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Table of Content - Volume 21 Issue 2 - February 2022


 

Trends and seroprevalence of transfusion transmitted infections among blood donors of tertiary care centre: A retrospective study from central Gujarat

 

Avani Panchal1*, Nilesh Shah2, Jignasa Bhalodia3

 

1Second Year Resident, 2Associate Professor, 3Professor & HOD, Department of Pathology, GMERS Medical College and Hospital Sola, Ahmedabad, Gujarat, INDIA.

Email: avanipanchal1516@gmail.com

 

Abstract              Background: Transfusion Transmissible Infections (TTIs), particularly through the viruses lead to the major health problems and challenges faced by the transfusion services. Screening of transfusion transmissible infections among blood donors can be a cost-effective approach to monitor the prevalence, distribution and trends of infections among healthy looking individuals. Aims: The aim of this study is to assess the trends and seroprevalence of Transfusion Transmissible Infections (TTIs) among blood donors in tertiary care centre of Ahmedabad. Methods: A retrospective study of donor’s record covering the period between January 2017 to December 2020 is carried out at Blood Bank, GMERS Medical college and hospital, Ahmedabad. All donor samples were screened for HIV, HBV, HCV, by ELISA method, Rapid plasma regain method for Syphilis and peripheral smear examination for Malaria parasite. Result: Seroprevalence of HIV, HBV (HbSAg), HCV and syphilis among the blood donors were observed to be 0.56%, 0.14%, 0.16% and 0.18% respectively in our study.  Conclusion: The screening of blood donors, and usage of highly sensitive blood testing methods such as ELISA and RPR are the corner stone in assuring the safety of blood transfusion.

Keywords: Transfusion Transmissible Infections, Seroprevalence

 

INTRODUCTION

Transfusion of blood and blood components is a life saving measure at the same time it is frequently accompanied by the risk of transmission of Transfusion Transmissible Infections (TTIs).2 The viruses, bacteria and parasites responsible for TTIs have prolonged incubation period and survive in the stored blood.5,6 TTIs can exist as silent killer being asymptomatic in the hosts. Government of India has made it mandatory to screen donated blood for HBV (Since 1971), HIV (since 1989) and HCV (since 2001) to prevent spread of TTIs through blood transfusion.4 After the completion of medical examination and donor questionnaire, donor’s serum is tested for hepatitis B surface antigen (HbsAg), Antibody to Hepatitis C virus (Anti HCV), Antibody to Human immunodeficiency virus (Anti HIV1/2), Syphilis and malaria.1 However, risks of TTIs are still present due to blood donation by infective donors during the window period.2,3 Over the period of time, availability of newer and more sensitive screening tests with strict implementation of testing rules has significantly reduced incidence of TTIs in most developed countries, on the other hand the scenario in developing countries has not changed much.2 Poor health infrastructure, lack of health awareness among people, and failure to implement strict norms of screening result in increasing prevalence and incidence of these infections in the population.1,6

 

MATERIALS AND METHODS

A retrospective cross-sectional study was conducted in GMERS medical college and hospital, sola Ahmedabad, blood bank over a period of four years from January 2017 to December 2020. Data were collected from the records of blood bank which also included data of blood donation camps. Data regarding sex, screening test results and type of donors, i.e., whether voluntary donors or replacement donors, were collected from the records. Blood was collected from apparently healthy donors after following the standard questionnaire to screen the donors. The blood donation camps organized by voluntary organizations, voluntary and replacement donors in blood bank were source for donated blood. It was ascertained that voluntary donors came on their own without any incentive or remuneration. Donors who attended voluntary blood donation camps were included in voluntary donor group. Replacement donors were donors who donated blood for their family members and friends admitted in the Sola civil hospital, Ahmedabad. Name, age (18-55 years), sex, date of birth, address and contact numbers were recorded for each donor and a unique identification number was allotted to each donor. Donors with history of any febrile illness in the recent past, weight loss, uncontrolled diarrhoea, recent jaundice, liver disease, cardiovascular disease, pulmonary disease, malignancy, epilepsy, malaria, unusual or excessive bleeding, recent donation 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 anaemia was done clinically along with rapid hemocue method. A written informed consent was taken from each donor before the blood donation. Proper sterilization and other precautions were taken during the blood collection and blood units were collected along with the sample for TTIs testing and blood grouping. After collection all samples were screened for HIV, HBV and HCV with third generation ELISA (Merilisa, Meril diagnostic Pvt Ltd) while syphilis was tested with rapid kit (RPR) and malaria tested with peripheral smear examination. Tests were performed according to manufacturer’s instructions. Before labelling them seropositive, all the reactive samples were retested. Subsequently the infected blood was discarded as per the guidelines. The affected donors were informed through proper channels and were properly counselled.

