Revelations that Ukrainian doctors frequently bypass blood banks and transfuse blood that has not been screened for the AIDS virus set off a round of finger-pointing this week as medical officials sought to explain why a system designed to ensure such testing has failed. Blood bank officials blamed misguided doctors who prefer newly-donated blood to frozen plasma. Doctors blamed inadequate screening by the blood banks and the sporadic availability of tested plasma. Meanwhile, a Health Ministry official charged with overseeing compliance with transfusion guidelines said she was new to the job and unfamiliar with the rules.
The national Committee For Prevention of AIDS and Drug Abuse revealed on Monday that two hospital patients, a father of seven children from the Kirovohrad Region and a 9-year-old boy from the Chernivtsi Region, have contracted the HIV virus after receiving unscreened blood transfusions. HIV is the virus that causes the Acquired Immune Deficiency Syndrome.
Though these were the first cases reported in Ukraine, AIDS Committee Chairman Valery Ivasyuk said in an interview Thursday they are likely only the known instances of a much wider problem.
'I am sure there are hundreds of such cases all over Ukraine,' Ivasyuk said.
The Kyiv Blood Transfusion Center, one of the city's three blood banks and the one that supplies plasma to all of the municipal hospitals, has been asked two times so far this year to test blood for the HIV virus after it was already transfused into patients. Both transfusions took place in the maternity ward of Hospital No. 1 in the Darnytsya District, and in both cases subsequent screenings showed that the blood was safe.
'This happens because the doctors who come from the old school were taught 50 or so years ago that there is nothing better than fresh blood [in such cases],' said Yury Demyanenko, the blood bank's deputy director. He said that preserved blood, or its components are never worse than the actual blood.
'In the blood taken from a donor, … blood clots start forming which can cause various complications, when they land in lungs, for example. The more blood is transfused, the more probable the complications are,' he said. Valentina Godz, who manages the HIV testing laboratory at the blood bank said all departments in all Kyiv hospitals, even maternity ward that often deal with heavy and unexpected blood loss in patients, have tested blood available for use during operations.
'All hospitals have frozen plasma, and other liquids that can replace blood. Besides, if they need more blood, they can call us and get it within an hour,' she said. But doctors at Darnytsya's Hospital No. 1 disputed that claim. 'They have never been in our situation when a patient is dying, and the blood center says they can deliver 400 grams of blood in another two hours, instead of the needed five liters,' said Vitaly Korchak, head of the hospital's reanimation department.
Korchak was one of the three doctors who decided to give freshly-drawn blood to a patient without testing in one of the two cases registered by the blood bank this year. 'If I had counted on the [blood bank], the patient would have died,' he said.
'Is it better to let the person die without AIDS, or to take the risk when a young woman is dying from blood loss?' Shortages of frozen plasma are commonplace at blood banks, said another doctor at the hospital. 'Because they do not have enough money, they don't have a good bank of blood, and they do not give you enough blood when you ask them,' said Lev Martynov, head of the hospital's blood transfusion department.
But Lyudmyla Zanevska, the blood bank's chief doctor said there have been no cases since 1983 when the center could not supply a hospital with requested blood supplies. Zanevska said the blood bank could have met the needs of Hospital No. 1 in both instances when untested blood was used.
Health officials said the use of untested blood is illegal even during medical emergencies.
'Putting a person in danger of getting AIDS is punished by five years in prison, and infecting a person with AIDS is punished by eight years in prison,' said Ivasyuk. But officials did not know of a single instance of a doctor punished for infusing unscreened blood, even though they have acknowledged such violations are commonplace. Halyna Antonenkova, head of transfusion service control at the Health Ministry and the sole official charge with overseeing transfusion practices, said she was new to her job and did not know how the ministry's regulations are enforced. Neither could she provide statistics on the number of untested blood transfusions, though she said the ministry is now conducting a 'routine' survey to obtain that information.
Even if Ukrainian hospitals used only screened blood, the danger of infection would remain because blood banks test all samples only once, rather than twice as in the West. Godz, the manager of the HIV testing lab at the Kyiv blood bank, said her staff screen samples for antibodies to the HIV virus, which start to be produced by the body only several months after the infection.
The laboratory has neither the storage equipment nor sufficient supplies of plasma to store all blood for several months and test it again, she said. 'I fully trust the tests of my laboratory, but there is still a percentage of risk,' said Godz.
All blood centers in Ukraine use American and French blood testing systems, which are considered very reliable. The tests automatically detect and flag samples where the antibody count even approaches that of HIV-positive blood. Such samples are discarded and the names of donors are entered into a computer database that should, in theory, prevent them from donating again.
But one of the nurses at the blood bank who declined to give her name said she does not trust blood donors on the whole. 'I would not like to get a blood transfusion of the blood from our laboratory,' she said. 'Have you seen the donors here? They are alcoholics and paupers who need money and want to drink.'
Ukrainian blood donors receive Hr 20 and a free meal for giving 450 milliliters of blood.
'Now we have a new profession forming, the donors. Donorship has turned into a way to earn money,' said Demyanenko. 'That's why you get very different people coming to give blood.'
