Prevalence Of Transfusion Transmitted Infections Research Articles

Seroprevalence of transfusion transmissible infections among blood donors by chemiluminescent assay in a tertiary care centre

Blood transfusion is a life saving measure, but also carries risk of transfusion transmitted infections (TTIs). In spite of improved donor screening, risk of transmission of TTIs still remains a major concern. Stringent screening of blood not only ensures safe supply of blood and blood products, but also gives us an idea about prevalence of TTIs among general population. Blood donors (voluntary and replacement), fulfilling national and regional blood bank criteria, attended our blood bank, during Jan 2015-Dec 2016 (included). Retrospective data analysis was performed by a structured database. After obtaining informed consent, venous blood was collected and analysed for HBsAg, anti-HCV and Anti-HIV1 and 2 (Chemiluminescent assay -OrthoVitrosECi/ECiQ), Malaria (ICT-pf/pan-Alere) and Syphilis (RPR-Labcare Dignotics). A total of 9027 donors were screened; Males and females were 99.23% and 0.76% respectively with the mean age of 27.4 ± 2 years (19-58 years). Voluntary donors were 68.7%; replacement donors 31.3%. Voluntary donation increased by 3% in 2016 (69.7%) vs 2015 (67.1%). TTI prevalence was 1.12% (102/9027). Surprisingly prevalence was higher among voluntary donors, females and 21-30 years. Seroprevalence of HBV (0.42%), HIV (0.13%), and Malaria (0.01%), in our region was relatively inferior than other parts of country. Nonetheless, HCV (0.56%) infections were on the rise. No syphilis case was reported. Low seropositivity rate is believed to be attributed to improved counselling of blood donors, adherence to standard donor selection criteria and rational use of blood. Even though low prevalence, effective control strategies including stringent screening, implementation of more sensitive tests and health education are urgently needed to prevent those TTIs.

Prevalence and trends of transfusion-transmittable infections among blood donors in Southwest China.

The high prevalence of transfusion-transmitted infections (TTIs) is causing serious harm to human health worldwide. The aim of this research was to assess the prevalence and influencing factors of TTIs in Southwest China. A retrospective study of blood donor records from January 2008 to December 2015 was conducted. All samples were screened for HBV, HCV, HIV and syphilis. The donor's data was recorded and analyzed statistically using SPSS software. We revealed that the prevalence of TTIs showed a decreasing trend from 2.39 to 1.98%, and this was slightly lower than that in other regions of China. Syphilis infection was the most serious issue among blood donors in Southwest China, which demonstrated a significantly higher rate than that in other areas of China. The high infection rate of the female and farmer groups in rural regions is worth noting. The logistic regression model showed that age, occupation and donor category was the influential factors for TTIs. The overall prevalence of TTIs demonstrated a decreasing trend from 2008 to 2015 in Southwest China, but there is still a sufficient threat to blood safety, and more efforts are needed to further guarantee blood safety in China.

Prevalence of Transfusion Transmitted Infections among Blood Donors at a Tertiary care Teaching Hospital in Southern Rajasthan

Background: Safe blood transfusion is of utmost importance as an unsafe blood transfusion bears lot of burden on human life and economy. Amongst the blood transfusion complications, transmission of certain infections like HIV, Hepatitis B, Hepatitis C and Syphilis are most significant for the long term detrimental side effects. The present study was carried out with an aim to assess the trend and seroprevalence of transfusion transmitted infections (TTIs) among blood donors at our blood bank. Methods: The present retrospective study was carried out at blood bank attached to Pacific Medical College and Hospital, Udaipur, Rajasthan after ethical committee approval. Data regarding sex of the donor, type of donors and screening test results were collected from the records of blood bank over a period of 3 years (May 2014 - June 2016). Result: Total 2015 donors were registered of which 1944 (96.5%) were males and 71 (3.5%) were females. Replacement donors (68.7%) were more compared to voluntary donors (31.3%). Overall prevalence of TTIs in our blood bank is 2.38% of which prevalence of Syphilis (1.2%) was highest followed by HBV (0.89%), HIV (0.14%), and Malaria (0.1%). Conclusion: TTIs were more common in replacement donors than in voluntary donors, hence more voluntary donations need to be encouraged. Extensive donor screening by more sensitive methods to detect infections early can reduce the risk of TTIs. Despite high financial cost, adoption of newer screening methods like NAT can help in reducing the prevalence rate of TTIs to a large extent. DOI: 10.21276/APALM.1095

