Medical experts have revealed that 15 percent of HIV patients across the country contracted the virus due to unsafe blood transfusions. Syphilis, malaria, and dengue can also be transmitted through blood, prompting the introduction of the National Blood Transfusion Policy.
Under the National Blood Transfusion Policy, CLIA and nucleic acid testing have been made mandatory to ensure safe blood transfusions. Doctors say the biggest challenge in making this system effective is the lack of a culture of voluntary blood donation.
In this regard, Professor Dr Bushra Moiz, Head of the Section of Hematology and Transfusion Medicine at Aga Khan University Hospital and President of the Pakistan Society of Hematology, stated that Pakistan’s blood bank system remained fragmented for a long time, as blood banks of varying standards were operating across the country. Some blood banks met international standards, while many operated at a very basic level. Although a policy with minimum standards existed in the past, after the 18th Amendment, separate regulatory authorities for blood banking were established in each province.
According to Dr Bushra Moiz, the Sindh Blood Transfusion Authority was established in Sindh with the primary objective of eliminating fragmentation in blood banking and establishing regional blood centers. This model proved largely successful, and 18 regional blood centers were set up across the country. As a result, there was significant improvement in IT technology, screening systems, and other standards. These regional blood centers were linked to hospitals and were providing free and safe blood to patients. This reform phase continued from 2014 to 2020.
She further said that a national blood transfusion policy has now been developed up to 2030, comprising a total of 15 targets. In simple terms, these targets are based on three main pillars, including governance and structure, patient safety, and system sustainability. Under the new policy, blood and blood products, including plasma derived products, have now been recognized as drugs. This means blood banks will now be regulated in collaboration with the Drug Regulatory Authority.
She explained that plasma-derived products include albumin, clotting factors, immunoglobulins, anti tetanus, and anti rabies immunoglobulins. According to her, under World Health Organization standards, blood and blood products are regulated as drugs, and Pakistan’s new policy is aligned with these global principles. To ensure patient safety, the new national policy has, for the first time, clearly defined and standardized blood screening procedures.
Dr Bushra Moiz said that currently five diseases are screened during blood screening in Pakistan, including HIV, hepatitis B, hepatitis C, syphilis, and malaria. Under the new policy, emphasis has been placed on adopting standardized international level screening methodology across the country, known as CLIA.
She said that in the past, most blood banks relied on kit based or rapid testing, which sometimes failed to detect viruses such as hepatitis B and C, posing a risk of further spread. Under the new policy, all blood banks will be bound to conduct CLIA based testing. In addition, nucleic acid testing, a PCR-based method, has also been included.
She said that sometimes a virus is present in such small quantities that it does not appear in serological tests but can still 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 determined when and where a donor donated blood, through which blood bank the blood was transferred, and to which hospital and patient it was given. If a virus is later confirmed in a patient, the donor can be traced anywhere in the world through the International Society of Blood Transfusion tracking system.
She said the aim is that if hepatitis or any other infection is transmitted from a donor, that donor should not be allowed to donate blood in the future. This way, blood banks will have clear data on which donors are carriers of hepatitis C or other diseases and should not be accepted for blood donation.
She said that according to regional blood center data from 2022, hepatitis C cases were found to be higher in northern Pakistan, while in interior Sindh, the hepatitis C rate was reported at 8 to 9 percent. In Karachi, the hepatitis B rate is around 5 percent. She added that hepatitis C cases are higher in Sindh, while hepatitis B cases are also emerging in Peshawar and Islamabad, with Sindh becoming a hepatitis C hotspot.
She said that for the first time, the policy has given special attention to children with thalassemia. Since thalassemia treatment is expensive, the policy emphasizes prevention rather than treatment.
Infectious disease expert Professor Syed Faisal Mahmood said that blood borne diseases include HIV, hepatitis B, and hepatitis C, while syphilis, malaria, and dengue can also spread through blood. Hepatitis C is curable, but complete cures for HIV and hepatitis B are not yet available, and these viruses can remain in the human body for long periods or even for life.
According to Professor Faisal Mahmood, if blood is infected, the disease can be transmitted to another person with 100 percent certainty, which is why screening and testing before blood transfusion are extremely important.
He said unsafe blood transfusion refers to blood given to patients without proper screening and safety procedures, increasing the risk of blood-borne diseases. A survey conducted at Aga Khan University Hospital revealed that 15 percent of HIV patients across the country stated they contracted HIV due to unsafe blood transfusions. He said that while 15 percent may appear to be a small number, in the modern era this rate should be zero. If even one person contracts HIV due to unsafe blood transfusion, it is a matter of shame for society.
He said that the transmission of blood borne infections in children is not limited to blood transfusions alone, but these diseases also spread through reused syringes and surgical instruments. It is often observed that for powdered injections, syringe water is repeatedly drawn from the same large bottle or bag. If germs enter during this process, they can be transmitted to multiple individuals. This practice is particularly dangerous for children, though elderly people and women can also be affected.
Professor Faisal Mahmood said that reported HIV cases are fewer than the actual number, while hepatitis B and C cases are far more common, placing Pakistan among the countries with the highest burden of hepatitis C worldwide.
He clarified that effective medicines are available for HIV treatment, and with regular use, patients can live normal lives. Patients on treatment do not transmit the virus to others. HIV patients often hide their illness due to fear of social stigma, even though it can affect anyone, as everyone undergoes dental procedures, injections, and other medical interventions.
He also pointed out that sometimes doctors pay insufficient attention to HIV testing. Thousands of people have been trained in infection control in Sindh and are further training others, but infection control is often neglected in medical facilities across the country because it is considered an expensive process.
According to a National AIDS Control Program survey, 30 to 50 percent of drug users, 7 percent of transgender individuals, 5 percent of men who have sex with men, and 2 percent of female sex workers are affected by HIV. Medical experts warn that the alarming aspect is that HIV is no longer limited to these specific populations.
