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Unregulated blood transfusion remains a dilemma

Blood transfusion is a routine medical practice all over the world but the recent case of two siblings contracting HIV in an Islamabad hospital after blood transfusion has raised worst fears about “safe blood” in the country.

Health experts say that only safe blood gives healthy results.

But unfortunately the substandard and cheap blood screening kits used indiscriminately in Pakistan cannot detect the presence of HIV and Hepatitis viruses in the donated blood.

It makes a sad story for the two children, seven-year-old brother and eight-year-old sister. They were suffering from platelets functional disorder and had been receiving blood transfusions in different hospitals of Rawalpindi and Islamabad since 2010.

Despite the treatment, the little girl developed chronic sickness. In November 2016 doctors decided to get her tested for HIV, which turned out to be positive. Later her brother too was found to be HIV positive.

Since the parents were not afflicted with the disease, the suspicion arose that contaminated blood infected the poor children.

Their plight caused a public uproar, forcing the Capital Hospital of the Capital Development Authority to institute an inquiry. The National Commission on Human Rights (NCHR) also took notice of the tragedy and sought reports from concerned quarters.

Media’s focus on the story took the issue to the parliament where legislators stressed on making the blood transfusion system in the country “flawless”.

However, it was not the first time that innocent children reportedly became victim of HIV because of unsafe blood transfusion.

In December 2014 health expert Prof Dr Javaria Mannan had rocked the country by announcing that her research found at least 10 child Thalassemia patients infected with HIV.

But her finding was discounted because she refused to share her data to prove her claim.

Media coordinator of Pakistan Institute of Medical Sciences (Pims) Dr Waseem Khawaja told Dawn that people suffering platelets disorder, Thalassemia and some other diseases were vulnerable to infections through blood transfusions.

Blood samples being screened at a laboratory of Safe Blood Transfusion Programme in Islamabad.
Blood samples being screened at a laboratory of Safe Blood Transfusion Programme in Islamabad.

“Those who have dialysis, because of the kidney problem, also face same sort of the problems because they can be infected if non sterilized equipment and unsafe blood is used,” he said.

“It should be a top priority that only safe blood is provided,” he added. “Otherwise people will stop trusting the system and may hesitate to donate blood.”

Prof. Hassan Abbas Zaheer, incharge of Safe Blood Transfusion Programme (SBTP), identified the use of sub-standard manual screening devices in blood banks as the “main cause” of infection of HIV and Hepatitis.

“These cheap poor quality devices give false negative results,” he said. “Unfortunately, the use of such kits is widespread in our public and private sector blood banks for want of regulation of the blood screening kits, except in Islamabad.”

“Worse, the blood transfusion authorities in the provinces are either non-functional or ineffective for various reasons,” he added.

According to Dr Zaheer, sixty to seventy percent of the around 3.5 million donations of blood across Pakistan every year are screened on substandard manual kits. A good quality manual kit costs Rs150 but majority of the blood banks in the country go for the ones that cost Rs6 or Rs7.

“Those (cheap) kits are not US Food and Drug Administration (USFDA) approved and cannot be trusted. That the blood transfusion sector is totally unregulated is a very serious issue,” he said, stressing that “we cannot compromise on quality.”

Sadly, the government hospitals have no choice but to buy the substandard kits. Under the rules they have to call tenders and buy the cheapest, not the better quality automated blood screening kits which cost more, he said.

Once the Drug Regulatory Authority of Pakistan (Drap) starts registering blood screening kits, he said the SBTP will be in a position to ensure that only the registered kits are used.

Dr Zaheer, however, claimed that in Islamabad automated or good quality manual kits are being used and all relevant data is saved.

“Last year, a total of 68,224 blood donations were collected in the federal capital out of which 66,757 were screened on automated kits. Only 1467 donations were screened on manual kits but of good quality,” he said.

About the two unfortunate siblings whose suffering brought the issue under spotlight, Dr Zaheer said that since they got blood transfusion at different hospitals and different cities, the source of their horrid infection cannot be pinpointed.

From Pims, the two together received 1830 transfusions without any charge and without replacement donation, he said.

“We have all the records, bag numbers which were given to children and even details of who donated the blood in the bags,” he said.

“A detailed inquiry should be held to find out when siblings were infected as it is possible to diagnose, with the level of infection, and if both children were infected at the same time,” Dr Zaheer said. “It is possible that one got infected by contaminated blood and the other because the same syringe was re-used.

Definitely the Drap should ensure that World Health Organization approved blood screening kits are used all over Pakistan, but that is no surety that transfusion of infected blood will stop, he cautioned.

Drap’s Chief Executive Officer Dr Muhammad Aslam insists that it is the responsibility of the diagnostic labs to use quality kits or stress for the use of registered kits.

“No one has ever contacted us for the registration of blood screening kits and we cannot force any company to register its kits,” he told Dawn. “Laboratories can do it or may be the Health Regulatory Authority.”

“Indeed blood screening kits are not regulated,” he conceded but argued that one department cannot address the issue.

“Kits can only be registered if blood banks refuse to accept or refuse to buy unregistered blood screening kits,” said the CEO conclusively.

Reporter. Unregulated blood transfusion remains a dilemma. Dawn, February 13, 2017.

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