Editor's note:
Smart medicine is where medical development goes. Information technology, artificial intelligence and big data are playing more important roles in health service, which tends to be increasingly human-centered and convenient. This series covering various aspects of health field is meant to show what high technology, smart system and inventions are behind.
Shot by Jiang Xiaowei. Edited by Sun Chao. Subtitles by Sun Chao and Cai Wenjun.
A screenshot shows a person's 400 milliliters of blood donated at the People's Square collection center on October 1, 2018, being transported to the Shanghai Blood Center that night. On October 16, the blood was delivered to Fudan University's Obstetrics and Gynecology Hospital.
Blood is precious because it cannot be produced. The only way to obtain blood for clinical use is through volunteer donation.
Making blood donation more convenient, efficient and organized is among the top priorities for Shanghai authorities.
"Our public WeChat account can fulfill the entire blood donation process, from reservation, blood test result to whereabouts of the blood, record checking on donation history, awards for top donors, and application for blood use," said Zou Zhengrong, director of the Shanghai Blood Administration Office.
When people want to donate blood, they can look up the location of each blood collection site, which includes the address, working hours and contact information. People who want to donate platelets can book a seat, because the process takes about an hour.
They can check the results of their blood tests after donation, with detailed results for each item. The result is also available while privacy is protected for those whose blood is not qualified.
"The highlight, which is the first of its kind in the world, is that donors can see when and where their blood is transported for clinical use," Zou said. "There is even a route that connects the blood center to the hospital. It is extremely encouraging for donors who are glad that their blood is used to help a patient."
The blood administration system
The entire blood collection, use and transportation process is monitored and managed by a single system, which displays real-time collection quantity at each donation location, blood storage at each district- and city-level blood center, blood storage at each hospital and blood deployment between districts and provinces.
"It is an intelligent system that monitors the city's entire blood issue," Zou said. "It can generate an alert in the event of a potential blood shortage or forecast potential blood demand based on historical data.
"We can take steps to ensure clinical use. As we can see their storage in the system, blood allocation between hospitals will become more reasonable," he explained.
"The system will also update in response to health management and patient demand.
"We are thinking about an evaluation function for each major disease that requires blood transfusion in order to regulate blood use and drive medical progress.
For instance, the system will be able to track each hospital's use of blood during hip replacement surgery, he added. "Blood transfusion is an important data point in determining the risk and complexity of the surgery, as well as the ability of each surgeon."
"With this information, we can better predict and manage blood allocation and use," Zou said.
Lab staffers at the Shanghai Blood Center conduct rare blood tests.
Another critical task for the authorities is blood safety, and Shanghai has taken the lead in this area.
"Checking for viruses and bacteria among blood donors is more difficult and time-consuming than in hospitals. We must use the most strict check and pathogen inactivation technology to ensure blood safety because these are healthy people who may be carriers or asymptomatic," said Zhu Ziyan, vice director of Shanghai Blood Center.
In addition to using advanced technology to stop diseases from being passed through the blood, local scientists are working with their counterparts from other countries to make a new blood collection machine that can kill pathogens while collecting blood.
"Typically, blood center technicians must open the blood bags to insert the inactivator. There is a risk of pathogenic exposure and contamination. The new machine, which has an international patent, can lower the risk," hu said. "The next step will be to conduct a clinical trial."
Blood safety is not only a clinical issue, but it also provides people with a sense of security. Shanghai is home to the country's largest rare blood bank, which has identified and stored information on over 1,200 different types of rare blood.
The sample machine can collect blood and do pathogen inactivation at the same time.
Most countries such as China have similar definitions of rare blood. Blood types with fewer than one per 1,000 persons are classified as "rare blood," according to Zhu.
"When determining whether a donated blood sample is rare, we conduct extensive tests. Hospitals will also share information about patients who have been identified as having rare blood during primary screening prior to blood transfusion."
"Blood is complex. There are over 350 classifications for red blood cells alone. There are only two types of ABO and Rh, which are known to the general public," said Zhu. "We also developed two chips that can identify more than 120 genetic loci for common rare blood types in a single analysis."
"When we find someone with rare blood, we contact him or her for more personal information. If there is another rare blood holder with clinical demand, they can assist one another.
"Because rare blood types are usually genetically inherited, we encourage the person to bring their family here for testing. We will recommend that such a person freeze their blood in our center for emergency use," said Zhu.
"Unfreezing the blood for clinical use only takes one to two hours."
There is a long deadline for rare blood freezing period. It is 10 years in China while different countries have different rules.
"To detect and collect more rare blood types, we have established the Yangtze River Rare Blood Alliance, which centralizes all rare blood type information in the region in a single database. Over 600 rare blood types have been identified and recorded in the last two years."
Compared with Han Chinese, minorities and foreigners are more likely to have rare blood.
"If we have information on more holders of the same rare type and more frozen samples, it will be extremely useful in the event of an accident or medical emergency."
He said that Shanghai Blood Center has sent or received rare blood from both domestic and international blood centers in order to save patients.
"A large rare blood bank is also a kind of public health and safety guarantee," he added. "So, for our own safety, I believe blood donation is the best way to find rare blood. Everyone who is eligible to donate blood is encouraged to do so not only for others but also for themselves and their families."