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ORIGINAL ARTICLE
Year : 2014  |  Volume : 5  |  Issue : 2  |  Page : 113-116

Seroprevalence of Transfusion Transmissible Infections (TTIs) among blood donors in a tertiary care hospital, central India: A prospective study


1 Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra; Department of Pathology, Government Medical College, Jagdalpur, Chhattisgarh, India
2 Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India

Date of Web Publication1-Jul-2014

Correspondence Address:
Alok Kumar
Department of Pathology, Government Medical College, Jagdalpur, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.135737

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  Abstract 

Background: Blood transfusion having some risks of transfusion transmissible infections (TTIs) in the recipients especially when blood is collected during window period. In Africa, about 10-15% of human immunodeficiency virus (HIV) transmission had been related to blood transfusions. Aims: The aim of this study is to present the prevalence of TTIs among the apparently healthy donors, both voluntary as well as replacement donors. Settings and Design: This was a prospective study, carried out in a blood bank attached to a tertiary care hospital, Central India. Materials and Methods: All blood bags collected from these blood donors during the study period were screened for TTIs like hepatitis B surface antigen (HBsAg; Hepalisa, J. Mitra), anti-HIV antibodies (HIV Ab; HIV 3rd generation kit for detection of antibodies to HIV1 and HIV2, J. Mitra), anti-hepatitis C virus antibodies (HCV Ab; MicroELISA 3rd generation, J. Mitra), and Venereal Diseases Research Laboratory (VDRL) reactivity (Carbogen kit, Tulip Diagnostics). Serum were separated from all blood bags and serological test was performed according to the instructions provided by the manufacturers of respective kit. All seroreactive blood bags were considered as positive for TTIs and the blood bags were discarded. Statistical Analysis: A total of 10,582 blood donors were selected for blood donation after clinical history and brief medical examination by medical officer. Blood bags collected from them were screened for TTIs. Among the total blood bags screened, 273 (2.57%) were found positive for transfusion transmissible infectious diseases. Results: Among TTIs, the most common infection was hepatitis B followed by HIV infection in our study. Prevalence of coinfection in our study was very low (0.01%). Voluntary donations have low seroreactivity (2.40%) for TTIs as compared to replacement donations (3.20%). Conclusions: Multiple infections have a very small but definite risk to the recipients, recieving blood and blood products. Hepatitis B was the most common infection in our study. The incidence of coinfection was very low in our study. Prevalence of TTIs was more among replacement donors as compared to the voluntary donors. So, it is possible to improve the safety of blood and blood product by the promotion of voluntary donation, selection of low-risk donors, and use of highly sensitive laboratory screening test.

Keywords: Blood donors, seroprevalence, transfusion transmissible infections (TTIs)


How to cite this article:
Kumar A, Sharma SM, Ingole NS, Gangane N. Seroprevalence of Transfusion Transmissible Infections (TTIs) among blood donors in a tertiary care hospital, central India: A prospective study. Muller J Med Sci Res 2014;5:113-6

How to cite this URL:
Kumar A, Sharma SM, Ingole NS, Gangane N. Seroprevalence of Transfusion Transmissible Infections (TTIs) among blood donors in a tertiary care hospital, central India: A prospective study. Muller J Med Sci Res [serial online] 2014 [cited 2019 Oct 16];5:113-6. Available from: http://www.mjmsr.net/text.asp?2014/5/2/113/135737


  Introduction Top


Blood transfusion is one of the therapeutic interventions that is associated with some risks of transfusion transmissible infections (TTIs) in the recipients especially when blood were collected during window period. In Africa, about 10-15% of human immunodeficiency virus (HIV) transmission had been related to blood transfusions. [1] Despite stringent donor screening and testing procedures, the safe to safe blood free from TTIs remains an elusive goal. Although there are many studies on the prevalence of TTIs in blood donors, [2],[3],[4],[5] data on the presence of coinfection is few. [6] The aim of this study is to present the prevalence of TTIs among the apparently healthy donors, both voluntary as well as replacement donors.


  Materials and Methods Top


The study was carried out in the blood bank, attached to the tertiary care hospital, Central India over a period of 19 months from November 2009 to May 2011.

It was a prospective study. All blood donations collected during this period were included. The donors were either voluntary or replacement donors. Replacement donors were either relatives or friends of patients.

All blood bags collected from these blood donors during the study period were screened for TTIs like HBsAg (Hepalisa, J. Mitra - J. Mitra & Co. Pvt. Ltd, New Delhi, India), anti-HIV antibodies (HIV Ab; HIV 3rd generation kit for detection of antibodies to HIV1 and HIV2, J. Mitra - J. Mitra & Co. Pvt. Ltd, New Delhi, India), anti-hepatitis C virus antibodies (HCV Ab; MicroELISA 3rd generation, J. Mitra - J. Mitra & Co. Pvt. Ltd, New Delhi, India), and Venereal Diseases Research Laboratory (VDRL) reactivity (Carbogen kit, Tulip Diagnostics-Tulip diagnostics (P) Ltd, Uttarakhand, India).

