Rre: Boy infected with HIV + blood

[Guest guest]

Dear members,

To understand the scenario in a better way, let us split blood banking into

three.

A. Blood donor aspects

B. Blood banking (mainly TESTING considered)

C. And utilization.

Let us discuss B and C first, and then we will look at A.

Blood banking:

Problems with testing mainly are, 1) Technical and Human errors (which can be

taken care of to some extent, by proper quality control and training), 2)

problems of false positive and false negative results (inherent to testing

procedure and prevalence of disease in the population), and, 3) window period

infections (where the antibodies to the infecting virus has not reached

sufficient levels so as to be detected by the tests employed).

Window period infections can be shortened by using more sophisticated tests that

are presently very expensive and its use is debatable for low-income countries

like India.

Blood utilization:

The use of blood is very irrational. There is over prescription and misuse

analogous to the over prescription and misuse of antibiotics. A lot of

literature on transfusion audits has proven this.

Now let us consider the donor aspects, which in my opinion is the most important

of the three.

Such mishaps can be minimized if we have a pool of properly counseled, truly

altruistic, regular, voluntary donors in our country.

There are many studies done both in India and abroad which show that the rates

for Transfusion Transmitted Infection’s is low in these donors as compared to

replacement donors (family donors)

But sadly, voluntary donors constitute only about 20% and replacement donors

about 80% of all donors in Delhi.

In other states the ratio varies. The average national figures are 40% and 60 %,

voluntary and replacement donors respectively.

Officially professional donors no longer exist, but those working in this field

very well know that the professional donors have now shifted base and donate in

guise of either voluntary donors (and sell off their cards to the needy and

desperate), or donate as relatives of patients.

It is also questionable whether the so-called voluntary donors who donate in the

camps are truly so, as politics, religion and economics have a big role to play

in these camps.

Moreover proper counseling for the Transfusion Transmitted Infections are not

done in these camps. It is the number of units collected which is important and

not the quality of blood collected.

Experts are of the opinion that an approach which combines efforts at all three

levels will reduce risk considerably.

So a properly organized mass IEC campaign to motivate healthy low risk

population to donate blood voluntarily, on a regular basis, (so that relatives

do not have to run about for blood during crisis situations) is the ideal

solution to this problem in India.

I would also like to mention that government policy of issuing licenses to new

blood banks, in places where they already exist is leading to lot of chaos.

There is only duplication of activities and as such the number of voluntary

donors really remain the same or have increased only marginally. They just have

more options of place for donation. Therefore instead, the government should

have worked towards strengthening those that already existed and increasing the

number of voluntary donors by proper IEC.

To add to this menace is the problem of sale of blood in the name of processing

charges, which adds to the vicious cycle of unhealthy donors donating on the

sly, labs missing out on the window period infections and transmission of

disease by infected blood.

I am personally of the opinion that a “donation” should not be “sold”.

If NACO is already supplying testing kits, free of cost, can it not bear the

other blood banking expenses as an important and urgent public health

intervention? Is it asking for too much?

Kiran Chaudhary.

E-mail: <drchaudharyk@...>