A study of transfusion transmissible infections in blood donors in blood bank of north Gujarat

Introduction

A transfusion of blood is a therapeutic process that delivers a good blood to the individual by an intravenous line (IV) that is obligatory for the survival of patients with blood loss. Blood, on the other side, is a perfect delivery medium for any contagious infection that can exist in the blood¹. Blood transfusions if not monitored can lead to transmission of various infective agents which may endanger human life and also lead to morbidity and economic burden to the patients.1

A transfusion transmissible infection (TTI) is any infection that is transmissible from person to person through parenteral administration of blood or blood products for example hepatitis B (HBV), hepatitis C (HCV), Human Immunodeficiency Virus (HIV), syphilis, and less commonly to malaria, toxoplasmosis, brucellosis and other viral infections.2 Transfusion transmissible infectious diseases carry long term consequences for the recipients, families and the communities since the infected person represents a pool for the infection and can transmit the disease during its asymptomatic period.3, 4

In developing countries India, blood safety is a major issue due to the high prevalence of infectious agents among blood donors.5 The prevalence of human HIV in adults in India was recorded 0.2–0.3%.6 The prevalence of average hepatitis B surface antigen in India was 4.7% (range 1% to 3%).7 Overall, 0, 4-19.2% of blood donors had HCV infections.

While In India, HCV prevalence < 2% has been reported.8 Minimising the chances of transfusion transmitted infections (TTI) remains an important measure of blood transfusion safety. Due to availability of nucleic acid amplification technologies classic TTI like HIV, HBV and HCV are detected during window period of disease. Nowadays donor evaluation, highly sensitive laboratory screening tests and pathogen inactivation procedures are important measures to decrease the risk of TTI.9, 10

TTI are very common in all over India including Gujarat but studies on TTI in donors from north Gujarat areas are lacking. The present research is performed to establish the incidence and transfusion patterns transmitted infections in a tertiary care hospital of northern Gujarat.

Materials and Methods

The research was a sort of secondary analysis of the results. Blood donation data from January 2018 to February 2020 were taken in to analysis. The donor inclusion criteria were as follows: age 18 to 60, weight 45 kg, haemoglobin level at least 12 g percent, no history of hepatitis B and hepatitis C and sexually transmitted infections, no history of jaundice in the last 1 year. Both donors were questioned for high-risk actions for HIV, hepatitis B, and syphilis. All donors were categorised in to two groups; replacement donors and volunteer donors. Testing was carried out for donors from both the groups before blood transfusion. For HIV-1 & 2, HBsAg, and HCV, enzyme-linked immunosorbent assay or (ELISA) were carried out while Rapid Plasma regain test was carried out for screening of syphilis. HIV-1 and 2 were detected by any of these four kits: ENzaids, Pareekshak Erbaliza or Meriliza kits. HBV ad HCV testing were done by Erbalisa or merilisa kits. Syphilis screening was done by Reckon rapid test kits.

Results

In present study 4433 donors details were reviewed. Prevalence of Transfusion transmitted infection were described in Table 1. Overall prevalence of all TTIs was 2.12%. Percentages of HIV and HBsAg infection were 0.52% and 0.68% respectively in present study syphilis has prevalence of 0.81%. Highest prevalence of HIV and HBsAg were seen in 2018. HCV infection was seen only in 2019 which was 0.16%.

Age distribution of the study participants is shown in Table 2. Highest number of HIV, HBsAg and HCV positive donors were seen among 18 to 30 years of age while in case of syphilis, positive donors were belonged to 31- to 40 years of age group.

Table 3 describes distribution of TTIs among blood donors according to their type of donation. Replacement donor has significantly higher number of all TTIs (HIV, HCV, HBsAg and Syphilis) as compared to voluntary donors.

Discussion

Transfusion related infections ose more danger in the developing countries like India as compared to developed countries. Viral infections like HBV, HIV, and HCV are the main cause of morbidity and mortality in blood recipients. The overall prevalence of TTIs in our study was 2.12% which is almost similar as previous observations by Mandal R et al.11 (2,93%), Karmakar et al.12 (2.79%) and Koshy et al.13 In present study the HIV seroprevalence was 0.52%. In a study done by Suresh B et al.14 the seroprevalence of HIV amonst donor was 0.36% and Sindhu et al15 reported as low as 0.08%. In our study HIV prevalence amongst replacement donor was higher as 2.72% while in voluntary donor it was 0.52%. Sharma et al16 showed the prevalence of HIV 0.45% in replacement donors and 0.32% in voluntary donors while it was 0.44% and 0.15% in replacement and voluntary donor, respectively in Chandigarh.17 HIV transmission is possible during “window period” even if each unit is tested for HIV antibodies. This can be minimized by better selection of low-risk donors by stringent screening.

In our study, over all prevalence of HBV infection was 0.68%. Seroprevalence of HBV in the present study is in accordance with Gupta et al.18 who reported seropositivity of 0.66%. In our study, prevalence of HBV infection was 3.24% amongst replacement donor while in voluntary donor it was 0.29%. Kaur et al.17 reported 1.07% and 0.65% in replacement and voluntary donors; Pahuja et al19 reported much higher prevalence of 2.23%. Increasing trends of HBV infection was seen in replacement donors which may be due to fact that replacement donors conceal information about their health during donor selection to get the blood for their patient, thus compromising blood safety. In our study, over all prevalence of HCV infection was 0.11%. Same prevalence was reported in Gupta et al. from Punjab reported. In our study, prevalence of HCV infection was 0.68% amongst replacement donor while in voluntary donor it was 0.03%. Kaur et al.17 reported 0.5% and 0.3%, Sharma et al.16 reported 0.52% and 0.23% in replacement and voluntary donor, respectively. In our study, over all prevalence of syphilis infection was 0.81%. Studies done by Pallavi et al 1 and Arora et al20 reported prevalence of syphilis among blood donor was 0.23% and 0.9% respectively.

Conclusion

In the present research, the average prevalence of transfused infection among all donors was 2.12%. Blood donation is a Nobel job, and people must be inspired by it, but besides this, they must be trained and made cautious of the diseases transfused. Blood donors should screen themselves periodically for the various infections which may be present in the carrier stage. The pattern of transfusion transmissible infections may be different among the general population, but it can be used as monitoring tool.

Source of Funding

None.

Conflict of Interest

The authors declare that there is no conflict of interest.