Woman asked to give blood after positive hepatitis test

FOR 10 years they phoned her, wrote to her and welcomed her to Pelican House

FOR 10 years they phoned her, wrote to her and welcomed her to Pelican House. Betty (not her real name) was on a rare donor panel and gave blood regularly. Her blood type, O Negative, was a precious commodity.

Her last donation was in November 1993, more than two years after the Blood Transfusion Service Board introduced a second generation screening test for hepatitis C.

It was her 21st donation. When she had reached her 20th they had given her a gold pelican pendant. "I was really proud of that." She still has it. She never wears it now.

Three months after the 21st donation she tested positive for hepatitis C antibodies in the national screening programme of February 1994. She tested negative for the virus. The batch number on the anti D she received in 1977 after the birth of her fourth child indicated that it was manufactured from plasma given by Donor X, the source of a hepatitis C infection in 1976.

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The BTSB said in a statement yesterday that the second generation ELISA test used to routinely screen her donations was the most sophisticated available at the time. The third generation test was introduced in February 1994.

Betty discovered she had the antibodies when she went to Pelican House in Dublin to give blood on February 22nd, 1994, after getting her regular call from the BTSB.

It was the day after the board announced the screening programme for anti D mothers. "When I heard about it I got a bit of a shock, but I thought I would be OK because I was a donor and my blood had been tested all along for 10 years.

She mentioned her anti D history to the nurse, and was taken to a separate room for screening. She felt too upset to give blood that day. A few days later she phoned to get the results and was told not to worry because her blood would have been screened for hepatitis C from 1991.

She had never had jaundice, a condition that would have ruled her out of the donor panel. The only symptoms she could attribute to the last anti D injection were stomach problems and tiredness. But tiredness was part of rearing a family."

Three weeks after being tested, a courier delivered a letter to her house. It asked her to telephone the BTSB to give it permission to send the results of the test to her GP. "They said there was something."

She was told she had tested positive for antibodies. A further test was needed to determine if she had the virus. She was waiting for the results of this test when the board phoned looking for a blood donation.

The phonecall, in the summer of 1994, was almost more distressing than the test results. Less than four months after she had had a positive hepatitis C test, the BTSB was asking her to donate blood.

Betty says she was appalled. "It sent a chill down my spine." She told them she was one of the antiD women. That Was the end of the phonecalls.

The BTSB refuses to comment on individual cases. It is understood that the phone call may have been the result of someone working from an old list.

A young doctor in the BTSB told Betty the chances that she may have infected anyone with the virus were slim. "He said: `You can't give somebody something that you haven't got.' I remember his words exactly."

According the report of an expert group chaired by Dr Miriam Hederman O'Brien, the BTSB introduced routine screening of blood donors for hepatitis C in October 1991.

The board received Government grants of £300,000 in 1992, 1993 and 1994 to fund the testing. The virus was first identified in 1989 and by early 1990 the first screening test, known as ELISA, was available. However, preliminary tests threw up a number of false results.

By 1991 a second generation of ELISA had been developed and was introduced for routine screening. The report said the expert group was satisfied that the "question of introducing a test for hepatitis C was actively and properly considered in Ireland".

The BTSB explanation for the apparent failure of routine screening to pick up Betty's hepatitis C antibodies is that she may have been one of six "seroconversion donors". These are people who screened negatively on the second generation ELISA test, and positively on the third generation when it was introduced.

People in this category have been further tested on the RIBA and PCR (two separate tests).

These are termed "seroconversion donors", i.e. people whose antibody status changes from one test to the next.

All previous donations from this group are looked at and the recipients of their blood screened.

In no case have the recipients of previous blood donations from seroconversion cases screened positively." The BTSB statement stresses the complexity of science surrounding blood transfusion.

It states that the incidence of seroconversion at the BTSB is "in the order of one per 150,000 a, very low number by international standards."

Betty has never been informed that she was one of six "seroconversion donors". Apart from the reassurance from a young doctor that she could not have passed on a virus that she did not have, she has never been given any information on recipients from "seroconversion donors".

One doctor who has dealt with women infected with hepatitis C said he had seen a number of cases where women donors screened positive. They are naturally upset by the idea they may have infected others. However, he stressed the value of blood donations.

Betty, like most of the infected women, would like to know what really happened.

Catherine Cleary

Catherine Cleary

Catherine Cleary, a contributor to The Irish Times, is a founder of Pocket Forests