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OJHAS Vol. 10, Issue 2:
(Apr-Jun 2011) |
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| Blood Transfusions:
Are They Life Saving or Transfusing
Infections? |
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Amrutha Kumari B, Associate Professor,
Deepa S, Assistant Professor,
Venkatesha D, Prof & Head,
Department of Microbiology, MMC&RI, Mysore |
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Address for Correspondence |
Associate Professor,
Department of Microbiology,
MMC&RI, Irwin Road,
Mysore, India.
E-mail:
amrutakb@yahoo.co.in |
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Amrutha Kumari B, Deepa S,
Venkatesha D. Blood Transfusions:
Are They Life Saving or Transfusing
Infections? Online J Health Allied Scs.
2011;10(2):7 |
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Submitted: Jun 21,
2011; Accepted: Jul 16, 2011; Published: Jul 30, 2011 |
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| Abstract: |
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Introduction:
There is a risk of 1 - 2 per 1000 recipients receiving contaminated
blood with viral, bacterial and parasitic agents.TTI’S are the most
commonly encountered complications in transfusion medicine. The objective
of the study was to determine the seroprevalence of TTI’s among blood donors,
who represent healthy population at large. Materials & methods:
A total of 33,658 blood units were received from voluntary and replacement
donors over a period of 5 years. Surface antigen of HBV and antibodies
to HIV and HCV were determined using ELISA. Syphilis was detected using
TPHA test. Results: 947 (2.81%)
blood units tested positive for HBV, HCV, HIV and / or syphilis. Overall
prevalence was HBV – 1.77%, HCV – 0.13%, HIV – 0.63% and Syphilis
– 0.28%. Nine (0.03%) donors had coinfections. Conclusion: The
screening of blood donors is the corner stone in assuring the safety
of blood transfusion.
Key Words:
Transfusion Transmitted Infections; HBV; HCV; HIV; Syphilis
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Transfusion of blood
and blood components as a specialised modality of patient management
saves millions of lives worldwide.1
Getting safe blood is becoming increasingly difficult because of blood
borne infections like Hepatitis B virus (HBV), Hepatitis C virus (HCV),
Human immunodeficiency virus (HIV) & Treponema palladium.
There is a risk of 1–2 per 1000 recipients receiving contaminated
blood with viral, bacterial or parasitic agents.2 According
to WHO estimate the lack of effective screening of blood donors’ results
in up to 16 million new infections with HBV, 5 million new infections
with HCV, 1, 60,000 new cases of HIV infections every year.3
HIV, HBV & HCV are
known to cause coinfections due to common route of transmission .The
viruses are partners in crime augmenting the pathogenesis & there
by increasing the morbidity & mortality.
Evaluation of data for
the prevalence of transfusion transmitted infections (TTI’s)
permits an assessment of acquisition of these infections in the blood
donor population & consequently the safety of the collected blood
donations. It also gives an idea of epidemiology of these infections
in the community.4
A total of 33,658 units
of blood were collected from both voluntary and replacement donors over
a period of 5 years (Jan 2006 – Dec 2010) at blood bank attached to
Mysore Medical College & Research Institute, Mysore, Karnataka,
India. Samples were screened for HBV, HCV, HIV & Syphilis.
HBV screening was done
using ERBALISA kit to detect HBsAg using polyclonal antibodies against
surface antigen of Hepatitis B virus. ERBALISA kit was used to detect
HCV antibodies using a mixture of synthetic peptides & recombinant
proteins of HCV that is CORE NS3, NS4
& NS5. ERBALISA kit HIV 1 / HIV 2 a solid phase immunoassay
utilising a mixture of synthetic peptides for detection of HIV1 &
HIV2 antibodies was used to detect HIV. Validity of ELISA tests was
assessed by means of acceptance criteria laid down by the manufacturer.
A rapid TPHA test for the diagnosis of syphilis to detect IgG &
IgM antibodies to Treponema palladium
was used. Seropositive blood units were discarded. Infected donors were
referred for specialist care.5
A total of 33,658 blood
samples were included in the study during the period Jan 2006 – Dec
2010. 947 (2.81%) blood units showed seropositivity for TTI’s.
