Thalassaemia patients at HIV risk due to unsafe blood transfusion
KARACHI: At least three thalassaemic children have been found to have contracted human immunodeficiency virus (HIV) in recent months, indicating that children suffering from thalassaemia are highly vulnerable to infectious diseases amid unsafe blood transfusion practices in the province.
Dr Azra Abro, the official in charge of the Sindh Aids Control Programme’s HIV/Aids treatment centre at the Civil Hospital Karachi, told Dawn on Tuesday that the three children, aged between four and 11 years, combating thalassaemia — the inherited blood disorder that needs multiple blood transfusions — were referred to it by a couple of thalassaemia centres.
She said all the three tested positive for HIV.
Experts believed that the children might have received HIV strains through blood transfusion though the symptoms did not appear then.
They noted that since the risk of tainted blood entering the human body was always there, the Sindh Blood Transfusion Authority, hospitals and private organisations should join hands to develop a common pool of critical medical facilities to detect impure strains in bloods and avoid fatal errors.
Dr Mohammad Ashraf, a senior pathologist at the SACP’s referral laboratory at the CHK, said that the number of children brought to the HIV/Aids treatment centre so far could be a tip of the iceberg because every thalassaemic child was not frequently tested for HIV.
A focal person at a blood bank catering to thalassaemia patients in the city said that two thalassaemic children who had contracted HIV died about five years back.The number of young multiple blood recipients contracting HIV might be alarming, in view of the poor monitoring of blood banks and the archaic system they had for the screening of blood units against the transmissible diseases such as hepatitis B and C, HIV, syphilis and malaria, Dr Ashraf said.
Discussing the peculiarities of blood collection and preparation of various products, the pathologist said: “Not all the banks conduct verbal screening [by asking questions on risky behaviour before lab screening] despite the fact that they were legally bound to properly screen the donated blood unit to ensure safe blood transfusion.”
He said blood from such donors could be infectious that might not be detected through tests. “Virus despite its presence in the sample cannot be detected on a timely basis in most laboratories as the related antibody develops after six to 12 weeks.”
Blood was not screened for HIV in many banks particularly those situated in the rural areas, said an HIV/Aids activist. He urged the SACP to ensure that blood was tested for HIV with high standards of quality control.
Dr Abro told Dawn that the three thalassaemic boys with HIV, including one from the interior of Sindh, had been visiting the SACP centre for follow-ups from time to time. According to their viral loads known so far, they did not need any anti-retroviral therapy (ART), she added.
It was learnt that four children suffering from thalassaemia tested positive for HIV over the past 15 months and three of them were registered with the SACP during the last five months.
Thalassaemic patients with HIV were about 17.5 per cent of the total children registered at the SACP’s treatment centre at the Civil Hospital Karachi. As many as 13 HIV children were on medicines.
Dr Sikandar Iqbal, a senior physician at the CHK HIV/Aids centre, said that an eight-year-old child with thalassaemia major, who needed blood transfusions on a regular basis since he was two, tested positive for hepatitis C as well. “This indicates that the boy has possibly been transfused the blood acquired from drug users,” he said, adding that about 80 per cent of the intravenous drug users were reportedly suffering from both HIV and hepatitis C.
He said that the case history of thalassaemic patients received at the CHK centre showed that they were referred to the SACP lab for HIV tests only after they had developed symptoms like fever, off-and-on diarrhoea and weight loss.
“This underlines the need for regular counselling of blood recipients and their attendants by available physicians and staffers at the blood banks handling the thalassaemia children,” Dr Iqbal said.According to estimates, there are about 9,000 reported cases of thalassaemia major in Sindh. Of them, about 4,500, including 3,000 located in Karachi, are registered with blood banks being run by various NGOs and major government hospitals for at least two blood transfusions every month.
The blood requirement is met largely by donors, including relatives and friends of the patients.
According to experts, the blood donated on a voluntary basis has a very low risk of being tainted with HIV. However, the country had a very narrow voluntary blood donors’ base.
Sources said that mostly blood banks did not assess the HIV status of blood donors; rather they screened the blood products.
Dr Sarfaraz Jaffery, vice president of the Thalassaemia Federation of Pakistan, said that blood and blood products were the potential source of HIV in patients who needed multiple blood transfusion or blood products, but the HIV infection could also be transmitted through infected needles, syringes and other instruments.
However, he did not rule out the possibility of HIV infection through blood transmission and stressed the need to undertake studies for HIV infections, particularly in the wake of non-observance of safe-blood banking three to four years back or due to the fact that thalassaemia children living in the rural areas had to rely on different blood banks for routine transfusions.
Dr Jaffery said that many blood collection facilities faced the problem of accurate detection of HIV in blood products and that too in a short time. “Except for a couple of blood banks in Karachi, all the transfusion establishment in the city and other parts of the province use the outdated ELISA (enzyme-linked immuno-sorbent assay) test on donor blood, which is time consuming and not 100 per cent accurate,” he added.
Responding to a question, he said that advanced Nuclic Acid Testing (NAT) technology that could detect the Aids virus was not affordable by all the banks, and at the same time this test too had a window period of four to five days. “Five to seven per cent of the NAT tested patients too can show sero-positive for HIV at some later stage,” he added.
He said that a couple of banks being run by NGOs in Karachi ensured monitoring of children in need of blood transfusion and conducted various tests for the confirmation of hepatitis B and C and HIV once a year.
He said that the prevalence rate for hepatitis C among the thalassaemia patients was about seven per cent. Blood banks, however, should not use blood or related products that were more than 10 days old.
He said that two of the HIV confirmed cases registered with a major blood bank in Jamshed Town had died about five years back, while he was not aware of any new case.
Secretary of the Sindh Blood Transfusion Authority Dr Zahid Ansari told Dawn that there was a system for regular monitoring of registered blood banks across the province to ensure that the criteria for safe blood transfusion were met.
He said that about 75 per cent of the 138 registered blood banks submitted summaries of results of blood bags screened by them for HIV or hepatitis C to the SBTA on a regular basis. The banks were required to ensure a mandatory ELISA screening of blood and blood products for HIV and hepatitis C, he said.
However, he added that the NAT equipment was very costly and as such none of the blood banks in the public sector and many in the private sector could afford that.