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Live chat: HIV through bad blood transfusions

31 May, 2016 9:49 AM
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4:57 p.m.: Welcome to The Hindu's live chat on HIV through contaminated blood transfusions.

5:00 p.m.: With us today, we have our Health and Science Editor Vidya Krishnan, Chapal Mehra, Senior Director, Global Health Strategies, Leena Menghaney, HIV activist and lawyer, and Dr. Shobini Rajan, Assistant Director General, NACO.

Welcome the fact that NACO made the data public and it should bring back focus on the blood safety programme which functions not only to reduce the risk of HIV from blood transfusions but also HBV, HCV and other infections.

Let me clarify at the outset that the data in question is self reported information obtained during post test counselling of positive clients, as to what they think is their possible mode of having contracted HIV infection.

So, Dr Rajan, are you saying this data could be inflated? Or could be an underestimation since there is no scientific way to track it?

It certainly is authentic data. However it only lets us know that transfusion of infections through blood exists, but that is a known scientific fact.

Leena, as an HIV activist do you feel that everything that needs to be done is being done by the government when it comes to ensuring the safety of blood products?

Greetings! Isn't a check done on the blood samples when it is donated?

i just want to know, is there any timely routine visit from the govt. officials for the facility livecheck and most importantly, are they been updated and reminded as an exercise so important?a little away from the discussion.

Do we have more information on where exactly is the issue ? it is the collection process or storage ? Who are all responsible for this ?

And isnt this a minimum figure? 2234, given the sheer scale of the programme?

The blood banks are visited by State FDA to check compliance to license requisites periodically. Additional visits are also made by the officers of State Blood Transfusion councils and Blood Transfusion Experts.

Considering the scale of the program this figure may be considered acceptable by some but I think the program itself would find these figures alarming because it points to trends .

This actually questions when we donote blood .. Can we donate without any fear .. because we might get infected with HIV if we give blood with contaminated needles ...

Dr Rajan, could you respond to what Chapal said about the acceptability of the numbers?

I would agree with Chapal that the numbers are not alarming in the perspective of the total HIV positives estimated, ie 2.1 million.

Transfusion is done in a new blood bag which has inbuilt needle. still there are chance to contaminate?

Dr rajan: If we are to achieve the ambitious 20-20-20 vision, how do we aim to further reduce these errors?

Leena: you think patients who declare transfusion as the point of infection could be doing so because of the stigma?

Dr Rajan: If you could respond to Leena on the massive shortage of vial load testing kits.

All those who need blood should take it only from a licensed blood bank and at the prescription of a qualified medical practitioner. Blood is to be used rationally, and only when really needed.

Chapal: How big is the problem of majority blood donors not being aware of their HIV status?

At which stage of the process does contamination usually play a role? Is there a way to find this out?

Leena, presently there are kits available through the programme for those blood banks which are supported through it, and there is no shortage.

States and blood banks also have standing instructions to procure through their resources to mitigate stock outs so as to ensure mandatory blood testing.

Yes Chapal. But this story is creating such strong reaction because the people who are not from high risk groups feel unsafe about the systems in place to ensure blood safety.

Leena, agree. It is easier for the newly positve client to say he got HIV through blood, than to reveal his sexual inclination or needle sharing behaviour.

So, Dr Rajan, could it be possible that this data set is exaggerated ?

Chapal, to further add on to the window period, there is this period in the course of an infection when it cannot be detected by any known test. WHO also describes an eclipse period where the infection cannot be detected even through NAT and molecular tests.

So either we have get the entire blood packets tested in all labs which will not be the case , or based on the case to case basis , when ever there is need for blood , that blood should be certified by labs that it doesnt contain HIV.

So, there are always going to be cases that fall within this bracket? Of getting unsafe blood?

Vidya, this data set is accurate, but it requires to be interpreted with the denominators and with trend data over a period of time, only then can we really understand it.

Dr Rajan/ Leena and Chapal: Would it not be wise to have regular voluntary donors, check their status before they donate?

