On World AIDS Day 2007 –
Call for safe blood transfusion

Blood Transfusion should be safe and not transmit HIV or Hepatitis B, C infections No Patient should suffer preventable HIV and Hepatitis B & C infections with Blood Transfusion.

Thalassemia is a serious inherited blood disorder. In this, blood formation is defective since early childhood. When the child is born he/she is absolutely hail & hearty. By the age of 3 month to 2 years the child starts showing the symptoms of severe anemia which does not improves with medicines [iron, vitamins, etc] and he/she is diagnosed as Thalassemia major by a special blood test. Child requires regular, repeated life-long blood transfusions for his/her survival. As the age grows the blood requirement also increases. 

The multiple transfused Thalassemics always carry high risk of being infected with serioustransfusion transmitted infections like HIV, Hepatitis B & Hepatitis C. 

National Thalassemia Welfare Society formed in 1991 by the patients, parents, doctors and well-wishers committed for the welfare of Thalassemics conducted a survey on 551 multiple transfused Thalassemics of age ranging from 1yr to 49 yrs from 10th Dec 2006 to 29th Aug 2007. 33 of them were found HIV positive, 89 Hepatitis C (Anti HCV) positive and 43Hepatitis B (HBs Ag) positive i.e. approx 6% of them are HIV, 8% Hepatitis B, & 16 % HCV infected.  

Out of 89 infected with Hepatitis C, 5 were born after 2002, the year when HCV screening was made mandatory in all blood banks in India and out of 33 infected with HIV, 28 were born after 1989, when HIV screening was made mandatory. It clearly indicates that at least 28 Thalassemics got HIV & 5 Thalassemics got HCV infected after mandatory screening. 

However actual figure is much more because many Thalassemics were HIV/HCV negative before these tests were made mandatory since they are regularly tested for these infections once a year. 

The above facts clearly shows that 1. either testing kits are substandard 2. or human error

3. or window period transmission. 

None of the blood bank will accept first two reasons and people will continue to be infected with (true or scapegoat) excuse “window period transmission”. 

So let us focus on this issue. The ELISA kits used by blood banks in India cannot detect

HIV before 22 days of infection, Hepatitis B before 59 days and Hepatitis C before 82 days. 

Leave aside US & Europe; Hong Kong & Singapore are using NAT [Nucleic Acid Test]

in addition to conventional ELISA method for over five years. Even in less developed

countries like Thailand, Malaysia & Indonesia, Red Cross has started NAT testing for

approximately a year. 

In India a study was done on 21731 units of donor’s blood from 8 different blood banks of different states & cities. It was found that 1 in 1811 was positive with NAT but negative with ELISA for at least one of the three infections HIV, Hepatitis B or Hepatitis C. 

Apparently 1 in 1800 figure looks very small but if we consider total consumption of blood 3.5 to 4 lac units in Delhi, say 3.6 lac units then 200 units are issued infected with at least one of three - HIV, Hepatitis B or Hepatitis C infections with “best” ELISA kits and “no” human error. These days each unit of blood in divided in 2 or 3 components, i.e. RBCs, Plasma and Platelets, that means 400 to 600 persons are infected with one or more of these three dreaded infections in Delhi. If we replicate this calculation with National annual requirement of blood, 9 million units then 10,000 to 15,000 people are being infected with at least one of the three infections under best current system of testing. These figures are not small for any city or country and necessarily not acceptable for any individual who gets either of these infections. 

It has been found that with NAT (Nucleic Acid Testing) window period is reduced to 11

days in case of HIV; 23 days in case of HCV & 34 days in case of Hepatitis B in comparison to 11, 82 and 59 days with ELISA respectively. That is approximately 50% reduction in window period of HIV, 72% in Hepatitis C and 34% in Hepatitis B Infection.

The above window period (the time when one is infected but does not test positive with a

particular testing method e.g window period for HIV is 22 days by Elisa method and 11 days with NAT) is based on the NAT by pool method i.e. when we tested blood by pooling samples of 12 units of blood. But if we do ITD [Individual Donor Testing] the window period is further reduced to 5.6 days in case of HIV, 4.9 days in Hepatitis C & 35.4 days in Hepatitis B. It is not irrelevant to mention here that during first 3 days of infection [window period] viral load is so less that transmission of infection is almost negligible. That means with IDT with NAT. We can reach to “Near zero risk blood transfusion”. 

1st December is observed as World AID Day world wide but unfortunately innocent Thalassemics are becoming victims for none of their fault. First they get Thalassemia because of ignorance of Obstetricians who do not advise HbHPLC (Thalassemia testing) at the time of first visit of pregnant women to their clinic, even though they advise a battery of tests and repeated ultrasounds to look into other rare abnormalities in the foetus and not Thalassemia which is most prevalent among all inherited disorders i.e.3.9% in India and 5.56% in Delhi (ICMR studies). Secondly they get HIV, Hep B and/or Hep C infection through blood transfusions due to one or more of the following reasons: Blood donation by multiple sex partners

Concealing the history of sexual behaviour by the blood donors

Faulty testing kits

Human error in testing

And most importantly Govt of India is making lot of hue and cry about HIV/AIDS but not introducing latest testing techniques (NAT) and making it mandatory in all blood banks. Leave aside US & Europe, Hong Kong and Singapore are using NAT for almost half a decade. They have therefore managed to eliminate transfusion transmitted infections. Developing countries like Thailand, Malaysia, Indonesia has implemented NAT in phased manner 

Though late Govt. should wake up now and make NAT mandatory in all blood banks, says Dr J.S. Arora, General Secretary National Thalassemia Welfare Society & Federation of Indian Thalassemics.