Unsafe blood transfusion-The menace and its solution

This was a painful story that I read a few months back in major newspapers as well as online media. On 26th December 2018, The Hindu reported about an incident where a pregnant woman from Tamil Nadu was tested positive for HIV after blood transfusion. Upon further investigation, it was revealed that the blood that was transfused to this lady was collected from a 19-year-old donor, who was already infected with HIV.

The said donor was not aware that he was HIV positive during the blood donation process. Later, as he came to know about his HIV positive status and that his blood was already transfused to the pregnant lady who was declared HIV positive after the blood transfusion, this youth committed suicide, probably out of guilt.

All blood banks across the country are mandated to check the donated blood units for the presence of infections such as HIV, Hepatitis B, Hepatitis C, Malaria and Syphilis before the blood is transfused. If they detect that any blood unit that is collected from blood donors is infected with any of the said infections, the blood banks discard those blood units. Only safe blood that is devoid of such infection causing agents are transfused. Then how did that incident happen in Tamil Nadu?

The answer lies in the method of testing used in the blood banks. The government has mandated that all blood banks must screen the donated blood using a method called ELISA or equivalent serological tests to check for the presence of HIV, Hepatitis B or Hepatitis C. However, the limitation of this method is that it cannot detect the presence of the said viruses in the donated blood, if the donor has very recently acquired the infection. Such blood units that have presence of virus but are not detected by the conventional ELISA method are issued by the blood bank for transfusion to patients. Finally, the innocent recipient becomes the victim by getting infected with the virus that was passed through unsafe blood. This is called Transfusion Transmitted Infection (TTI).

A lot many cases reported in media 

Earlier on 16th September 2017, The Hindustan Times reported that a 9 year old leukemia patient acquired HIV after she was transfused with unsafe blood at a state run Cancer hospital at Trivandrum.  This lead to great furore among the general public and dented the reputation of the said hospital.

Days after the death of that patient, the Kerala Aids Control Society (KSACS) said that the girl had tested HIV positive after transfusion of blood;  reported The New Indian Express on 16th April 2019. The newspaper quoted the KSACS Project Director Dr. R Ramesh: “ It had been that blood from a donor, who was in the ‘window period’ at the time of donation, had been given to the patient in March last year”

So what is this Window Period? Simply put, it is the time gap from the time a person is infected with a virus, to the time that the infection can be detected in his/her blood. Normally, after the virus enters a human body, it takes some time to multiply and then our body mechanism produces antibodies against those viruses. The ELISA/Serology tests check for the presence of specific antibodies in the blood against the virus. It takes a few weeks to a few months for the ELISA/Serology tests to detect the antibodies, and this gap is called ‘Window Period’. If a person who is in this Window Period donates blood, the blood bank often misses to detect the infection using the conventional ELISA/Serology tests. This infected blood would then be transfused to innocent patients, thus putting them at risk of acquiring the infection.

In yet another unfortunate incident, reported by Express News Service on 21^st Dec 2016, a 42-year-old lady from Bangalore alleged that she got HIV infection through unsafe blood transfusion during her treatment at a reputed private hospital. An FIR was registered against the staff of the said hospital based on the complaint from the lady. People choose reputed private hospitals thinking that they get the best medical care, but when it comes to safe blood transfusion, it is unfortunate that many private and corporate hospital managements look the other way !

I also came across another report from India Today news portal dated 27^th March 2018, that reported an incident of an infant allegedly contracting HIV after platelet transfusion and the family of the infant has claimed a compensation of Rs 6 crores from the blood bank as well as the hospital, where the two days old infant was treated. The hospital is a highly reputed private hospital in Hyderabad that claims to provide excellent healthcare to women and the newly born!

I was baffled to read so many reports about unsafe blood transfusion that have infected the recipients with HIV, Hepatitis B or Hepatitis C. With all these reports emanating from various parts of the country, one wonder- how many such cases of TTIs happen in India. Well, that’s when I stumbled upon another important piece of data from and RTI response from a govt agency which stated that about 20500 people got HIV infection through blood transfusion during a period of 11 years between 2007 to 2018. Add to this figure the huge number of Hepatitis B and C infections that could have passed through blood transfusion; we are either blissfully ignorant of this alarming situation or we don’t care enough.

Is there any solution to this problem?

Let us look at what other developed countries follow. Almost all developed countries have mandated a test called Nucleic Acid Amplification Test (NAT or ID-NAT) to screen the donated blood. This test detects the infected blood units more accurately and much earlier than the conventional ELISA/Serology tests, thereby significantly reducing any instance of unsafe transfusion.

The technology is already available in India since 2005; however, since it costs a few hundred rupees per blood component, many blood banks are not adopting this screening method. Even government authorities think of it as an additional cost and thereby do not consider it as a priority. But for the innocent recipient of contaminated blood and his/her family, it is often devastating to know that this could have been avoided if the blood bank adopted the NAT screening method, even if it costs a few hundred rupees extra.

As of today, only about 150 out of 3000 blood banks screen the donated blood using NAT method. A publication from AIIMS New Delhi says that five years of ID-NAT screening has interdicted 228 to 684 probable TTIs to transfusion recipients.  If a single blood bank could save so many lives, what about the lives saved from getting infections, if all the 3000 blood banks adopt ID-NAT?

Prevention is better than cure!

Prevention of a disease is easier and often cheaper than its treatment. It takes about Rs 1000 crore per annum to ensure that all blood units are screened by NAT in India. Considering our large country with huge number of blood units collected every year, and the fact that by universal adoption of NAT, many TTIs can be prevented, this amount is not exorbitant. An important report made by Asian Association of Transfusion Medicine titled “Consensus Document on Prevention of TTI: Future Directions” stated that by adopting NAT across all blood banks, the country can potentially prevent about 90,000 new infections every year ! The report estimates that the total cost of treatment and management of these patients, if not prevented from getting infected, would be Rs 21,275 Crores. By spending Rs 1000 crores in preventing the infection through blood transfusion, not only can we save thousands of lives but can also save over Rs 20000 crores every year, in terms of treatment cost of these infected people. That’s quite a huge saving in terms of financial resources as well as saving thousands of families every year from the devastating impact of HIV or Hepatitis infection. The report also recommended adoption of NAT at a national level.

It is high time that the government wakes up to this healthcare menace and makes NAT screening available to all.

About Author: Sangeeth Kini is the Vice President of Hemogenomics, Bangalore. He has over 23 years of experience in the healthcare industry. In his current role, Sangeeth, together with his enthusiastic team, relentlessly works towards the cause of ensuring blood safety in India by spreading awareness, partnering with blood banks and hospitals and providing the right solutions.

*The views expressed by the author in this article are his own.