 


 

RESULTS

In the present study 12,315 blood donors with 2717 (22.06%) voluntary donors and 9598 (77.93%) replacement donors were screened as shown in figure 2. The majority were male donors 12,031 (97.69%) as compared to 284 (2.30%) female donors as depicted in figure 1.

 

Figure 1: Total number of male and female donors; Figure 2: Numbers of voluntary and replacement donors

 The overall prevalence of TTI markers reactive donors over four year is shown in figure 3.

 

Figure 3: Spectrum of transfusion transmitted infection among donors as percentage of total TTIs

 

From 12315 donors in the study, 129 (1.42%) donors were seroreactive among which 70 donors were reactive for HBV (0.56%); 17 were reactive for HCV (0.13%); 20 were reactive for HIV (0.16%); 22 were reactive for syphilis (0.17%) and none of the case was positive for malaria (fig 4).

Table 1: Evaluation of seroprevalence of transfusion transmitted infections among blood donors

Year

Donors

HIV

HBV

HCV

Syphilis

Malaria

TTI prevalence

2017

2987

4(0.14%)

21(0.70)

7(0.23%)

3(0.1%)

0(0%)

1.17%

2018

3387

1(0.03%)

20(0.59%)

0(0%)

2(0.06%)

0(0%)

0.68%

2019

3328

10(0.3%)

19(0.57%)

5(0.15%)

15(0.45%)

0(0%)

1.47%

2020

2613

5(0.19%)

10(0.38%)

5(0.19%)

2(0.08%)

0(0%)

1.55%

Total

12,315

20(0.16%)

70(0.56%)

17(0.14%)

22(0.18%)

0(0%)

1.04%

 

Figure 5: Trends of TTI in present study

 


DISCUSSION

Blood transfusion being a life-saving procedure should be practiced with proper donor screening as well as blood testing practices to minimize risk of TTIs.8 In the present study, the male donors (97.69%) outnumbered the female donors (2.30%). Indian females are subjected to a greater number of deferral at the time of blood collection due to various reasons like malnutrition, underweight, anaemia leading to reduced number of female blood donors.1,8 In this study the overall prevalence of TTIs markers was 1.04%. The other studies in India done by Agarwal N et al.17 and Leena M S et al.6 (0.87% and 1.35% respectively) also found similar to lower TTIs marker rates. In present study, TTIs markers in decreasing order as follows: HBV, Syphilis, HIV, HCV, and Malaria were 0.56%, 0.18 %, 0.16%, 0.14 % and 0% respectively. In the present study lower seroprevalence of HBV (0.56%) and HCV (0.14%) were seen among the blood donors. Viral Infections by HBV and HCV cause serious mortality and morbidity. Hepatitis B virus and C virus have acquired worldwide importance as these are the commonest TTIs which are highly infectious and are the commonest cause of chronic liver diseases.1,8,9