Serum was separated from all blood bags and serological test was performed according to the instructions provided by the manufacturers of respective kit. All seroreactive blood bags were considered as positive for TTIs and the blood bags were discarded.

Statistical Analysis

A total of 10,582 blood donors were selected for blood donation after clinical history and brief medical examination by medical officer. Blood bags collected from them were screened for TTIs. Further, within the seroreactive group, cases with a combination of two or more than two TTIs were labeled as coinfection.


  Results Top


A total of 10,582 blood donors were screened for TTIs, 97.05% were male and 2.95% were female. Almost 78% were voluntary donors and 22% were replacement donors. Among voluntary donors, 96.24% were male and 3.76% were female donors as shown in [Table 1].
Table 1: Status of donors as per sex and type

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Among a total of 10,582 blood donors screened, 273 (2.57%) were found positive for infectious diseases, in which hepatitis B infection (1.76%) was the commonest infection among blood donors followed by HIV infection (0.53%). Most of the infections were caused by single organism, except in one having mixed infection caused by hepatitis B and HIV and no donors were positive for malarial parasite as shown in [Table 2].
Table 2: Seropositive infections among donors

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A total of 8,232 voluntary donors was screened in which 197 (2.40%) were found positive for infectious diseases while 76 (3.20%) of replacement donors were found positive against a total of 2,350 replacement donors. Distribution of TTIs among voluntary as well as replacement donors is shown in [Table 3].
Table 3: Seropositive infections among voluntary and replacement donors

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  Discussion Top


In our study, a total of 273 (2.57%) donors were seropositive for infectious diseases (TTIs) out of 10,582 donors screened, hepatitis B virus infection 187 (1.76%) was the commonest infections among donors followed by HIV (0.53%) while hepatitis C accounts for 21 (0.20%) and syphilis in 07 (0.07%) of all donors screened. No donors had malarial infections. Most of the infections were caused by single organism, except one having mixed infection caused by hepatitis B and HIV.

In the study done by Chickwem et al., [7] it was found that the most common infection was hepatitis B (14.84%) followed by HIV-1 (5.77%) while Plasmodium falciparum accounted for 4.12% and Treponema pallidum for 3.57%. No donors had HIV-2 or filarial infections. On the whole, a total of 94 (25.8%) blood donors were infected by one infectious agent or the other. Only nine (2.5%) had mixed infections.

In study done by Fasola et al., [8] (2001-2006), Nigeria, it was observed that the most common infection was hepatitis B (13.2%) followed by HIV (7.6%), HCV (3.6%) and no donors had syphilis infection.

Shrestha et al., [9] (2004-2007), Nepal, observed that hepatitis C infection (0.64%) was the most common infection followed by hepatitis B (0.64%), syphilis (0.48%), and HIV 0.12% of total donors.

Mathai et al., [3] (1994-96), Trivandrum, Kerala observed that the most common infection was hepatitis C infection (1.4%) followed by hepatitis B infection (1.3%), and both HIV and syphilis each were seen in 0.2% of donors.

Garg et al., [5] (1994-99), Jodhpur, Rajasthan observed that hepatitis B (3.4%) was the most common infection followed by HIV (0.44%), hepatitis C infection (0.28%), and syphilis was 0.22%.

Chandra et al., [10] (2001-2006), Lucknow, U. P. observed that hepatitis B infection was most common (1.96%) followed by hepatitis C infection (0.85%), HIV (0.23%), and syphilis was 0.01%.

Bhawani et al., [11] (2004-2009) observed that hepatitis B (1.41%) was the most common infection followed by hepatitis C infection (0.84%), HIV (0.39%), and syphilis was 0.08%.

Kapur and Mittal et al., [12] found that in HIV-positive donors, HBsAg was positive in 12.2% while VDRL was reactive in 11.8%.

Jain et al., [13] estimated the seroprevalence of hepatitis virus in patients infected with HIV and found that 9.9% of patients were HBsAg-positive, 6.3% were HCV-positive and about 1% had dual infection with HBV and HCV.

Mathai et al., [3] found that of 31,942 donors screened over a 6-year period, mixed infections were seen in only 10 donors (0.03%).

Studies on the prevalence of hepatitis viruses in patients with HIV have shown the HIV and HBV/HCV coinfection rate to be 12-15%. [14],[15],[16] However, studies from India show that this varies with the geographical region with rates of 9-30% for HBV and 2-8% for HCV have been reported. [17],[18],[19]

On comparing with these studies, we observed that hepatitis B infection (1.76%) was the most common among blood donors in our study as also observed in other studies [5],[8],[10],[11],[12] followed by HIV infection (0.53%). No cases of malarial parasites were detected in our study. It was due to proper clinical assessment and history of the donor. Only one donor had coinfection with both hepatitis B and HIV out of 10,582 donors screened. Prevalence of coinfection in our study was very low (0.01%) as compared to other studies where prevalence of coinfection was high. [12],[13],[14],[15],[16] However, prevalence of coinfection in our study was similar to study done by Mathai et al., [3] (2002).


