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Year : 2014 | Volume : 2 | Issue : 1 | Page : 19 - 22  


Original Articles
Prevalence of Transfusion Transmissible Infections in a Hospital Attached Blood Bank

Kandukuri Mahesh Kumar1, Sudhir Kumar Vujhini2, V. Indira3, V. Harishanker4

1Assistant Professor, 2Associate Professor, 3Prof & HOD, 4Professor, Dept. of Pathology, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad.

Abstract                 

Background: Screening of transfusion-transmissible infections (TTIs) among blood donors is a cost-effective approach to monitor the prevalence, distribution, and trends of the infections among healthy-looking individuals. The study aimed to determine the seroprevalence of four TTIs, human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis, among blood donors in a hospital attached blood bank , suraram , hyderabad.

Objectives: The present study was conducted to estimate the prevalence of transfusion transmitted infections in blood donors in a small scale hospital attached blood bank.

Methods: All the donors reporting to the blood bank were screened for HBsAg, Hepatitis C Virus (HCV), HIV by using the appropriate enzyme-linked immunosorbent assay (ELISA).The Venereal Disease Reference Laboratory (VDRL) test / Rapid Plasma Reagin Test was used for estimation of syphilis infection.

Results: The study was designed for duration of two years from January 2012 to December 2013.

A total of 2039 blood donors were screened, of which voluntary donors were 644 (33 %) replacement donors were 1369 (67 %). Seroprevalence in 2012 prevalence rate for HIV, HBV, HCV and Syphilis were 0.62%, 2.04%, 1.53%, and 1.47% respectively. In 2013 prevalence rates for HIV, HBV, HCV and Syphilis were 0.66%, 2.47%, 1.70% and 1.15%. Blood is still one of the main sources of transmission of infections. HIV, hepatitis B, hepatitis C viruses and syphilis are prevalent among blood donors.

Conclusion: Voluntary donations are safer when compared to replacement donors. Replacement donations are to be discouraged and promotion of voluntary blood donation should be done.

Our study shows is an increase in HBV prevalence, especially among replacement males above 30 years of age.

Key Words: Sero-prevalence, Transfusion transmissible infections, Blood donors, HIV, HBV, HCV, Syphilis.

Corresponding Author : Kandukuri Mahesh Kumar, Assistant Professor Of Pathology, Malla Reddy Institute Of Medical Sciences, Suraram , Hyderabad. Email: doctormaheshgoud@gmail.com

Introduction:  

Blood transfusion, an integral part of medicine and surgery, also carries the risk of transfusion-transmissible infections like Hepatitis B and C, HIV and Syphilis, malaria and infrequently toxoplasmosis, brucellosis and viral infections like Cytomegalovirus (CMV), Epstein Barr Virus (EBV) and Herpes. Measuring their severity, WHO has recommended pre-transfusion blood test for HIV, HBV, HCV and Syphilis as mandatory. All these diseases are capable of causing significant mortality, morbidity along with a financial burden for both the affected person and the country. With every one unit of blood transfusion there is 1% chance of transfusion related complications including Transfusion transmitted infections. An increase in Transfusion related infections has been reported in India. [1] India is already carrying a burden of 50 million of HBV carriers and 2.27 million of HIV cases. Keeping in mind the grave consequences of these infections and to restrain the transmission to minimum, it is very important to remain vigilant about the possible spread of these diseases through blood transfusion. In our study, we aimed to estimate the prevalence of HIV, HBV, HCV and Syphilis among blood donors of Malla Reddy hospital blood bank, Suraram, Hyderabad. It would also reflect on the blood safety measurements and can be carefully extended to provide estimation about the disease burden in the community. Ours is a two consecutive years study to identify the trend of increase or decrease among these Transfusion transmissible infections (TTIs) /diseases.

Materials and Methods:

Blood was collected from healthy donors through blood camps organized by voluntary organizations, voluntary and replacement donors and motivated student bodies including the students of Malla Reddy Institute of Medical Sciences (MRIMS), Suraram, Hyderabad. Name, age (18-55 years), Sex, date of birth, address and contact numbers were recorded for each donor, while giving them a unique identification number. Donors with history of any febrile illness in the recent past, weight loss, uncontrolled diarrhea, recent jaundice, liver disease, cardiovascular disease, pulmonary disease, malignancy, epilepsy, malaria, unusual or excessive bleeding, recent donation of blood, receipt of blood, and taking contraindicated drugs were excluded. Detailed history of immunization was taken. Weight, pulse, blood pressure and temperature were recorded for each patient. Screening for anemia was done clinically along with laboratory methods. Inspection was made for any marks of drug abuse or any skin lesions/ infections at the venepuncture site. A written informed consent was taken from each patient before the blood donation. Proper sterilization and other precautions were taken during the blood collection and blood units were stored by appropriate methods.

