Tainted Blood Research Articles

Blood transfusion in the Caribbean: Historical perspective in the context of Trinidad and Tobago.

To compare the historical development of blood transfusion in Britain and a former British West Indian colony. International transfusion bodies recommend national coordination and exclusively voluntary non-remunerated donation as essential pre-requisites for blood safety. These ideals have been achieved in high-income countries including Great Britain, the United States of America and Canada. However, most West Indian countries have fragmented, hospital-based blood services that rely on family replacement and remunerated donors. Comparative historical analysis of blood transfusion service development in Great Britain and Trinidad and Tobago was undertaken to provide insight into their dichotomous development and inform policy decisions to bridge the gap between the two types of transfusion service. The British National Blood Transfusion service was based on voluntary non-remunerated blood donation from its inception but achieved national coordination over 50 years that included a period of regional control during which incoordination contributed to a tainted blood scandal. Failure to establish community voluntary non-remunerated donation in Trinidad and Tobago during the colonial period, before independence in 1962, allowed regionally-controlled family replacement and remunerated blood donation to become entrenched then perpetuated by path dependence. A university-led programme has recently used historically-proven methods, drawing on the experiences of the British National Blood Transfusion Service, to establish a model for developing a voluntary non-remunerated programme. The programme aims to avoid historical pitfalls during its national extension. Historical analysis provided information for introducing voluntary non-remunerated blood donation and planning a nationally-coordinated blood transfusion service.

Reading My History

I am a child of a person with haemophilia, I am a nurse, I am a researcher. I am a lucky one. The Contaminated (or Tainted) Blood Scandal was a worldwide event that infected many people, including People with Haemophilia (PwH), with blood-borne diseases. With the recent inquiry, more is revealed about decision making and events, allowing families like mine to see the truth for the first time. This essay explores the published literature, both by academics and by people from the haemophilia community, alongside exo-autoethnographic and autoethnographic elements. It will include my journey as I traveled the path from considering the trauma inherited alone, to discovering my own place in the story.

Hepatitis B infection among hemodialysis patients in Al-Jazirah State: a seroepidemiological survey

Abstract Hemodialysis patients are more susceptible to HBV infection because they have low immunity and can be inflicted through an improperly sterilized machine or through a tainted blood transfusion. A cross-sectional study aimed to study the prevalence of HBV among hemodialysis patients in Aljazeera State, Hospital for Renal Disease and Surgery during the period between March and August 2018. A total of ninety-one blood samples were obtained randomly from hemodialysis patients. The plasma was examined for the presence of HBsAg using a sandwich Enzyme-Linked Immuno-Sorbent Assay (ELISA). Data collected by a structured questionnaire included sociodemographic data such as age, sex, marital status, education level, duration of dialysis, previous HBV vaccination, history of surgical operation, history of jaundice and history of blood transfusion. Detectable marker for HBV infections (HBsAg) were found in 21 (23.1%) patients, while the remaining 70 patients (76.9%) were negative. We noted that education level and a history of jaundice had a significant effect on the seroprevalence of HBV, with a P value <0.05. The study concluded that HBV infection among hemodialysis (HD) patients is high. So, extensive effort to enroll HD patients in a vaccination programme against HBV is recommended. Moreover, periodically screening for early detection of HBV infection among hemodialysis patients is deemed essential in order to for therapeutic measures to be promptly initiated, and for the prevention and protection of other patients and staff in the hemodialysis unit.

The impact of the Contaminated Blood Scandal on the next generation: the state of the evidence

Abstract The Contaminated (or Tainted) Blood Scandal was a worldwide event that infected many people, including people with haemophilia (PwH), with blood-borne diseases. This has had a significant psychological impact on the families involved, alongside the physical and financial toll. Although some studies have focused on those directly affected – PwH, their families, and the community – very little is known about the intergenerational impact. This narrative review explores the impact on the children of PwH affected by the contaminated blood, demonstrating a significant gap in the understanding of the families’ experiences.