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Table: Seroprevalence
of various Transfusion Transmitted Infections |
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Year |
Total donors |
HBV |
HCV |
HIV |
Syphilis |
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2006 |
08487 |
111(1.31%) |
0 |
047(0.55%) |
08(0.09%) |
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2007 |
06569 |
091(1.38%) |
02(0.03%) |
049(0.74%) |
25(0.38%) |
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2008 |
06404 |
166(2.59%) |
14(0.22%) |
044(0.69%) |
30(0.47%) |
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2009 |
06257 |
087(1.39%) |
10(0.16%) |
040(0.64%) |
11(0.18%) |
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2010 |
05941 |
127(2.14%) |
19(0.32%) |
032(0.54%) |
20(0.34%) |
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Total |
33,658 |
596(1.77%) |
45(0.13%) |
212(0.63%) |
94(0.28%) |
Nine donors had coinfections
of which six were coinfected with HIV & HBV, two of them were infected
with HIV & HCV & one donor with HBV & HCV.
In recent years there
has been a special interest in donor selection strategies in blood banks
in order to provide safer blood supply. There is no screening method
to reduce the risk of TTI’s to zero. It appears that it is essential
to adopt strict criteria in the selection of donors and to avoid unnecessary
transfusions.4 Serosurveys are one of the primary methods
to determine the prevalence of TTI’s. In our retrospective study,
we have evaluated the seroprevalence of HBsAg, anti-HCV, anti-HIV and
syphilitic antibodies among blood donors who are considered to be of
low risk behaviour group as there is no data available from this region.
Over a period of five
years the prevalence of HBsAg was 1.77% (range 1.31% - 2.59%). A study
in Orrisa has reported 1.13% and another study in Delhi has reported
2.23% of HBV infection in blood donors respectively.6,7 A
low prevalence of HBV of 0.62% was reported in a study at costal Karnataka.8
In our study a significant rise in HBV prevalence has been noted in
the year 2010 i.e. 2.59%.
HCV seropositivity
in our study was 0.13% (0.03% - 0.32%). In India the prevalence of HCV
in blood donors has been reported to be 0.12% to 2.5%. A study in Delhi
has reported HCV in blood donors as 0.66% to 2.5% and in Western India
0.28% respectively.7,9 There is significant increase in HCV
seropositivity rate in the present study from 0.03% to 0.32% over a
period of 5years. A study in Eastern India also has reported an increase
in HCV seropositivity among blood donors.10 High prevalence
of 6% HCV infection was reported by another study in Hyderabad, South
India.11
HIV antibodies were detected
in 0.63% (0.53% - 0.74%) in our study. Other authors have reported HIV
seropositivity of 0.4% and 0.55% among blood donors.12,13
Syphilitic antibodies were detected in 0.28% (0.09% - 0.49%) in our
study. Similar prevalence has been reported by other authors.13,10 Data on the prevalence of >2
TTIs is limited.14 In
our study 9 donors (0.03%) had co-infections of which six donors had
HIV & HBV (2.83% of HIV positive donors), 2 donors (0.91% of HIV
positive donors) had HCV co-infection. One donor was positive for both
HBV and HCV.
Studies
on the prevalence of hepatitis viruses in patients with HIV have reported
HIV and HBV/HCV co-infection rate as 12%–15%. However in India studies,
this varies with the geographical region ranging from 9%–30% for HBV
& 2%–8% for HCV. A study in North India has reported
coinfections in blood donors as 0.05% of which 5 donors had HIV &
HBV, 2 donors had HIV & HCV and another 2 donors had HBV & HCV
coinfections.14
The absence of HBsAg
in blood donors may not be sufficient to ensure the lack of circulating
HBV and hence there are chances of missing occult HBV infection.8
A study in central India has shown a positivity of 2.2% for HBV DNA
in donors who tested negative for HBsAg by ELISA.15 Majority
of the problems are due to prevalence of asymptomatic carriers in the
society, as well as, blood donations during the window period of infections.
