TRANSFUSION TRANSMISSIBLE INFECTIONS AMONG BLOOD DONORS FROM A SUB-HIMALAYAN RURAL TERTIARY CARE CENTRE IN DARJEELING, INDIA��(RUPALI MANDAL , KRISHNENDU MONDAL)

PRESENTED BY : DENNLIE LESLIE

MLT U29

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INTRODUCTION

• Transfusion therapy has been mainstay of several medico-surgical therapeutics since 1930 .
• 3 types of blood donors :

a) voluntary/unpaid donor

b) family/replacement donor

c) paid donor

INTRODUCTION�

• According to WHO Global Database on Blood Safety (GSBS) 2008 , total around 91.8 million blood donations are collected annually.

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• With almost 9.8 millions units of yearly collections and 84% voluntary donors , India is expected to bang on the WHO target of 100% voluntary donors by 2020.

INTRODUCTION

• Blood transfusion aggravates the risk of transfusion-transmissible infections (TTIs) like Hepatitis B (HBV) , Hepatitis C (HCV) , and Human Imunodeficiency Virus (HIV).

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• Globally , HbsAg prevalence varies between 0.1 and 11.7 %. Amongst Indian general population and blood donors, it lingers within 2-8% and 1-2% respectively.

INTRODUCTION

• Accordingly , worldwide 0.4-19.2% blood donors test positively for HCV and a low cumulative HCV prevalence below 2% has been reported from this country .

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• As for 2009 , around 2.5 million Indians were infected with HIV. Succumbing to a prevalence of 0.3 % , India presently stands third on planet, in numerical terms of HIV-infected people.

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INTRODUCTION

• Darjeeling district in India has a high HIV prevalence of >1% much higher than national distribution .

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• Despite that ,very little is learnt about the seroprevalence of HIV and others TTIs among blood donors here.

MATERIALS & METHODS

• Study was executed in Department of Blood bank, North Bengal Medical College & Hospital , Darjeeling , India.

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• Various immunological screening methods were performed on all donated samples for HIV-1 & 2 , HBsAg, HCV (by ELISA) , and syphilis (by VDRL) .

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MATERIALS & METHODS

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• Data from three consecutive years of 2010-2012 was retrieved from various documents maintained by blood bank authority.

MATERIALS & METHODS

MATERIALS & METHODS

Age and sex distribution of blood donors in three years (2010-2012)

MATERIALS & METHODS

RESULTS

• Total of 28,364 donors were screened during the period of January 2010 to December 2012.

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• Most of the donors were aged 35 years or less , and a mere 4.27% (1210) donors were living beyond their mid-forties.

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• Male were the dominant cohort , while female constituted only 10.04% (2847) of the study population .

RESULTS

• Total of 476 blood donation camp were arranged, which collectively compiled 20985 (73.98%) voluntary donations .

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• Astonishingly, the voluntary donors’ strength drastically declined in 2012 than its yesteryears, which actually reflected the reduction in donation camps instituted that years .

RESULTS

RESULTS

• As a whole 832 seropositive donors were identified corresponding to a summed-up seroprevalence of 2.93% .

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• Seroprevalence of HIV, HBV, HCV, and syphilis among studied donors were 0.42% (118) , 1.24% (353), 0.62% (175) , and 0.65% (185) respectively .

RESULTS

RESULTS

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• The overall seroprevalence of TTIs was significantly more pronounced among replacement donors (3.28%) than their voluntary (2.81%)counterparts .

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RESULTS

RESULTS

• Altogether the highest prevalence for each TTI was observed in the 26-35 years age group , followed by the 36-45 years age group.

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• Seropositivity among discussed donors dipped lowest for the >45 years age group.

DISCUSSION

• Blood transfusion is a life-saving integral remedy in current medical practices, but also carries contemporary risk of transmitting dreadful TTIs like HIV , Hepatitis B and C .

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• The overall seroprevalence of various TTIs among studied donors figured out as 2.93 % (Table 2) with a significant dwinding trend over successive years, which intimately stimulated previous observations by Mathai et al (3.1%) , Karmakar et al (2.79%) , and Koshy et al (2.9%) .

DISCUSSION

• The infectivity of HBV, HCV, HIV and syphilis amongst Indian donors has been documented as 0.66-12%, 0.5-1.5%, 0.084-3.87% and 0.85-3% respectively.

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• HBV was the most frequent (1.24%) TTI encountered in presently concluded study, recapitulating earlier Indian literatures accomplished in similar context.

DISCUSSION

• Mathai et al , Gupta et al , and Koshy et al encountered HCV as the commonest TTI in their respective studies.

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• On the contrary , 0.62% subjects were tested reactive for HCV , which lagged third behind HBV and syphilis in the list of TTIs. Chattoraj et al also experienced identical order of seropredominance among their examined donor.

DISCUSSION

• Serological evidence for syphilis turned to be affirmative in 0.65% of currently studied donations . Gupta et al encountered higher of 0.85% syphilis patients in their observed group.

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• Although HIV-prevalence in Darjeeling (1%) is much higher than whole Indian (0.3%) scenario . Still HIV-seroprevalence in discussed donors was quantified as 0.42% only, least of the chief four TTIs.

DISCUSSION

• In this on-going study most of the donors were males and the seroreactivity for HBsAg and VDRL was found to be significantly higher among males.

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• Such gender variation in seroresponsiveness could be attributed to their heterogeneous risk-behavior.

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DISCUSSION

• Koshy et al noted most of their studied seropositive donor to be aged between 18-30 years while Karmakar et al noted donor from 21-40 years age group . In the present study , most of the infected donor are from 26-35 years age group .

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• In the earlier study, RD frequently out-numbered the VD. Whatsoever in correspondence to existing worldwide trend, VD were profusely predominant in discussed study population.

CONCLUSION

• This study highlight that blood transfusion is one of the major modes to contact HIV, HBV, HCV and syphilis.

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• Males as much as the voluntary donors overwhelmingly predominate the donor subpopulation in modern world.

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• HBV is the most and HIV is the least common TTIs affecting blood donors .

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CONCLUSION

• Therefore :
1. immaculate eligibility criteria should be adopted while selecting blood
2. Augments the pool of voluntary donors
3. Increase the feminine participation in nationalized blood donation campaign.

National Blood Centre�Prevalence of TTIs among blood donors in PDN�

National Blood Centre

• Based on NBC’s statistic , a total of 180051, 180650 and 189190 of blood donation are collected in 2016 , 2017 ,and 2018 respectively .

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• As a whole 3309 seropositive donors were identified corresponding to a summed-up seroprevalence of 0.60% .

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• Seroprevalence of HIV, HBV, HCV, and syphilis among studied donors were 0.13%, 0.14%, 0.20%, and 0.12% respectively .

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National Blood Centre

• HCV is the most and syphilis is the least common TTIs affecting blood donors in National Blood Centre for the 3 consecutives years .

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• This study also shows an increasing prevalence from 2016 to 2018 . Therefore, more awareness campaigns among community should be done and immaculate eligibility criteria should be adopted while selecting blood .

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