What a great blunder: Unknowingly disregarding the standard testing protocol for a patient exposed to a possible HIV infection

The world globally is presently saddled with a pandemic that started un-announced but subtly and progressively become a world-wide health concern. This is the general sequence of the Covid-19 pandemic that started locally in one city but had spread to affect all nations of the world with a loud roar. Human Immunodeficiency Virus (HIV) infection likewise started as a localized unexplained disease manifestation which was aggressively investigated and the causative virus was eventually identified and subsequently isolated. What initially seemed then to be a local disease was eventually reported gradually over-time to be seen all over the world. It was seen in both males and females and the original questions’ was to ascertain the routes of the spread of the virus between humans and possibly other primates, and to identify the reservoirs of the now known causative organism of the new human disease. On a regular basis, the sign and symptoms of the disease were manifesting and reported and several routes of transmission identified and reported. Among such numerous routes include but not excluding having unprotected sexual intercourse, transfusion of untested tainted blood donated by an active carrier of the virus, inadvertent needle pricks of a health worker, sharing of needles and syringes by drug abusing persons, unsterile tatooing instruments, use of common manicure/pedicure instruments. Rape or Sexual Assault (SA) is a problem that is reported from all nations of the world. It is probably grossly under reported, and can even be described as a pandemic because of its world-wide spread. The activities of SA has been known to be capable of transmitting disease from one person to the other, and HIV can be transmitted from the assailant to the victim and/or vice-versa of the victim is the infected one. It is based on this revelation of a potential transmission of HIV through this route that a protocol of testing of victims of this horrific crime was developed. So, what happens when a victim was not properly tested, the assailant not seen and not tested, the victim not placed on the available post-exposure prophylaxis but was re-assured and told “not to worry” that “all is well” and sent away.

Transfusion medicine: Overtime paradigm changes and emerging paradoxes.

This essay aims to discuss some aspects of blood transfusion in the perspective of the changes that occurred over time as well as modifications of the paradigms that transformed the activities and the organization of blood transfusion services. Without specific knowledge, pioneers envisioned precision and personalized medicine, rendering transfusion medicine operational. Transfusion medicine is like The Picture of Dorian Grey: always young despite being old and sometimes appearing old-fashioned. Over the years, the transfusion medicine discipline has evolved, and major progress has been achieved, despite some troublesome periods (for example, the tainted blood scandal, and—at the time being—the offending plasma market and the selling of human parts). Transfusion medicine has at all times implemented the rapidly developing biomedical technologies to secure blood components. The safety of blood components has now reached an exceptional level in economically wealthy countries, especially compared to other health care disciplines. Strengthening of the safety has mandated that blood donors and recipients are unrelated, an issue which has eased preservation and fractionation practices; blood is no longer arm-to-arm transfused and neither is whole blood, the commonest component. However, it is interesting to note that a revival is occurring as whole blood is back on stage for certain specific indications, which is one among the many paradoxes encountered while studying this discipline.

Act Up, the heart of French AIDS activism

Based on fieldwork conducted since the early 1990s, Action=Vie: A History of AIDS Activism and Gay Politics in France is an updated, extended translation of the book published in French in 2005, where the sociologist Christophe Broqua sheds light on the interplay between the politics of AIDS and homosexuality in France's leading AIDS activism organisation. Act Up-Paris was founded in 1989 and rose to prominence in the wake of the 1992 “tainted blood scandal”—when it was disclosed that HIV-infected blood had been used for transfusion to haemophiliacs. While initially perceived as modelled on a US-imported form of identity-based activism that “would not work” in France, Act Up-Paris not only became a major player in the field of AIDS activism in France, but has outlived most of its sister Act Ups worldwide.

Blood, perceptions, resource and ownership: When transfusion illustrates the complexity.

Blood is apart from the rest of the tissues as this fluid is overseen by basic and applied life and humanistic sciences. Blood is the essence of human functioning. It is the object of one of the most commonly known cancers, leukemia. It is life-saving in transfusion - a property that also gives blood a special credit and questions blood as a valuable merchandise or as no ones' property but common good. But blood is also scandalous after the tainted blood affair in the 1980s and 1990s. Blood is further inseparable from most religious practices, both forefront and hidden (magic cults). It is frightening as it is versed in legitimate and illegitimate combats; it is poured to compensate offenses or debts in many civilizations. Any time blood comes forefront, rationale science leaves it to irrational digressions. Even the very same life-saving transfusion, is beaten by groups of opponents on religious grounds. Further, at a time blood cells and molecules are scrutinized, no one can claim having a complete understanding of what blood is, off the vasculature, as - to study it - one has to alter it. The study of blood is fascinating for all colleges of an academy and not many topics can share this property: chemists, physicists, geneticists, physiologists, medical doctors, philosophers, ethicists, theologians, artists, historicists, anthropologists, sociologists, etc. have all contributed to depict different, specific, aspects of blood. The present review aims at merging different aspects of blood to give pathophysiologists a platform to better understand fears and hopes related to this special tissue, when dealing with patients of theirs.

