DO BLOOD TRANSFUSIONS TRANSMIT INFECTIONS?

ABSTRACT :

BACKGROUND: Blood transfusion is a life-saving procedure. However, the recipient has

the potential risk of acquiring transfusion-transmissible diseases (TTD), important infectious
agents being Human Immunodeficiency Virus (HIV), Hepatitis B & C viruses, and
Treponema pallidum

AIM: This study was undertaken to know the prevalence of TTD in our hospital blood bank
and hence evaluate the safety of the blood units

MATERIAL AND METHOD: The present study was conducted at the Blood Bank of our
Medical College Hospital. Data was collected retrospectively for a 4.5-year period from
January 2008 to June 2012. Donor data including demographic details and results of the
screening tests were recorded.

RESULTS: In the 4.5-year period, there were 7128 donors – both voluntary and replacement
donors. The donors were in the age group 18 to 50 years. Out of the 116 donors tested
positive for any test, there were 5 female donors and the 111 male donors. The donors who
tested positive formed 1.6% of the total number of donors. The maximum number of donors
were positive for HBsAg (40.5%), followed by positivity for HCV (38.8%). The
seroprevalence of HBsAg, HCV, HIV and Syphilis was 0.66%, 0.63%, 0.25% and 0.1%
respectively. There was no case with smear positive for malaria parasite.

CONCLUSION: The risk can be kept to a minimum by proper donor selection and testing of
the collected units.

Key words: HIV, Hepatitis B virus, Hepatitis C virus, Blood donors

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INTRODUCTION: Timely transfusion of blood saves many lives, but puts the people
receiving transfusions at risk of acquiring transfusion transmissible diseases (TTDs) which is
still a major concern in the practice of transfusion medicine. Blood transfusion carries the risk
of transfusion-transmissible infections, including human immunodeficiency virus (HIV),
hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis (Treponema pallidum), malaria
and infrequently toxoplasmosis, brucellosis and some viral infections like CMV, EBV and
Herpes. With every unit of blood, there is 1% chance of transfusion-associated problems
including transfusion-transmitted diseases [1]. Preventing the transmission of infectious
diseases through blood transfusion in developing countries is difficult but can be improved by
policies and strategies. These strategies have been extremely effective but transmission of
diseases still occurs, primarily because of the inability of the test to detect the disease in the
pre-seroconversion or ‘window’ phase of their infection, high cost of screening,
immunologically variant viruses, and non-seroconverting chronic or immuno silent carriers.

The aim of the this study was to find out the prevalence of transfusion transmissible
diseases (TTDs) in both voluntary and replacement donors in our hospital transfusion service
set up and thus aid in evaluating the safety of the blood units ready for transfusion.

MATERIAL AND METHOD: The present study was conducted at the Blood Bank of our
Medical College Hospital. This Blood Bank is located in suburban Mangalore in Karnataka
state. Data was collected retrospectively for a 4.5-year period from January 2008 to June
2012. Donor data including demographic details and results of the screening tests were
recorded. The donors were both Voluntary and Replacement donors. Professional donors are
not permitted to donate in our Blood Bank. Donors were selected strictly by the standard
criteria for donor fitness.

Tests are routinely done on every blood unit to exclude HIV, HBV, HCV, syphilis
and malaria as per the regulations of the Drugs Control Authority in India. The testing was
done by CLIA (Chemi Luminescence Immuno Assay) using kits manufactured by Ortho-
Clinical Diagnostics for HIV (Anti-HIV 1+2), HBS Ag (HBsAg ES) & HCV (Anti HCV).
Test for syphilis was done by RPR (Rapid Plasma Reagin – Nontreponemal
macroagglutination method) manufactured by Agappe Diagnostics Ltd. and blood was
screened for malaria parasites by peripheral blood smear. All the reactive samples were
repeated in duplicate before labelling them seropositive. The donated blood was discarded
whenever the pilot donor sample was found positive for any TTD.
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RESULTS: In this 4.5-year period, there were 7128 donors – both voluntary and
replacement donors. The donors were in the age group 18 to 50 years. The results of the
serological testing are given in Table 1. Out of the 116 donors tested positive for any test,
there were 5 female donors and the 111 male donors. The donors who tested positive formed
1.6% of the total number of donors. The maximum number of donors were positive for
HBsAg (40.5%), followed by positivity for HCV (38.8%). There was no case with smear
positive for malaria parasite.The seroprevalence of HBsAg, HCV, HIV and Syphilis was
0.66%, 0.63%, 0.25% and 0.1% respectively.

