Bad Blood

[George K]

https://www.bbc.com/news/health-68978513

About 1,750 people in the UK are living with an undiagnosed hepatitis C infection after being given a transfusion with contaminated blood, according to BBC analysis.

Official documents, seen by BBC News, reveal how the UK government and the NHS failed to adequately trace those who were most at risk of having the virus.

They show how officials slowed detection rates and even sought to keep public awareness of the virus low.
Up to 27,000 people were exposed to hepatitis C after having blood transfusions in the 1970s, 80s and 90s.

The true scale of undiagnosed cases is based on BBC analysis of statistics submitted to the Infected Blood Inquiry by an expert panel, as well as Freedom of Information requests to infected blood support schemes.

BBC News can reveal for the first time how the UK government and the NHS actively tried to limit the public's awareness of the virus to avoid embarrassing "bottlenecks" at liver units. Testing was limited because of "resource implications for the NHS".

"Raising awareness poses undoubted difficulties for the NHS," an internal government note from the 1990s says. "In terms of value for money, there may be better candidates for additional resources." The document has been added to the inquiry's website.

Rather than prioritising care for those harmed by NHS-provided blood, officials squeezed budgets as cost concerns took precedence over patient safety.

Even though it wasn't formally identified until 1989, health officials and NHS staff recognised that this form of hepatitis could be fatal as early as 1980.

But they chose to delay "look back" programmes until 1995, which further hampered efforts to track down people who may have been infected, reducing their chances of receiving treatment before permanent liver damage was caused.

As NHS funding for hepatitis remained limited, and awareness low, victims told BBC News how they felt doctors patronised and ignored them instead of offering tests and support.

Known as the "silent killer", hepatitis C may cause few symptoms initially, with early signs including night sweats, brain fog, itchy skin and fatigue. But for every year a person carries the virus, their chance of dying from liver cirrhosis and related cancers increases.

The infected blood scandal is one of the biggest treatment disasters in NHS history - 3,000 people who were infected with HIV and hepatitis C after being given contaminated blood products have died.

I know of one surgeon who died of Hep C.

[Jolly]

I remember NANB hepatitis. That's what we called it, non-A non-B. Then, we knew the causative agent, but didn't have a test for it. I remember the old Abbott Quantum system for doing Hep A & B, I don't recall if it did HCV. The Quantum was back in the early 80's. Plastic wells and coated beads in batches, technique dependent....But we had some hepatitis testing.

Then Abbott came out with a batch analyzer, the IMX. May be wrong, but I think the IMX may have had a Hep C test. Good box, a bit slow, with the limitations of batch, but it was walk-away.

https://www.corelaboratory.abbott/us/en/about-us/history-heritage.html

The game changer was the AxSym. Discrete testing, full walk-away, Hep C and HIV tests on-board with Quant hCG's, female hormones, etc. Would interface or you had a dot matrix printer with a chartable paper result. An AHEP was a HBsAG, HBV, HB-core and a HCV. Any positives were repeated...Two positives were reported as positive. A pos and a neg necessitated a repeat specimen in one week.

AxSyms were ubiquitous, because they could be used in medium sized labs. Until Abbott pissed off the FDA and the feds knocked their business into a cocked hat, without a single consideration of patient impact. After a transition period other boxes took their market share and the AxSym died.

[Jolly]

Back to look-backs... Sometime in the 90's, the CDC mandated that we do a look-back for transfusion recipients. The cap was 1988 for paper records, further if you had computerized records.

I don't remember the details, because I wasn't involved with the nuts and bolts, but I do remember that even if a patient had received blood that was HCV pos, transmission rates were less than 10% and some said considerably less.

Seems like, not long after the look-back process was in full swing, the first NAT HCV tests came on board, with a lot better sensitivity. More expensive, though.

Lastly, we've only had a really good treatment regimen for the last ten years or so.

Trying to be fair, I see the NIH's quandry...

1. British laboratory medicine was still antiquated in the 80's and 90's. Labor intensive, paper intensive, antiquated methodology. Look-back would have sucked a lot of resources.
2. How much of a public campaign do you wage with a fairly low transmission rate, particularly this far down the line? With the exception of trauma or some surgeries, most multiple unit transfusions involve patients such as GI bleeders or oncology patients that were probably deceased by the time a substantial look-back could be done. And multiple transfusions are where most of your transmissions will take place.

So, this was a cost-benefit decision, perhaps the wrong one.

It does underscore one of the worst facets of government sponsored, single-provider healthcare...Resources are limited and dependent upon the government for allocation and expansion.

[George K]

Back in the day...

I never, ever, wore gloves when starting IVs or arterial lines. I'm sure I stuck myself more than half a dozen times as well.

Jebus, for that matter, I remember putting NG tubes down without putting gloves on in unconscious patients - I'd feed the tube into the nostril and direct it down the esophagus with my left (ungloved) fingers. This is going back to the late 70s, when we were a bit more ignorant stupid lax about this kind of stuff.

When I started seeing docs regularly, they always found I had a mild, mild elevation of my liver functions. They always attributed it to my need to lose about 20 pounds and some (cheap) Scotch. Finally about 10 years ago, my now-retired internist said, "We gotta look into this."

Sure enough, Hep C antibodies positive. However, no antigen could be found. The hematologist I saw said that I cleared it on my own (I guess that happens about 10% of the time) and there's no need to do anything.

I've lost (and kept off) about 30 lb since then, but I still enjoy some (moderately cheap) Scotch.

LFTs are all normal now.

[Jolly]

Can't stick worth a damn with gloves on. I've stuck myself once in 44 years.