Shuping Wang: helped save the lives of thousands in China by exposing contaminated blood scandal

Photo credit: Dan Wooller During the 1990s, in her native China, Shuping Wang, a doctor and medical researcher, was ostracised by colleagues and harassed by her supervisors. A small woman,...

Healthcare professionals in the 'tainted blood' era in Canada: Their forgotten emotions.

During the 1970s and early 1980s, Canada's comprehensive care haemophilic programs were established. Newer therapies led to a rapid increase in quality of life and expected life span for persons with haemophilia (PWH). The outlook was bright. However, beginning in 1982, the appearance of HIV/AIDS transmitted by treatment products led to the 'tainted blood' era with its devastating impact on PWH, recently highlighted in the Canadian Broadcasting Corporation mini-series 'Unspeakable'. What has received less notice is how the healthcare professionals (HCP) managing these patients then were affected. To report the emotional effects of that era on HCPs. In developing an oral history of haemophilic care in Canada we have interviewed 76 HCPs, the majority of whom had worked in haemophilic clinics during that era. During each interview, we asked the interviewee to reflect on what this did to haemophilic care and to him/herself. The interview responses were analysed. HCPs have been markedly affected by the events of the 1980s with feelings that persist more than 30 years later. Most related to the loss of so many of their patients and the inability to alter the rapidly changing course of events at the time. The 'tainted blood' era had persistent strong emotional effects on HCPs. They were helpless to stop or to mitigate the devastating epidemics. Wellness support programs were less well developed then. While the focus is in the Canadian context, we suggest that a parallel can be drawn within haemophilic communities in other countries.

A Modern Approach to Blood Loss Management

The field of orthopedics has been well known for its ability to mend broken bones, muscles, and tendons but is also quite famously, or should we say infamously know for the substantial blood loss associated with these procedures. We are the modern day barbers, performing our “bloodletting” procedures under names such as total hip replacement, fracture open reduction, and internal fixation and let us not forget total knee replacement. Is this a fair comparison? Are today’s orthopedic surgeons the vampires of the medical profession? Perhaps in the past this was the case with transfusion rates noted on numerous studies to be nearly 50% for procedures such as hip and knee arthroplasty. What was more concerning was that during this time period, there was question as to the safety of the blood supply. With issues of human immunodeficiency virus tainted blood not to mention hepatitis, there was a real call to improve blood management for orthopedic patients As a specialty, orthopedics did answer the call. We looked at the causes of transfusions and quickly noted that preoperative anemia was a predictive factor in determining transfusion needs. Orthopedic surgery was an early user of Epoitin Alpha in the correction of this preoperative anemia as a measure to reduce transfusions. Orthopedic surgeons were also quick to help eliminate transfusion triggers and base the transfusion on the patient’s medical condition and symptoms. Orthopedic surgeons also developed autologous blood donation programs, which in retrospect was not the best method, but it was an attempt to decrease allogenic transfusions to a more acceptable level. Well, as we all hear on a regular basis, medicine is different now. With the use of newer modalities such as tranexamic acid, transfusions for elective single joint replacements have become a thing of the past. However; this does not mean that blood loss management is any less important. We are in an era of bundled payments and same day joint replacements where less blood in the joint certainly can lead to earlier discharges as well as return to function. Patients also expect to be more active and have a shorter recovery and certainly improved blood loss management can help us obtain these goals. By no means have we solved all issues relating to blood loss management for orthopedics. Although elective joint arthroplasty blood loss is managed quite well, it can always be better, and there is still room to improve in other areas such as trauma. This symposium will not only examine where we have been with blood loss management but also will discuss the future direction. Various techniques will be reviewed and the social implications of blood loss management will also be discussed.