After collection all samples were screened for Human Immunodeficiency Virus I & II: By microwell ELISA to detect antibodies against HIV I & II in plasma. Hepatitis B Virus: By microwell ELISA, Hepatitis C Virus: By microwell ELISA and Treponema Pallidum: Detection of Treponemal Antibodies (Reagin) by Rapid Plasma Reagin Test.

Results:

A total of 2039 units of blood were collected during the period of January 2012 to December 2013 (Fig. 1). Donors were subdivided into three age groups between 18-29 years, 30-44 years and 45-55 years. Maximum donors were from the age group of 18-29 years in our study (Fig. 2). In 2012 prevalence rate for HIV, HBV, HCV and Syphilis were 0.62%, 2.04%, 1.53%, and 1.47% respectively (Fig. 3).

In 2013 prevalence rates for HIV, HBV, HCV and Syphilis were 0.66%, 2.47%, 1.70% and 1.15%. In relative risk analysis significant statistical difference were found in case of HBV and Syphilis; HBV cases increased, Syphilis cases decreased when comparison was made between the two years (Fig. 4). Frequency of co-infection among these viruses was negligible (Fig. 5). Co-infection is the infection with more than one infective agent occuring in a single donor which can be detected by screening methods. In our study, we screened three donors with co-infection. Two donors with HIV - HbsAg and one donor with co-infection of HCV – HbsAg were there. Incidence of TTIs age-wise is shown in Fig. 6. The TTIs are more common in the age group of 30- 44 years, least in the age group of 18- 29 years. Seroprevalence of TTIs was higher among male donors in the age group 30-44 years. TTIs considered for this study can be transmitted by sexual route, sharing of infected needles and syringes by drug abusers. The findings could indicate some risk behaviours of males, such as outside socialization, multiple sex relationships, etc. when compared to female donors and young donors.

Figure 1: Total blood donation year wise

Figure: 2: Age wise distribution of blood donors

Figure 3: Prevalence of Transfusion Transmissible Infections (TTI s) in 2012

Figure 4: Prevalence of Transfusion Transmissible Infections (TTI s) in 2013

Figure 5: Prevalence of Co-Infection among blood donors

Figure 6: Age wise distribution of Transfusion Transmissible Infections (TTI s) among blood donors

Discussion:

Most of the donors, who were included in this study, were between the age group 18-29 years. It may reflect proper awareness among the young population about blood donation. Percentages of female donors have been low for both the years. In case of HBsAg there was a statistically significant increase in the prevalence (2.47% when compared to 2.04 % in 2012) and there was a decrease in the trend for the prevalence of syphilis (1.15 % when compared to 1.47 % in 2013). But it is very important to take care about sex and age distribution of these infections. When we stratified the data on the basis of sex and age we found that for HBsAg the prevalence rate was statistically significant only for male population above 30 years of age. Similar trend was present in the syphilis also. This data suggests we have to be more careful about the prevalence of HBsAg in male population over 30 years. On the other hand, it was an encouraging sign that prevalence of Syphilis decreased in the same population.

A total number of 54 units of blood were discarded due to presence of Transfusion transmissible Infections (TTIs) from the above pathogens. More stringent criteria for proper donor selection may help to cut down the wastage.

Testing the blood serum for various antibodies and more conservative guidelines for blood transfusion have been effective and have successfully brought down the transmission rate. Inability of the serological tests to detect the diseases in their window period and virus immunological variants is a major drawback in making the preventive approaches more effective. Earlier studies have shown that even HBsAg negative bloods may be anti-HBcIg/ HBV DNA positive and may retain the capacity to transmit infection. [2] Presence of occult HBV infection has also been reported from various parts of India. [3, 4, and 5] As a result TTI still remains a concern for both the patient and the treating physician.

