HIV+ girl may have been infected by blood transfusion
Mother told no treatment available By Samantha Alleyne
Stabroek News
July 25, 2002

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A 32-year-old mother of two is struggling to come to grips with the devastating revelation that her five-year-old daughter most likely contracted the virus that causes AIDS through a blood transfusion she received at the Georgetown Public Hospital Corporation (GPHC) soon after she was born.

The distraught Shondell Darell, visited Stabroek News recently with five-year-old Jasonie, whom she said was discovered to be HIV positive when she was tested at the GPHC due to a mouth infection she had developed.

Contacted yesterday, Head of the National Blood Transfusion Service (NBTS), Dr Clement Mc Ewan said that there was a strong possibility that the child had contracted the virus via the blood transfusion since the donor who gave blood to the child died earlier this year from a cause unknown. He said that the blood was tested at the time of donation, and there was no trace of the virus. He acknowledged that the donor could have been infected and this went undetected in the window period in which HIV antibodies develop. Stabroek News attempted to make contact with Minister of Health, Dr Leslie Ramsammy and Chief Executive Officer of GPHC, Michael Khan, on the issue, but these attempts proved to be futile even though several messages were left with their secretaries.

The strong likelihood that the child was infected via the transfusion raises serious concerns about the safety of the blood supply at the NBTS and what should be done to make it safer.

Darell said she gave birth in 1997 and she was told that the child had jaundice and would need blood which was given to her. She said that the child has always been very sickly and because of this she was forced to take her out of school.

The single parent said that she spent thousands of dollars on her child for treatment for various complaints. She said that in May of this year she was forced to carry her daughter to the GPHC after she developed a mouth infection, which remained even though the child was treated.

Darell said she was shocked when the doctor who was treating her daughter suggested that the little girl could be HIV infected. Darell said that the doctor also suggested that both she and her daughter be tested for the virus. This they did and the woman said her test returned negative but her daughter’s was positive. “I could not believe it. I mean how could my daughter be positive and I was negative?”

She said that she did two tests after the first one and received the same results. She said that she then recalled that her daughter had had a blood transfusion at birth and knew right away how her daughter contracted the disease.

According to the woman, after it was brought to the attention of the hospital that her daughter must have contracted the disease through the blood transfusion she received little help. “They only start pushing me around and told me that they had no treatment for children with HIV,” the distraught mother said.

She said she visited Ramsammy and he referred her to Dr Ali at the Genito-Urinary Medicine (GUM) Clinic at the GPHC, but still she received no treatment for her daughter.

The woman said that Dr Ali told her there were no drugs for her daughter, but that Head of the National AIDS Programme (NAP), Dr Morris Edwards, who was on leave, would attempt to see if he could get the drugs for her. “What I am suppose to do in the mean time? I don’t want my child to die and she is ill all the time,” she said.

Darell, who was in tears by this time, related that the tablet prescribed to her for her daughter’s mouth infection cost $2,000 each and she was forced to foot the bill.

“My daughter was born healthy, they made her sick and now they don’t even want to help me to get treatment. I can’t take this anymore I am frustrated,” the woman wept.

While her daughter might have the deadly disease, Darell pointed out that with the right treatment she could remain alive for a long time.

Dr Mc Ewan told Stabroek News that the centre learnt about the issue about two to three weeks ago from the Paediatric Department of the GHPC. He said he was told that the child had developed signs of HIV and when tested she was positive while her mother was negative. Also he was informed that the child had received a blood transfusion in 1997.

“Right away I asked the department to send the child and her mother over to the centre so we could have investigated the possibility of HIV infection via transfusion,” Dr Mc Ewan said.

He said while there could have been other ways through which the child could have contracted the disease including sexual molestation or being stuck with a contaminated sharp instrument, they had an obligation to launch an investigation since she had received a blood transfusion.

The doctor said that he sympathised with the mother and informed her they would have to investigate the matter because there were inherent risks in every transfusion. He said on investigating the records showed that in 1997, the donor tested negative. However, when the NBTS attempted to contact the donor they learnt that the person had died earlier this year.

“This made it even more likely that it is a stronger case to suggest that yes, the child may have been infected by the blood transfusion,” the doctor said.

He explained that when the donor was tested that person could have been in the window period and the infection would not have been evident. (The window period represents the stage when a person has been infected with HIV, but the body hasn’t yet created antibodies to fight it. The window period can last anywhere from six weeks to six months or more. The current test done for HIV looks for antibodies, so if infected persons are tested while in this window period, the test could come back falsely negative.)

Mc Ewan acknowledged that the NBTS tested for antibodies in the blood, which would only be evident after the window period.

He said that in the developed countries they tested for the virus itself which would show up right away, but added that they used more sophisticated and expensive technology to detect the virus or antigen and this reduced the risk of persons receiving contaminated blood. These technologies, he said, are not available in the Caribbean.

In the US, the Food and Drug Administration has licensed the first nucleic acid test (NAT) systems intended for screening of plasma donors last year. These test systems are expected to further ensure the safety of plasma-derived products by permitting earlier detection of HIV infection in donors. However, since 1997, the FDA website said that it has encouraged the investigation of NAT technology through the use of experimental protocols, in the hope of improving the safety of plasma derivatives and further reducing the risk of an infectious unit of blood being transfused.

Mc Ewan said that Darell’s case was the first known case for the centre in the 12 years of its existence.

And according to the doctor, there are inherent risks in every transfusion and this is known throughout the world.

He said that just last week there were two such cases in Florida. Dr Mc Ewan said that no blood transfusion centre in the world could guarantee 100% safety, even given the technology available.

Outlining the responsibilities of the NBTS, Mc Ewan said that it has to ensure from a quality assurance perspective, that test kits and test procedures were evaluated and that there was ongoing proficiency testing procedures.

The latter entails the sending of samples to recognised reference labs around the world for evaluation. Further, the centre has to ensure that prospective donors are efficiently screened to eliminate “high risk” donors, he said. (High-risk donors would include persons who have unprotected sex with multiple partners and intravenous drug users.)