  Conclusions Top


Multiple infections have a very small but definite risk to the recipients, receiving blood and blood products. Hepatitis B was the most common infection in our study. The incidence of coinfection was very low in our study. Prevalence of TTIs was more among replacement donors as compared to the voluntary donors. So, it is possible to improve the safety of blood and blood product by the promotion of voluntary laboratory screening test.

 
  References Top

1.Fleming AF. HIV and blood transfusion in sub-Saharan Africa. Transfus Sci 1997;18:167-79.  Back to cited text no. 1
    
2.Singh B, Kataria SP, Gupta R. Infectious markers in blood donors of East Delhi: Prevalence and trends. Indian J Pathol Microbiol 2004;47:477-9.  Back to cited text no. 2
    
3.Mathai J, Sulochana PV, Satyabhama S, Nair PK, Sivakumar S. Profile of transfusion transmissible infections and associated risk factors among blood donors of Kerala. Indian J Pathol Microbiol 2002;45:319-22.  Back to cited text no. 3
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4.Singh B, Verma M, Kotru M, Verma K, Batra M. Prevalence of HIV and VDRL seropositivity in blood donors of Delhi. Indian J Med Res 2005;122:234-6.  Back to cited text no. 4
    
5.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;44:409-12.  Back to cited text no. 5
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6.Nanu A, Sharma SP, Chatterjee K, Jyoti P. Markers for transfusion-transmissible infections in North Indian voluntary and replacement blood donors: Prevalence and trends 1989-1996. Vox Sang 1997;73:70-3.  Back to cited text no. 6
    
7.Chikwem JO, Mohammed I, Okara GC, Ukwandu NC, Ola TO. Prevelence of transmissible blood infections among donors at the University of Maiducuri Teaching Hospital, Maiducuri, Nigeria. East Afr Med J 1997;74:213-6.  Back to cited text no. 7
    
8.Fasola FA, Kotila TR, Akinyemi JO. Trends in transfusion-transmitted viral infections from 2001 to 2006 in Ibadan, Nigeria. Intervirology 2008;51:427-31.  Back to cited text no. 8
    
9.Shrestha AC, Ghimire P, Tiwari BE, Rajkarnikar M. Transfusion transmissible infections among blood donors in Kathmandu, Nepal. Blood Transfusion 2009;7:293-9.  Back to cited text no. 9
    
10.Chandra T, Kumar A, Gupta A. Prevalence of transfusion transmitted infections in blood donors: An Indian experience. Trop Doct 2009;39:152-4.  Back to cited text no. 10
    
11.Bhawani Y, Rao PR, Sudhakar V. Seroprevalence of transfusion transmissible infections among blood donors in a tertiary care hospital of Andhra Pradesh. Biol Med 2010;2:45-8.  Back to cited text no. 11
    
12.Kapur S, Mittal A. Incidence of HIV infection and its predictors in blood donors in Delhi. Indian J Med Res 1998;108:45-50.  Back to cited text no. 12
    
13.Jain M, Chakravarti A, Verma V, Bhalla P. Seroprevalence of hepatitis viruses in patients infected with the human immunodeficiency virus. Indian J Pathol Microbiol 2009;52:17-9.  Back to cited text no. 13
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14.Rouet F, Chaix ML, Inwoley A, Anaky MF, Fassinou P, Kpozehouen A, et al. Programme Enfant Yopougon (Agence Nationale de Recherches sur le SIDA et les Hépatites Virales B et C 1244/1278). Frequent occurrence of chronic hepatitis B virus infection among West African HIV type-1-infected children. Clin Infect Dis 2008;46:361-6.  Back to cited text no. 14
    
15.Telatela SP, Matee MI, Munubhi EK. Seroprevalence of hepatitis B and C viral coinfections among children infected with human immunodeficiency virus attending the paediatric HIV care and treatment center at Muhimbili National Hospital in Dar-es Salaam, Tanzania. BMC Public Health 2007;7:338.  Back to cited text no. 15
    
16.Egah DZ, Banwat EB, Audu ES, Iya D, Mandong BM, Anele AA, et al. Hepatitis B surface antigen, hepatitis C and HIV antibodies in a low-risk blood donor group, Nigeria. East Mediterr Health J 2007;13:961-6.  Back to cited text no. 16
    
17.Padmapriyadarsini C, Chandrabose J, Victor L, Hanna LE, Arunkumar N, Swaminathan S. Hepatitis B or hepatitis C co-infection in individuals infected with human immunodeficiency virus and effect of anti-tuberculosis drugs on liver function. J Postgrad Med 2006;52:92-6.  Back to cited text no. 17
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18.Tankhiwale SS, Khadase RK, Jalgoankar SV. Seroprevalence of anti-HCV and hepatitis B surface antigen in HIV infected patients. Indian J Med Microbiol 2003;21:268-70.  Back to cited text no. 18
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19.Kumarasamy N, Solomon S, Flanigan TP, Hemalatha R, Thyagarajan SP, Mayer KH. Natural history of human immunodeficiency virus disease in southern India. Clin Infect Dis 2003;36:79-85.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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