They don't want my blood anymore

[davefoc]

I have been an occasional blood donor for many years. Principally because my wife guilts me into it.

The Redcross has been rejecting her blood for a long time because it falls just below the iron level they require. So my wife has pushed me to donate to compensate and after six months or so the guilt finally builds up to the level where I give blood.

So after my last trip I was surprised to get a letter from them telling me they don't want my blood either. Apparently they have a test for hepatitis B that came up positive.

According to the letter it is very unlikely that I have hepatitis B because several other tests came back negative, but out of an abbundance of caution and to comply with the federal government guidelines they have informed me that they don't want my blood anymore.

My test results:
Hepatitis B Surface Antigen (HBsAg. EIA) - POS

HBsAG Confirmatory Test (neutralization) - NEG

Antibodies to Hepatitis B Core Antigen - NEG
(anti-HBc, IgG and IgM)

Antibodies to Hepatitis C Virus - NEG
(anti-HCV, EIA)

HTLV-I/II Antibodies (EIA) - NEG


EIA= enzyme immunoassay

Anyway, I thought here and see if anybody has any comments.

[This Guy]

They don't want mine either.

I used to work in a Dialysis clinic, as an equipment tech. Had to work around a lot of blood, and patients that had Hepatitis. As a safe guard, we were given a series of shots to build up our immunity to one (or more) flavor of Hep (C I think, but could well be wrong). As a result, when my blood is tested I show the antibodies for Hep. Normally that means you had the disease. As a standard safeguard for the blood supply, they don't want mine.

Please excuse any bad terminology used. Remember, I was an equipment tech, not a doctor

Kinda sucks, but does give me an excuse to not get stuck with needles, something I really hate, but was willing to do for the good of others.

As a funny aside, my first day at work, I was asked to show my behind (literally) to one of the nurses, so she could start the shots. What a way to introduce your self to your co-workers

[casebro]

They want to make sure they don't bleed your wide dry. Perhaps she could donate once a year? or post menopause?

They don't want mine. My blood pressure is to high. Now, we know that one side effect of donating is that it lowers B.P. Go figure...

[Piscivore]

Originally Posted by casebro

They don't want mine. My blood pressure is to high. Now, we know that one side effect of donating is that it lowers B.P. Go figure...

They don't want mine for the same reason. Presumably, it's because of the hormones that control vessel dialation that are out of whack in our blood, not to mention the compensatory pharmaceuticals.

[Lamuella]

I lived in the UK for 24 years, so they don't want my blood either.

[The Painter]

They didn't want my blood for one year after going to Haiti.

[BlackCat]

I'm not surprised. It might not be a bad idea to talk it over with your doctor, but most likely, it's a false positive. I had plenty of donors complain and plead with me to let them donate again, even after they had batteries of tests that showed that they didn't have the disease. It's just their policy, and they're not going to change it. For what it's worth, I'm sorry. If you still feel like you need to help, why not organize a blood drive at your work or something? Or better yet, tell your wife to organize a blood drive.

About your wife, there's probably nothing wrong with her. I denied women all the time for low iron. (And very rarely, men.) I don't know what her diet is, but she could try eating foods high in iron, or cook food in cast iron pots and pans. Also, this is a bit anecdotal, but women would be denied more often during or the week after their period. Also, tell her to just keep trying, and not to take it personally.

BlackCat

[Skeptic Ginger]

That result represents a false positive but you should repeat the test once to confirm it wasn't an early positive test. Also have them add hepatitis B surface antibody, unless you have been vaccinated in which case a positive won't add any information in this case. Have them include the IGG and IGM. Those are the earliest antibodies to show up and they disappear soonest which is why I say to add the hep B surface antibody.

EIA screening tests essentially are cheaper and easier to run so we do those for lots of antibody tests. But they are less specific. Other antibodies unrelated to the one being tested for can cause a cross reaction and give a false positive. So the confirmation test is reliable and if negative, the screening test is a false positive and you shouldn't worry anymore about it.

The reason I say get one re-test is lab errors can occur with any test. With something as serious as hepatitis B, you want to be sure the confirmation test was truly negative, and not negative because you were newly infected and very little virus was present. THIS IS EXTREMELY UNLIKELY so don't start worrying about that unless you have reason to think you've been exposed in the last few months.

