Evidence Leading To Change
Our constant surveillance helps us to understand infectious diseases and gather evidence of risk to make policy changes that will improve safety and operational efficiency.
Examples of change
- Operational change : West Nile Virus testing was reduced to summer only when increased risk is present. We are monitoring impact of this change over time.
- Discontinuing the Confidential Unit Exclusion process. This change streamlined the blood collection process, improved system performance without compromising safety and reduced discards by approximately 1,500 units a year.
- Recent reduction of MSM eligibility requirement. This change in policy was made after extensive review of scientific and epidemiologic evidence. Further change will be supported by evidence.
Canadian Blood Services Driving world-class innovation
Through discovery, development and applied research, Canadian Blood Services drives world-class innovation in blood transfusion, cellular therapy and transplantationbringing clarity and insight to an increasingly complex healthcare future. Our dedicated research team and extended network of partners engage in exploratory and applied research to create new knowledge, inform and enhance best practices, contribute to the development of new services and technologies, and build capacity through training and collaboration.
Crisk Of Hiv Transmission From Blood Transfusion
The risk of receiving a blood transfusion containing depends on a number of factors, including the prevalence of HIV viremia in the donor population, the likelihood of donation during the preantibody phase of viremia, the sensitivity of the screening test to detect HIV antibody when antibody is in fact present, and the number of units of blood received.
The risk that a donated unit of blood contains can be expressed as:
D = PL + P.
The first part of the expression to the right of the equals sign, PL, represents the portion of risk due to blood donation during the preantibody phase of infection. The remainder of the equation, P , represents the portion of risk due to donors with antibody whose blood escapes detection by the screening test.
The pertinent concern from the vantage point of a blood recipient is the following: Given the number of units transfused, what is the risk that one or more units contain ? This is approached by first asking the computationally simpler, related question: What is the likelihood that none of the transfused units contains HIV?
If n units are transfused, the likelihood that none contains virus can be expressed as:
C = n.
Then the risk, R, of exposure to in an individual receiving transfused blood is:
R = 1 – C.
Assumptions in the Estimation of Risk of HIV Transmission from Blood Transfusion.
Following are comments on the variables entering the equations:
Risk of Exposure to HIV from Blood Transfusion .
Blood Transfusions Linked To Infection Risk In Hospitals
Hospitalized patients who had fewer blood transfusions had lower risks of infection, according to a large analysis. The results suggest that more conservative transfusion strategies could help reduce infection rates at health care facilities.
About 1 in every 20 hospital inpatients develops an infection related to their care. These infections can have devastating consequences lengthening the time hospitalized and, in some patients, contributing to death. Strategies to reduce infections include using checklists, improving hand hygiene, and avoiding the use of urinary catheters.
One common inpatient therapy is transfusion of red blood cells. More than 37,000 units of red blood cells are transfused every day in the United States. Transfusions can replace blood lost during surgery or after a serious injury. Transfusions may also help people who are unable to make enough blood due to an illness, such as cancer or kidney failure. Transfusions are often given when patients have low levels of hemoglobin, an iron-rich protein in red blood cells. Normal hemoglobin levels range from about 14 to 17 g/dL in men and 12 to 15 g/dL in women.
The risk of developing an infection from a blood transfusion is extremely low. Donated blood is carefully screened for infectious agents, such as viruses. However, when patients receive blood from a donor, their immune system may react to substances found in the stored donor blood, placing them at greater risk of infection from other sources.
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Hospital Policies That Protect You From Hiv And Other Infectious Diseases
To prevent the spread of HIV, hospitals follow strict infection prevention and control guidelines. All blood and body fluids from patients are treated as potentially infectious:
- Syringes and needles are single use and disposed of in approved sharps containers.
- Reusable medical devices are decontaminated and sterilised after each patient use.
- Many medical devices are disposed of after single use.
- Healthcare workers wear protective equipment including gowns, gloves and eyewear when carrying out any procedures involving a patients blood or body fluids.
- All spilt blood and body fluids are cleaned up according to strict cleaning guidelines.
- Laundry is cleaned according to strict Australian Standards .
How Common Is Hiv
Globally, there are over 37 million people living with HIV. About 1.2 million people in the United States are living with HIV. Of those people, however, it’s estimated that as many as 13% do not know their HIV status.
Since the 1980s, rates of HIV have declined. In 2019, there were 34,800 new cases identified in the U.S., and the incidence rate was 12.6 per 100,000 people.
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Research For Your Health
The NHLBI is part of the U.S. Department of Health and Human Servicesâ National Institutes of Health âthe Nationâs biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders including the improvement of blood transfusion. Learn about current and future NHLBI efforts to improve health through research and scientific discovery.
