KARACHI, Feb 14: Ironically, the country’s blood transfusion services, which are supposed to help doctors combat suffering, are in all likelihood fuelling diseases like HIV and hepatitis B and C.

The reason: despite several awareness initiatives high-risk blood donors are still doing great business and only a portion of the blood bags are screened for HIV and hepatitis.

According to a comprehensive paper, published late last year in the Infectious Diseases Journal, very few establishments actually screen blood for infections. In Karachi, arguably the country’s most developed city, only 20 per cent of the blood transfusion facilities screen blood for HIV and hepatitis B and C.

Screening of blood for syphilis and malaria is also not universal. The research paper, which can be described as an indictment on our health-care system, says that up to 54 per cent of Karachi’s blood banks use blood donated by commercial donors.

Commercial or professional donors — according to the paper written by S. Abdul Mujeeb, Arifa Akram, Moenuddin Ahmed and Shakeel Ahmed of the Jinnah Postgraduate Medical Centre — are mostly drug addicts. These people generally indulge in unsafe sexual practices and are also anaemic due to frequent donations.

The paper says 20 per cent of the blood from commercial donors was found to have hepatitis C infection and 10 per cent hepatitis B infection. However, few HIV cases were reported.

Data at the national level suggest that only around 25 per cent of the blood comes from true voluntary donors, says the paper which is titled “State of Blood Transfusion Services in Karachi: A Review in the Context of Blood Transmitted Infections”.

About 65 per cent of the blood comes from family donors and ten per cent from commercial donors.

Replacement family blood, says the paper, is considered to be safe for transfusion. “There is a misperception that blood of family donors is safe for donation.

“(However,) circumstances may force them to donate blood despite having high-risk behaviour or blood-transmitted infections.”

Analyses have shown that this blood has a rate of infection of between 7 to 15 per cent, depending upon the donors’ socio-economic and linguistic backgrounds, says the paper.

The lowest prevalence of blood-transmitted infection was found among college-going voluntary donors, who can be described as true voluntary donors.

According to the research paper, earlier studies had reported high prevalence of blood-borne infections among the recipients of blood transfusion. “Twenty-two per cent hepatitis B infection and 51 per cent hepatitis C infection (rates) were found among patients of beta thalassaemia major.

“Twenty-three per cent hepatitis B infection and 46 per cent hepatitis C infection (rates) were noted among haemodialysed patients”. This shows that the blood transfusion services are most probably fuelling infectious diseases like hepatitis B and C and HIV.

The paper — based on already published literature on the subject and interviews of key personnel in Karachi — says donated blood is being used irrationally by the blood banks. “(A) study reported that 10 per cent of blood was given for ‘generalized weakness’.

“Whole blood is used most. And very few establishments are actually preparing blood products.”

The supply of blood is far from safe, concludes the paper. The reasons for this, according to the paper, are: fragmentation of blood transfusion services; increasing cost of screening and diagnostic procedures; lack of motivation for voluntary blood donation programmes; poor quality of medical supervision; and, ignorance towards safe transfusion practices among health care providers.

The important paper calls for a national blood transfusion policy. “Public and private partnerships should evolve a national safe blood transfusion policy involving voluntary donors in the country.

“Mandatory screening for infections, development of facilities for preparation (of blood products), and training of personnel for collection, preparation and transfusion of blood and blood products should be enforced.”

Great emphasis has been placed on voluntary donation in the paper. “True voluntary blood donors are generally better educated and healthy and hence have the lowest prevalence of blood-transmitted infections and should be motivated and encouraged to regularly donate blood.” The paper has treated family donors as involuntary donors.

Speaking to Dawn about it, the editor of the Infectious Diseases Journal, Dr Naseem Salahuddin, stated that the paper had blown away several myths. “The people generally thought that over the last couple of decades our blood transfusion services had seen a lot of improvements.

“It’s true that the services have indeed made some progress. But a lot still needs to be done. From that angle, this paper is a real eye-opener.”