The prevalence of transfusion transmitted infections: A focus on hepatitis B virus among blood donors at Hawassa blood bank center, Southern Ethiopia

Aims: Millions of lives are saved each year through blood transfusion but a safe blood supply is a critical component of health care to prevent the spread of blood-borne infectious diseases. Therefore, it is essential to assess the prevalence and identify the most common culprit and risk in transfusion services. Methods: A cross-sectional study was conducted from April 2015 to May 2015 at the Hawassa blood bank center. Blood donors who donated blood for transfusion purposes were considered for the study. Whole blood was collected and serum was separated from each donor. The sera were used for examination of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis. Thick film was prepared and stained using Giemsa for malaria detection. Results: A total of 384 blood donors were screened during the study period. Among these donors, 67.2% (258) were males and 32.8% (126) were females. The overall prevalence of transfusion transmitted infections (TTI) was 28 out of 384 (7.29%) apparently healthy donors. The seroprevalence of HIV, HBV, HCV, syphilis and malaria was 6 (1.6%), 16 (4.2%), 2 (0.5%), 3 (0.8%) and 1 (0.3%) respectively. Two out of 384 (0.5%) had co-infections with HIV-HBV 1 (0.26%) and HBV-HCV 1 (0.26%). A 1:14 ratio (7.14%) of the blood collected was discarded only due to the presence of TTI. The highest discard rate was recorded from HBV infected units 57.1%, followed by HIV 21.40%, syphilis 10.7%, HCV 7.10%, and malaria 3.60%. Overall, TTIs were found in males (7.8%), married (2.5%), rural (8%), private/NGO employed donors (28.6%), 45–54 age group (20%), and in replacement/family donors (16.1%) (p = 0.039). Conclusion: Conclusion: The prevalence of TTIs in the Hawassa blood bank center was significantly high. HBV infection was the major cause for TTIs. Recommendations: Overall, effective clinical and laboratory screening of blood donors is essential. Proper treatment of TTI positive cases and a good donor selection program will help to reduce the prevalence of TTIs in donor units. Blood bank programs should give much more consideration in screening and diagnosis of HBV which is the main TTI that causes a high discard rate of blood.

Seroprevalence of transfusion transmitted infection among blood donors at Jijiga blood bank, Eastern Ethiopia: retrospective 4 years study.

BackgroundA transfusion transmissible infection (TTI) is any infection that is transmissible from person to- person through parenteral administration of blood or blood products. The magnitude of transfusion-transmitted infections (TTI) varies from country to country depending on TTI’s load in that particular population. Measuring their severity, WHO (World Health Organization) has recommended pre-transfusion blood test for Human immunodeficiency virus (HIV), Hepatitis B virus (HBV), Hepatitis C Virus (HCV) and Syphilis as mandatory. The aim of the current study was to assess the trend and prevalence of TTI among blood donors in Jijiga Blood Bank between 2010 and 2013.MethodsA Retrospective cross-sectional study was conducted by reviewing the records from 2010 to 2013 at Jijiga Blood Bank. All blood donors who presented to the blood bank and screened for TTI during the study period were included. The data was collected, entered and analyzed using Epi Info 3.5.1 & Microsoft Excel 2007. The descriptive statistics were determined in means of percentages. Chi-square was used for trend analysis and p-value was used to declare the statistical significance between the variable.ResultThere were a total of 4224 people donated blood during study period. Males formed the majority of the donor population accounting for 4171 (98.7 %). Majority 4139 (98 %) of donors were Replacement donors. The overall prevalence of transfusion-transmitted infection was 487/4224 (11.5 %). The prevalence for HBsAg, HCV, HIV, & Syphilis antibodies was 460 (10. 9 %), 17 (0.4 %), 6 (0.1 %) and 4 (0.1 %) respectively. Majority 460/487 (94.5 %) of infection was HBsAg. Statistically significant difference was observed in number of donation as well as sero-positivity from year 2010 to 2013 (Chi-square 9.24, p value = 0.02), in Trends of HBsAg from year to year (Chi-square 11.14, p value = 0.01), HIV virus was seen as the age of donors increases (Chi-square 8.37, p value = 0.01) and There was also statistically significance difference (p value = 0.01) in prevalence of HBsAg distribution by sex.ConclusionThe present study clearly documents high Seroprevalence (487 out of 4,224, 11.5 %) of TTI, low percentage of voluntary donors and low participation of female donors. Promoting the culture of voluntary donors, recruitment of female blood donors and proper testing of donor’s blood by using standard methods are recommended.

