A Right To Information query by activist Chetan Kothari revealed that 2,234 people in India contracted HIV infections from contaminated blood transfusions between October 2014 and March 2016. The data shared by the National Aids Control Organisation became the center of a wide discussion. Reports stated that the former minister and current Member of Parliament Jyotiraditya Scindia raised the question in the Lok Sabha asking the government whether it was aware of the problem. A report in Lancet, an international medical journal, also raised questions about the poor blood safety in India.
Any person undergoing a blood transfusion is at the risk of contracting transmissible infections such as HIV, Hepatitis B, Hepatitis C and syphilis, even though HIV infection is spread mainly through sexual behavior and use of needle and syringes. The role of the government is to ensure that donated blood is screened for these infections before it is transfused into a person requiring blood.
Scroll.in spoke to Dr RS Gupta, deputy director general and in-charge of blood safety at National Aids Control Organisation to understand the challenges for making blood transfusions safe in India.
How did these people contract HIV following a blood transfusion, given that it is mandatory for every blood bank in India to test donated blood before it is transfused to a patient?
When a person tests positive for HIV infection, we counsel them and take a detailed history to understand how they got infected with the virus. This is done to know the mode of transmission active in the community. Owing to the stigma attached to the disease, most people would say that they got the infection through blood transfusion.
It is impossible for us to go back and trace the blood that they were given and track the donor of that blood. Less than one percent of HIV cases can be attributed to blood transfusions. There was a time when close to ten percent of HIV infections were a result of blood transfusions.
What mechanism is in place to prevent spread of such transfusion transmissible infections?
Donated blood is screened for all transfusion transmissible infections before it is given to a patient in need of blood. We currently use the ELISA (enzyme-linked immunosorbent assay) test to screen the donated blood. The problem is that there is no test available which can say with certainty that the blood is free of any infection. If the blood donor was recently infected with HIV, Hepatitis B and Hepatitis C, the test will not be able to pick the infection from the blood. In medical terms we call it the window period which is when the blood, though infected, does not have the traces of the infection which can be picked by a test. Nobody will guarantee that blood is 100% safe.
In many developed countries nucleic acid amplification test (NAT) is used to test donated blood as it is more effective in screening the infection. Why is India not using it?
Yes, NAT is more effective a test compared to our current tests but it is very expensive. NAT is seven times costlier than the conventional test and it too can miss the infection. It can detect HIV infection in the blood in a seven-day window period, whereas ELISA will detect it between 21- and 28-day window period. Still there is a chance that infected blood will be given to a patient. Blood transfusion is a lifesaving procedure and just because there is a risk, we can’t let people die who are in want of blood transfusion. How is that right?
(At present 95% of the donated blood in the country is tested through ELISA)
We can’t use an old test (ELISA) just because it is cost-effective and allow people to get such life threatening infections. How can NACO ensure to people that the donated blood is free of any disease?
We need the community’s support for that. Blood donors need to give an honest and detailed history to the bank where they are donating blood. Before they donate blood, the counselors ask them questions about their sexual history and if they have suffered from any sexually transmitted infections in the past. A person who had jaundice should not donate blood. If the donor screening is done meticulously, the blood we get will be free of these infections. We are asking banks to display the donor screening form so that people who are not eligible don’t donate blood. We need blood but we also need quality blood.
If there is a mechanism to screen donors already in place, why is it not working?
Blame it on the political agenda (blood donation) camps. They always complain that we didn’t take blood of everyone who turned up for the camp. We brought 100 people and you are taking blood of just 80. It is not about numbers, we want blood donation camps every day in a sustained manner. I am not happy the way camps are being conducted in the country at the moment. We need blood across 365 days/12 months. Camps should be spread across the year to maintain a regular supply of healthy blood. We collect 12 million to 13 million litres of blood annually. I can’t deny the possibility that some blood can be infected.