Paradoxes of an assimilation politics: media production of gay male belonging in the Canadian ‘vital public’ from the tainted blood scandal to the present

Canadian media discourses on gay men’s sexuality and political inclusion serve as a rich site for understanding current tensions in debates on sexual citizenship under biopolitical regimes. This paper addresses how public health reporting in one health news media source, Canada’s leading newspaper The Globe and Mail, discursively produced contiguous understandings of the moral, social and biological dimensions of gay male subjectivity and sexuality within the context of HIV risk discourses. Specifically, we critically examine the newspaper’s coverage of what constitutes the public good when national blood supplies are at stake. Our analysis reveals a profound dichotomy in which gay men – as sexual subjects and subjects of rights – are recalibrated following the political and economic investments of bourgeoisie communities of interest. However encompassing the securing of legal social rights might be, gay men’s sexuality is resistant to a reformatting under a heteronormative regulatory regime, as the social traumas caused by HIV continue to cast a shadow on sexual behaviours that purportedly risk leakage of contamination into the body politic

A Prospective Study on Prevalence of Hepatitis B Viral Infection in Voluntary Blood Donors, Health Care Workers and Patients with Liver Disorders - A Hospital Based Study

Background: HBV is exceptionally irresistible that even moment hints of tainted blood as meager as 0.0001 ml can transmit disease. A few of the standard remedial, demonstrative, prophylactic intrusive techniques can spread HBV disease. Therefore, this study was conducted to know the prevalence of hepatitis B surface antigen in voluntary blood donors, health care workers (medical and paramedical personnel) and patients with liver disorders. Methods: Present study was hospital based cross sectional study carried out among 60 subjects during a period of one year in Geetanjali Medical College & Hospital, Udaipur, Rajasthan. These 60 subjects consisted of 20 patients with liver disorder, 20 health care workers and 20 voluntary blood donors. Subjects were selected randomly. After obtaining informed consent, detailed history and examination was carried out. The blood samples were collected and sent for detection of HBsAg by ELISA. Results: Maximum subjects 31 (51.7%) belonged to the age group of 21-30 years overall as well as among the voluntary blood donors i.e. 60%. Among voluntary blood donors, 96% were males. 60% belonged to urban areas. Among rural subjects, maximum (54.2%) were having liver disorders. Liver disorder was more common (66.7%) among heterosexual high risk behavior subjects compared to only 22.8% with no high risk behavior. Seropositivity was found highest among patients with liver disorder (65%) followed by among health care workers (15%). Seropositivity was nil among voluntary blood donors. Overall the seropositivity was 26.7%. Conclusions: Patients with liver disorders especially chronic hepatitis were mostly seropositive. Among health care workers, being a doctor was an important risk factor for acquiring hepatitis B infection. Hence all health care workers should be immunized for hepatitis B.

When life played dice with royal blood

Haemophilia is a blood clotting disorder that is genetically transmitted. In the 19th century, this disease made an appearance in the British royal family, and eventually spread across Europe through marriage within the royalty. This review traces the path of the ‘tainted blood’ through the European royalty and comments on how the disease played a role in the Russian revolution. Being a scientist, I also felt it my responsibility to explain the basic biology of the disease itself for the enthusiastic reader, finally concluding the story where history met science to divulge an episode of modern history which is like a page out of a thriller.

Canadian Association of Gastroenterology position statement: fecal microbiota transplant therapy.

The increasing public interest in fecal microbiota transplant (FMT) raises serious concerns, when the application of this treatment is still in its infancy and long-term safety is not yet established. Indeed, there is evidence that anecdotal reports of success from initial results of uncontrolled studies are encouraging patients to try this line of treatment in the absence of medical direction or supervision. It is important that medical practitioners, the media and the general public are made aware of the safety issues involved in ‘stool transplant’. While FMT has been widely used in veterinary practice and the exchange of intestinal contents in humans is documented back to the fouth century (1), this intervention requires the exchange of body fluids with all its known and unknown risks. In the early 1980s in Canada, tainted blood and blood products for the treatment of hemophilia led to the serious outbreak of hepatitis C and HIV (2). The stool microbiome is complex, containing, bacterial, viral and fungal components in addition to prions and potentially unknown biologically active substances (3,4). Several excellent studies have indicated the important role of the microbiome in a variety of diseases. In addition to Clostridium difficile infection (CDI) and inflammatory bowel disease (IBD), these include obesity, diabetes and behavioural disorders (5). There is an urgent requirement for further careful prospective and controlled research in a variety of these diseases but especially to protect the safety of patients who, understandably, may be frustrated with the poor efficacy of their current treatments. Here, we consider the evidence for the use of FMT in resistant C difficile infection and its current status as an intervention in IBD, together with a brief summary of the current evidence for the safety of FMT and recommendations for the future.