Study of prevalence of seropositivity in multi-transfused thalassemia patients - A hospital based study

Background: Thalassemia is an inherited hemoglobinopathy for which blood transfusion is an obligatory treatment. However, blood transfusion has its own adverse effects among which transfusion transmitted infections (TTIs) are major threat to the patients. Objective: To evaluate the seroprevalence of various TTIs in thalassemia patients. It also aims to correlate age group and prevalence of TTIs. Materials and Methods: In this study, a total of 55 beta thalassemia major patients attending C U Shah Medical College, Surendranagar, Gujarat, India, were screened for human immunodeficiency virus (HIV)-1 and HIV-2 IgG and IgM antibodies, hepatitis C virus (HCV) IgG antibody, HBsAg antigen, and IgG antibodies against Treponema pallidum using National AIDS Control Organization approved third generation enzyme-linked immunosorbent assay (ELISA) kits. Selected clinical, sociodemographic, and other characteristics were also recorded to understand the determinants of risks of these infections. Result: It was observed that of the total 55 patients, 2 (3.63%) were HIV reactive, 20 (36.36%) were HCV reactive, and none was found to be hepatitis B virus or venereal disease research laboratory reactive. Conclusion: To reduce the incidence of TTIs, especially HCV and HIV, stringent screening of donor should be done with fourth generation ELISA methods, polymerase chain reaction, or nucleic acid amplification techniques.

A study on transfusion transmitted infections (TTIs), transfusion-related complications, and quality of life among the beta-thalassemia major patients in Jamnagar district

Background: Thalassemia is considered the most common genetic disorder worldwide. The condition affects economical and psychosocial quality of life of whole family broadly. It is a serious public health issue throughout Indian subcontinent and southeast Asia. Objective: (1) To study the prevalence of transfusion transmitted infections (TTIs) in patients of beta-thalassemia major who are on transfusion therapy, (2) to assess the complications of iron overload and complications owing to chelation therapy, and (3) to study psychosocial and economic burden on patients’ family. Materials and Methods: This cross-sectional study was conducted in Thalassemia ward of Pediatric Department from December 2010 to December 2011. All the patients of beta thalassemia major on blood transfusion therapy were included in the study. Preformed, pretested questionnaire was used to interview the patients and their caretakers. Data entry and analysis were done using Microsoft Excel 2007 and SPSS software, version 17. Result: Prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) was 3.95%, 2.25%, and 2.25%, respectively. Six in every 10 patients ever have experienced from blood transfusion reactions. Almost 40% patients had left the studies owing to illness or they have not gone to school ever. Conclusion: Even after introduction of sensitive screening test, prevalence of TTIs is more in patients than general population. Quality of life is affected economically and psychosocially.

Prevalence and Trends of Common Transfusion Transmitted Infections Using Serological and Nucleic Acid Markers in Saudi Blood Donors

Background: Epidemiologic studies on the prevalence of transfusion-transmitted infections (TTIs) in Saudi Arabia (SA) regions are limited. This study investigated prevalence of HBV, HCV, and HIV using both serological and nucleic acid testing (NAT) methods to determine temporal and geographic trends among blood donors in Makkah. Our secondary objective was to realize the most suitable NAT format, without compromising sensitivity of NAT results by using individualized or mini-pool testing. Methods: Serologic and NAT screening records of 22,963 blood donors from January 2011 to December 2014 were evaluated for HBsAg, Anti-HBc, Anti-HCV, Anti-HIV, HBV-DNA, HCV-RNA, and HIV-RNA. Prevalence rates were calculated for TTIs per hundred donations and additional analysis was conducted to examine donor profiles associated with positive serologic and NAT results. Known viral loads (<20 IU/ml for each HBV and HCV and <50 copies/ml HIV) diluted in negative plasma were evaluated by NAT screening. Results: Overall serological prevalence of HBs-Ag, anti-HBc, anti-HCV, and anti-HIV were 0.7, 6.7, 0.44, and 0.07%, while molecular HBV-DNA, HCV-RNA, and HIV-RNA were 0.72, 0.05, and 0.03% respectively. There was a gradual decline in percentage of infected donor blood based on combined serological and/or NAT screening from 8.3% in 2011 to 6.8% in 2014 with an overall 7.4% (n=1,689) TTI-infected. Prevalence of HBV, HCV and HIV was unevenly distributed among different regions in SA. Analysis of donor serologic and molecular profiles revealed solitary anti-HBc- positive was the highest (6%) donor profile followed by anti-HBc-positive/HbsAg-positive/HBVDNA positive donor profile at 0.6%, and solitary anti-HCV at 0.4%. Simulation of mini-pool NAT format by dilution of known viral loads at 1:6, resulted in 70% reduction in HBV detection, 50% for HCV, and 40% for HIV. Conclusions: This is the first study to provide current data collectively comparing prevalence and trends of HBV, HCV, and HIV serologic and nucleic acid markers amongst Saudi blood donors. Makkah boasts one of the lowest TTIs prevalence in SA and to surrounding countries. The majority of seropositive and NAT-reactive blood donors are in a state of acute, chronic or resolved HBV infection. Individual donor NAT is the ideal methodology that should be applied in SA where diluted samples could compromise clinical sensitivity and blood safety.

