Seroprevalence and trends of transfusion transmissible infections among voluntary and replacement donors–an institutional retrospective study

Introduction: Transfusion transmitted infections are major problem associated with blood transfusion. There are several infectious as well as non-infectious risks associated with transfusion of blood. Aim and Objective: The present study was carried out to find out the sero-prevalence and changing trends of various TTIs in blood donors. Material and Methods: A record based study was conducted from January 2008December 2010. Data were collected from therecords of blood bank which also included data of blood donation camps. Data regarding sex, screening testresults and type of donors were collected from the records. Results: Out of 17640 donors, voluntary donors (78.4%) were more in comparison to replacement donors (21.6%). Out of all TTIs, prevalence of HBV (2.14%) was highest followed by, HCV (0.66%), HIV (0.6%), Malaria (0.14%) and Syphilis (0.05%). TTIs were more prevalent in replacement donors than voluntary donors. The number ofvoluntary donors has fallen from 2008 -2010, but there is male preponderance in both voluntary and replacement donors. Conclusion: From results it has been concluded that prevalence of transfusion transmitted infection (HIV, HBV, HCV, VDRL, and malaria) was more in replacement donors in comparison to voluntary donors. With the implementation of strict donor selection criteria, use of sensitive screening tests and establishment of strict guidelines for blood transfusion it may be possible to reduce the incidence of transfusion transmitted infection in the Indian scenario.


Introduction
A well organised blood transfusion service is a vital component of patient management in any health care delivery system. When used correctly it can save life, nevertheless in addition it carries the risk of transmission of wide number of infectious agents as well. It has been estimated that every two seconds someone needs blood [1] andone-third of all patients admitted to intensive care units (ICUs) in the developed world receive a blood transfusion [2]. According to WHO, safe blood is a universal right, Globally, more than 81 million units of blood is donated annually. More than 18 million units of blood are not screened for these transfusiontransmissible infections. With every unit of blood transfused, there is a 1% risk of transfusion associated problems including transfusion transmitted diseases [3]. Transfusion transmitted infections (TTIs) are a major problem associated with blood transfusion An integrated strategy for blood safety is required for elimination of these transfusion transmitted infections and for provision of safe and adequate blood transfusion services to the people. The main component of an integrated strategy include collection of blood only from voluntary non-remunerated blood donors, but this mode of collection though ideal is not always practically implementable in our country due to various factors such as illiteracy, negative attitudes towards blood donation, and fear of weakness and disease.
Due to these factors our blood banks depend also on replacement donation which is not entirely voluntary, as the patients relatives are under pressure to replace the blood transfused to the patient. . Voluntary donors are preferred over replacement donors because replacement donor may tend to conceal some history with the

Original Research Article
Pathology Update: Tropical Journal of Pathology & Microbiology Available online at: www.pathologyreview.in 331 | P a g e intention of benefitting their patient, out of ignorance that they are putting someone's life at risk [4] There are basically 3 types of blood donors: voluntary/ unpaid; family/replacement and paid. It is important to note that the problem of TTIs is directly proportionate to the prevalence of Infections among the blood donor community. Thus the present study was conducted with an aim to assess the percentage ofvoluntary as well as replacement blood donors and to find out the sero-prevalence and changing trends ofvarious TTIs among blood donors.

Materials and Methods
Place Exclusion Criteria: For blood donation were age <18 years and >60 years, weight < 45kg, current history of medication, recent blood transfusion, any infection, anaemia and recent history of any surgical procedure.
Data regarding voluntary blood donation at the blood bank as well as various blood donation camps organized by the blood bank were analyzed. In the blood bank each donor blood sample was screened for five infections -HIV, HBV, HCV, Syphilis and Malaria. Donor blood was screened for HIV, HBV, HCV, Syphilis and malarial parasite using rapid kits and ELISA.

