It is only the second case of infection by transfusion in America since better testing started in 1999.
By STEPHEN NOHLGREN, Times Staff Writer
© St. Petersburg Times, published July 19, 2002
ST. PETERSBURG -- Two people were infected with HIV this year when they received blood transfusions from a donor whose disease went undetected by the Tampa Bay area's primary blood bank.
Florida Blood Services revealed the discovery Thursday, and stressed the blood supply for the Tampa Bay area is safe.
The organization -- the primary supplier of blood in Pinellas, Pasco and Hillsborough counties -- said it learned May 11 that one of its donors had tested positive for HIV. In the next 67 days, the organization says it retested the donor, found seven recipients and confirmed two were HIV positive.
Blood bank officials declined to identify the two people infected, the donor who carried the lethal disease or the hospitals where the transfusions occured.
But the donor and the two recipients have been notified, as has the sexual partner of one of the recipients. That sexual partner has been tested and does not have HIV disease.
"Everyone involved has been notified," Dr. German Leparc, medical director for Florida Blood Services, said Thursday in an interview.
The Tampa Bay area case appears to be the second HIV infection from a blood transfusion since improvements in testing went into effect in April 1999. Given that 12-million of pints of blood are donated in the United States every year, officials consider the nation's blood supply largely HIV-free since 1985, when the first screening test was developed for donated blood.
The chance of HIV infection is roughly 2-million to 1, as rare and random as death by lightning bolt.
Still, there is one unavoidable way that transfusion infection can occur.
When people first get infected with HIV, usually through sex or sharing needles, the virus takes seven to 10 days to build up sufficiently for blood tests to detect it.
If a newly infected person donates blood during that window, the blood will appear clean to testers. The blood bank will pass it along to hospitals and surgical centers, hoping to save lives.
But it will be deadly.
That's what happened in the Tampa Bay infection, blood bank officials said.
Leparc declined to give full details, citing medical confidentiality. But he gave this outline:
On May 11, a donor gave a pint of blood to Florida Blood Services. It was one of about 200,000 donations the blood bank receives in a typical year.
Leparc and other blood bank officials would not reveal where the donor gave blood, or the donor's age or sex. In Thursday's interviews, they referred to the donor as "he" and "she."
The donor had become a regular. He or she had first donated at a blood mobile on Sept. 12, the day after terrorists brought down the World Trade Center, when grieving citizens all over the country were rushing to blood banks. The donor returned loyally every two months, as frequently as regulations allow. From Sept. 12 through May 11, the donor gave 5 pints.
The May 11 blood was tested within 24 hours, then retested and found to carry HIV. During the next week, a more precise, more time-consuming test showed the same result. The blood never left the blood bank and was destroyed.
Ten days after the May 11 donation, the blood bank mailed a letter to the donor, asking him or her to come in to discuss the test results. The donor was devastated to hear the news. According to Leparc, the donor's reaction was: "It can't be."
Another blood sample was taken from the donor May 30 and it also came back positive for HIV. That prompted the blood bank to take a closer look at what had happened to the donor's previous 4 pints. All previous donations had tested clear of the human immunodeficiency virus, said blood bank chief executive Don Doddridge. But it was best to be safe.
On June 19, the blood bank notified six Tampa Bay area hospitals that the blood bank had sent blood components from a person who later tested positive.
A pint of blood can be broken down into three useful components: plasma, red blood cells and platelets. So each pint can be transfused into as many as three people.
Seven patients had received blood components from the donor before the red flag went up with the May 11 test. The hospitals contacted those patients, tested them, and found that five of the seven were free of HIV.
The other two were infected.
One had received red blood cells, the other had received plasma. One was transfused in a Pinellas County hospital, one in a Hillsborough County hospital, Leparc said.
In both cases, the blood had come from the donor's March 12 donation. The donor must have been infected just before he or she donated, Doddridge said, because the blood had tested free of HIV. The virus had not built up sufficiently in the donor's bloodstream for the test to discover it.
Identifying the recipients and testing them took time, Leparc said. They were tested last week.
Leparc helped deliver the news Wednesday. One recipient learned of the infection at a hospital, the other at a doctor's office.