The Prevalence of Transfusion Transmitted Infections in ABO Blood Groups and Rh Type System.

Screening of blood and blood products is important to reduce the risk of transfusion transmitted infections (TTIs). The transfusion of unscreened or inadequately screened blood and blood products are the major source of TTIs. The aim of this paper is to find out the prevalence of TTIs in ABO blood groups and Rh type system. A total of 4128 blood donors were screened from January 2010 to April 2014. Serological tests were performed for hepatitis B surface antigen (HBsAg), anti hepatitis C virus (Anti-HCV), anti HIV-1 and 2, venereal disease research Laboratory test (VDRL) and malaria parasite (MP) antigen. In seroreactive donors, HBsAg, Anti-HCV, VDRL, MP antigen and anti HIV were positive in 40 cases, 26 cases, 19 cases, 6 cases and 2 cases, respectively. Highest percentage of HBsAg, Anti HCV, VDRL, MP antigen and anti HIV was observed in blood group A negative (2/50), O negative (1/66), B negative (1/91), AB positive (2/377) blood group respectively. In the present study, the total number of Rhnegative donors is lower when compared to Rh-positive blood donors, but Rh-negative blood donors show higher percentages of seroreactivity for TTIs. Larger scale studies at molecular level are required to improve the knowledge of this aspect.

Going beyond “same-for-all” testing of infectious agents in donated blood

Blood products, derived from donated blood, are essential for many medical treatments, and their safety, in terms of being free of Transfusion-Transmitted Infections (TTIs)—i.e., infectious agents that can be spread through their use—is crucial. However, blood screening tests are not perfectly reliable and may produce false negative or false-positive results. Currently, blood donations are tested using a same-for-all testing scheme, where a single test set is used on all blood donations. This article studies differential testing schemes, which may involve multiple test sets, each applied to a randomly selected fraction of the donated blood. Thus, although each blood donation is still tested by a single test set, multiple test sets may be used by the Blood Center. This problem is modeled within an optimization framework and a novel solution methodology is provided that allows important structural properties of such testing schemes to be characterized. It is shown that an optimal differential testing scheme consists of at most two test sets, and such a dual-test scheme can significantly reduce the TTI risk over the current same-for-all testing. The presented analysis leads to an efficient greedy algorithm that generates the optimal differential test sets for a range of budgets to inform the decision-maker (e.g., Blood Center). The differential model is extended to the case where different test sets can be used on sub-sets of donations defined by donation characteristics (e.g., donor demographics, seasonality, or region) that differentiate the sub-set’s TTI prevalence rates. The risk reduction potential of differential testing is quantified through two case studies that use published data from Sub-Saharan Africa and the United States. The study generates key insight into public policy decision making on the design of blood screening schemes.

A 10 Years Comparative Study to Assess Trends in Seroprevalence of Transfusion Transmitted Infections among Blood Donors at Gwalior, India