 Prevalence of HBV varies from 1.86% to 4% in various studies, such as study done Leena M S et al.6 found prevalence of HBV 0.71 % and Amrutha Kumari et al.9 found 1.17 %, whereas in our study, seroprevalence of HBV was 0.56% which may be due to proper pre-donation screening and counselling. WHO has estimated that more than two billion people in the world have been infected with HBV and about 257 million people are living with HBV infection (surface antigen positive) with majority in developing countries of Asia and Africa.8 About 3.9 million of people are affected by HCV with increased risk of liver cirrhosis.10 In our study seroprevalence of HCV was 0.14%, Which is similar to the study done by Leena M S et al.6 Whereas Mahapatra et al.9 found seroprevalence of HCV 0.17% in his study. The wide variations of HBV and HCV seroprevalence found in different studies from India might be result of using ELISA kits of different generations that have variable sensitivity and specificity of detecting TTIs. The seroprevalence of Syphilis was 0.18% in this study, which is higher than the study of Leena et al.6 (0.10%). Replacement donors sometimes conceal their medical history to donate blood for their relatives. Thus, blood safety still depends highly on open and honest answering of the screening questions. The emphasis must also be given on voluntary risk reductions, which will require increased knowledge and change in attitude of people.16 A serologic test for syphilis is important because the disease is characterized as being sexually transmitted and places the donor at higher risk for possible exposure to hepatitis and HIV.5 In our study there is none cases of malaria, whereas Sudhakar et al.1 found 0.003% prevalence of malaria. This lower prevalence rate of malaria in blood donors was because of better pre donation screening and good knowledge of malaria related symptoms in blood donors.

 


Table 2: Comparison of prevalence rate of TTIs in different studies of India

Studies

Study region

Study period

HIV

HBV

HCV

Syphilis

Malaria

Sudhakar et al.1

North Andhra pradesh

2013-2018

0.21

0.89

0.25

0.06

0.003

Anita s et al.2

Maharashtra

2014- 2017

0.37

1.04

0.49

0.01

-

Leena MS et al.6

South India

2004-2010

0.27

0.71

0.14

0.1

 

Mahapatra S et al.8

Odisha

2010- 2016

0.052

0.5

0.17

0.001

0.0005

Amrutha Kumari et al.9

Karnataka

2006-2010

0.63

1.77

0.13

0.28

 

Panda M et al.10

Orissa

2005

0.35

1.13

1.98

 

 

Pahuja S et al.11

Delhi

2002-2005

2.23

0.56

0.77

 

 

Bhattacharya P et al. 19

Eastern India

2004-2005

1.51

1.29

1.26

1.17

 

Present study

Gujarat

2017-2020

0.16

0.56

0.14

0.18

0

 


As there is higher number of replacement donors, chances of high seroprevalence of TTI are more in replacement donors in comparison to voluntary donors. This observation is consistent with the WHO viewpoint that remunerated blood donors and familial replacement donors are more likely to transmit transfusion transmissible infections, compared to voluntary donor. This encourages one to be focussed on promoting more voluntary blood donation camps which will decrease the incidences of seroprevalence and enhance the transfusion of safe blood and blood products.11,14 Various studies suggesting increase in the hepatitis infection not many steps have been taken for its prevention. The emphasis should be lead on the increase the knowledge and to change the attitude of the people. The most important aspect is to handle the HIV transmission leading to social stigma along with many fatal complications by highlighting proper pre-counselling questionnaires, with deferring the donors after getting the slightest hint regarding their medical history and referring the seropositive HIV cases to Integrated Counselling and Testing Centre (ICTC) for counselling and treatment after the repeat test.3,9

 

 

 

CONCLUSION

The first and most important step in ensuring that blood transfusion will not transmit any pathogen is a careful donor selection and reliable blood testing. To conclude this study, HBV is the commonest TTI in apparently healthy donors. This survey gives the overview about epidemiology of TTIs and also helps in assessing the safety of blood and blood components. Testing for hepatitis B core antigen, along with the already existing enzyme linked immunosorbent assay (ELISA) tests for detection of hepatitis B surface antigen will aid in better detection of HBV. The introduction of fourth generation ELISA (where both antigen and antibodies are detected) for the screening tests for HIV will aid in better detection of HIV. Transmission of Transfusion Transmitted Infections during the serologically window period still poses a threat to blood safety in environments where there is high rate of Transfusion Transmitted Infections. So, to ensure safety of blood for recipients, strict selection of blood donors preferably replacement donors and comprehensive screening of donors for Transfusion Transmitted Infections using standard methods are highly recommended.

 

 

 

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