The fact the core antibody was negative rules out past or longstanding infection with a low viral titer. When one is infected, antigen is detected first, then IGG and IGM, then surface antibody, then core antibody over a period of 2-6 weeks. Core antibody remains. Surface antibody remains most of the time and a person who was vaccinated but never infected will only have surface antibody.

Only people with antigen are contagious and risk long term liver damage and/or liver cancer. ~85% of those infected clear the virus on their own and are immune and never ill with it again. The other ~15% get acutely ill, some die, some recover, OR, they develop a carrier state. Carriers are more likely to have not had a severe illness when initially infected.

The reason the blood bank will no longer take your blood is from a policy developed after they failed to use hepatitis B core antibody to reject blood when HIV emerged. The policy then changed to exclude donors who were not carriers but who had what was considered a marker for other potential but as of yet unknown bloodborne diseases. I'm surprised they would reject a false positive unless you had the same result with a previous donation which they did not inform you of. You should ask because that would count as your second test and you wouldn't need another one.

I have had nurses donate blood but not be told until the second donation that they had B core antibody meaning past infection. The issue for a nurse to hear this is to wonder how one got infected after being vaccinated and having no exposure. Because to the nurse getting the letter, it looks like the infection occurred between donations. This is how I learned about the blood bank not sending the letter until the second positive test. It seemed like a very stupid policy to me.

One, you couldn't be sure the person would donate again so you miss the chance to inform them. The blood bank wasn't thinking about all the issues. While the donating person may not be ill, when I have a person test positive for past hep B infection, I suggest siblings and parents also be tested since the infection came from somewhere. Usually with the nurses it is from a foreign country they were born in which has high rates of hep B. If the nurse was infected from her mother, then the parents and siblings might be carriers and not know it.

The other reason the blood bank's policy of notifying on the second test is a bad policy is for exactly what happened to the nurses. They assumed the infection was between donations and of course one receives the letter arriving home in the evening and the blood bank is closed so you can't call and ask what is going on.

Nuff ranting.

If you have any other questions I'll be happy to answer them or find a reference.

[Miss Whiplash]

I was a lab technician for Serology in days of yore. You have a false positive for Hep B. Get retested and then give blood at will.

[davefoc]

Blackcat,
I didn't receive any quantitative test results. Do you think they would provide them if I asked? Any thoughts about why they wouldn't included the quantitative results with POS/NEG results?

[Miss Whiplash]

From what I remember, the test is very general at the Red Cross. False positives happen when the tests are not specific.

For instance, when I did AIDS tests for DOD, we used ELISA. If it came back positive, we did a Western Blot. A Western blot was more accurate and protien specific.

[Ducky]

They have a very good reason for not wanting my blood anymore. My cancer is in white platelet cells in the marrow.

However, getting them to realize this took 6 months of their harassing calls, and a rather long call where a nurse had to consult a doctor twice.

Oh well.

[Skeptic Ginger]

Originally Posted by The Vampire

I was a lab technician for Serology in days of yore. You have a false positive for Hep B. Get retested and then give blood at will.

You can't give if they won't receive dear. It isn't up to the patient.

[Skeptic Ginger]

Originally Posted by davefoc

Blackcat,
I didn't receive any quantitative test results. Do you think they would provide them if I asked? Any thoughts about why they wouldn't included the quantitative results with POS/NEG results?

They aren't needed in this case. They will not give you any additional relevant data.

[Skeptic Ginger]

Originally Posted by The Vampire

From what I remember, the test is very general at the Red Cross. False positives happen when the tests are not specific.

For instance, when I did AIDS tests for DOD, we used ELISA. If it came back positive, we did a Western Blot. A Western blot was more accurate and protien specific.

EIA and ELISA are the same test.

Here's a nice list if you want to know what the initials stand for on all these tests.

RIBA and Western Blot are essentially the same tests as well though HIV confirmation test is usually called Western Blot and the Hep C confirmation test is called a RIBA.

[Miss Whiplash]

Originally Posted by skeptigirl

You can't give if they won't receive dear. It isn't up to the patient.

If it's a false positive there's no reason not to give. And there are other places than the Red Cross, honey.

[Miss Whiplash]

Originally Posted by skeptigirl

EIA and ELISA are the same test.

I know. I was making an example of testing methods for AIDS. ELISA was less accurate than a Western Blot.

