HIV reality check

HIV reality check

News:

A pregnant women in Madurai, TN tested positive for HIV after receiving infected blood from government hospital blood bank

Important Facts:

• A 23-year-old pregnant woman in Tamil Nadu tested positive for HIV after receiving a unit of blood at a government hospital blood bank, indicating glaring lapses in screening procedures.
• The Ministry of Health and Family Welfare establishes blood safety related national policies with inputs from National AIDS Control Organization (NACO) and the National Blood Transfusion Council (NBTC)

What are the threats to safety of blood supply?

• The greatest threat of blood transfusion is the transmission of infected blood which is undetected by conventional tests.
• Current licensed blood screening techniques enable blood banks to determine the exposure to blood-borne pathogens through the detection of virus-induced antibodies.
• Mandatory serologic tests like ELISA Test, detect the antibodies, but not the virus itself. Consequently, some transfusion recipients may unwittingly be exposed to serious disease if the blood products they receive contain the virus, but not the antibodies.

Problems Faced by Indian Blood Transfusion Service.

• Fragmented blood transfusion service – Some hospitals open blood banks as they are denied permission to open storage centers. Only Regional Blood Transfusion centre (RBTC) are permitted to open storage centers and very few blood banks are RBTCs
• Informed consent for transfusion – In the case of M. Chinnaiyan vs Sri Gokulam Hospital and Anr, which declared “consent of the patient is required for transfusion of blood”. Surgery carries risks, but blood transfusion carries additional risks.
  • Informed consent must be a written document explaining the risks, benefits and alternatives to transfusion, taken after a dialogue between the treating physician and the transfusion recipient
• Absence of standards for safe transfusion – National Aids Control Organisation/NBTC standards address only safe donor and safe blood issues and do not cover safe transfusion, the third element of blood safety. Transfusion triggers are at best limited to individual institutions
• Positive patient identification – A documented method/protocol for positive (correct) patient identification is essential. Absence of this may lead to wrong transfusions and may be construed as negligence on the part of the doctors
• Monitoring transfusion – Transfusion should be prescribed and administered under medical direction. National (NACO) guidelines recommend continuous supervision during transfusion.

Blood safety scenario in India:

• The Government of India mandates testing all donated blood for HIV, Hepatitis B, Hepatitis C, Syphilis and Malaria.
• Blood Banking is governed by the Drugs & Cosmetic Rule in India. According to this rule, only blood tested non-reactive can be transfused to patients.
  • HIV testing mandatory for blood banks.
  • Hepatitis B surface antigen, Malaria and Syphilis testing made mandatory.
  • Hepatitis C virus and test for antibody to Hepatitis C made mandatory.

Framework of Indian Blood Transfusion Services:

• The National Blood Policy(NBP) was published by the Government of India in 2002.
  • The NBP reiterates government commitment to safe blood and blood components and has well documented strategies, for making available adequate resources, technology and training for improving transfusion services.
• Role of National Aids Control Organization – While the drugs controller is the regulatory authority, NACO/NBTC has been the main technical body to frame guidelines for the practice of transfusion medicine.

Mandatory tests for blood screening are:

• ELISA for HIV I/II Antibody
• ELISA for Hepatitis B (HBV) surface antigen
• ELISA for Antibody to Hepatitis C (HCV)
• VDRL/RPR for Syphilis
• Screening for Malarial Parasite

Recommendation:

• Regular repeat voluntary blood donations, better screening and counselling, tracking blood donors, haemovigilance etc. are some of the measures.
• 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
• Promote ID-NAT (individual Donor – Nucleic Acid Testing) – For blood screening is an international standard 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.
• The focus should also be on creating awareness among donors to visit a voluntary counselling and testing centers (VCTC) to confirm their HIV status when alerted by blood banks.