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World Blood Donor Day: Strengthening protocol; improving donor and recipient counselling

M3 India Newsdesk Jun 14, 2018

On World Blood Donor Day, here is an article discussing seropositivity, TA-GVHD, and ways doctors, blood banks, and hospitals can strengthen protocols and improve counselling for donors and recipients.

 


A recent case report published in the Global Journal of Transfusion Medicine, highlighted an unfortunate event of a blood bank being attacked for referring a blood donor who tested positive for HIV to the Integrated Counselling and Testing Centre (ICTC). A lack of forewarning and counseling before donation led to a lot of unnecessary negative publicity for a good blood bank. Here is a look at the two sides of blood transfusion- donor and recipient; and what doctors, blood banks, and hospitals can do to improve their practices and prevent future incidents.


Blood donation- a case of seropositivity

This specific incident was highlighted in the case report:

A voluntary blood donor visited a blood bank for donation in January 2018. Upon routine testing  of his sample, he was found to be HIV sero-reactive. The test used was a 4th generation HIV Combo Kit, known to be highly sensitive and capable of detecting infections as early as in the 4th week.

The blood bank tested the same sample again and once it was confirmed to be positive again, the donor was informed and asked to come again for testing. A new blood test after 7 days confirmed HIV seropositivity again, after which the donor was referred to the ICTC of the nearest medical establishment with a letter and advised further counselling. The donor instead skipped counselling and attempted suicide. After being rescued, a private laboratory again tested the donor and found him to be HIV non-reactive.

This was enough to spark outrage among people and the very next day the issue escalated, causing the blood bank to be blamed and shamed for its practices on several media channels. In this case, the blood bank did everything right and as per protocol, and still got blamed for the suicide attempt. Of course, confirming HIV seropositivity in the donor was a mistake, but this was a case of 'false-positive result' provided by the test kit.

Guidelines for testing donor units

Most blood bank tests are highly sensitive to never miss out on the possibility of an infected unit being transfused and compromising patient safety. So false-positive results are common too. In this specific case too, the donor was referred to ICTC for this sole purpose- further confirmation. His donation was destroyed as per protocol at the bank.

The National AIDS Control Organisation and DGHS guidelines for Blood Donor Selection & Blood Donor Referrals for donors testing seropositive is:

  1. Donor has to sign a form prior to donation consenting that:
  • Donation is a voluntary act
  • Acceptance of any risk associated with the donation procedure
  • Use of donated blood for fractionation and use of plasma fractions for plasma-derived medicines
  • Blood will be tested for Hepatitis B & C, Malaria, HIV, and Syphillis in addition to other screening tests
  • Donor will be informed by the blood bank if any abnormal test results emerge from the screening
  1. For initial sero-reactive blood donors, the guidelines clearly state that: “It is not the primary duty of the blood bank or blood transfusion service to confirm the diagnosis of any Transfusion Transmitted Infections (TTIs) screened for”
  2. The blood bank will perform a repeat test on the donated sample to re-confirm sero-positivity before recall or referral


Just like the above incident, there have been cases, when doctors and hospital blood banks have rightly warned donors and referred them for counselling, but donors have failed to follow up.


From seropositivity to counselling

Recently, Mumbai District AIDS Control (MDACS) introduced a new system that will enable blood banks to reach out to such donors who test positive for HIV at blood banks. To improve the turnover for counselling, blood banks have now been told to counsel seropositive donors to the nearest ICTC centre of their convenience instead of asking them to report at the blood bank-linked centre.

To steer clear of unnecessary attack and defamation in the light of an unfortunate incident, doctors, staff at independent blood banks and hospitals should:

  • Possess adequate knowledge about the blood donation process- testing and referrals
  • Have a deep understanding of the protocols followed- National AIDS Control Organisation and DGHS guidelines
  • Mention before the donation process that it is not the duty of the blood bank to provide confirmatory evidence of transfusion transmitted infections to donors and thereby stress on the importance of follow up test (after 7 days) and confirmation at an ICTC centre
  • Display a printout of the donation process and what happens to the donated unit of blood after; explaining the process from donor to recipient
  • Have a separate flowchart explaining how blood is tested for the presence of infections, and the process that ensues once a donor tests seropositive
  • Collect adequate information and background history of the donor to be able to contact them more easily in case they test seropositive
  • Have a list of the various ICTC centres to refer seropositive donors for confirmation and counselling


Recipient fear of receiving an anonymous donor's blood

Moving on to recipients; doctors in the past have continuously warned patients about the dangers of using a relative’s blood instead of an anonymous donor’s unit. They have mntioned about the dangers of Transfusion-associated Graft Versus Host Disease (TA-GVHD), that can lead to the death of the patient who received the transfused blood.

These cases too were widely reported in the media. Yet, even today, many doctors are faced with strange requests from patients, mentioning that they should only receive blood from kin or close relatives for fear of ‘infection’ or ‘disease’ transmission.

A few things doctors can do about reducing the fear around receiving anonymous donor blood units are:

  • Educate patients and families about the risks of receiving blood units from close relatives
  • Briefly explain the process of component separation, blood storage and use
  • Talk about the highly-sensitive testing involved before passing a unit of blood as ‘fit for transfusion’
  • Educate patients and families about the importance of blood donation, and importance of replacing used units of blood
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