Why is it mandatory to test for hepatitis B and C when donating blood?

 Why is it mandatory to test for hepatitis B and C when donating blood?

Medical science says that hepatitis B and C infection can be transmitted through blood, so before giving blood to the patient, it is mandatory to test these viruses.

Millions of patients around the world are given blood to save their lives. Surgery, accidents, childbirth, cancer, thalassemia, anemia - in all these cases blood is vital. But if this life-giving blood carries the hepatitis 'B' or 'C' virus, it can become a silent risk rather than a life saver. Therefore, it is very important to test for hepatitis B and C before giving blood to the patient.

Is every blood donated around the world tested for hepatitis B and C?

What is Hepatitis B and Hepatitis C?

Hepatitis means inflammation or swelling of the liver. It can be caused by a virus attack, excessive alcohol consumption, medication or other reasons. In terms of blood circulation, Hepatitis B (HBV) and Hepatitis C (HCV) are considered the most dangerous because both of them can be transmitted from one person to another through blood.

hepatitis b

Hepatitis B virus is the most common hepatitis virus in the world. According to the World Health Organization, more than 296 million (296 million) people in the world are chronically infected with HBV.

This virus is transmitted through the following means.

– through infected blood and blood components,

- Through unprotected sex,

- In infants born from infected mothers,

-Transmitted through infected needles or medical equipment.

Chronic (HBV) infection can lead to liver cirrhosis and liver cancer. About 1.1 million people die each year from (HBV) related complications.

hepatitis c

Hepatitis 'C' virus (HCV) is equally dangerous. According to the World Health Organization, about 58 million people in the world are chronically infected with HCV. One of the most dangerous aspects of HCV is that it can remain in the body for years without showing any symptoms, but it continues to destroy the liver internally. There is a vaccine for HBV but the vaccine for HCV has not yet been developed.

One of the biggest sources of HCV infection is unsafe blood transfusions. Before 1992, when there was no blood test for HCV, millions of people were infected with HCV through blood transfusions.

Bloodborne Hepatitis Infection: How Serious Is It?

Transmission of hepatitis through blood is a serious challenge for modern medical science. Both HBV and HCV can remain active in the blood at very low levels. Even microscopic blood on the tip of a needle can cause infection. This means that one untested bag of blood can make dozens of patients suffer from chronic liver disease for life.

According to the World Health Organization, the problem of HCV infection through blood transfusions is high in developing countries. About 2 percent of the total hepatitis C infections worldwide are transmitted through blood transfusions. This ratio is even higher in developing countries.

Hepatitis Test: Mandatory step before blood transfusion

In modern blood transfusion centers, TTI screening is done compulsorily after collecting the blood of every blood donor. Testing for hepatitis B and C plays a central role in this.

Tests for Hepatitis B The following tests are done for complete and effective screening of Hepatitis B:

1. HBsAg (Hepatitis B Surface Antigen)

This is the most basic and mandatory test. It detects the presence of HBV in the blood. Most transfusion centers around the world perform this test.

2. Anti-H 'B' 'C' (Hepatitis 'B' Core Antibody)

Even if HBsAg is negative, in some cases, there may be HBV in the blood - this is called the 'window period'. Anti-H 'B' 'C' test can also detect infection during this free period.

3. 'HBV' NAT (Nucleic Acid Testing)

This is the most sensitive test that detects HBV DNA directly. This test further reduces the 'window period' and also detects infection.

4. HBEAG (Hepatitis B E-antigen)

It tells the amount of activity and infectivity of HBV.

Tests to screen for hepatitis C

1. Anti-HCV (Hepatitis C Antibody Test)

This test detects antibodies the body has made against HCV. This is the most widely used HCV screening test method.

2. 'HCV' NAT (Nucleic Acid Testing)

It detects HCV RNA directly and can detect infection 7-10 days earlier than anti-HCV. The window period lasts about 3-5 days.

3. HCV core antigen test

It is used as an alternative between anti-HCV and NAT, especially in places where NAT is more expensive.

Window period: greatest risk

The window period is the time when a person is infected but the test is negative. The window period for anti-HCV test can be around 30-45 days for HBV and 50-80 days for HCV. This window period is much shorter if NAT is used.

It is about 15-20 days for 'HBV' and 3-5 days for 'HCV'.

This means - HBsAg test alone is not enough. Anti-HBC and NAT tests should also be mandatory in high-risk countries. This is why developed countries have implemented such testing methods in their blood transfusion centers.

State of the World: Is It Testing Everywhere?

Sad reality The thing is that in all the countries of the world, blood "HBV" and "HCV" tests are not at the same level. According to a research by the World Health Organization, about 39 countries in the world have not yet ensured mandatory TTI screening of all donated blood.

Status of high-income countries In developed countries such as America, Europe, Australia, and Japan, blood screening is very advanced. Not only these, HIV, Syphilis, HTLV and other infections are also tested. In these countries, the possibility of transmitting 'HBV' or HCV is very low when a patient is given blood.

Challenges of developing countries

Due to limited budget, some blood transfusion centers can only perform routine tests. They are not able to do advanced tests. Small blood transfusion centers in rural areas lack modern equipment and trained manpower.

In case of emergency, it is mandatory to give blood without waiting for the test. Due to lack of blood, the patient's relatives have to donate blood immediately, which is another major challenge

What is happening in Nepal?

HBsAg, Anti-HCV, HIV, Syphilis and Malaria tests have been made mandatory in blood transfusion centers established under the National Blood Policy in Nepal.

But the reality of Nepal is serious. These tests with ELISA (enzyme-linked immunosorbent assay) and CLIA (chemiluminescence immunoassay) are performed in less than 5 percent of blood transfusion centers in Nepal. The remaining 95 percent blood transfusion centers are dependent on the Rapid Test Kit. NAT (Nucleic Acid Testing) test is not done anywhere in Nepal.

Challenges of Nepal

- There is a lack of modern equipment in small hospitals and transfusion centers in rural areas.

- The risk of infection from blood given in the window period has not yet been reduced to zero.

- There is no complete data on infections transmitted through transfusion.

Anti-HBC testing is still not done in most transfusion centers in Nepal.

The immediate need for Nepal is to expand the testing done by ELISA (enzyme-linked immunosorbent assay) and CLIA (chemiluminescence immunoassay) and to start NAT testing.

The World Health Organization has called on all countries in the world to ensure mandatory screening of all donated blood. According to World Health Organization guidelines, the following tests should be mandatory for each unit of blood:

- For AzBSAG-Hepatitis 'B'

– Anti-HCV – for Hepatitis C

– Anti-HIV – for HIV

– Syphilis test

-Malaria testing in malaria affected areas

The World Health Organization has recommended the gradual implementation of NAT testing and the addition of anti-HBC testing to high-risk areas.

The International Society of Blood Transfusion also encourages member countries to adopt these standards.

Safe Blood: A Human Right

A safe, adequate and quality blood supply system is the cornerstone of a healthy society. Transmitted blood without testing for hepatitis B and C means giving a serious disease to a patient while curing one disease. It is morally unacceptable and medically unforgivable.

Remember: one bag of untested blood can cause a family a lifetime of grief. Getting safe blood is not only humanity and kindness, it is also a right. Its assurance is the responsibility of the state.