Safe blood still a luxury

More than a decade after the Supreme Court of India came out with the blood safety measures for the blood banks across the country, safe blood still remains outside the ambit of most people.

The approved and accepted blood screening procedures (the Rapid test) followed in the country are outdated and life threatening Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) may go undetected.

Dr. Saranya Narayan, medical director, Jeevan Blood Bank, Chennai, says, “We make sure that the safety standards are followed throughout. Unlike the other blood banks, we follow the Nucleic Acid Test (NAT) for blood screening.”

NAT, a Food and Drug Administration (FDA) approved test for screening donors of whole blood and blood components intended for use in transfusion is developed by Gen-Probe Inc., San Diego, California. It spots very small amount of HBV, HCV and HIV infections in donors’ blood as it reduces the “window period” of infections. Window period is the time between first infection and when the test can reliably detect that infection.

Unfortunately, there is no test available that can detect viruses immediately after someone has been infected, but NAT detects viral genes and not antibodies (a protein produced by certain white blood cells in response to entry into the body of a foreign substance) in blood, leading to earlier detection. If the blood test shows positive results, the donor can be stopped from donating blood. In addition to the window period, antibody testing has a very high rate of false-positives.

Jeevan blood bank in Chennai and Apollo hospitals are the only ones which have adopted NAT for blood screening. This means that very few Indians receiving transfusions can be reasonably confident that the blood they receive is free from infections.

Department of transfusion medicine, Indraprastha Apollo Hospital, New Delhi, concluded after a study conducted in 2006 that with high prevalence of virus in blood of donors, blood safety is a challenge in India.

The blood banks in India are licensed by the Drugs Controller General and are maintained under the dual authority of the Central and the State Governments, still standardised screening procedures lack.

Supreme Court, in 1992, in the case of Common Cause vs. Union of India came out with the blood safety guidelines for the blood banks in the country.

Dr. Saranya says, “Things have improved now. Prior to the Supreme Court judgment, people had no clue about the quality of blood they were buying to save the lives of their loved ones.”
There were hardly any tests done to check the purity of blood till the awareness about transmission of HIV through blood transfusion spread. Till then, anyone in need of blood could walk into a blood bank and buy whatever was given. Only the test to match the blood type was conducted.

“The Supreme Court’s guidelines banned the professional, remunerative blood donors from donating blood. This surely improved the quality of blood at the blood banks. But still, blood that is widely available is not completely safe,” says Dr. Saranya.

A study was conducted by the departments of regional blood transfusion centre, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India. In 2003, it concluded that blood transfusion has been the transmission mechanism in 15 per cent of total patients infected with HIV between a period of 2000 to 2002 in northern India.

Some of the replacement donors, the study claims, are actually professional donors who are paid by the patient’s relatives instead of blood banks. They sometimes conceal their medical history to donate blood for their relatives. Thus, blood safety still depends highly on open and honest answering of the screening questions.

To make sure that the blood received at Jeevan blood bank is completely pure, Dr. Saranya says, that the donors are supposed to fill a questionnaire at the first stage, where they even have to answer some personal questions about their health and behaviour. If they are not comfortable with the questions, they are free to walk out. Once this first barrier is crossed, donors’ haemoglobin, weight, blood pressure and temperature are checked to assess their physical condition. If the person is fit, only then he or she is allowed to donate blood.

Only a healthy person between the age group of 18 – 60 years, weighing 45 kg or more with haemoglobin content of 12.5 grams per 100cc or more can donate blood.

Although NAT screening cannot completely eliminate the risk of infections transmitted, it has reduced the risk where it has been implemented.

Japan was the first country to implement NAT screening and observed a significant reduction in transmission of the HIV, HBV and HCV. South Africa and a number of EU countries also employ the NAT, the study by Indraprastha Apollo Hospital states.

“Today, we can confidently say that we are the safest blood providers in the country,” Dr. Saranya says.

The application of NAT still hasn’t been made mandatory by the policy makers in India. This tool could provide the next large step in improving the safety of blood supply in our country. Since many of our modern blood banks break the whole blood into multiple components like red cells, plasma and platelets, a single infected unit may transmit the infection to 2 or 3 recipients, further increasing the number of infections transmitted, if NAT is not used.

Dr. Jayalaxmi Shreedhar, technical health advisor, Internews network says “NAT is really expensive. But all those who can afford it shouldn’t be deprived of it. People should be made aware of this technology.”