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What Happens If We Find A Problem With Your Blood
If you test positive for any of the diseases named above, you will be notified and your blood will not be used for transfusions. In addition, you may be asked to speak with one of our medical professionals at the blood bank and scheduled for a follow-up visit and further testing. Your consent for re-testing will be requested again at that time.
The names of donors with positive test results are kept in confidential files and will not be released without your written consent unless required by law. We will not notify you if your test results are negative and we do not find any problems or if the blood samples we collected were insufficient to provide enough blood to complete laboratory tests.
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Hiv Infection From Blood Transfusions: References
American Association of Blood Banks. Transfusion Transmitted Diseases. Viruses. April 2, 2007. Accessed December 30, 2009 from .
MMWR. HIV Transmission through Transfusion â Missouri and Colorado, 2008.
NHLBI. What Are the Risks of a Blood Transfusion? US Dept of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. Jan., 2012. Accessed 1/2014 from .
US Dept of Health and Human Services, Centers for Disease Control, Morbidity and Mortality Weekly, October 22, 2010 / 59 1335-1339. Accessed 12/31/2011 from .
What Does This Mean For Me
Undetectable equals Untransmittable has been a life-changing finding for many people living with HIV. It means that if you are on effective treatment with an undetectable viral load, you do not have to worry about passing on HIV through sex, even if you do not use a condom.
This has helped many people living with HIV have more fulfilling sex lives and less anxiety around sex.
Knowing that Undetectable equals Untransmittable is especially useful for people wishing to have a child. Couples in which one person has undetectable HIV and the other is HIV negative can have unprotected sex in order to conceive.
However, the law on HIV may not have caught up with the science. In some countries, condomless sex without disclosing your HIV status is a criminal offence, regardless of the likelihood of HIV transmission. For information on specific countries, visit our page on criminalisation laws around the world.
For as long as your viral load stays undetectable, your chance of passing on HIV to a sexual partner is zero.
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Can I Get Hiv From Donating Blood
There is no chance of getting HIV from donating blood. New, disposable and sterile needles will be used to collect your blood.
If you suspect that the needle your healthcare professional is using is not new or sterile then ask them to change the needle and check that it comes out of a sealed pack before agreeing to give blood.
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How Is Hiv Not Spread
HIV is not spread by:
- Mosquitoes, ticks, or other insects
- Saliva, tears, sweat, feces, or urine that is not mixed with the blood of a person with HIV
- Shaking hands hugging sharing toilets sharing dishes, silverware, or drinking glasses or engaging in closed-mouth or âsocialâ kissing with a person with HIV
- Drinking fountains
- Other sexual activities that donât involve the exchange of body fluids .
HIV canât be passed through healthy, unbroken skin.
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When Is Hiv Most Infectious
HIV is most infectious in the first one to four weeks after infection. In the early stages of infection, the amount of HIV in your blood is high so youre more likely to pass the virus onto others. At this time, many people are unaware of their status which is why its a good idea to always use condoms or PrEP to keep you and your sexual partners safe.
What Is Residual Risk
Physicians use residual risk estimates to counsel patients about the risk of transfusion. At Canadian Blood Services we use residual risk to monitor the safety of the blood supply, to compare with other countries, and to evaluate our policies. Here in Canada, the current residual risk is very low and comparable with other blood services in developed countries.
The residual risk of infection is the estimated risk of a potentially infectious donation being collected during the window period. For example, in 2015, the estimated residual risk of human immunodeficiency virus transfusion-transmitted infection was 1 in 21.4 million donations.
Estimated Residual Risk 2015
1 in 21.4 million donations
1 in 12.6 million donations
1 in 7.5 million donations
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Does Hiv Viral Load Affect Getting Or Transmitting Hiv
Yes. Viral load is the amount of HIV in the blood of someone who has HIV. If taken as prescribed, HIV medicine can reduce a personâs HIV viral load very low level, which keeps the immune system working and prevents illness. This is called viral suppression, defined as having less than 200 copies of HIV per milliliter of blood.
HIV medicine can also make the viral load so low that a standard lab test canât detect it. This is called having an undetectable level viral load. Almost everyone who takes HIV medicine as prescribed can achieve an undetectable viral load, usually within 6 months after starting treatment.
As noted above, people with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIVto their HIV-negative partnersthrough sex.
HIV medicine is a powerful tool for preventing sexual transmission of HIV. But it works only if the HIV-positive partner gets and keeps an undetectable viral load. Not everyone taking HIV medicine has an undetectable viral load. To stay undetectable, people with HIV must take HIV medicine as prescribed and visit their health care provider regularly to get a viral load test. Learn more.
