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ORIGINAL ARTICLE |
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Year : 2014 | Volume
: 7
| Issue : 5 | Page : 620-624 |
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Transfusion transmissible infections in blood donors: A 7-year study in central Gujarat
Pragnesh J Patel
Department of Pathology, GMERS Medical College, Gujarat, India
Date of Web Publication | 10-Sep-2014 |
Correspondence Address: Pragnesh J Patel 548/A/1, Sector 8-B, Gandhinagar - 382 008, Gujarat India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.140451
Context: One of the major adverse effects of blood transfusion is transfusion transmissible infections (TTIs). Serological testing can help to reduce, but not eliminate occurrences of TTIs. Study of TTIs in different blood donor groups help to find safe blood for patients. Aims: The aim of this study was to determine the prevalence and trends in TTIs in voluntary and replacement blood donors. Settings and Design: Voluntary and replacement blood donors were studied for TTIs over the duration of 7 years. TTIs were documented with particulates like gender and type of donation (voluntary or replacement). Materials and Methods: Blood donation taken after predonation examination. Tests for TTIs carried out from donated blood and results were documented. Statistical Analysis Used: Data entered into Microsoft Excel sheets and studied for prevalence, trend, and odds ratio. Results: Total blood units taken during the period from 2007 to 2013 were 15,368. 93.1% were male donors and 6.9% were female donors. Prevalence of TTIs was 0.72%. Human immunodeficiency virus, hepatitis B surface antigen, hepatitis C virus, and syphilis were detected in 0.14%, 0.38%, 0.06%, and 0.14% of donors, respectively. No female donors had TTI. TTIs in voluntary donors (VDs) and replacement donors were 0.64% and 1.15%. Conclusions: Outcome of the study shows increasing trend for total blood donation, voluntary donations, and female blood donors. All TTIs were reducing except syphilis. To provide safe blood to patients, blood donation from VDs and female donors should be encouraged. Keywords: Prevalence, transfusion transmissible infection, trend
How to cite this article: Patel PJ. Transfusion transmissible infections in blood donors: A 7-year study in central Gujarat. Med J DY Patil Univ 2014;7:620-4 |
Introduction | | |
Blood transfusions are inevitable element of modern medicine. Simultaneously, it is not a risk free procedure. It is associated with transfusion transmissible infections (TTIs) and transfusion reactions. Approximately, 1% of transfusions are associated with adverse events. [1] TTIs include human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV), Syphilis and Malaria. In this scenario, it is our duty to use blood judicially to minimize undesirable effect. Outcome of TTIs are a range from subclinical to life-threatening manifestations of diseases. It is blood bank's moral and legal obligation to protect patients from acquiring TTIs by doing recommended testing before issuing blood. These types of testings are helpful to reduce TTIs, but not up to 100%. There is always chance of false-negative due to detection limitation of kits used and "window period" of diseases. Every transfusion is a potential risk factor. Minimizing its use and taking donation from low risk population for TTIs are some of the modalities used for reduction for adverse events associated with blood transfusions. The aim of this study was to determine the prevalence of TTIs in blood donors, voluntary as well as replacement and to evaluate trends in TTIs in blood donors.
Materials and Methods | | |
Pretransfusion screening for TTIs were carried out on 15,368 blood units taken from voluntary donors (VDs) and replacement donors (RDs) by Blood Bank, GMERS Medical College, Gandhinagar, Gujarat, previously known as General Hospital, Gandhinagar, Gujarat during the period of 2007-2013. Before donation "Blood Donation Form" had been filled by every donor and this form had particulars about age, gender, address, and occupation, date of previous donation, any illness and medical treatment taken. The consent was taken. Donation taken only after physical examination carried out by the doctor. Professional donors were not taken for donation and ruled out by asking family and personal questions regarding patients. Blood donations taken either in outdoor blood donation drives or in blood bank, without remuneration were considered as VDs. RDs included donation given for a particular patient.