Most government hospital blood banks in India use ELISA test kits, which
cannot detect HIV before 22 days, HBV before 59 days and HCV before
82 days of infection.16 Considering the vast population of
the country, even low prevalence amounts to the large number of infected
people.16 With this prevalence of TTI’s, pit falls in detection
methods and the morbidity and mortality associated with TTI’s, we
have to urgently consider the need to modulate and adopt newer sensitive
technologies. Stringent measures need to be taken for blood donor screening,
by using more sensitive methods to detect infections early, like Nucleic
acid amplification technology (NAT) assays.17
Considering the various
risks in transfusions, we have to adopt judicious blood transfusions
and sensitive technologies for screening of blood donors in order to
safeguard recipients of blood and its components.
We thank Dr. Manjunath,
blood bank officer for his cooperation in providing us the materials
for the study.
- Mahmud Z. Are the blood transfusions
safe! JAFMC June 2009;5(1):1-2.
- Choudary N. Transfusion Transmitted
Infections: How many more? Asian J Transfus Sci July 2010;4(2):71-72.
Available at
http://www.ajts.org/text.asp?2010/4/2/71/67017
- Olokaba AB, Salawu FK, Danburam
A et al. Viral Hepatitides in Voluntary Blood Donors in Yola, Nigeria.
Europ J Sci Res 2009;31(3):329-334.
- Afsar I, Gungor S, Sener AG et al. The prevalence of HBV, HCV and HIV infections among blood donors
in Izmir, Turkey. Indian J Med Microbiol 2008;26:288-289.
- World Health Organization
2010. Screening Donated Blood For Transfusion Transmissible Infections: Recommendations.
WHO; Geneva. 2010. Available at
http://www.who.int/bloodsafety/ScreeningDonatedBloodforTransfusion.pdf
- Panda M, Kar K. HIV, hepatitis
B and C infection status of the blood donors in a blood bank of a tertiary
health care centre of Orissa. Indian J Public Health 2008;52:43-44.
- Pahuja S, Sharma M, Baitha
B, Jain M. Prevalence and trends of markers of hepatitis C virus, hepatitis
B virus and human immunodeficiency virus in Delhi blood donors: a hospital
based study. Jpn J Infect Dis 2007;60:389-391.
- Singh K, Bhat S, Shastry S.
Trend in Seroprevalence of Hepatitis B Virus Infection among Blood Donors
of Coastal Karnataka, India. J Infect Dev Ctries May 2009;3(5):376-379.
Available at
http://www.jidc.org/index.php/journal/article/viewFile/19759508/140
- Garg S, Mathur DR, Garg DK.
Comparison of seropositivity of HIV, HBV, HCV and syphilis in replacement
and voluntary blood donors in western India. Indian J Pathol Microbiol
2001;44:409-412.
- Bhattacharya P, Chandra
PK, Datta S et al. Significant Increase in HBV, HCV, HIV & Syphilis
Infections Among Blood Donors in West Bengal, Eastern India 2004-2005:
Exploratory Screening Reveals High Frequency of Occult HBV infection.
World J Gastroenterol July 2007;13(27):3730-3733.
- Khaja MN, Madhavi C, Thippa
Vazzula R et al. High prevalence of hepatitis C Virus infection and
Genotype Distribution Among General Population, Blood Donors & Risk
Groups. J infect Genet Evol May 2006;6(3):198-204.
- Sabharwal ER, Langer S.
prevalence and trends of seroprevalence of HIV & syphilis in blood
donors of Delhi. Indian J Practising Doctor 2008;5(3):1-3.
- Nanu A, Sharma SP, Chaterjee K, Jyothi P. Markers for transfusion-
transmissible infection in North Indian voluntary and replacement donors :
prevalence and trends 1989-1996. Vox Sanguinis 1997;73:70-73 (s)
- Kaur G, Basu
S, Kaur R et al. Patterns of infections among blood donors in a tertiary
care centre: A retrospective study. Natl Med J India 2010;23(30):147–149.
- Punde RP, Bhargava A, Varshney S et al. Ascertaining the prevalence of occult
HBV infection in voluntary blood donors: A study from Central India.
Indian J path Microbiol 2011;54:408
- Editorial.
Improving Blood Safety Worldwide. Lancet. 2007:370(9603):1879-1974.
- Meena M,
Jindal T, Hazarika A. Prevalence of HBV & HCV among blood donors
at a tertiary care hospital in India: A five year study. Transfusion
2011;51:198-202.
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