Risk of serious infections from blood transfusion increasing due to old testing methods

We are all aware that blood transfusions are required for surgery, trauma and loss of blood (accidents or other causes), some types of cancer, thalassemia etc. Most of us also believe that that blood obtained through a blood bank is 100% safe and can be transfused to our near and dear ones. It is therefore a serious cause for concern that there is a rise of infections like HIV, Hepatitis B & C etc. being transfused through blood. The shocking data mentioned below brings to light the bitter truth that screened and tested blood available in Indian blood banks might not be so safe after all:

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 seven years from 2009-2016. Not just this, but observations from the report also reveals that there has been a 10 per cent 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. NACO is the apex government body dealing with India’s HIV/AIDS control program. 

These are the number of cases which have been self reported by patients at NACO’s Integrated Counselling and Testing Centres (ICTC) spread across the country.  There are many cases which don’t even come to light and go unreported. Apart from HIV, other serious diseases such as Hepatitis B&C, malaria, dengue and syphilis can also pass through blood from an infected donor to a recipient. This increase in the reporting of the spread of infections through blood transfusions is a really alarming situation.

It also revealed that the Indian government has yet to order a study or inquiry into this medical crisis that puts millions of lives at risk. Separate RTI responses from 22 states and union territories confirmed that none of them have conducted any studies on HIV transmitted through blood transfusions.

As per Central Government submission to Kerala High Court, there is a minimal risk of infections such as HIV, HBV (Hepatitis B), and HCV (Hepatitis C) despite testing all blood units prior to transfusion due to a window period ranging from few days to few weeks during which such infections cannot be detected by laboratory testing.” 

Despite the testing and screening done at blood banks, every other day there are cases of people getting infected with HIV, HBV or HCV due to 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 (3 weeks to 2 months) 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 multiply in the recipient’s body thus infecting the person.

This infection risk due to blood transfusion can be avoided/ minimized by the latest and most effective medical technology used globally, ID-NAT (Individual Donor – Nucleic Acid Testing).  This ID-NAT 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 blood screening tests. It is a method of testing blood that is more accurate and detects early stage thereby decreasing the possibility of transmission of infection via transfusion. 

Ravi Reddy, who heads the South African National Blood Services (SANBS) and is the current President of International Society of Blood Transfusion (ISBT) has time and again emphasised that through implementation of ID-NAT, South Africa was able to eradicate the spread of infections through blood transfusions. His thoughts have been echoed by Dr TR Raina, Secretary General of the governing body of Indian Society for Blood Transfusion and Immuno-haematology (ISBTI) who says that ID-NAT is the best technique to ensure blood safety in India.

Developed countries rarely report such cases now. Canada, for instance, hasn’t seen a single case of blood transfusion-related HIV since 1985, UK since 2005, and the US since 2008. While in India, one in every 100 HIV patients could be a victim of infected blood transfusion, the tally in the US is one in 300,000 cases, according to data shared by the Centers for Disease Control and Prevention (CDC), a US national health agency. This means that the chances of an HIV patient in India having contracted the virus through a blood transfusion are 3,000 times higher than in the US.

Most countries with known prevalence of HIV or hepatitis or TTIs now test each unit of blood individually for NAT. New Zealand, Australia, Egypt, Israel, South Africa, France, Denmark, Greece, Italy, and many countries do ID_NAT to keep their blood supply safe. Almost all of Asia which has high rates of Hepatitis B including Japan, South Korea, Thailand, Singapore, Hong Kong, UAE, Saudi Arabia, Indonesia, Malaysia use ID-NAT now.

There are close to 2750 registered blood banks in India, which follow different screening techniques. But this latest ID-NAT test which is mandatory in many countries, continues to be an optional test in India. Some progressive hospitals and blood banks in India now ensure that their blood supply is safer by screening with ID-NAT technology.  These include AIIMS, Apollo, Fortis Hospitals (including Escorts and FMRI), Medanta, Gangaram, RML, AFTC, Artemis, Jaypee, etc. in New Delhi/ NCR; PGI Chandigarh; CMC Vellore; Hinduja, KDAH, HN in Mumbai; SIMS and Global in Chennai; Amrita and Aster in Kochi; CMC and DMCH in Ludhiana, International and Marwari Hospital in Assam. We strongly recommend our readers to use blood from these above mentioned blood banks only, as they use the latest technology for blood screening, and the chances of contracting serious infection from their blood units is negligible.

Blood is required by patients during emergencies and various health conditions. While conditions like sickle cell anaemia and dengue require blood transfusions occasionally, Thalassemics and patients suffering from cancers like acute myeloid leukaemia and lymphoma require blood frequently. Emergency situations like surgeries and accidents require blood during times of blood loss. While there must be consistent effort in ensuring an adequate supply of blood units, making sure that patients get safe blood must be the top priority, there should be a multi-faceted strategy to tackle this issue:

  1. Encouraging and motivating regular repeat voluntary blood donations, better screening methods, adherence to guidelines and procedures during blood collection and storage, and counselling methods at blood banks, haemovigilance etc.
  2. With the rise of digitisation, technology as well can be incorporated to tackle this infection issue in blood transfusion. 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.
  3. Also, Karnataka Government is the only state government in India which has now made ID-NAT mandatory in all government hospitals and blood banks, while in all other Indian states, it is still optional. This puts millions of people at risk of serious infection from transfusion, and the Central Government should take immediate steps to ensure that  all blood banks and hospitals across India use the latest ID-NAT testing for screening all blood units, without any exception.

All these steps combined can almost end the chances of an infected sample being transfused to an unsuspecting receiver, and significantly reduce prevalence of serious infections in India.

Sources:

  1. Article in The Times of India dated June 28, 2018 (Click here)
  2. Aticle in Expresshealthcare.in dated Jan 11, 2019 (Click here)

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