of blood supply oxygen and micronutrients to the cells and the tissues. And this is the source of energy. Blood simultaneously collects and helps get rid of bodily wastes.

Blood automatically contains antigens. Besides, when there’s a cancer cell created inside the body, blood components become active against it. On the other hand, bad blood cells can cause harm to the human body.

Q :

What role does blood have in diagnosis?

There are a certain number of red blood cells, white blood cells and platelets in certain amounts of blood.

If there’s a change in those numbers, this indicates symptoms of a disease of some kind or other. In other words, when suffering from a disease there’s a change in the number of blood cell.

Blood deficiency is a disease better known as anaemia. This happens when there’s a deficiency of red blood cells. Then again, red blood cells break down due to diseases like thalassemia.

An increase of white blood cells can be the cause of cancer sometimes. That can also happen because of some sort of infection in blood.

And when infected with dengue, platelets count keeps falling. There can be many such examples. So, it’s ideal to keep track of one's health condition by getting one's blood sample tested every six months.

Q :

There is so much advices about keeping lungs, kidneys or the heart healthy, but so little is heard about blood. What should be done to keep the blood healthy?

This is the lack of common knowledge and awareness. There’s less discussion about blood because of no knowledge or understanding about blood and its importance.

Blood is created from bone marrow and it’s a regular process. Blood is produced in a special environment, enriched with vitamins and minerals in the bone marrow.

This environment needs to be perfect for keeping the blood quality intact. Radiation or chemical effects can destroy this environment. It can be damaged by medicines as well. If the environment is destroyed for some reason, the producing of blood will be disrupted or contaminated blood will be produced.

It must be kept in mind if the blood isn’t good or the body doesn’t produce good-quality blood, none of the organs will be safe. To keep the bone marrow healthy, one has to have a balanced diet alongside being careful about radiation, chemicals and the use of drugs.

One must have a regular intake of foods rich in minerals. Damage can happen if the food is adulterated. The same damage can be done by pesticides as well.

Q :

Many suffer from anaemia while many other find themselves in sudden need of blood. They meet this need by taking blood from other people. What is the concept of blood transfusion actually? Can anyone donate blood if they wish? 

Many suffer from anaemia; many can suddenly lose a lot of blood, for example many lose blood in an accident. Besides, blood can be required during operations.

These circumstances do require blood donations from others. However, not just any blood can be used for transfusion; the blood has to be safe. Safe blood means blood that is free of any disorder or infection.

Generally, blood cannot be considered safe, if it contains HIV, Hepatitis B, Hepatitis C, malaria and syphilis, any of these five germs. These tests need to be done before blood transfusion. It’s done all across the globe.

One more thing is considered before giving or receiving blood is cross matching the blood. There are different groups or types of blood. The donor’s and receiver’s blood has to be the same type.

There could be post blood transfusion reactions, even if it’s the same blood type. Whether there will be a reaction or not can be and is checked before the blood transfusion and that’s the rule.

Q :

How is the significance about blood pressure and blood circulation?

The heart is the organ that pumps and circulates blood throughout the body as well as collects it back. If the heart doesn’t work or stops for some reason, blood circulation ceases as well.

Blood doesn’t flow throughout the body on its own. Like any liquid, blood flow requires pressure. Some hormones, some organs including the heart, blood vessels (blood vessels have an elastic quality), different components of blood, protein-minerals present in the blood, all of them play a role together in creating this pressure.

Blood pressure can increase for different reasons. Blood pressure, more than what’s required can cause strokes or damage the kidneys. Then again, low blood-pressure hampers the supply of oxygen and micronutrients across the body.

Q :

What is haematology and what does it encompass?

All blood-related issues fall under the area of haematology. Apart from blood formation, blood structure, blood components, these basic concepts, blood functions and roles are also included in this science.

As much as 6.5 per cent of all cancer types in Bangladesh are actually blood cancers. The issue of diagnosis through blood is also a topic discussed under haematology.

Q :

How much importance is given to blood in the MBBS curriculum? What scope is there if apost graduate degree in the country? 

Compared to the extensive blood disorders and blood’s role in determining disease, blood as a subject is somewhat neglected in the MBBS curriculum.  This should be given more importance to at the graduation level.

There are two post-graduation level courses in Bangladesh. One is FCPS and the other is MD course. There’s no higher degree in the country. There’s still no PhD haematologist in the country yet. BSMMU however is taking an initiative to confer PhD degrees in haematology.

Q :

Some diseases are only identified as blood disorders. How many people are suffering from blood disorders on the whole? What specialised treatment facilities are there in the country for this?

Any blood related issue is a blood disorder. Red blood cells, white blood cells, and platelets — problems with any of these three are considered haematological disorders.

Many people in Bangladesh, especially women, suffer from anaemia; that too is basically a blood disorder. Blood cancers are known as leukemia, lymphoma and multiple myeloma. We hear of or talk about thalassemia; it is a congenital blood disorder.

Another congenital blood disorder is haemophilia. A person who's affected with it, keeps bleeding incessantly when they cut themselves anywhere in the body. Women are the carriers of this disorder, but it's the men who get affected.

Some blood disorders require a coordinated treatment. In other words, they need complete diagnosis, complete treatment and arrangements for all necessary drugs. But, the country is lacking that.

There's not even a single model integrated treatment center in the country. There are only 150 haematology specialist doctors in the country. Hospitals across the country have very few beds for such patients. Even BSMMU has only 23 beds.

Bone marrow transplantation is the modern treatment for leukemia. There's a very limited scope of this treatment in the country. BSMMU however has taken an initiative to introduce this advanced treatment in full-fledged way.

Even the diagnosis capacity required for this treatment is inadequate here. For this, tests are being done outside of the country in many cases.

Q :

Is there any research on blood being done in the country? What is the scope of basic blood research?

There's a lack of basic research on blood in the country. FCPS or MD students are doing some thesis for examination requirement or as part of their course. Apart from that, teachers are also engaging in some type of research work.

Basic research on blood requires planning, animal houses (animals used for testing), regular funding as well as support or aid. There’s a lacking in everything. Plus, advanced technology is also needed. Without these, it's impossible to run clinical trials or tests.

Q :

Has Bangladesh been able to advance in haematology studies, research and specialised treatment of hematological disorder alongside the rest of the world or is it lagging behind?

Neighbouring India is doing great in the research of hematological disorder treatment and blood. Compared to India, we are lagging quite far behind.

Quite a few countries around the globe are way more advanced than India in this sector. In that sense we are lagging a lot behind globally, when it comes to modern treatment, use of technology and research.

Q :

Quite a few issues came up in your discussion. How do you see the solutions?

An action plan is required first, with a full grasp of the significance of the issue. The Director General of Health Services can create this action plan for the whole country. Universities can do that for themselves. Adequate workforce, funding, training and monitoring are vital.

I would say it’s necessary to set up a national institute for blood. Just the way national institutes have been established for cardiovascular diseases, kidney diseases, cancers, vision problems etc. similarly it has become quite essential now to set up a separate haematological national institute.

The institute will teach, do research and give treatment on haematology. At the same time, it will assist the health ministry in forming national policy and plans on blood related issues. The institute will be the country’s referral centre for haematological disorders.

The health ministry can take initiative to set up such a national institute. An institute like that can also be established with public endeavour. It’s possible to form the institute under public-private partnership as well.