Against the backdrop of recent revelations by National Aids Control Organisation (NACO) that around 1,000 people have contracted human immunodeficiency virus (HIV) in Maharashtra due to blood transfusion, rampant violation of blood donation guidelines during voluntary blood donation camps has further dealt a severe blow to blood safety across the state.
According to official sources, norms related to voluntary blood donation were blatantly flouted last year with reference to not sharing proper information to and from the donors and collection of whole blood over and above the prescribed limit of 500 litres as stipulated by NACO.
These trends were reported during a blood donation drive at a state-run hospital during the period between December 2013 and April 2014 where several camps were conducted in violation of the NACO guidelines. A case in point was of a camp conducted on December 1, 2013 wherein 707 litres blood was collected in the absence of the technician and nurse. In another such similar case, rules were blatantly flouted with the collection of 1,181 units of blood on 27 June, 2014. More than 15 such camps were conducted in the months of May and June 2014.
The situation even took an ugly turn when a state run hospital had to throw off 717 units of whole blood due to lack of a proper infrastructure. Moreover, around 80 people have also contracted HIV due to transfusion of infected blood last year due to negligence while conducting and then screening blood. Any person who tests positive for HIV during a donation camp is seldom informed about his status or referred to an Integrated Counselling and Testing Centres (ICTC) centre, although both are mandatory.
HIV in most blood banks is still tested through ELISA test that has an innate shortcoming. If a person has recently contracted HIV, this test may not show it. It can detect HIV antibodies that take a minimum of three months to show in the blood. Most blood banks have not graduated to advanced tests such as Nucleic Acid Amplification Testing (NAT) due to financial constraints. Currently, only a handful of the city's leading private hospitals offer NAT-tested blood, which costs at least Rs. 1,200 per unit. None of the state-run and BMC blood banks, however, has this facility.
Reveals Dr Ishwar Gilada, president, AIDS Society of India (ASI) on the unethical practice of commercialising blood donation, "Besides this, most of the private blood banks, despite collecting their blood supply from voluntary donors and through major blood donation drives, charge a deposit ranging from Rs. 1000 to 2500 per unit of blood, expecting the patient to replace the blood. In case of failure to replace blood in stipulated time limit, the deposit is forfeited. This amounts to selling blood. This is over and above the blood processing fee of Rs. 1000 to 2000 per unit charged by the blood bank."
In order to ensure blood safety, experts advocate the need to use only HIV-screened blood, use blood judiciously - only when it is really indicated, preferably use fractions (Plasma, Platelets or Red cells) than whole blood and avoid its commercialisation and follow the highest standards of medical ethics. Use donor deferral if any high risk activity among donors is suspected during counselling, use pool testing (pooling of 10 samples and doing test at one place to reduce cost of tests like Polymerase Chain Reaction (PCR) or Nucleic Acid Amplification Testing (NAT).