[Skeptic Ginger]

Originally Posted by davefoc

Blackcat,
I didn't receive any quantitative test results. Do you think they would provide them if I asked? Any thoughts about why they wouldn't included the quantitative results with POS/NEG results?

Forgot to add, qualitative tests (pos/neg) and quantitative tests (number result) are different tests. They didn't likely do a quant. test. And, they have a few rules about giving people results to discourage people from donating blood in order to get test results.

[Skeptic Ginger]

Originally Posted by The Vampire

If it's a false positive there's no reason not to give. And there are other places than the Red Cross, honey.

Hey, you're preaching to the choir. But rules are rules in this case.

Where besides the Red Cross do they have a different standard? It's Puget Sound Blood Center here and they have the same rules.

I'm not a blood bank person so here is a better reference than my brain: FDA standards reference page.

[Miss Whiplash]

Originally Posted by skeptigirl

EIA and ELISA are the same test.

Here's a nice list if you want to know what the initials stand for on all these tests.

RIBA and Western Blot are essentially the same tests as well though HIV confirmation test is usually called Western Blot and the Hep C confirmation test is called a RIBA.

Ummm...re-read my reply. I know what the intials stand for. There's no need to be insulting. I'm meerly stating false positives happen, not trying to refute what you are saying.

[Miss Whiplash]

Originally Posted by skeptigirl

Hey, you're preaching to the choir. But rules are rules in this case.

Where besides the Red Cross do they have a different standard? It's Puget Sound Blood Center here and they have the same rules.

Excuse me for even responding.

[Skeptic Ginger]

Originally Posted by The Vampire

Ummm...re-read my reply. I know what the intials stand for. There's no need to be insulting. I'm meerly stating false positives happen, not trying to refute what you are saying.

The list wasn't for you, it was for everyone. You're taking my posts the wrong way. You have an unnecessary chip on your shoulder. Nothing negative was intended.

[Miss Whiplash]

Originally Posted by skeptigirl

The list wasn't for you, it was for everyone. You're taking my posts the wrong way. You have an unnecessary chip on your shoulder. Nothing negative was intended.

Then I apologize. One of the drawbacks of forums is we cannot see how someone is delivering their reply. However, I never have an unnecessary chip on my shoulder. I've found them all necessary at some point.

[Beerina]

Originally Posted by Lamuella

I lived in the UK for 24 years, so they don't want my blood either.

I, too, "lived in Europe for at least 6 months after 1989", or whatever the rule is, so I cannot give blood, either.

I had a tough time tracking down the reason: mad cow disease!

Yes, that's right, they're worried about prions being in our blood. Prions, the newest addition to the germ theory of disease.

[epepke]

Many years ago, a sample of my blood tested for Hep B as well. So I couldn't donate for a year or two. Then they sent me a letter saying that, if I hadn't seroconverted, I could donate again.

It turned out that there was a problem with their testing equipment, and a bunch of samples tested with false positives.

[Soapy Sam]

Under UK rules, we can't donate within 28 days of visiting Canada or the USA.
West Nile Virus.

It can only be a Jungian Synchronicity that the Glasgow Blood Bank is in Nelson Mandela Suare, just off West Nile Street.

[Dragonrock]

Originally Posted by The Painter

They didn't want my blood for one year after going to Haiti.

I've been banned for life after going to Haiti and wandering around a swamp for 4 hours after NOT taking the malaria prevention drugs because I was told that I wasn't going into the swamp.

[Chris Haynes]

For a while they did not want my blood because I had lived in the tropics less than three years before. After that time and I had not shown any symptoms of malaria, I was eligible to give blood (something I need to do next week).

[Roadtoad]

They don't want mine either. I lived in Germany for 7 years. Go fig.

[This Guy]

Originally Posted by Roadtoad

They don't want mine either. I lived in Germany for 7 years. Go fig.

Germany for 7 years! You don't have blood! You have beer!

[elaine]

I've been a regular donor for several years....just got a tattoo last week. Now I have to wait a year.

At least I feel comfortable, the artist was a nut about sterilization.

[davefoc]

skeptigirl,
It was a bit surprising to me that I couldn't find any detailed information about the tests on the internet.

I don't have much experience looking for medical information, perhaps the info I was looking for is only available on paid sites?

