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.

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.

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.