Introduction: Transfusion Transmitted Infections (TTIs) threaten safety of the recipients and the community as a whole and are the subject of real concern worldwide. Aims and Objectives: To know the prevalence of transfusion transmitted infections amongst the blood donors, to evaluate the changing trends of TTIs and to compare these observations within the study as well as with the other relevant studies. Place and Duration of Study: This study was carried out at Blood Bank, Department of Pathology, Gajra Raja Medical College, Gwalior, India, from January 2004 to December 2013 (ten years). Materials and Methods: In this study 122,006 voluntary and replacement donations were screened for TTIs; HIV, HBV, HCV, Syphilis, Malaria and their seroprevalence was calculated. Further study was divided in Group “A” (from 2004 to 2008) and Group “B” (from 2009 to 2013) to compare the results. Results: Out of total 122,006 blood units collected, 79,750 (65.3%) were voluntary and 42,256 (34.7%) were replacement donors. The seropositivity of TTIs in the entire study, in group “A” and in Group “B” was 3.26% (3985/122,006) (p = 0.000005), 2.25% (1238/54,874) (p = 0.000005) and 4.09% (2747/67,123) (p = 0.000005) respectively. In Group “A” and “B” seroprevalence of HIV, HBV, HCV, Syphilis and Malaria was 0.29%, 1.16%, 0.61%, 0.06%, 0.11% and 0.13%, 3.15%, 0.24%, 0.17%, 0.03% respectively. Conclusion: Our study concluded that there was significant increase in seroprevalence of HBV and syphilis whereas decreasing pattern in HIV, HCV and Malaria was observed in last five years as compared to previous five years among the blood donors.

Transfusion Transmitted Infections in Indian Thalassemics: A Perspective

To the Editor, We read with interest the paper entitled “Blood transfusion transmitted infections in multiple blood transfused patients of beta thalassemia” by Vidja et al. [1] in your esteemed journal. Patients with thalassemia major require chronic blood transfusion and thus they are at serious risk of transfusion transmitted viral infections. There are several studies on prevalence of transfusion transmitted infections (TTI) in thalassemics from this country [2–5]. To put in proper perspectives these studies can be classified into three groups. (i) Those conducted prior to or within 2–3 years of Supreme Court order for mandatory testing for HIV. (ii) Those published between 1995 and 2002 when mandatory testing for HCV by serological technique that was not in force but HIV testing was a must. (iii) Post 2002 when serological screening of all three viruses i.e. HIV, hepatitis B and C were under taken in multitransfused thalassemic patients. Studies conducted in and around 1988 showed extremely high prevalence of HIV infection in the range of 14–18 % among multitransfused thalassemic patients [2, 3] while prevalence of hepatitis B and C virus infection remained at 14 and 25–38 %, respectively [4, 5]. Post 2002 studies [1, 6, 7] including the present one show interesting data. In the present study (1), the TTI in multitransfused thalassemics have been reduced substantially almost to the level of their prevalence in normal population. However, a similar study conducted from the same state [6] showed extremely high prevalence of hepatitis C infection. This high prevalence of hepatitis C infection is in line with similar contemporary study [7]. Hemophilia in India is still managed with liquid blood products like whole blood, FFP and cryoprecipitate. A study conducted by Ghosh et al. [8] showed high prevalence of hepatitis B and C infections in these patients. Today hepatitis B vaccine is available and it is very effective. Hence all patients who are likely to require multiple transfusions should always be vaccinated. NAT testing is widely recommended to reduce further the transfusion transmitted viral infections. One such study published from this country [9] has shown that blood units seronegative for HIV 1+2, HbsAg and hepatitis C has 1:1,000–1:1,500 NAT positivity rate (infective units) and majority of the positivity (80 %) is due to hepatitis B virus underlining the urgent need of hepatitis B vaccination for all likely multitransfused thalassemic patients. Variation in prevalence of TTI amongst multitransfused thalassemics even after serological screening could be related to geographical differences in prevalence of the viral infections amongst blood donors, nature of blood donors and nature of care the thalassemia patients are receiving. In centres where thalassemia patients are better cared for may show higher prevalence of these viral infections even if all other factors are constant simply because better cared thalassemics live longer and are exposed to more blood units hence more chances of TTI. Hence while describing prevalence of contracting TTI some normalization is required in terms of mean blood units transfused to patients so that the data becomes comparable.

