The experts’ committee set up by the government to inquire into the recent incident of an eight-year-old girl in Wayanad contracting HIV infection, possibly through blood transfusion, has recommended that immediate steps be taken so that all blood banks in the State move from third-generation ELISA tests to fourth-generation tests for testing HIV, HCV, and HBV.
In its report submitted to the government here recently, the committee recommends steps to set up at least three Nucleic Acid-based Techniques (NAT) laboratories in the northern, central, and southern zones in the State.
Mandatory test
To begin with, it must be made mandatory that the blood meant for transfusions to high-risk chronic recipients, such as Thalassemia patients, is tested using NAT.
The third-generation ELISA tests currently used by blood banks look for antibodies alone and have a window period of about 21 days while fourth-generation ELISA tests, which tests for both antibodies and viral antigens can bring down the window period to about 15 days.
NAT can further bring down the window period to 7 - 11 days but this is an expensive proposition (it costs around Rs.850 for testing a single donor’s blood) for which the government has to find funds.
The committee, headed by K.P. Aravindan, Professor of Pathology, Government Medical College, Alappuzha, collected the case history and clinical details and traced the treatment received by the eight-year-old Thalassemia patient at every hospital. The experts also collected the details of the 44 blood transfusions the child had received since 2007, when she was two-and-a-half years old.
The committee has pointed out that the blood she received at every transfusion had been tested negative for all blood-borne infections. After assessing all the risks involved, it was definite that the child had contracted HIV infection through blood which had been donated during the window period.
Though the investigators did try to isolate the particular instance of blood transfusion which could have given the infection to the child and the donor, it was not successful. This apart, there were ethical issues involved in recalling the blood donors and asking them to undergo tests again, one of the doctors pointed out.
The committee took this opportunity to study the blood safety practices in all major government blood banks in the State. They visited the blood banks in all five Government Medical Colleges and the practices in the modern blood bank run by the Indian Medical Association were studied. The data from all blood banks in the State were provided by the Kerala State AIDS Control Society.
“There is an inherent risk of getting a blood-borne infection through blood which was donated during the window period and we can only adopt risk-reduction strategies to minimise this time window by adopting fourth-generation ELISA tests or NAT. But first, we have to bring down the pre-transfusion risk as far as possible by counselling every donor so that he is motivated to stay away from blood donation if at all he has indulged in any risky behaviour,” one of the experts points out.
One of the main recommendations of the committee is that adequate number of trained counsellors be appointed in every blood bank and in every blood bank which handles over 12,000 donations annually, there should be a minimum of two counsellors. Also, all staff in blood banks should be given training in counselling so that they can step into the role if required in an emergency.
The committee has also recommended that leucodepletion facilities be set up in blood banks and that only pre-storage leucodepleted blood be given to high-risk chronic recipients like Thalassemia patients. (Leucodepletion is the process of removal of white blood cells (leucocytes) from a blood component). Such chronic recipients should be tested for HIV and HCV every six months.
It has also been recommended that a registry of regular, safe donors be maintained and to use the blood they donate primarily for high-risk chronic recipients.
The affected child in this particular instance must be given all financial help and medical treatment by the government. However, it is sad that the misfortune that has befallen the child and her family cannot be turned around.
The girl had been receiving blood transfusions since 2007. But it was in July 2012 that she was registered as an HIV patient at the Anti Retroviral Therapy (ART) clinic at Kozhikode MCH.
