THIS refers to the editorial ‘Safe blood transfusion’ (April 5). The detection of human immunodeficiency virus (HIV), hepatitis B and C in 40 per cent of haemophilia patients in Karachi is most distressing, but not surprising. If a similar exercise is conducted in thalassaemia major patients, it is likely that more alarming results would be witnessed.

The culprit behind the transmission of blood-borne infections through blood transfusions is the rampant and indiscriminate use of cheap, manual, substandard screening kits in many substandard blood banks. These poor quality kits are unable to detect the infecting pathogens present in the blood to be transfused. The life-saving blood/blood component transfusions thus end up causing life-threatening harm instead of saving or improving the quality of life.

In the developed and even developing countries, proper blood transfusion systems exist that ensure safe, efficacious and quality blood transfusions to those who need it. In addition, a regulatory system also functions to ensure that the blood service delivery system performs according to the highest safety standards.

In Pakistan, blood safety reforms were initiated by the government’s Safe Blood Transfusion Programme (SBTP) in 2010 with the support of the German govern-ment and the technical assistance of the World Health Organisation (WHO).

The SBTP developed a nationwide network of large modern regional blood centres which collect blood, and perform its testing, screening, processing, component preparation and storage as per the relevant international guidelines.

The prepared blood components are then provided to the linked hospital-based blood banks for transfusion to patients. Presently, about one-fourth of the national coverage is being met through this new system. The rest of the coverage is through the earlier unsafe system. Unfortunately, most haemophilia and thalassaemia patients are being covered through the old, unsafe system, which explains the high prevalence of HIV and hepatitis infections in them.

The need is to rapidly expand the coverage of the new system by building fresh infrastructure and make the blood regulatory system effective.

Presently, only the Sindh Blood Transfusion Authority (SBTA) is functioning, albeit with much resource constraints. In this day and age, acquiring infections through contaminated transfusions is unacceptable. No blood bank should be allowed to do manual screening of blood. Blood should only be screened on automated systems with quality assurance arrangements in place.

Prof Hasan Abbas Zaheer
Former Project Director, SBTP
Islamabad

Published in Dawn, April 21st, 2022

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