An Estimate of Transfusion-Transmitted Infection Prevalence in General Populations

Dear Editor, Blood donations saves the lives of millions of people worldwide, and blood transfusion is essential to the effectiveness of the health care system by supporting modern medicine as its pivotal role in patient interventions [1][2]. New, more sophisticated medical and surgical procedures such as transplant, heart surgery, and trauma or cancer treatment depend highly on blood transfusions in each country. Moreover, blood samples improve the quality of life of multitransfused patients. In developing countries transfusion-transmitted infections (TTIs) often threaten the safety of patients requiring blood transfusion, and medical providers face serious challenges with blood availability, safety, and affordability. It is estimated that 45% of the 80 million blood donations across the globe are collected each year in developing countries that comprised roughly 80% of the world’s population [3][4]. On a national level, countries should secure the safety of patients requiring blood transfusion by creating standard blood-transfusion establishments with solid support from policy makers and adequate and consistent government funding. One of the most prominent factors in ensuring safe blood samples is to have a national program for donor selection, recruitment, retention, and education to minimize donations from donors who might transmit diseases to recipients [2][4]. In addition, to ensure blood safety it is important to monitor and evaluate TTIs, including hepatitis B virus (HBV) and hepatitis C virus (HCV), among blood donors and in the general population. The prevalence of transfusion transmitted infections among blood donors in well-structured health care system with a well-organized blood establishment can be used as a reliable tool for statistical estimations of those infectious agent that can be transmitted through blood products including Hepatitis B and C. Indeed, the prevalence size of HCV or HBV among blood donors in such countries can contribute to statistical estimation of those viruses in the general population[5]. In Petrovic’s study, the prevalence rates of chronic HBV and HCV in the general populations of the Tuzla Canton in Bosnia and Herzegovina have been estimated by the adjusted prevalence of HBs-Ag and anti-HCV seropositive samples among first-time blood donors. In the current study the statistical analysis of prevalence rates has been performed based on incidence calculation of the estimated ratio between the two populations (the first-time blood donors and general population) using Poisson distribution method through reviewing published papers[6]. However, epidemiological studies of HBV and HCV in general populations have faced difficulties in obtaining sufficient sample sizes, gender and age distributions, and financial support. Nevertheless, the process of blood-donor selection aims to identify and recruit nonremunerated, apparently healthy people willing to donate blood. The donated blood should be free of bloodborne infectious agents that can be transmitted to recipients, and this depends highly on the structure of the country’s health care system [6][7]. In addition, blood-transfusion establishments should meet the international requirements for standard operating procedures that play a pivotal role in protecting the safety of both donors and recipients. Especially after the AIDS epidemic, the concern about blood safety in multitransfused patients has increased greatly. As the authors have explained, recruited blood donors are usually healthier because they are from people in the community who tend to exhibit healthier behaviors and safer life styles[8]. In conclusion, the accuracy of estimating TTI prevalence in the general population by surveying first-time blood donors depends on how similar the demographic characteristics of the two populations are. What we perceive from this study are significant differences in TTI prevalence rates between first-time and regular blood donors (data not shown here but available upon request), particularly in terms of demographic characteristics (e.g., cultural-economic issues), the structure of regional or country health care systems, blood transfusion service structures, blood donation incentives, blood type of donors (paid-donors, family replacement donors, or volunteer nonremunerated blood donors). Indeed, it seems that the populations of the countries or regions in which the reviewed studies were conducted are not demographically compatible or similar enough for valid inferences to be made.

Transfusion transmitted infections – A retrospective analysis from the National Blood Transfusion Service in Eritrea

The emergence of transfusion transmitted infection (TTI) especially HIV/AIDS has created a huge obstacle in ensuring blood safety. To assess the situation in Eritrea, we carried out a retrospective study of 29,501 blood donors for the prevalence of TTI's i.e. HIV, HBV, HCV and Syphilis. The study population included all donors who donated blood from January 2006 to November 2009. The data was collected from the National Blood Transfusion Services (NTBS) of Eritrea and includes category of donor and result for TTI markers. A total of 29,501 units of blood were collected from 23,385(79%) voluntary blood donors and the rest 6,116(21%) units were collected from family replacement donors. The over all prevalence of TTI's were 3.8% with 3.5% in voluntary blood donors and 5.1% in family replacement donors. The sero-prevalence for TTI markers were 0.18% HIV, 2.58% HBV, 0.57% HCV and 0.49% Syphilis. In conclusion, even if the TTI prevalence rate among Eritrean blood donors is low, ensuring blood safety has a long way to go.