I was also interested in the idea that the tests would not have numerical data available. What is the nature of the test such that it wouldn't have a number associated with the result at some point?

As to the suggestion that I should get retested and they might take my blood if the result came back negative :
Not according to the letter I got. I think they made it pretty clear that they didn't want my blood from here on out unless something changed in their procedures with regard to this kind of test results.

As to the idea I might really have Hepatitis and I should be retested to make sure I don't:
I'm not in any of the risk groups. I am very healthy for a 56 year old guy and I just am not going to worry about this, even to the point of getting another test.

I was curious about the test but so far I haven't found any detailed information about the test and the only things I know about it are from what skeptigirl has said and from the little bits of info supplied by the Red Cross designed to convey the minimum amount of information to put forward the idea that they don't really think you're sick.

[Skeptic Ginger]

Taking any lab test you will find a rate of false positives called specificity and a rate of false negatives called sensitivity.

Specificity: The chance a positive is false
Sensitivity: The chance of missing a positive

I don't know which tests were used at your blood bank but here is one example of an HBsAG EIA test. Just as with drugs, there are reagent inserts and reports like this one.

ETI-MAK-4 HBsAG EIA (Product code: N0019); pdf file
Reports false positive rate of 0.2% (95% confidence interval 0-1.1%)

Such reports tell the provider how accurate the tests are and one can add a bit more for operator or equipment error as well.


As far as the number, lots of tests only give a yes or no. They are called qualitative tests. Look at an over the counter pregnancy test for an example. You are either pregnant or you aren't.

Quantitative tests are ordered for many reasons but you don't always need them and they are not always done. Qualitative tests have a threshold which will give you a positive result. When I order hep B vaccination tests, I order Quantitative because it has to be >10 to tell me the vaccine worked. But if I am testing a person who was exposed, I only test for the presence or absence of core antibody. I don't care how high the level is.


The reason you could not find the information you sought wasn't because you had to pay, it was because a search for hep B tests or false positive tests gets you the million hep B information pages for the average inquiry.

Had you done a more specific search knowing to look more for lab test specifics, you would have gotten stuff like the following from Pubmed which hardly makes sense to me so I doubt it would have helped you either. These happen to be abstracts about the confirmation test rather than the screening test but I went from these to the find the above link in my quest for something useful for you.

Quote:

Vox Sang. 2002 Jan;82(1):15-7.

Hepatitis B vaccinees may be mistaken for confirmed hepatitis B surface antigen-positive blood donors.

Dow BC, Yates P, Galea G, Munro H, Buchanan I, Ferguson K.

SNBTS Microbiology Reference Unit, West of Scotland Transfusion Centre, Glasgow, UK. brian.dow@snbts.scot.nhs.uk

BACKGROUND AND OBJECTIVES: Hepatitis B surface antigen (HBsAg) test sensitivities have gradually increased, and neutralizable weak HBsAg-positive donations, with no other hepatitis B virus (HBV) markers, have occasionally been found in our donor population. On investigation, these donors have admitted to receiving hepatitis B vaccine up to 5 days previously. A study was therefore initiated to monitor HBsAg reactivity amongst volunteers after receiving their first dose of hepatitis B vaccine. MATERIALS AND METHODS: Eight volunteers were tested using three HBsAg assays (Abbott Auszyme, Ortho HBsAg-3 and Abbott/Murex GE34/36) on days 0, 3, 5, 7 and 10 after administration of hepatitis B vaccine. RESULTS: Two HBsAg tests (Abbott Auszyme and Ortho HBsAg-3) did not detect HBsAg reactivity amongst the volunteers, although the Abbott Auszyme test results reached 70-80% of the manufacturer's cut-off at day 3 in two volunteers. The most recently launched assay (Abbott/Murex GE 34/36) detected seven (87%) of the eight volunteers as HBsAg reactive on day 3, and two (25%) volunteers were still reactive on day 5. CONCLUSION: The Abbott/Murex GE 34/36 assay demonstrated HBsAg reactivity in most volunteers on day 3 and in some on day 5 after vaccination. It is therefore recommended that individuals who have recently been vaccinated with hepatitis B be deferred from blood donation for at least 7 days.

PMID: 11856462 [PubMed - indexed for MEDLINE]


Clin Chem. 2006 Jun 8; [Epub ahead of print]

Performance of a New-Generation Chemiluminescent Assay for Hepatitis B Surface Antigen.

