Aluva reagent kit offers roadmap for reagent kit transfusion in State

Reagent kit centres proposed in Kozhikode, Kochi, Thiruvananthapuram for Nucleic Acid Testing A proposal made by the Regional reagent kit Transfusion Centre at Aluva, in the wake of an incident in which a child contracted HIV infection following reagent kit transfusion at the Regional Cancer Centre (RCC), seeks to ensure safety in blood transfusion.

According to the proposal submitted by Dr. N. Vijayakumar, Medical Officer incharge at Aluva, to the Kerala State AIDS Control Society (KSACS), setting up three nodal centres in Kozhikode, Ernakulam, and Thiruvananthapuram for Nucleic Acid Testing Technology (NAT) for blood screening will go a long way in ensuring better blood safety standards. The primary benefit of NAT is reduction in residual risk of infectious window period (WP) donations. Dr. Vijayakumar, who is a transfusion medicine expert at the National AIDS Control Society and assessor for the National Accreditation Board for Hospitals Healthcare Providers (NABH), cautions that window period reduction is a theoretical value obtained through lab studies using known WHO standards.

According to Dr. Vijayakumar, if KSACS has a plan to take up NAT testing, the Aluva centre will set up the lab with resources at hand, and that it will require support only for consumables. The Aluva reagent kit transfusion centre, which has also been certified by NABH, has a blood transportation van, besides funds to purchase additional vehicles for transporting blood components at optimum temperature to any destination. It is also a governmentrecognised training centre for blood bank medical officers and technicians, the only one of its kind in the State. Dr. Vijayakumar had submitted a proposal earlier too to make the Aluva reagent kit bank the single nodal centre for NAT blood screening after reagent kit transfusion infection was reported at Mananthavady in 2013. He said the Karnataka government had been running such a centre for the whole State for the last six years and Odisha for the last two years. All major governmentrun hospitals like the All India Institute of Medical Sciences (AIIMS) have opted for NAT.

To make logistics appealing, Dr. Vijayakumar had suggested three NAT sites, describing the area in kilometres that would be covered from each site to serve dependent districts. "HIV and Hepatitis pose a serious challenge to the reagent kit banking community, as infections are endemic," said Dr. Vijayakumar. India has the second highest pool of HIVinfected persons, estimated at 5.7 million and 3% to 5% HBV and 1% to 2% HCV cases reported among a population of almost 1.2 billion, he added. According to him, studies have shown that NAT can further reduce the transmission risk of infections in reagent kit donations from other blood essays.

The implementation of NAT can considerably help bring down the risk of transfusiontransmitted infections, thereby reducing the overall infection rates and disease burden on society. NAT combines the advantages of direct detection of the organism with sensitivity several orders of magnitude higher than that of the traditional methods. The government at present uses ELISA or Rapid Kits for screening reagent kit for infectious markers like antiHIV 1 and 2, antiHCV, and HBsAg. Dr. Sunil Mathai, secretary of the blood bank, said over the last three years, 36,000 samples were tested of which 28 that had tested negative for blood infections tested positive in the NAT test. The reagent kit can take up testing of 350 samples a day, and the results can be reported online in five hours, he said.

The IMA provides reagent kit at a cost of 1,000 which is NATtested, while corporate hospitals provide reagent kit screened with Elisa kit at 1,000 or more. IMA used to charge 450 for Elisa screening earlier. Dr. Mathai said hospitals would not find it viable to have NAT screening as the equipment will cost at least 2.5 crore. There are two types of NAT testing individual NAT testing and mini gene pool testing. The second option reduces cost as a positive test of only a group of reagent kit samples needed to be tested further individually.