Licensed blood banks label the tested blood units as free from HIV,HBV, HCV, malaria and syphilis. They are required to do so under regulation.

Hello I am Ped Hemato-Oncologist and I think the problem in India is lack of "strict regulations" for blood banks and also for administering blood products by doctors!!

I have donated blood a once . But never do i think that it was checked for HIV . Unknowingly people which HIV might be donating blood . How do we check this ?

Responsibility also lies with entertainment industry who still picturizes blood transfusion in the Amar Akbar Anthony style, whereas it is nowadays a highly specialized activity.

For every transfusion the recipient has to accept the risk of the donor being in the window period.

Usually how long is this window period? Will it be possible to get blood, screen it and then wait for few days and screen it again and then provide it for the patients?

Vidya, we prefer repeat blood donors for the same reason as they are undergoing regular check and proving themselves to be free from infection each time they donate.

Yeah even i agree that enforcement is not stringent especially in govt hospitals !

5:27 p.m.: Vidya Krishnan: Chapal/ Leena/ Dr Rajan: Do rigorous is the process process of licensing blood banks in India? The "deemed renewed" policy needs a rethink, yes?

@Murali, the window period depends on the test used and the infection screened for. It may vary from few days to few weeks. And window period does not apply to blood already collected. That has to be used within its expiry period, ie 35-42 days.

Vidya, the Ministry has in policy accepted that there should be no mushrooming of clustering of blood banks and capacity of existing blood banks is to be enhanced. This will lower the load on the system as far as monitoring goes.

Hello Thank you for reply regarding regulations--I understand blood banks are required to do so but the standards are poor of state run banks and some private banks...doctors also do not get informed consent regarding Hepatitis and HIV risk--from patients---some doctors transfuse blood products right and left without understanding the indications properly because there are no "watchdogs" and there are no "guidelines"

Unfortunately, the HIV prog has been suffering from stock outs and budget cuts without provoking the lay people. In this report, the regular citizens feel threatened..

Hence the reaction. Having said that, for the 2000-odd people who did get infected in the last 17 months, the story does stand true.

It has to be understood that blood transfusions are made when there is an absolute indication. At that point in time, if the doctor loads the bystanders and the patients with the rare yet possible side effects, there is a chance that a savable life is lost. Hence the quality of the blood banks, their adherence to norms and proper sentinel surveillance from the banks play a huge role.

I would use this opportunity to appeal to all eligible healthy people between 18 - 65 to donate blood and not let a situation of shortage of this commodity arise in India. Only 1-3% of our population needs to donate to meet our blood requirements.

The govt cut and brought back funding for HIV in India. How effective has this been?

Another point is--Thalassemia and hemophilia patients are big chunk getting transfusions. In both case u can avoid Blood products. In thalassemia by BMT and for hemophilia by giving factors!! But unfortunately by and large Indian helathcare sector still not providing curative treatment to these patients---Which is Shame for Progressive India as people have moved to cellular and gene therpies while we r still stuck with old ineffective supportive therapies!!

What about pre-marital counselling and testing for Thal trait, to prevent??

Renewed in what aspects? I feel this story brings out the crying need to look at licensing process of blood bank, address the human resource shortages required to ensure that..

Vidya, the blood banks, especially in the govt and charitable sectors are receiving support from the central govt under various health programmes, but ultimately the States have to own up to provisioning the basic necessities at blood banks.

Bone marrow transplantation and Factors are very expensive propositions for the patient. And from the Government's side, it would accrue a huge burden if such therapies are made the norm. Even so, Govt of Kerala has been providing for eligible candidates, I having personally met a few.

The states have faced serious problem getting the allocation out of state treasuries- how can that be addressed?

Is there a practical approach available to lower the possibilities of a donor donating during the window period? Like screening him twice in a regular interval, like waiting for say a 10 days before using that unit?

Yes, blood is to be used only when clearly indicated and benefits outweigh the risks.