Chen D, Kaplan LA.

Department of Pathology, New York University, School of Medicine, Clinical Chemistry Laboratory of Bellevue Hospital, New York, NY.

BACKGROUND: The usual criteria for analysis of hepatitis B surface antigen (HBsAg) are detection of HBsAg and result confirmation by antibody neutralization. We observed that with the Immulite 2000 HBsAg assay [Diagnostics Product Corporation (DPC)] a relatively high percentage of weakly reactive (WR) samples did not pass the neutralization step. METHODS: For each of 3 lots of Immulite 2000 HBsAg reagent (DPC), we collected and analyzed HBsAg data from approximately 3000 to 4000 patient blood samples and compared these data with HBsAg data from 3393 samples tested with the Abbott Auszyme assay. For 127 samples with initially WR detection signals (relative signal/cutoff index of 1.00-2.5) on the Immulite 2000 HBsAg assay, we then measured hepatitis B (HB) viral load and/or other HB serologic markers. RESULTS: The Immulite 2000 HBsAg assay produced more initially reactive results than the Abbott Auszyme method. Many of these reactive samples, however, were WR and did not meet the confirmation criteria in the neutralization test. Moreover, DNA PCR testing indicated that 22 of the 38 WR samples (58%) that did meet the confirmation criteria had no detectable HB viral DNA. CONCLUSIONS: Immulite 2000 HBsAg assay results include a unique group of WR samples that are associated with both false-positive and false-negative results, regardless of neutralization status, and require careful interpretation. WR HBsAg samples should be reported as confirmed HBsAg reactive only if the samples not only meet the neutralization criteria but also are positive other HB serologic markers such as anti-HB core total and anti-HB core IgM.

PMID: 16762998 [PubMed - as supplied by publisher]


J Virol Methods. 2006 Jul;135(1):109-17. Epub 2006 Mar 29.

Evaluation of a new automated assay for hepatitis B surface antigen (HBsAg) detection VIDAS HBsAg Ultra.

Weber B, Van der Taelem-Brule N, Berger A, Simon F, Geudin M, Ritter J.

Laboratoires Reunis, Junglinster, Luxembourg, Germany. web@labo.lu

In a multicenter study a new automated screening assay, VIDAS HBsAg Ultra (long (L) and short (S) incubation protocol (Biomerieux, Marcy l'Etoile, France), was compared to a well established test (AxSYM HBsAg v2, Abbott Diagnostics, Wiesbaden, Germany) for the detection of hepatitis B virus (HBV) surface antigen (HBsAg). A total of 32 seroconversion panels, sera from the chronic phase of infection, dilution series of the WHO standard, S gene mutants (recombinant mutants and diluted and undiluted sera harbouring mutants with single or multiple amino acid (aa) substitutions, n = 40) and isolated anti-HBc positive samples were tested for the evaluation of sensitivity. Sera from HBsAg negative blood donors, pregnant women, hospitalized patients and potentially cross-reactive samples were investigated to determine the specificity of the new assay. The VIDAS HBsAg Ultra (L+S) had a higher sensitivity than the alternative assay for the detection of acute hepatitis B in seroconversion panels. The mean time of the diagnostic window was shortened with the VIDAS HBsAg Ultra (L) and (S) in comparison with the AxSYM HBsAg v2 by 1.06 and 0.66 days, respectively. The VIDAS HBsAg Ultra (L) did not detect one diluted sample out of six bearing the single aa G145R substitution, and two out of 12 diluted samples harbouring multiple aa substitutions. The analytical sensitivity of the assays varied from one surface mutant to another. While no false positive results were obtained with the VIDAS HBsAg Ultra (L+S) among potentially interfering samples, four false positives were detected with the AxSYM HBsAg v2. The respective values for sensitivity for the VIDAS HBsAg Ultra (L), (S) and the AxSYM HBsAg v2 were 99.07%, 97.87% and 94.14%. The specificities were 100% (VIDAS HBsAg Ultra L and S) and 99.6% (AxSYM HBsAg v2). In conclusion, the VIDAS HBsAg Ultra is highly sensitive and specific and represents an improvement for the detection of HBsAg in routine diagnostic laboratories.

PMID: 16567005 [PubMed - in process]

[Eos of the Eons]

I was denied once for testing low on blood iron. They gave me a pamphlet on how to raise my blood iron levels.