Pilot tubes were taken for screening of TTIs. Samples were tested for HIV, HBsAg and HCV by the third generation ELISA assay with automated ELISA washer and reader. Controls, procedure and cut off values for positive and negative results calculated as per kit manufacturer's literature. One step Syphilis anti-TP test which is solid phase immunochromatographic assay were used for testing of syphilis. Thick smears stained with Leishman stain were used for malaria testing. All the seropositive samples were tested in duplicate before labeling it positive. The drugs and cosmetics act requires blood bank to maintain different registers related to but not limited to blood donors, TTIs testing, compatibility testing and patient receiving transfusions. Material used in this study had been segregated from this data. Data were entered into Microsoft Excel Sheet and calculated for prevalence and trend.
Results | | |
A total of 15,368 blood donations were taken during the period of 2007-2013 at GMERS Medical College, Gandhinagar previously known as General Hospital, Gandhinagar. Out of which 84.2% were VDs and 15.8% were RDs. 6.9% of total blood donation came from female donors. Male female ratio was 9:1 for blood donation. Only 2% female were RDs while 98% were VDs. During the period of 7 years of study 1051 repeat donors were taken, out of which 932 were male and 119 were female. No repeat donor was positive for any of TTIs [Table 1] and [Table 2]. | Table 1: Gender distribution in replacement donors, voluntary donors, and total blood donations
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During the period of study seropositivity for HIV, HBsAg, HCV and syphilis were in the range from 0.04-0.23%, 0.23-0.65%, and 0-0.33% to 0-0.38%, respectively. A total of 111 donations were positive for TTIs. Detection rate for TTIs was 0.72% of all blood collected. No female blood donor was positive for screened test for TTIs. One donor was positive for both HIV and HBsAg. Prevalence of TTIs in voluntary and RDs were 0.64% and 1.15%, respectively. Voluntary blood donations were taken in-house as well as in outside camps, which were mostly organized by social organizations. In-house voluntary donations were 5671 units out of which 37 had TTIs. 45 of 7271 blood donation taken from outside camps had TTIs.
Discussion | | |
Study was carried out from 2007 to 2013. During this time, medical college started in year 2012. This helped to increase the number of patients treated in hospital and in the same way increase in utilization of transfusion services. Blood donation increased from 1718 to 2666 with an annual increase of 8.3%/year. 93% of blood donations were taken from male donors and 7% of donations were taken from female donors in our study. Increase in female donors were 20.1%/year. Participation from female donors were compared to study of Pallavi et al. (2%), Jain and Gupta (2%), Fernandes et al. (3%), Pahuja et al. (3%) and Arora et al. (4%). [2],[3],[4],[5],[6] Voluntary donations were 84% while replacement donations were 16% in the present study. A higher percentage of voluntary blood donors was achieved in this study as compared to study of Pallavi et al. (65%) and Fernandes et al. (61%). [2],[4] Excellent voluntary participation and female participation attributed to social awakening for blood donation by mass media campaign carried out by National AIDS Control Organization (NACO) and other organizations. VDs are nonremunerated, motivated donors and tend to donate repeatedly. RDs are more likely to be one time donors and various study documented high prevalence of TTIs in this group [Graph 1 [Additional file 1]]. [2],[3],[4]
No female blood donor was positive in pretransfusion screening tests. Female donors proved to be more safe blood donors than male donors. Numbers of blood donated by female participants were increased from 90 in 2007 to 1064 in 2013. Participation of female blood donors should be encouraged to carry forward this trend and help ensure safe blood for patients.
Practically most of the blood banks are in constant shortage of blood units. Many times when replacement insisted, patients family members and friends donate. Previously this group included in RDs. But now, this donations are considered as voluntary donation due to guideline provided by NACO to pursue the goal of National Blood Policy-sourcing the total requirement of blood through voluntary blood donation. [7] Jain and Gupta revealed this group has more prevalence of TTIs compare to VDs. [3] Donors from this group tend to hide their high risk behavior and medical illness due to family pressure, which make them no safer than RDs. This move definitely help to increase the number of reported voluntary donations but actually not much difference in total blood donations. In this study, replacement donations reduced from 57% in 2007 to 20% in 2013 [Graph 2 [Additional file 2]].
