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.