One of the two infected recipients had a sexual partner who was tested and was not infected with HIV, Leparc said.
The other recipient did not spread the disease through a sexual partner, Leparc said. But he declined to elaborate.
Both infected people live in the Tampa Bay area, but Leparc would not identify where. However, state law requires doctors to report positive HIV tests to the county health deparment, so infected people can be counseled and questioned about their sexual habits. Then, their sexual partners can be tested.
The blood bank notified the Pinellas County Health Department on Wednesday night about the transfusion infection, said Lisa Cohen, the health department's HIV-AIDS coordinator.
"We are aware of it and we are conducting an epidemiological investigation," she said Thursday. "But we are not at liberty to discuss it."
She would not say whether either of the infected recipients lives in Pinellas.
Dr. Keith Rosenbach, Hillsborough County's communicable disease director, said he was not aware of the incident. He said the Health Department will begin investigating today to see if Hillsborough needs to take action.
Florida Blood Services has reviewed its records and confirmed that it handled the infected donor's five donations correctly, Doddridge said. The company that manufactures blood test kits sets out handling procedures, as does the Food and Drug Administration. The blood bank adhered to those standards, he said.
When people donate blood they are asked a list of questions designed to weed out high-risk donors: In the past 12 months have you had sex with anyone who has AIDS? Have you used a needle to take drugs? Are you a male who has had sex with another male since 1977? Have you traveled to Africa since 1977?
The person who donated the infected blood had answered those questions, Leparc said. No answer indicated high-risk behavior, he said. And there was no indication that the donor had lied.
The questionnaire cannot cover every eventuality, Doddridge said. People might have regular, unprotected sex with their spouses, for example, and not know that their spouse is having a high-risk affair with someone else.
Since donor testing began in 1985, Florida Blood Services has tested about 5-million pints, Doddridge estimated. Until now, none of that blood infected a transfusion patient.
Florida Blood Services knew by early May that the donor had tested positive. Why wait two months to notify the six hospitals that had received components from that person's earlier donations?
It's a balancing act involving long odds, Leparc explained. On one hand, it's a 2-million to 1 shot that the donor's previous donations tested clean but were infected.
One the other hand, the blood bank sometimes mixes up the identifying numbers that follow each donation. It happens only once or twice a year, Leparc said, which would be once for every 100,000 to 200,000 pints. Blood banks try to avoid needlessly scaring patients by telling them they might have been infected with HIV.
Before notifying the hospitals, Leparc said, the blood bank needed to contact the donor, retest him or her and trace back through its paperwork to make sure the May 11 blood was infected.
According to several experts, the risk of contracting HIV or other diseases through blood transfusions has dropped sharply in the past 20 years. In the early 1980s, before the virus that causes AIDS was identified, someone who received a blood transfusion had almost a 1 in a 100 chance of contracting HIV.
By the mid 1990s, blood banks began using their first test. It didn't detect the virus, but detected antibodies that an infected person would create to fight off HIV. This test could not detect antibodies for several weeks after infection. Still, the risk dropped to 1 in 100,000.
Today, with new RNA tests that can find the disease in its earliest stages, the risk is considered better than 1 in 2-million.
Dr. Eric Delwart, a University of California at San Francisco expert who studied the Texas case of transfusion infection, said such infections are simply bound to happen. But he stressed the risk is about as small as science can make it. There will always be a window in which contamination can occur, he said.
Making the U.S. blood supply much safer is becoming close to cost-prohibitive, Delwart and others said. Some European countries, including Norway and Sweden, do not use the RNA test because the cost isn't worth the risk. And Great Britain is considering stopping it, said Dr. Michael Busch, vice president of research at Blood Systems, California's second-largest blood bank.
The U.S. Food and Drug Administration is reviewing procedures that can kill HIV and other pathogens in donated blood, but Busch said they might double the cost of processing blood to $100 per donation.
At Florida Blood Services, officials said their biggest worry is how the public will react to today's news.
"We want to make sure people don't link AIDS with donating blood," Leparc said. "You absolutely cannot get AIDS from giving blood."
-- Times staff writers Wes Allison, Curtis Krueger and Anita Kumar and Times researcher John Martin contributed to this report.