Blood ties that can kill

It’s a danger that most of us are not even aware of in India. For, every time there is an urgent need for blood donation, we first look for volunteers at home. But did you know that blood transfusion from a relative is far more dangerous than that from an unknown donor? It can even lead to death in many cases.

In fact, global studies have shown, that even though blood from an unknown volunteer tested by the standard ELISA process (for HIV infection), may not be fully safe, the risk of infection is much less, say one in five lakh.

“That’s equivalent to the risk of dying in an aeroplane crash. But on the contrary, blood transfusion between close relatives may lead to life-threatening complications and the risk is one in a thousand,” says Dr C Shivaram, chief, transfusion services, Manipal Hospital, Bangalore. Statistics show transmission of infections like HIV and hepatitis are more common among patients with blood transfusion from relatives than unknown voluntary donors. That’s because normally, relatives never ever disclose their deviant behaviour especially to their near and dear ones. So, during a crisis they are most willing to donate, but “in a way they are forced donors,” explains Dr Shivaram.

Blood donation from close relatives could lead to Post-Transfusion Graft Versus Host Disease (PT-GVHD). This is an under-recognised, under-reported entity in India, even though all developed countries have recognised this long ago and no longer encourage donations from relatives. Experts say, GVHD is even more dangerous than HIV.

For, with HIV one can still survive up to 10 years or more but with GVHD death is certain within a month. The mortality rate from PT-GVHD is as high as 90-100%. “Till date no individual, who has developed PT-GVHD, has survived in India,” says Dr Shivaram.

A study done by Dr Shivaram in Bangalore between May 2005 and July 2006, revealed four cases of PT-GVHD deaths from blood donations by kin. Perhaps, many more such deaths are going undiagnosed and unreported all over India for years. In Bangalore, all four patients had received fresh blood from close relatives. And they reported with symptoms of GVHD — very high fever and rashes on the skin. Eventually, all four patients died within a month of receiving fresh blood from relatives. In fact, fresh blood, too, is another risk factor, for it could lead to GVHD. Dr Shivaram says blood should always be stored as components like red blood corpuscle, white blood corpuscle and platelets are transfused based on the requirements of a patient.

Unfortunately, even tested blood is not safe, say experts. For ELISA only tests for HIV antibodies and it takes about a month to be formed. Therefore, early infections could easily go undetected. To overcome this problem, Manipal Hospital Bangalore has designed the Nucleic acid amplification test or NAT test for the first time in India. “This is a genetic test that looks at the gnome material and finds out the HIV and Hepatitis B & C genes present in the blood” says Dr Shivaram. So far, over 14,300 samples have been tested. One case of HIV positive and another of Hepatitis B positive, missed by the conventional ELISA method, were detected under it. “Since blood is split into components, had this test not been performed, probably six patients would have become infected with HIV or Hepatitis B,” says Dr Shivaram.

Next time you go looking for blood donors, look beyond your family — you could be saving a life that way.

Source:The Times Of India

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