Tuesday, March 14, 2017

Blood Transfusion : Is it safe enough ? - Sumit Bagaria

ETHealth‎‎‎‎: National: Tuesday, March 14, 2017.
Although blood transfusions are considered life-saving, unsafe blood transfusions can at times be life-threatening. The latest National Aids Control Organisation (NACO)released report in response to an RTI request reveal that 14,474 cases of HIV has been caused due to unsafe blood transfusion alone in India over the last seven years. Not just this, but observations from the report also reveals that there has been a 10% rise in the number of HIV cases through blood transfusion over the last one year from 1,424 in 2014-15 to 1,559 in 2015-16. This shocking data brings to light the bitter truth that screened and tested blood available in blood banks might not always be safe after all.
These are the number of cases which have been reported. There are many more cases which don’t even come to light. Apart from HIV, other dilapidating diseases such as Hepatitis B and C can also pass through blood from an infected donor to a recipient. The news about the spread of infections through blood transfusions increasing by the day needs immediate attention.
Blood donation is a noble act and it should be encouraged. However, blood banks should be properly equipped to test each donated blood and ensure that only the safe blood is transfused to a patient. According to National Blood Policy(based on a Supreme court judgement that put the onus of providing ‘safe blood’ on the Government), every unit of blood that is donated at a blood bank should be thoroughly checked and tested to ensure that the blood does not contain any viruses or other infection.
Despite this, every other day there are cases of people getting infected through blood transfusion. This is mainly due to the testing method called Elisa (Serology) used in most blood banks that has some limitation to detect very early stages of infection in a donated blood unit. So, if a person who is in an early stage infection of HIV or Hepatitis and he/she donates blood, there is a higher risk of Elisa test failing to detect the infection in that blood unit due to very low concentration of viruses or antibodies present in the blood unit. However, when that blood unit is transfused to a recipient, the viruses will multiply in the recipient’s body thus infecting that person.
How can we tackle this problem?
There should be a multi-pronged strategy to tackle this. Regular repeat voluntary blood donations, better screening and counselling, tracking blood donors, heamovigilance etc. are some of the measures. However, in a country as vast as India, with a fragmented blood transfusion system (close to 2800 blood banks), over 1.3 billion people with cultural issues, myths and superstitions about blood and blood donations, and minimum testing standards, it requires unique measures.
Technology can be used for safer transfusions. App based systems focusing on demand and supply, geographic proximity of donor and blood bank, AADHAR based tagging of donors etc. on one side to increase regular repeat voluntary donors combined with the latest advances in screening and inactivation for viruses and other pathogens on the other, can almost end the chances of an infected sample being transfused.
One of the latest and most effective medical techniques is the ID-NAT method of screening blood.ID-NAT (individual Donor Nucleic Acid Testing) is an international standard blood screening test where scientific evidence has shown that it has caught many cases of HIV and Hepatitis B & C infections that were not detected by conventional Elisa tests. It is a method of testing blood that is more accurate and detects early stage infections also. By detecting earlier than conventional tests it decreases the possibility of transmission of infection via transfusion.
While some countries pool samples because of low prevalence of diseases, it is now proven that countries like India and most of the Asian countries, which have a high prevalence of infections (especially hepatitis B) need to individually test each donation. Some multinationals may be dumping old technology or advocating pooling of samples to reduce cost.
It is sad that customers who use 1 test to screen 6-8 blood donations are charged per sample and not per test resulting in a 5-6 times extra cost, with the multinational making profits at the cost of the patient (pooling may result in missing 20-30% of the infections caught by individual testing).Government of India recently decided to control such activities of overcharging/excessive profiteering in the case of cardiac stents.
ID-NAT which is the safest way to screen blood is mandatory and regularly used in many countries like New Zealand, Australia, Egypt, Israel, Japan, South Korea, Singapore, Hong Kong, Thailand, Malaysia, Indonesia, South Africa, France, Denmark, Greece, Italy etc. but continues to be an optional test in India. But, there are a few progressive hospitals and blood banks in India which have realised the importance of ID-NAT testing and have adopted this technique to screen blood.
Centres in India who have adopted this technique, include AIIMS, Gangaram, Apollo and Fortis Hospitals in New Delhi; Medicity, Artemis, and FMRIin Gurgaon; PGI Chandigarh; Hinduja, HN and KDAH Hospitals in Mumbai; CMC Vellore; SIMS Chennai; Amrita and Aster Hospitals in Kochi, International Hospital Guwahati; DMCH and CMC Ludhiana; MGH in Jaipur and RNT in Udaipur etc. Also, Karnataka Government is the only state government in India which has made ID-NAT mandatory in all government hospitals and blood banks.