Transfusion‐transmissible viral infections among US military recipients of whole blood and platelets during Operation Enduring Freedom and Operation Iraqi Freedom

Current US military clinical practice guidelines permit emergency transfusions of non-Food and Drug Administration (FDA)-compliant freshly collected blood products in theaters of war. This investigation aimed to characterize the risks of transfusion-transmitted infections (TTIs) associated with battlefield transfusions of non-FDA-compliant blood products. US Service members who received emergency transfusion products in Iraq and Afghanistan (March 1, 2002-September 30, 2007) were tested for hepatitis C virus (HCV), human immunodeficiency virus (HIV), and hepatitis B virus (HBV) infections using reposed pre- and posttransfusion sera. Selected regions of viral genomes from epidemiologically linked infected recipients and their donors were sequenced and compared. Of 761 US Service members who received emergency transfusion products, 475 were tested for HCV, 472 for HIV, and 469 for HBV. One transfusion-transmitted HCV infection (incidence rate of 2.1/1000 persons) was identified. The pretransfusion numbers (prevalence per 1000 persons) were HCV-four (8/1000), HIV-zero (0/1000), chronic HBV-two (4 /1000), and naturally immune (antibody to HBV core antigen)-nine (19/1000). One HCV TTI was determined to be associated with emergency blood product use. The pretransfusion HCV and HBV prevalence in transfusion recipients, themselves members of the potential donor population, indicates better characterization of the deployed force's actual donor population, and further investigations of the TTI prevalence in these donors are needed. These data will inform countermeasure development and clinical decision making.

Prevalence of Transfusion Transmitted Infections in Voluntary and Replacement Donors

The aim of the study was to find out the prevalence of transfusion transmitted infections (TTI) in voluntary and replacement donors. A total of 9599 donors were analysed for the prevalence of TTI over a period of 2years.Of these 61.2% were voluntary donors and 38.8% were replacement donors. Prevalence of TTI in total donors was 0.6%. Prevalence of hepatitis B was highest (0.34%) followed by syphilis (0.11%), HIV&HCV (0.06%) and malaria (0.01%). Prevalence was more in male replacement donors. Extensive donor selection and screening procedures will help in improving the blood safety.

Study on effectiveness of transfusion program in thalassemia major patients receiving multiple blood transfusions at a transfusion centre in Western India

Background:Children suffering from beta-thalassemia major require repeated blood transfusions which may be associated with dangers like iron overload and contraction of infections such as HIV, HCV, and HBsAg which ultimately curtail their life span. On the other hand, inadequate transfusions lead to severe anemia and general fatigue and debility.Materials and Methods:Data were obtained from 142 beta-thalassemia major patients aged 3 years or more receiving regular blood transfusions at a transfusion centre in Western India from 1 April 2009 to 30 June 2009. The clinical data and laboratory results were subsequently analyzed.Results:Of the 142 patients, 76 (53.5%) were undertransfused (mean Hb <10 gm%). 96 (67%) of the patients were taking some form of chelation therapy but out of them only 2 (2%) were adequately chelated (S. ferritin <1000 ng/ml). 5 (3.5%) of the patients were known diabetics on insulin therapy. 103 (72%) of the patients were retarded in terms of growth. The prevalence of transfusion-transmitted infections (TTIs) such as HCV, HIV, and HBsAg was respectively 45%, 2%, and 2%, with the prevalence of HCV being significantly more than the general population. The HCV prevalence showed positive correlation with the age of the patients and with the total no of blood transfusions received. As many as 15% (6 out of 40) children who were born on or after 2002 were HCV positive despite the blood they received being subjected to screening for HCV.Conclusions:The study suggests the need to step up the transfusions to achieve hemoglobin goal of 10 gm% (as per the moderate transfusion regimen) and also to institute urgent and effective chelation measures with the aim of keeping serum ferritin levels below 1000 ng/ml to avoid the systemic effects of iron overload. In addition, strict monitoring of the children for endocrinopathy and other systemic effects of iron overload should be done. Rigid implementation of quality control measures for the ELISA kits used to detect HCV in donor blood needs to be done urgently. Alternately, more sensitive and specific measures (like NAT testing) should be employed for detection of HCV. In the absence of a definitive cure accessible and available to all patients, strict implementation of the above suggested measures will go a long way in improving the quality (and quantity) of life in patients of beta-thalassemia major.

Voluntary and not replacement donors are safe!

