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Journal insanecarbonbasedlif's Journal: Blood Donation, Africa, HIV, and the mysterious Group O 3

About two weeks ago, I attempted to donate some blood to the Red Cross. They have a handy website that will let you find a local upcoming drive and schedule an appointment. I did so, and carefully perused their eligibility guidelines, and found nothing amiss. So, the day of the donation came, and I went, excited to be able to help people in some small way.

Well, it turns out I'm not good at reading, or somehow was looking at the wrong eligibility guidelines. My wife lived in the Democratic Republic of the Congo for a stretch of her childhood, and I was ignorant of the fact that I am therefore indefinitely ineligible to give blood. Here's the first restriction based on travel:

Persons who were born in or who lived in certain countries in Western Africa, or who have had close contact with persons who were born in or who lived in certain West African countries are not eligible to donate. This requirement is related to concerns about HIV Group O. Learn more about HIV Group O, and the specific African countries where it is found.

And here's the specific bit about HIV:

  • were born in, or lived in, Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea,Gabon, Niger, or Nigeria, since 1977.
  • since 1977, received a blood transfusion or medical treatment with a blood product in any of these countries, or
  • had sex with anyone who, since 1977, was born in or lived in any of these countries. Learn more about HIV Group O, and the specific African countries where it is found.

(And yes, in that last section, it offers a link to learn more about HIV Group O that just links right back to itself. Helpful.)

First note: my wife is from the DCR, not a country simply called Congo - but the worker at the donation drive did not think there was a difference. A call to the Red Cross has not yielded any further enlightenment about whether they intended to exclude both the Republic of the Congo (which is colloquially called the Congo) and the confusingly similar Democratic Republic of the Congo (used to be called Zaire, but now just muddies the waters, nomenclature-wise). It seems likely that they mean to exclude both, but I would like to know. Either way, they really should spell out the full country names in their guidelines - bits are cheap on the internet, and it would have saved me a trip.

More disturbing to me is the fact that they are restricting donors based on first or second-hand exposure, but that still only matters if you know. First-hand, most people would know if they lived in one of the restricted countries. Second-hand, what if my wife had not told me she lived in one of them? If we were in a casual relationship, I may or may not have heard about her childhood in the DCR. She has no accent, so I would have no reason to assume that she had lived anywhere but the USA without further information. Furthermore, what if I had an intimate relationship with someone else after? They could know all about me, and I still may never have told them that my wife had lived in the DCR. If they were then screened at a donor drive, they would be let through. Risky business.

The biggest question is, why does it matter? Doesn't the Red Cross test all the blood that they collect at drives anyhow? They certainly screen for a lot of things - why not HIV Group O? Well, it turns out that (and you can read about this near the end of the eligibility guidelines) that HIV screening tests do not always catch Group O.

There is a rare form of HIV called Type O that is found in western Africa. The available tests for HIV do not always detect the Type O strain. This means that blood programs must take special precautions to keep this virus out of the blood supply by not taking blood donations from those who have been where the virus is found.

A side note - they don't even test for malaria, they handle that entirely by screening questions, which also seems a bit risky to me.

Recently (December of 2008) a combination test has been approved by the FDA:

The new FDA-approved test detects nucleic acid from HIV-2 and from HIV-1 Group O. ... In addition to HIV-2 and HIV-1 Group O, the MPX test simultaneously detects nucleic acid from the most common form of HIV, HIV-1 Group M, as well as the Hepatitis C Virus and the Hepatitis B Virus.

Up until this point, they only had an 80% success rate identifying Group O in samples. As I noted earlier, I have not heard back from the Red Cross, but I'd like to think I could go test myself for Group O and then be cleared to donate. We'll see. In the meantime, my trepidation about blood transfusions has gone up quite a bit, and I don't think I'll feel completely comfortable with the situation until they start testing all donations for Group O. The web site says:

It is possible that the tests used to screen donated blood may someday be improved so that they detect Type O HIV. If so, these donation restrictions may be removed.

Obviously, it'll take a while to put a new blood test in place, so 1 month after approval by the FDA, they haven't rolled it out everywhere. Even so, it seems like HIV is a damaging enough disease that testing for even rare strains should be rolled out across the US as aggressively as possible. If they ever do call me back, I'm definitely asking them what their timeline is on implementing Group O testing across the board.

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Blood Donation, Africa, HIV, and the mysterious Group O

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