Dr Rajan: is that followed though? How big is the problem of unnecessary procedures that Leena was talking about earlier?

@ vidya , convince the states its cheaper to prevent than to treat , -blood donors irrespective of previous status need to be checked for HCV, HIV and hep B .

I would also use this opportunity to request-- Government and NGOs to fund and start BMT programs/research institutions across India so that Thalassemia, Aplastic anemia patients can be transplanted. --these patients require regular blood transfusions. Govt should subsidies or make free factor treatments for hemophilia. Laws should be enacted to make it mandatory for doctors to clearly write the indication of transfusion and to take written informed consent from patient.....

@ Murali, I would like to explain that once a unit is tested positive for any of the TTI, keeping it in quarantine is not going to change the status. It has to be discarded as per regulation. The window period can be detected only through retesting the donor, which is possible only in a scenario where majority of blood donors are regular and repeat.

Dr rajan: are the feasible strategies to be implemented? Use of blood components instead of whole blood; reduction of unnecessary procedures and enlisting only regular donors- whose status is HIV known.

At best, the data published today must pave way for more studies to ascertain the risk of getting infected from a donor in window period. To say that blood is not screened would be a layman's prejudice.

Dr Rajan, has NACO's spending on IEC activities gone down in the past year? Secondly, how much emphasis is given by the ministry to ensure we have regular donors-- are there incentives?

Leena: how can civil society help in ensuring blood safety programmes are implemented properly?

@ vidya ,et al - high risk groups need to be ear marked , truck drivers in India are a major risk group along with the sex workers and IVDUsers , their blood need to be double cheked and not used if for the first time meaning they need to be checked and left alone for 90 days and then checked again and if found negative then they can donate ( but even that does not detect those if infected in the interim )

Other Ministries can join hands by givign the donor some brownie incentives like privilege in availing benefits, some points for school admission of kids,. Rajasthan govt has recently given additional pouints for PG admission to blood donors.

Dr Rajan: So, in case a patient declares himself to have contracted HIV from the hospital, why doesnt the government follow up in great detail to ensure the claim is correct. Look at sexual history- drug usage etc..

@ Dr Rangarajan, Truck drivers and IDU do not qualify to be ideal blood donors. If a person gave such a history, he would be deferred as a donor.

I disagree with Dr Rangrajan as transfusion from family members in some indications is not ideal. Because this can create antibodies to potential BMT donors!

Chapal/ Leena/ Dr Rajan: So, the burden of proof falls upon the patient? And the government cannot do anything about it?

I would tend to disagree that blood transfusion should be from related blood donors, as in India, we do not follow directed blood transfusions.

Also, how come some states do better while some- like UP in this case- fare so bad, year after year. It just points to systemic issues.

@Vidya, Blood Donation should be an voluntary act, and should not be based incentives. This would promote unethical practices and Donors who are not healthy/eligible would end up donating blood just for the sake of benefits!

No, Vidya. HIV transfusion through blood is the only mode where the onus is not on the client, it is the system that needs further strengthening to reduce this figure to as close to nil as can be.

People can give incorrect histories. It is impossible to conclusively claim the route of infection. The onus of proof cannot be shifted either to the patient nor to the government.

bloodbanks need to be stocked up and blood must be screened before transfusion which should be the call for the day!

You can "up to some extent" rely on history from patient but still Proof of the Pudding lies in quality tests---We are still stuck with antibody testing which misses windove period--PCR testing is cheap now a days and I dont see any reason why cant be implemented for serious infections like HIV/Hep B????

5:55 p.m.: Vidya Krishnan: Dr Rajan/ Leena/ Chapal: Final remarks on the subject?

Blood Transfusion Services of India require to be strengthened to ensure standardized service delivery and the reliance of a safe unit of blood/ components to the user. The policy and regulation requires a closer tie up. REpeat blood donors further encouraged. Quality management systems and accreditation to be taken forward in blood banks.

And with that we bring this live chat to a close. Thank you for joining us, and a special thanks to our guests.

Source: thehindu.com

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