A WHO report state that viral load is much higher with infected blood transfusion compare to other modality of transmission. [8] This lead to death in about 2 years in children and 3-5 years in adults. HIV detection by ELISA method has window period of 2-8 weeks. During this time, person remains falsely negative. Nucleic acid test help to identify reactive samples earlier, but their cost is prohibitory in routine use. In this scenario, the most effective way to minimize HIV transmission is reduce the blood usage at minimum by rational use of blood and taking donation from safer donor groups like VDs and female donors. In the present study, VDs reduce the odd of TTIs by 45% compared to RDs. VDs in outside camps are more motivated compared to VDs who give blood donation in blood bank under social pressure of patients. VDs from outside camp had reduced odd of having TTIs by 5% compared to in-house VDs.
In the present study, HIV prevalence had been reducing. It ranged from 0.04% to 0.23% with an average of 0.14%. This was comparable with the study done by Fernandes et al. who reported 0.06% prevalence. [4] However, this was lower than reported prevalence of 0.56%, 0.3% and 0.44% by Pahuja et al., Arora et al. and Pallavi et al. respectively. [2],[5],[6] Enrollment of more female donors and more VDs helped to achieve reducing trend in HIV prevalence [Graph 3 [Additional file 3]].
Hepatitis B surface antigen prevalence was 0.38% with a range of 0.23-0.65% in the present study. Decreasing trend was observed. Prevalence in the present study group was lower than reported findings of 1.27%, 2.23% and 1.7% by Pallavi et al., Pahuja et al. and Arora et al. respectively and comparable with study of Fernandes et al. (0.34%). [2],[4],[5],[6] Careful screening of donors for previous illness help to reduce the rate of HBsAg in donors. Moreover, vaccine is also available for HBV. WHO included India in Intermediate zone (2-7%) for prevalence of HBsAg. [9] This study observed less prevalence than documented in WHO bulletin [Graph 4 [Additional file 4]].
Study done by Pallavi et al. and Fernandes et al. show anti-HCV prevalence of 0.23% and 0.06%, respectively. [2],[4] My study show similar prevalence, which was 0.06 with a range of 0.0-0.33. Pahuja et al. and Arora et al. have reported higher prevalence 0.66% and 1.0%, respectively. [5],[6] Difference on the prevalence of HCV in blood donors attributed to use of a different generation of ELISA having diverse sensitivity and specificity. [5] Approach of the trend line for negative value was explained by no donor was positive for HCV in 4 years and prevalence was very low. Data from more years of study will help to show more acceptable trend in future [Graph 5 [Additional file 5]].
Syphilis prevalence in donors was 0.14% in the range of 0.0-0.19%. Prevalence was lower than reported by Pallavi et al. (0.23%) and Arora et al. (0.9%). [2],[6] Trend show increase in prevalence during the study period. In year 2013, 4 out of 10 positive donors were from a single outside voluntary blood donation camp which was organized in the nearby city which is more industry oriented and donors were workers came from lower socioeconomic status.
No malaria case detected in this study. Fernandes et al. have reported one case out of 9599 donations. [4] Srikrishna et al. also not reported any case of malaria out of 8617 donations. [10] Donors with recent history of fever were excluded from donation. This helped to control malaria prevalence in blood donors.
Low prevalence rate of TTIs in this study attributed to legitimate history taking for medical conditions and enrollment of more voluntary and female donors. Concealment of medical history from the donor is a major bottleneck for safe blood. [4] Difference in TTIs between voluntary and RDs has been observed in many earlier studies. [11],[12],[13]
In the present study, blood donors were studied for TTIs during the period of 2007-2013 which help to better understand the trend compared to other studies with shorter durations. [2] Blood donations from voluntary and female donors were safer than RDs. Due to multidimensional approach by blood bank, nongovernment organizations and government support through NACO, voluntary donations were increase year by year. Decreased reliance on RDs helps to show reducing trend for prevalence of TTIs. Steps should be taken to encourage more VDs and female donors to provide safe blood to our patients.
References | | |
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[Table 1], [Table 2]
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