Dear Editor I read with the interest article ‘Infectious disease markers in blood donors’ published in Jan 2008 issue of MJAFI [1]. The authors reported the data of routinely screened Transfusion Transmitted Infection (TTI) markers from 2003-2005. Similar article by Gupta P et al [2] presented the blood donor screening data for period from 2000-2004 of Department of Transfusion Medicine, Armed Forces Medical College (AFMC) Pune. Screening of blood donors for these TTI markers is statutory requirement vide Drugs and Cosmetics Act 1940 [3]. Further all blood banks are required to submit the data to National AIDS Control Organization (NACO). In addition, blood banks of Armed Forces are required to submit the data to Central Disease Registry/AIDS Control Organization (ACO), Dept of Preventive and Social Medicine, AFMC, Pune. The authors reported 14.3% voluntary blood donation [1]. Voluntary donation of 58.7% and 55.2% in year 2003 and 2004 respectively was reported at AFMC [2]. NACO reported overall voluntary blood donation of 52.2% in 2004 [3]. A study from Kolkata reported voluntary blood donation of 94.6% [4]. Thus voluntary blood donation of 14.3% is abysmally low; against the national short term goal of 80% [3]. The authors reported no difference in prevalence of TTI markers in voluntary and replacement donors (in fact prevalence of infectious markers except HIV was lower in replacement donor than voluntary, though statistically not significant). Based on these findings, authors recommended replacement donation in meeting blood demand in Armed Forces setting [1]. The recommendation is retrograde and against the present national policy of recruitment and retention of voluntary donors [4]. Even data from AFMC in Armed Forces perspective is unambiguous; replacement donors carry more risk of TTI [2]. Further, any such recommendation needs to be based on all India data, in which role of ACO for Armed Forces perspective is of paramount importance. The authors arrived at conclusion of better socioeconomic status of blood donors being the reason for low prevalence of TTI. Will these individuals be more amenable to motivation for voluntary donations? It will be prudent to know the effect of more proactive strategies in improving voluntary blood donations in this group; which will avoid reverting back to replacement donations. The authors found declined trend in prevalence of Hepatitis C virus infection and syphilis; which is encouraging. This also means the time to move on and evaluate newer tests or strategies such as nucleic acid tests, anti HBc assay or leucodepletion in achieving newer heights in safety of transfusion than rejoicing the declining trends of conventional TTI markers. We need to evolve for safety in transfusion!

Transfusion-transmitted infections among multi-transfused patients in Brazil

Background: Transfusion-transmitted infections (TTI) continue to be a problem in many parts of the world, and multi-transfused patients (MTP) are at a particularly increased risk of TTI. Objectives: to estimate the prevalence of TTI among multi-transfused patientsin Brazil, and to understand the epidemiological characteristics of TTI among these patients. Study design: cross-sectional study of 353 MTP, who were interviewed using a structured questionnaire and tested for serological markers of hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infection. Results: the overall prevalence of HCV, HIV, HBV and co-infection among MTP were 16.7%, 1.7%, 0.8% and 1.7% respectively. A dose-effect relationship could be detected between the number of units transfused and HCV infection. Other non-transfusion related (NTR) risk factors for HCV did not confer any excess risk of HCV infection to MTP. Conclusions: HCV infection was the most prevalent TTI among MTP, and remains a major health problem for these patients.A dose-effect relationship could be detected between HCV and the number of units transfused. The implementation of measures such as donor education programs, standards for donor selection criteria, and of improved serological screening protocols, paralleled the decline in the prevalence of TTI, specially of HCV, observed in MTP, underscoring the importance of such measures for the reduction of the residual risk of TTI.

Seroprevalence of common transfusion-transmitted infections among blood donors in Bangladesh

Transfusion-transmitted infections (TTIs) remain a major global public health problem and a challenge to transfusion services worldwide particularly in developing countries in managing transfusion-dependent children especially the thalassaemics. However developed countries are not exempt from TTIs despite multiple layers of protection in their advanced blood collection centres. The magnitude of this problem is directly related to the prevalence of TTIs among blood donors. To assess the global burden of TTIs the World Health Organization (WHO) estimated that 3% of the world’s population (.170 million people) are infected with hepatitis C virus (HCV). The global prevalence of HCV reported by the WHO ranges from 10 to 15% to as little as 0.04%. HCV in blood donors varies from 0.4 to 19% including 0.9% among Namibian first-time blood donors. The overall prevalence of HCV in Bangladesh as documented in the WHO’s records ranges between 1 and 2.5% whereas it was observed in 2.4% of professional donors (poor people who sell their own blood to make a living and who have had no evident disease) in Bangladesh. However in voluntary donors (healthy adults who only donate blood in emergencies) in India the prevalence of HCV ranged from 0.8 to 1.78%. In Japan and Germany figures of 0.6% and 0.2–0.8% respectively have been reported. (excerpt)