Previous studies have reported that prevalence of an infection among the donors reflects the disease burden in the society. [6] The prevalence rate obtained from this study found to be a bit higher from various previous reports. [4, 7, and 8] This may be due to variation in the population or may reflect an increased burden of infection in the community. Increased prevalence of HBV among the donors underscores the concern about growing infection of this disease in the community. In India transfusion associated HBV is estimated to be approximately 50% or more in multiple transfused patients and approximately 1.5% in post surgical recipients. Thus the absence of HBsAg in the blood of apparently healthy individuals may not be sufficient to ensure lack of circulating HBV. More appropriate methods need to be applied to find out the exact scenario.

 

The risk of TTI has declined in developed countries with the use of 3rd and 4th generation ELISA kits and advent of NAT (Nucleic acid Amplification Testing). It is used to detect very low levels of DNA or RNA that may be present in donated blood. NAT test reduces window period by direct detection of viral nucleic acid sequences and it reduces the time for effective detection from 22 days of serological identification to 11 days for HIV, 70 to <10 days for HCV, 56 days to less than 21days for HBV. By the practice of donor self-exclusion helps in the deferral of high risk donors. Due to low socioeconomic status and lack of awareness of risk factors, the implementation of donor self-exclusion is difficult in India. Replacement donors constitute the largest group of Blood donors in India, which reflects the lack of awareness among the general population. The strict selection of donor, screening with standard methods and promoting more of voluntary blood donation would reduce the prevalence of Transfusion Transmitted Infections (TTIs).

 

Conclusion:

There was an increase in HBV prevalence, especially among replacement males above 30 years of age. Replacement donations are to be discouraged and promotion of voluntary blood donation can be done through Educational and Motivational Programmes and involvement of Government bodies like National Aids Control Organization (NACO) & Andhra Pradesh State AIDS Control Society (APSACS). Women can also be encouraged for voluntary blood donation. Voluntary blood donation has to be made as a part of healthy lifestyle, enlightening the public about the benefits of voluntary blood donations. Voluntary donations are safer as compared to replacement donors and should be encouraged. Based on the results of our study TTI can be reduced by strict selection of donors and NAT Donor screening can be implemented in blood banks all over India.

 

References:

  1. Rose D, Sudarsanam A, Padankatti T, Babu PG, John TJ. Increasing Prevalence of HIV antibody among blood donors monitored over 9 years in blood donors monitored over 9 years in blood banks. Indian J Med Res. 1998;108:42-4.
  2. Hennig H, Puchta I, Luhm J, Schlenke P, Goerg S, Kirchner H.Frequency and load of hepatitis B virus DN in first-time blood donors with antibodies to hepatitis B core antigen. Blood. 2002;100(7):2637-41.
  3. Chaudhuri V, Nanu A, Panda SK, Chand P. Evaluation of serologic screening of blood donors in India reveals a lack of correlation between anti-HBc titre and PCR-amplified HBV DNA. Transfusion. 2003;43(10):1442-8.
  4. Bhattacharya P, Chandra PK, Datta S, Banerjee A, Chakraborty S, Rajendran K et al. Significant increase in HBV, HCV, HIV and syphilis infections among blood donors in West Bengal, Eastern India 2004-2005: exploratory screening reveals high frequency of occult HBV infection. World J Gastroenterol. 2007;13(27):3730-3.
  5. Behzad-Behbahani A, Mafi-Nejad A, Tabei SZ, Lankarani KB, Torab A, Moaddeb A. Anti-HBc & HBV-DNA detection in blood donors negative for hepatitis B virus surface antigen in reducing risk of transfusion associated HBV infection. Indian J Med Res. 2006;123(1):37-42.
  6. Shukla RS, Bhuyan KK. Can Data on HIV Sero­reactivity among Blood Donors Provide an Insight into HIV Prevalence in the General Population?. Indian J Public Health. 2007;51(1):14-2 1.
  7. Srikrishna A, Sitalakshmi S, Damodar P. How safe are ours safe donors? Indian J Pathol Microbiol. 1999;42(4):411-6.
  8. Arora D, Arora B, Khetarpal A. Seroprevalence of HIV, HBV, HCV and Syphilis in blood donors in Southern Haryan. Indian J Pathol Microbiol. 2010;53(2):308-9.

Source of Support: Nil. Conflict of Interest: None.





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