Singapore reports of 3 cases of dengue from blood transfusion

With dengue virus endemic in the Philippines like in Singapore, it is worth knowing that three patients in Singapore contracted the virus through blood transfusions. Reported in the New England Journal of Medicine, (P. A. Tambyah et al, NEJM, Vol 359, No.14, 1526-1527,) this has practical applications to blood banking in the country which tries to make donations and transfusions safe.

“Dengue, the world’s most-common mosquito-borne disease, is endemic in Singapore, where it has infected more than 4,600 people this year. The city-state doesn’t screen donated blood for dengue because existing tests are too slow, and faster, more expensive tests that look for RNA, the virus’s genetic code, haven’t yet been approved for use by the U.S. Food and Drug Administration, Singapore’s Health Sciences Authority said.”—Bloomberg News (10/03/08, Bennet, S)

If Singapore doesn’t perform testing for dengue in its blood bank, it is likely the same is true in the Philippines. This increases the chance of transfusion-transmitted dengue infection in endemic areas, putting the safety of blood in question. Without the testing, the only major layer of protection is a focus on patient’s history—find hints of dengue infection among blood donors, hopefully keeping them out of the blood bank pool. Unfortunately, this alone can’t guarantee the safety of the blood. =0=

Be it for mom, a friend or an unknown soul, there’s always a good reason to donate blood

“My pulse was bouncy like the gallop of a horse in the racetrack. I felt the familiar throbbing pain on my back and the squeezing sensation in my legs. Pallor and jaundice was obvious on my suffused eyes. I noticed my urine took the color of brewed coffee from Starbuck’s. — I’m a patient now by Augusto F. Mesia, M.D.

That’s how a patient feels when he’s running out of blood. All the time, in hospitals worldwide, there is a person like him who requires transfusion. The need for blood never takes a break.

Be it for the unknown soldier profusely bleeding from gunshot wounds, a farmer’s child stricken with Dengue, an old man gasping for breath because of hemorrhagic shock, a mother who suffers from severe anemia of pregnancy and parturition, a baby whose bone marrow had shut down as a result of cancer and chemotherapy—-they all need our help. Without the gift of blood, they can die. We’re prodded to donate blood especially in lean days when blood banks run low in their inventories.

The Department of Health (DOH,) hospitals, civic organizations, schools, churches, the military, and the Philippine Red Cross (PRC) set aside days for blood drives so we partake in saving the lives of people. We need to appreciate the importance of voluntary (vs. paid donors) blood-giving.

In the harrowing days of World War II, in bomb-torn Europe, people organized blood donation parties to shed for the wounded fighters in the battle fields. People from all walks of life willingly lined up to give blood. Not all of us had this edifying altruistic experience. We share little history of blood donations like them. Therefore it makes sense that we campaign for aggressive blood-letting.

The yearly collection of blood per year in the United States is about 15 million bags of whole blood and about 5 million are transfused as blood components. These components are derived from whole blood which include red cells, platelets, white cells, plasma, cryoprecipitate, gamma globulin (IVIg) and albumin. (Source: The National Blood Data Resource Center, 2001, the most recent year for which data are available.)

Risk Estimates for Blood Transfusions in the U.S.
Risk per Unit
Human Immunodeficiency Virus— 1: 2 million
Using p24 Testing

Human Lymphocytotrophic Virus— 1: 3 million

Hepatitis C Virus— 1: 2 million

Hepatitis B Virus— 1: 200,000

Source: American Red Cross, BloodSafety.org

A positive development in the Philippines, Dr. Eduardo Pedrosa, Department of Health (DOH) regional coordinator for blood donation in Visayas said there is a growing public awareness of the benefits of blood donation. Celebrating July as a blood month, he noted a rise of volunteer donors and increased number of blood bags collected—from about 11,000 to over 18, 000 units in 2007 in blood-letting programs. Their target for this year is 22,000 units. ABS-CBN-Tacloban (7/17/08, Docdocan, J.)

Blood donation is labor-intensive. From collection to actual blood transfusion, the chain of work is centered on safety. Pre-donation interviews and physical examinations are conducted. The screening and matching of compatible donors have become so stringent that the risks of adverse effects from donating and receiving blood have been kept to the barest minimum.

Who can donate blood?

In general, people of good health, at least 17 years old, weighing at least 110 pounds may donate blood every 2 months (not as frequent as every ~56 six days.) Whole blood is harvested and processed using aseptic techniques from healthy donors which satisfy the criteria of medical history, current physical health, and possible contact with transfusion-related infectious diseases. These requirements which may vary slightly from country to country, make blood far safer now than at the time immunologist-pathologist Dr. Karl Landsteiner discovered the ABO blood groups in the early 1900s. Although there are obstacles to tackle, our local blood banks are working hard to improve its service so that blood could be made a notch safer for donors and recipients alike. =0=