OK, I get they don't want HER blood, but presumably you still have Norweigan blood. Oh well. Maybe you should think about bring your own needles. Or watch as they open a new envelope. Soon Thais will be carrying Norweigan bacteria... and developing a sudden urge for herring!

Its more than that, Gard.

LALeslie, the hospital in Siem Reap and the Bangkok hospitals all use sterile needles. There are places in the world where one should worry about sterile needles, but not there.

gard, the explanation of why they no longer want your blood is interesting. It's viruses, not bacteria, they are worried about. It harks back to the early days of AIDS when they didn't yet have good, reliable screening tests, so they eliminated blood donors on the basis of perceived risk. Having sex with a (for instance) Haitian or an African would increase your preceived risk, as these viruses are passed through sexual contact or blood. Also, Hep C was something they couldn't reliably test for early on. Of course, they can now test for those diseases reliably, and in the US all blood is screened for those and several other diseases, so it makes little sense.

I'm glad Kathie responded. These testing protols are in place everywhere for people considered 'at risk'. I believe I'm correct in thinking that gay men still can't donate blood... perhaps someone could advise me. Yes, these measures began in the early days of the epidemic but there may some salient reasons for continuing.

2007 figures:

'...in Namibia, South Africa, Zambia and Zimbabwe around 15-20% of adults are infected with HIV. In three southern African countries, the national adult HIV prevalence rate now exceeds 20%; Botswana (23.9%), Lesotho (23.2%) and Swaziland (26.1%)...'

Gard is clearly seen as being in the 'at risk' category.

'...I used to be a blood donor here in Norway but then I married a sweet girl from South Africa...and that was the end of my career as a blood donor in Norway. I think these rules are stupid...'

I'm sure this reaction from the medicos is offensive to Gard and his wife - however, 'stupid' may not be an appropriate word. It smacks of Pollyanna. It does seem to me that Gard's rather unusual need to give blood may have as much to do with the Norwegian medical authorities' refusal to allow him to donate as 'I like to help'.

Well, in a sense, there's nothing wrong with that. Who cares what the motivation is for good deeds? Your knowledge is clearly superior to that of the international medical fraternity, so go right ahead. I'm sure we can all assume that the screening proceedures in Jayavarman VII Children Hospital, Siem Reap are every bit as rigorous as in the rest of the world.

Thanks Kathie for the explanation. Maybe they have better screening methods but I'm in touch with the Norwegian bloodbank from time to time to check if the rules have changed and so far they haven't for me. The problem is of course with very rigid rules and more foreigners moving into Norway, more and more people are falling into the "at risk" category and hence there are story on the news from time to time about lack of blood in the Norwegian bloodbanks.

Dogster is right of course...I do feel offended that I'm not allowed to help out here at home by donating blood as I used to just because I married a person from South Africa. I know all about the HIV/AIDS situation there so I understand that I'm being put in the "at risk" category. But wouldn't a simple test of my wife get me out of the "at risk" category? Anyway, I'm pretty sure that they will test my blood if I donate in Bangkok and I'm pretty sure it will be "clean". My wife was also a blood donor back in South Africa before she moved to Norway ;-)

Regards
Gard
http://gardkarlsen.com - trip reports and pictures

Do you have any reason to think that the guidelines for blood donors in Thailand are more lax than those in Norway?

gard, sorry, I missed your post above. Of course they can test your blood and your wife's blood and clear it as safe (or not). But some countries have opted for the behavioral/demographic rules as a first screen before testing, which it sounds like Norway has.

Other places opt to do pre-screening to make sure the person is not at risk for a new infection (as it takes time for antibodies to show up in the blood), but then do blood screening to determine id your blood can be used. You are right, Thailand does screening of blood.

Indiana, I don't think it's a matter of more lax, it's a matter of differences in how countries choose to deal with risk. There are a number of ways to do it.

Kathie, educate me because I still don't get it. (Are you a doc or nurse?)

If they test Gard's blood and he's HIV-free (or whatever they're looking for) and "clean," then why won't Norway take his blood? What risk does he pose if the labs show he's virus free? Why should it matter who he's married to if they're drawing his tested blood? Can some viruses "hide" in the blood?

LAleslie, I don't know the exact rules in Norway, but let me extrapolate from the issues in the US.

When HIV/AIDs first appeared there was initially not a reliable blood test for it. So they eliminated people who were demographically at risk: gay men, Haitians or people whose sexual partners were Haitian, people from sub-Sahara Africa and their sexual partners, and IV drug users. Even when good blood tests became available, the tests are for anti-bodies against HIV and it takes time to develop those anti-bodies. In some people it can take up to 6 months after infection to develop measurable anti-bodies. But an infected person can pass on the disease even though they haven't developed antibodies. So even though they now had a reliable test, the issue was in determining whether someone who is demographically at risk is actually at risk for infection after the blood is tested.

