Karachi: Medical experts have revealed that 15 percent of HIV patients across the country contracted the virus due to unsafe blood transfusions, while syphilis, malaria and dengue can also be transmitted through blood, in view of which the National Blood Transfusion Policy has been introduced.
CLIA and nucleic acid testing have been made mandatory under the National Blood Transfusion Policy to ensure safe blood transfusions. According to doctors, the biggest challenge in making this system effective is the lack of voluntary blood donation.
In this regard, Professor Dr. Bushra Moeez, Head of the Section of Hematology and Transfusion Medicine at Aga Khan University Hospital (AKUH) and President of the Pakistan Society of Hematology, told Express News that Pakistan’s blood bank system remained fragmented for a long time because blood banks of different standards were operating in the country. Some blood banks met international standards while many were working at lower levels. Although the policy existed in the past and minimum standards were also set in it, after the 18th Amendment, separate regulatory authorities were established for blood banking in each province.
According to Dr. Bushra Moeez, the Sindh Blood Transfusion Authority (SBTA) was established in Sindh, the main objective of which was to eliminate fragmentation in blood banking and establish regional blood centers. This model was largely successful and 18 regional blood centers were established across the country. As a result of their establishment, there was significant improvement in IT technology, screening systems and other standards. These regional blood centers were attached to hospitals and were providing free and safe blood to patients. This reform period continued from 2014 to 2020.
He further informed that now a national blood transfusion policy has been prepared for 2030, which includes a total of 15 goals. If these goals are to be explained in simple terms, they have three main pillars which include governance and structure, patient safety and sustainability of the system. Under the new policy, blood and blood products, including products derived from plasma, have now been recognized as drugs. This means that blood banks will now be regulated in partnership with the Drug Regulatory Authority.
He explained that plasma-derived products include albumin, clotting factors, immunoglobulins, anti-tetanus and anti-rabies immunoglobulin. According to him, blood and blood products are also regulated as drugs under the standards of the World Health Organization (WHO) and Pakistan’s new policy is also in line with these global principles. For the first time, the new national policy has clarified and standardized the blood screening procedure to ensure patient safety.
Dr. Bushra Moeez says that currently in Pakistan, five diseases are tested during blood screening, including HIV, Hepatitis B, Hepatitis C, syphilis and malaria. Under the new policy, it has been emphasized that a standardized international level methodology, known as CLIA, should be adopted for screening across the country.
He said that in the past, most blood banks relied on kit-based or rapid testing, as a result of which viruses like Hepatitis B and C were sometimes left out of diagnosis and there was a risk of further spread. Under the new policy, all blood banks will be required to use CLIA-based testing. Along with this, nucleic acid testing, which is a PCR-based method, has also been included.
He said that sometimes the virus is present in such small quantities that it does not show up in serology tests, but it can cause infection through blood transfusion, such cases can be identified through nucleic acid testing. Through this policy, complete tracing from patient to donor will be possible. It will be possible to find out when and where which donor donated blood, through which blood bank, to which hospital and to which patient. If the virus is later confirmed to be transmitted to a patient, the donor can be traced to any part of the world through the tracking system of the International Society of Blood Transfusion.
He said that the aim of this is that if a donor has transmitted hepatitis or any other infection, he should not donate blood to anyone else in the future. In this way, blood banks will have clear data on which donor is a carrier of hepatitis C or other diseases and blood should not be taken from him.
He said that according to data from regional blood centers in 2022, hepatitis C cases were found to be more in northern Pakistan, while the hepatitis C rate was reported to be 8 to 9 percent in interior Sindh. The hepatitis B rate in Karachi is about 5 percent. He said that hepatitis C cases are more in areas of Sindh, while hepatitis B cases are also coming up in Peshawar and Islamabad, Sindh is becoming a hotspot for hepatitis C.
He said that for the first time in this policy, special attention has also been paid to children with thalassemia. Since the treatment of thalassemia is expensive, the policy emphasizes prevention and treatment instead of treatment.
Professor Syed Faisal Mahmood, an expert in infectious diseases, says that blood-borne diseases include HIV, hepatitis B and C, while syphilis, malaria and dengue can also be spread through blood. Hepatitis C is treatable, but HIV and hepatitis