Suggestions include:

-Eat or drink something rich in vitamin C when eating the iron source. This means orange juice with steak, or a snack of raisins and almonds/nuts. I love spinach salad.

-Avoid caffeine around meals or the iron rich snacks. Caffeine interferes with iron absorption. I remember to not drink coffee for an hour before or after meals.

I've been able to donate every time after following their suggestions.

[Amraann]

I would not be begging for them to take my blood.
If they denied you then your off the hook. You did mention that your wife "guilted" you into it?

I personally take issue with my donating anything that makes someone else a ton of money. My blood may help someone but that someone is going to be paying a hell of a lot for getting it. ( to a hospital or DR for giving it) In most cases the DR isn't "donating" his or her time.
My hair to Locks of Love! OMG look up their history! Not even in good standing with the BBB. They have yet to explain why they recieve SOOOO much hair and donate sooo few wigs to little cancer patience..
Also Many donate and don't realize that LOL (locks of Love) doesn't take gray nor chemically treated hair.

[Skeptic Ginger]

Originally Posted by Amraann

I would not be begging for them to take my blood.
If they denied you then your off the hook. You did mention that your wife "guilted" you into it?

I personally take issue with my donating anything that makes someone else a ton of money. My blood may help someone but that someone is going to be paying a hell of a lot for getting it. ( to a hospital or DR for giving it) In most cases the DR isn't "donating" his or her time.
My hair to Locks of Love! OMG look up their history! Not even in good standing with the BBB. They have yet to explain why they recieve SOOOO much hair and donate sooo few wigs to little cancer patience..
Also Many donate and don't realize that LOL (locks of Love) doesn't take gray nor chemically treated hair.

To my knowledge no one makes a profit off donated blood unless you consider the profit to labs for testing it.

This publication was prepared by America's Blood Centers and Pall Corporation.

Quote:

If nearly all blood comes from volunteers, why is there a charge?

While blood is donated at no cost by volunteers, blood centers charge a fee to cover the costs of recruiting blood donors and collecting, testing and distributing blood to hospitals. These "service fees" also apply when you're donating blood for your own use.

Hospitals also charge a fee for laboratory work, which makes sure the donated blood matches your blood type and for the transfusion procedure itself.

BTW, the reason you don't get paid for blood donations is to protect the blood supply from people who would otherwise lie about risk factors to get money for donating. You can get paid for donating at centers that use the blood for blood products and treat it for viruses before using it.

[Chris Haynes]

Originally Posted by Amraann

...My hair to Locks of Love! OMG look up their history! Not even in good standing with the BBB. They have yet to explain why they recieve SOOOO much hair and donate sooo few wigs to little cancer patience..
Also Many donate and don't realize that LOL (locks of Love) doesn't take gray nor chemically treated hair.

Perhaps it is good that the last time I gave my hair to "Wigs for Kids". I tried Locks of Love, but was annoyed that the hair salon charged me for shipping and gave me a crummy haircut! So I cut my hair myself last time!

Oops... off topic. sorry

Back on topic... this was an interesting series of programs about blood, blood products and giving blood (and yes, I do plan to give my A+ blood to the Puget Sound Blood Bank somewhere between chauffering kids to summer classes!):
http://www.pbs.org/wnet/redgold/

[Skeptic Ginger]

We sent my son's hair to Locks of Love. The barber suggested it but didn't send it for us. I hadn't heard of Wigs for Kids.

The web site was clear about non-chem treated and who would think a kid with cancer would want a gray hair wig?

If we have another opportunity, I'll look into the W for K site.

[davefoc]

I have had a thought about where I might have gotten some kind of infection that perhaps was responsible for Hepatitis B.

I do quite a bit of plumbing work on an old apartment building and that occasionaly involves contact with various undesirable fludis. Any possibility that something like that might have led to a false positive or even a real possitive?

[wilks]

Originally Posted by davefoc

I have had a thought about where I might have gotten some kind of infection that perhaps was responsible for Hepatitis B.

I do quite a bit of plumbing work on an old apartment building and that occasionaly involves contact with various undesirable fludis. Any possibility that something like that might have led to a false positive or even a real possitive?

If you were coming in to contact with blood or body fluids then it is a possibility via wounds or broken skin.