So, John Doe who is married to a Haitian woman tests negative for HIV; six months later he also tests negative for HIV. Great. But the question is, has he or his wife done anything that might infect them during that time. Did either of them have sex with someone else, were either exposed to possibly contaminated needles? You can see the difficulties. Questions need to be asked that people may be wary about answering honestly. In some places there was talk about taking blood donations and freezing them for six months, then re-test the donor before using the blood. But as you know some blood components can be frozen and some cannot.

Of course, even people who are considered demographically low risk at not "no risk" and may engage in behaviors that might expose them to the virus.

The tests are better now and can pick up lesser amounts of anti-bodies. I don't know the exact parameters of the current tests. (I'm no longer working in a medical center setting, so while I keep up on developments, I don't have day to day contact with the practical issues.)

I've only addressed the HIV issues, but Hep C is also an issue and there are similar testing issues for it. Also, in some places, they won't allow you to donate blood if you have been to a malarial risk area in the previous year.

I haven't covered all of the issues involved, but perhaps I've given you an idea of what the complexities are.

This is also a good reminder that those who want to donate blood at home and have foreign travel planned should check local regulations concerning countries visited.

It would be awful to intend to give blood after an international trip, only to be told you will have to wait a year because of where you visited - especially if you could have given before you left on the trip!

Here is a Red Cross set of guidelines:

http: //www.redcross.org/en/eligibility

As you can see, it's much more complicated that simply HIV infection. "Mad cow" and other related diseases are also a consideration, as well as medications and other infections the donor might have. Since many people donate blood, simple ways of screening out potentially infected donors is the norm. To test gard and his wife would be fairly complicated.

Be aware, too, that almost no one receives a unit of whole blood. A donation is typed and screened, then centrifuged into its components: plasma, platelets, and packed cells. Be aware, too, that a significant portion of donated blood is not used for donations. Each component has a shelf life --- platelets for a very short time, packed cells for about 35 days, and plasma that can be frozen. Once the components have expired, they must be discarded, although frozen plasma can be used to obtain clotting factors for hemophiliacs.

The most sensitive test for HIV as well as other viruses is by polymerase chain reaction (PCR) PCR is able to detect even small amounts of virus at a much earlier stage of infection, but it is quite expensive compared with a simple antibody screen. When I was a working girl, it wasn't used for blood donations, just to monitor HIV patients who were on anti-retroviral therapy.

All I know is that when my Grandmother was sick and we sent her to a very expensive hospital in the States, we were not allowed to give blood directly to her. Half of the family were not allow to donate blood in the first place because they, mostly the women, did not have the sufficient body weight of 120 lb to be classified as a possible donor. Different country, different rules.

For Gard and his wife, their donation will be welcome in Thailand. After they have donated their blood and if it passes all the screening procedures of the Thai red cross then it will be put to good use. They will not be deny the right to give blood.

indiana, the most sensitive tests for HIV (and as we've both pointed out HIV is only one of many diseases to be concerned about) are for viral load. As you point out, that is not used for screening, but for monitoring those who have HIV.

However, even this is complicated. Some people are genetically able to clear the virus from their blood. These people are HIV positive, but do not get sick from HIV. If tested for antibodies, they are positive, if tested for viral load, they have none. FOr instance, a dear friend of mine lost his partner and his whole group of friends to AIDS over a several month period back in the 80s. He is HIV positive, but has never been ill, nor does he have any viral load, though he has never been on anti-retrovirals.

The funny thing about the blood donation in Norway is that it is based on a lot of trust. Before I donated blood here in the past I had to fill out a form where you have to indicate if you have gotten a tattoo, have traveled to malaria areas, had sex with others that you regular partner etc. So I think it would have been better if Norway start going for the post-checking method instead as I think that will be safer in the long run ;-)

Regards
Gard
http://gardkarlsen.com - trip reports and pictures

Hi

Just want to say thank you for all the feedback. I'm now in Bangkok and I have been to the blood bank today and I have donated blood (see http://gardmobile.blogspot.com/2009/...lood-bank.html ). The only hassle I had once when I checked of yes on the question "Do you drink alcohol" - I had to admit to the lady that I had a couple of beers last night when eating dinner. But she allowed me to donate but I had to promise to not drink the day before donating the next time :-)

Regards
Gard
http://gardkarlsen.com - trip reports and pictures