Table 1 – showing the year-wise distribution of seropositive cases among Voluntary and

Replacement donors in our study

VOLUNTARY REPLACEMENT Total

TEST 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
(6m) (6m)
HIV 7* 3 2 3 0 2 0 0 1 0 18
(15.5%)
HBsAg 10+ 9 4 7 5 3 5 1 2 1 47
(40.5%)
HCV 13*+ 8 7 5 1 4 3 2 2 0 45
(38.8%)
Syphilis 1 1 1 0 0 1 1 0 0 1 06
(5.2%)
Malaria 0 0 0 0 0 0 0 0 0 0 0
Total 31 21 14 15 6 10 9 3 5 1 116
*one donor was both HIV & HCV positive +one donor was HBV & HCV Positive

DISCUSSION: Transfusion of blood and blood products is a life saving measure and helps
innumerable people worldwide. At the same time however, blood transfusion is an important
mode of transmission of infection to the recipients. The majority of known cases of
transfusion transmitted diseases in India have been caused by HIV, HBV, HCV, Treponema
pallidum and malarial parasites. Hence screening donors for these tests has been made
mandatory in India.

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 Seroprevalence varies with different regions. In various studies done the
seroprevalence was variable in different regions in India. In Northern India, a study from
New Delhi showed a seroprevalence of HBsAg - 1.66%, HCV – 0.65%, HIV – 0.35% and
Syphilis – 2.8%[2], a study from Haryana showed a prevalence of HBsAg – 1.7%, HCV –
1%, HIV – 1% and Syphilis – 0.9%[3], a study from Ludhiana showed a prevalence of
HBsAg –0.66%, HCV – 1.09%, HIV – 0.084% and Syphilis – 0.85%[4], and a study from
Lucknow showed a prevalence of HBsAg –1.96%, HCV – 0.85%, HIV – 0.23% and Syphilis
– 0.01%[5]. In our study the prevalence of HIV was mostly comparable to these studies but
that of Hepatitis B & C, and syphilis was lower.

A study from Western India showed a prevalence of HBsAg –3.4%, HCV – 0.28%,
HIV – 0.44% and Syphilis – 0.2%[6]. These figures were slightly higher when compared to
our study except for the incidence of Hepatitis C.

In Eastern India, a study from Kolkata showed a seroprevalence of HBsAg - 1.55%,

HCV – 0.35%, and HIV – 0.32%[7]. The prevalence of HIV was comparable to these studies
but that of Hepatitis B was lower and hepatitis C was higher.

In South India, a study from Andhra Pradesh showed a seroprevalence of HBsAg -

1.41%, HCV – 0.84%, HIV – 0.39% and syphilis 0.08%[8]. These figures were slightly
higher when compared to our study. Studies from our state, Karnataka, also showed slight
differences in seroprevalence. A study from Mysore in southern Karnataka showed a
seroprevalence of HBsAg - 1.77%, HCV – 0.13%, HIV – 0.63% and syphilis 0.28%[9]. The
figures from this study were slightly higher when compared to our study except for the
incidence of Hepatitis C. A study from a Blood bank in the urban area of Mangalore showed
a seroprevalence of HBsAg – 0.34%, HCV – 0.06%, HIV – 0.06% and syphilis 0.11%[10].
This seroprevalence was much lower than that found in our study.

The low seropositivity among donors is mainly attributed to pre-donation counselling.

The improved screening and testing of blood donors has significantly reduced transfusion-
transmitted diseases in most developed countries. This has not been so in all developing
nations. Poor health education and lack of awareness result in blood transfusion being a
potentially significant route of transmission, although risk may be reduced by the vigorous
screening of donors. Moreover, it is important to remember that blood donations collected in
the “window period” of the infection may be infectious despite a negative antibody test.
Concealment of medical history by donors poses a great threat to the safety of blood supply.

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Efforts to ensure an adequate and safe blood supply should also include striving for optimal
use of blood and its products. Blood should be transfused only it is absolutely essential to the
care of the patient.

To reduce the risk of these TTDs non-remunerated voluntary donor services need to
be instituted. Extensive donor selection and screening procedures can improve the blood
safety. The emphasis must also be laid on voluntary exclusion, which will require increased
awareness and change in the attitude of people. Voluntary blood donation has to be made a
part of healthy lifestyle, enlightening the public about the benefits of voluntary blood
donations

CONCLUSION:
Transfusion of blood and blood products is a life-saving procedure. However, every blood
transfusion has a potential risk of transmitting infections which are hazardous to the recipient.
This risk can be greatly minimized by continuous improvement in donor selection practices
and the quality of screening tests. Evaluation of data on the prevalence of these diseases
permits an assessment of their occurrence in the population and consequently, the safety of
the donor.

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