Hepatitis A And E Viruses
The hepatitis A virus is a single-stranded RNA enterovirus and a member of the Picornaviridae family. In humans, viral replication depends on hepatocyte uptake and synthesis, and assembly occurs exclusively in liver cells. The common method of HAV transmission is via the fecal-oral route, but the infection may also rarely be transmitted through blood transfusion.
The hepatitis E virus is classified in the Caliciviridae family and has many similarities with HAV. The common mode of transmission is also fecal-oral, but HEV may also be transfusion transmitted. HEV can occur with transfusion of RBCs, platelet concentrate, fresh frozen plasma, and pooled granulocytes.
Both of these nonenveloped viruses are not inactivated by the methods used in the production of blood components subjected to plasma fractionation and processed by solvent and detergent methods alone.
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In 3 Infected With Hiv In Blood Scandal Was A Child
Almost one out of every three people infected with HIV through contaminated NHS blood products in the 1970s and 80s was a child, research has found.
About 380 children with haemophilia and other blood disorders are now thought to have contracted the virus.
The new estimate was produced by the public inquiry into the disaster, after a BBC News report into the scandal.
In August, the government agreed to pay survivors and the partners of those who died compensation.
The first interim payments of Â£100,000 per person were made last month.
The initial agreement does not cover bereaved parents or the children of those who have died.
A wider announcement on compensation is expected when the inquiry concludes, next year.
Between 1970 and 1991, 1,250 patients with blood disorders were infected with HIV in the UK when given Factor VIII – a new treatment that replaced the clotting protein missing from their blood.
About half died before life-saving antiretroviral drugs became available.
Tens of thousands of others are believed to have been exposed to hepatitis, which can cause liver failure and cancer, through the same treatment or a blood transfusion.
Previous estimates for the number of children infected were based on documents referenced in the national archives.
The files, from November 1990, showed at least 175 children infected with HIV had qualified for a financial settlement after bringing a legal action against the Department of Health.
How Should We Prepare For A Blood Transfusion
If your child needs a blood transfusion, the doctor will describe the procedure. Parents should ask questions if the explanation isnât clear. A parent or legal guardian will need to sign an informed consent form. This states that you understand the procedure and its risks, and give your permission for your child to have it.
If the situation is not a life-threatening emergency, two important tests will be done before the transfusion:
1. Blood typing. To confirm your childâs blood type, a nurse or technician will draw a sample from a vein in your childâs arm. This blood is immediately labeled with your childâs name, birth date, and medical record number, and an armband with matching information is made for your child to wear. The blood is then sent to the hospitalâs blood bank lab, where technicians test it for blood type.
The 4 types of blood are:
Each blood type also can be positive or negative.
2. Cross-matching. After blood typing is complete, a compatible donor blood is chosen. As a final check, a blood bank technologist will mix a small sample of your childâs blood with a small sample of the donor blood to confirm they are compatible. Then the blood is labeled with your childâs name, birth date, and medical record number and taken to where your child will get the transfusion.
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Important Information About Hiv And Aids
- I am a man who has had sex with another man even one time since 1977.
- I have taken illegal drugs with a needle.
- I have taken clotting factor concentrates for a bleeding disorder such as hemophilia.
- I have taken money or drugs for sex since 1977.
- I have had sex within the last 12 months with someone who has been involved in any of the activities listed above.
- I have received blood, for any reason, within the last 12 months.
- I have had or been treated for syphilis or gonorrhea in the last 12 months.
- I have had sex in the past 12 months with someone who has AIDS or who has tested positive for the AIDS virus.
- I have been held in a correctional institution for more than 72 hours consecutively within the last 12 months.
- Fever higher than 100.5 for more than 10 days
- Unexplained sweating, especially at night
- Persistent cough
- swollen lymph nodes lasting more than one month
- White or unusual spots in your mouth that will not go away
- Blue or purple spots on or under the skin or inside the mouth or nose
To donate blood, you must:
- Be at least 17 years old.
- Weigh at least 110 lb .
- Be in good health.
Some people cant donate because of health or other issues. For example, you may not be able to donate if:
Having a long-term illness, such as , doesnt mean you cant donate. You may be able to give blood if your health problem is under control. But you shouldnt donate blood if you feel like youre getting a cold or the flu.
What More Needs To Be Done
As well as reviewing the rules that apply as three-month deferral , theres currently a lifetime exclusion for anyone who has ever injected drugs, regardless of when this took place. This is clearly an unnecessary exclusion affecting anyone with historical use of injecting drugs. This rule is in part dictated by EU Directive. However, there is precedent for deviating from directives when they are unnecessarily exclusionary and there is evidential basis for doing so. We would therefore like to see an urgent review of this, with changes made to the law if necessary.
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