Blood banks need advanced HIV test kits

With almost all the 200-plus blood banks in the state still following the conventional serology testing method to detect HIV virus in blood samples, doctors say a tragedy like the recent one in Tamil Nadu, where an HIV-positive donor’s blood was transfused to — and infected — a pregnant woman, could happen in Karnataka any time.

“We need sophisticated, expensive tests to detect such infections,” said Dr Venkatesh Prasad, a retired blood bank officer at KIMS Hospital. “Blood donors may not be aware that they are carriers of infections such as HIV, Hepatitis B virus (HBV) or Hepatits C virus (HCV) when they donate. If the blood unit is not tested properly, the chances of infecting recipients is high.”

K’ka yet to get Elisa 4 test kits

Private blood banks claim that cases like the recent one in TN  have happened earlier in Karnataka too, and say they can be prevented with sophisticated tests like Individual Donor-Nucleic Acid Testing (ID-NAT).

However, the ID-NAT facility, which was started in the state in 2013, was withdrawn from hospitals in March last year, with the government citing its non-viability due to high costs.

Deputy Director of Karnataka State Blood Transfusion Council, D Jayaraju, said, “We had to pull out ID-NAT as it is expensive and not viable. Instead, we have sought ELISA fourth generation test kits that have less window period and are good to detect infections. However, we haven’t received them.”
Harsha G of KVK Blood Bank said blood banks in the city are still following old methods of testing, but tests like NAT or ELISA 4 are the much-needed ones as the window period in these new-age tests is less.
Botched-up transfusions

Two years ago, a 26-year-old woman in Hubballi was given O+ve blood during the delivery of her second baby. She tested positive for HIV when she returned to the hospital for a family planning operation nine months later. Her brother, K Prakash, later discovered she contracted the infection through blood transfusion. The reason stated was the use of serology test, which had a longer window period, during which the blood was already transfused to the woman.

Status of blood banks

The National Human Rights Commission has asked the Secretary, Union Ministry of Health and Family Welfare, to call for a status report on blood banks from all states and submit a report within six weeks along with their comments.

“We have been asked to submit a detailed report on the condition of government-maintained blood banks and also on the procedures of storage and transfusion of the blood units which are collected,”
confirmed a KSBTC official.

Old vs new tests

According to doctors at blood banks, the difference between the ID-NAT, conventional type of testing and ELISA 4 is huge. The ID-NAT method looks for the genetic material of the disease-causing organisms and can detect infections quicker than the conventional serology tests.

Explaining the effectiveness of ID-NAT, a Bowring Hospital blood bank officer said, “ID-NAT assays can detect HIV-1 within 4.7 days after infection as against 15 days taken through ELISA (serology). This reduces the risk of infection by 90 per cent,” he said. “It takes 58.3 days and 38.3 days to detect HCV and HBV, respectively, through ELISA (serology), while it can be detected within 2.2 days and 14.9 days, respectively, post-infection using NAT,” he added.Serology tests do not determine infections in its ‘window period’ (time taken by virus to get into body and become reactive), Dr Prasad explained.

Cost factor

While the aim is to ensure faster and cheaper availability of blood, private blood banks say the purpose is lost due to the expenses occurred for such testing facilities. The idea of NAT test was dropped as it also paved way for some private blood banks to fleece patients.

“One cannot force the organisation or blood bank to get NAT-ID tests done. If there is an order passed from the Central Drug Control Department, we can then force people for it,” said an officer from Karnataka State Aids Prevention Society.

Counselling challenges

While several procedures are followed before drawing blood from a donor, officials face several challenges.“Donors do not open up when we ask if they have gone to any sex worker. It gets difficult for us.” a senior doctor working with KSAPS said.