Issues in the ageing individual with haemophilia and other inherited bleeding disorders: understanding and responding to the patients’ perspective

An increasing number of individuals with haemophilia and other severe bleeding disorders who are ≥40 years of age are entering uncharted territory with respect to the identification and management of medical, physical and social issues relevant to ageing with a bleeding disorder. This is because the population experienced considerable mortality during the HIV/AIDs and hepatitis C epidemic due to exposure to tainted blood products for treatment of bleeding. As a result, few older individuals with this disorder survive today. To provide insight for how the comprehensive care team can adapt to the changing needs of the adult haemophiliac we evaluated the patient perspective. The objective of this study was to identify key themes of importance in the ageing population with haemophilia and other inherited bleeding disorders. For this study all subjects with a diagnosis of haemophilia A or B, von Willebrand disease or rare bleeding disorders 40 years or older from a single clinic were invited to participate. Audio-recordings of groups of six to eight participants were conducted by an independent investigator without content expertise. Transcripts were analysed using N*vivo (v. 8) software using thematic content analysis. Overall, 32 subjects, 18 men/14 women, with a mean age of 57.5 years (median 56.0 years) and range of 40-77 years, participated. Three major themes emerged: (i) reflection on living an active life, (ii) 'normal' ageing vs. disease-specific impacts and (iii) the health system, and its ability to respond to their needs as ageing individuals with bleeding disorders. We found some anticipated themes and some unexpected ones, confirming that true perspective can only be provided by the patients themselves. Knowledge of these important themes has informed the development of new programmes aimed at this growing segment of the patient population.

Making Disease, Making Citizens: The Politics of Hepatitis C

Since the naming of hepatitis C in 1989, knowledge about the disease has grown exponentially. So too, however, has the stigma with which it is linked. Associated with injecting drug use and tainted blood scandals, hepatitis C inspires fear and blame. Making Disease, Making Citizens takes a timely look at the disease, those directly affected by it and its social and cultural implications. Drawing on personal interviews and a range of textual sources, the book presents a scholarly and engaging analysis of a newly identified and highly controversial disease and its relationship to philosophies of health, risk and harm in the West. It maps the social and medical negotiations taking place around the disease, shedding light on the ways these negotiations are also co-producing new selves. Adopting a feminist science and technology studies approach, this theoretically sophisticated, empirically informed analysis of the social construction of disease and the philosophy of health will appeal to those with interests in the sociology of health and medicine, health communication and harm reduction, and science and technology studies.

Resolving Canada’s jurisdictional health quagmire

The pan-Canadian, integrated management model that was used to overhaul the discredited national blood system in the aftermath of the tainted blood crisis of the 1980s could and should be used to achieve other needed changes in the health care system, according to Canadian Blood Services CEO Dr.

Community-based mental health counseling for children orphaned by AIDS in China

There is an urgent need to develop scalable approaches to community-based mental health services for children in rural China and other developing countries involving task shifting from clinicians to trained community workers. Evidence is needed about the effectiveness of interventions for children affected by AIDS in rural areas. This article describes an intervention study aimed at developing, implementing, and evaluating a community-based counseling program for the AIDS orphans of Fuyang, Anhui Province, an area of central China where a tainted blood donation scheme infected countless farmers and left many children orphaned by AIDS. In China these children live in rural settings with no access to mental health services. The authors trained a group of community-based counselors to provide group counseling sessions focusing on self-awareness and communication and to provide a basic therapeutic approach for depression and anxiety. The authors conducted a baseline and two follow-up surveys of 39 children who met the clinical diagnostic criteria for anxiety and depression. There was a statistically significant improvement for the children on anxiety, but there was no statistically significant improvement on depression, with greatest gains immediately following the intervention. We demonstrated the feasibility of task shifting for mental health services in this setting.

“Drowned in Blood”:

“Drowned in Blood”: