Ensuring blood safety

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Ensuring blood safety

S Senthalir

With transfusion transmitted infections touching dangerous levels,

blood safety has become one of the major health concerns today. The

appalling fact is that it is the patients who fall prey to these

diseases. The patients are more vulnerable to HIV, hepatitis B and C,

which get easily transmitted through blood.

A National AIDS Control Organisation's report (for 1998-99) indicated

that approximately 7 per cent of individuals who are HIV positive got

the infection from blood transfusion.

Transfusion associated hepatitis B and C combined, is in the rate of

7 per cent for patients receiving between 1-8 units of blood. Those

getting repeated transfusions, such as patients of thalassemia or

patients on renal dialysis are distinctly worse off and show evidence

of infection with HBV in 50 per cent and HCV in 30 per cent of the

patients.

NAT

" In spite of the methods adopted to provide safe blood, the risk of

being prone to diseases is also increasing.

Hence, we see many countries adding Nucleic Acid Testing (NAT) as

part of their routine blood screening protocol to prevent transfusion

transmitted infections, " says Sumit Bagaria, president Hemogenomics,

marketing, selling and research company.

NAT is a method of testing that is more sensitive than conventional

tests that require the presence of antibodies to trigger a positive

test result. It works by detecting the low levels of viral genetic

material present when an infection occurs but before the body begins

producing antibodies in response to a virus.

NAT significantly reduces the `window period' of the time between the

donor exposure to the virus and the appearance of antibodies. By

decreasing the window period, it allows for earlier detection of the

infection and thus further decreases the possibility of transmission

via transfusion.

Blood Transfusion Services (BTS) in India are mainly hospital based

and is governed by The Drugs & Cosmetic Act.

There are about 2,060 licensed blood banks under different

administrative controls i.e. government 41 per cent, voluntary 12 per

cent, private hospital 22 per cent and private commercial 25 per

cent. There is a wide gap in the demand and supply of blood as the

annual collection is about 6 million against the demand of

approximately 9 million.

" The challenge for blood safety is not just the lack of standardised

screening in the approximately 2,060 licensed blood collection

centres, operated both privately and by the government. Majority of

voluntary donors are first time donors, as there is little concept of

regular repeat voluntary blood donation. This increases the chances

of transfusion-related diseases, " adds Sumit.

Blood screening

" Now many hospitals are adopting this method for blood screening and

patients are given a chance to choose the kind of test they want.

Though expensive than ELISA (Enzyme-Linked Immuno Sorbent Assay),

there is a huge demand for this, " says Sumit.

In Bangalore, hemogenomics is tied up with Rotary Blood Bank blood

and provides help in blood testing through NAT.

But, this alone doesn't help in eliminating the transmission

transferred infections. There is a greater responsibility on the

government to organise awareness campaigns to help people understand

the importance of blood safety.

Rational use of blood and voluntary donation should be encouraged to

ensure safe blood to people, he adds.

http://www.deccanherald.com/Content/Feb22008/living2008020149915.asp

[Guest guest]

Safe blood collection

Whenever we talk about safe blood we talk about only blood transfusion. There is

a huge risk of exposure to the healthcare workers engaged in the collection of

blod samples for various types of clinical investigations including HIV through

needle stick injuries. There are very few reports which document the incidence

of NSIs in our country, hence it is difficult to gauge the real problem.

But suffice it to say that even in western countries where they have adopted

safe medical devices, there is a huge incidence of needle stick injuries, then

in India where we are still not into the use of medical devices, the incidence

has to be a lot higher. In the wake of this, it is critical to create a NSI

registry with an aim to track the extent of incidence. This will help the govt

in taking appropriate policy decisions aimed at limiting the incidence.

The problem could be more acute in the ICTCs where the average HIV prevalence is

in the range of ~12-15% and hence the probability of a health care worker

getting an HIV infection through a needle stick / sharp related injury is a lot

higher than any other setting.

In addition to HIV, there is a huge risk associated with the transmission of

BBVs like HBV and HCV. WHO¢s 2005 report on environmental burden entitled " Sharp

injuries " , indicates that each year sharp related injuries contribute to 65000

new cases of HBV infection, 16,400 cases of HCV and at least 1000 news cases of

HIV infection. A recent study by PD Hinduja hospital in Mumbai has reported 380

cases of needle stick injuries between 1998 and 2003. Of these 380, nearly 45%

were nurses, 33% lab attendants, 11% doctors and another 11% were technicians

indicating that NSIs affected all classes of healthcare professionals.

This incidence can be brought down significantly through the use of safe medical

devices for the collection of blood (such as the evacuated blood collection

tubes) as well as by adopting novel methods of waste disposal. Abundant

literature pointing towards the lowered incidence of NSIs thru introduction of

safe medical devices in clinical setting is available thruout the world.

Sincerely,

Dr. Sanjay Sarin

e-mail: <ssarin_2000@...>

[Guest guest]

Dear All,

Re: /message/8387

The concern S. Senthalir has raised is really very important as well by Sanjay.

I would say the HIV transmission through blood and blood products is

decreasing from 1998-99.

Still some states shows high PR . Mainly Repeat voluntary blood donors

emphasis at various blood banks in India need to be addressed seperately with

evidence of that state. Also this should be part of mass IEC campaigns.

Close monitoring and periodic Service Quality Assessment of Blood

Banks should be in place. To begin with in phased manner IV generation ELISA

kits (NAT if cost effective) should be started in Blood safety programme.

Thanks

--

Dr. Laxmikant Chavan B.

State Epidemiologist, MD,DNB

(National AIDS Control Organisation)

Gujarat State AIDS Control Society

0-1Block, New Mental Hospital Complex, Menghaninagar,

Ahmedabad 380 016

drlbchavan@...

Cell: +91-9904379545