Results
During the study period, a total of 17640 donors were screened during the three-year period from January 2008-December 2010 for TTIs. Among them, 15770 (89.4%) were males and 1870 (10.4%) were females. A total of 13820 (78.4%) were voluntary donors which included donors at the blood bank of J.J. Hospital, Mumbai and also donors at the blood camps organized by the blood bank. and 3820 (21.6%) were replacement donors.  This shows the predominance of males as compared to females in blood donation during the study (Table 1&2)  The year wise proportion (in percentages) of different TTIs among blood donors has been shown in (Table 3). With respect to individual TTIs, it was observed that out of total 17640 donors screened, the maximum number of donors 379 were found positive for HBV infection followed by 117 donors for HCV, 105 donors test positive for HIV, 25 donors for malaria and 6 donors test positive for syphilis.
Thus the proportion (in percentages) of TTIs among blood donors at blood bank during three year period was found maximum for HBV (2.14%) followed by HCV (0.66%), HIV (0.6%) malaria (0.14%) and least for syphilis (0.05%). Every country needs to meet its requirements for blood and blood products and ensure safe blood supplies that are free from HIV, hepatitis viruses and other lifethreatening infections which can be potentially transmitted through unsafe transfusion practices.
Despiteof counseling and medical tests, conducted prior to blood donation, the presence of TTIs is inevitable in donated blood. Since a person can transmit infections during its asymptomatic phase (window period), transfusions can contribute to an ever-widening pool of infection in the general population. Extensive donor selection and sensitive screening tests will help in improving the blood safety and hence ensure the elimination, or at least reduction, of the risk of acquiring TTIs.
Blood safety is integral to the WHO HIV/AIDS plan to combat the spread of HIV infection and to the achievement of the health-related Millennium Development Goals to reduce child mortality, improve maternal health, combat HIV and develop global partnership for development [5].
Accurate estimates of risk of TTIs are important for monitoring safe blood supply and in evaluating the efficacy of the currently employed screening procedures " [6].
The prevalence of TTIs among blood donors in a structured health care system with a well-organized blood establishment can be used as a statistical tool for against those infectious agents that can be transmitted through blood and blood products and hence forth can contribute to statistical estimation of these viruses in the general population " [7].
WHO promotes voluntary over replacement donation. In the presentstudy, 78.4% were voluntary and 21.6% were replacement donors. Similar predominance of voluntary donors was noted byShah et al [8] in their study. This reflects the presence ofblood donation awareness among the general population. In a study done inwestern Ahmedabad by Patel et alvoluntary blood donors were reported as 95.56% [9], but a study from Karnataka and from Haryana reported it as 58% and 31.4% respectively [10,11]. People should be motivated to become voluntary blood donors for which blood camps are organized. The third highest prevalence of TTI in the present study was HIV being 0.60%. Other studies reported HCV prevalence as 0.34%, 0.57%, 0.84% and 1.09%. [16][17][18] For HIV, India is second only to South Africa in terms of overall number of people living with HIV [15]. The prevalence of HIV in various parts of India is different with high rate in western and southern parts [14]. In the present study the prevalence of HIV in donors was found to be 0.60%. Other studies conducted in various parts of India reported HIV prevalence in donors as 0.23%, 0.51%, 0.39% and 0.08% [16][17][18].
A WHO report states that the viral dose in HIV transmission through bloodis so large that one HIV positive transfusion leads to death, on an average, after 2 years in children and after three to 5 years in adults. 11 The least prevalence of TTI in the present study was for syphilis being 0.05%. Other studies reported syphilis prevalence in donors as 0.01%, 0.23%, 0.08% and 0.90% [16][17][18][19]. Out of all TTIs, prevalence of HBV (2.14%) was highest in the donors followed by, HCV (0.66%), HIV (0.6%), Malaria (0.14%) and Syphilis (0.05%). The pattern of TTIs among blood donors from 2008-2010 has shown a rising trend for HIV and HCV infections.

Conclusion
Voluntary donation should be encouraged for the prevention of transfusion transmitted infections. Replacement and voluntary donors should be screened thoroughly before blood donation and professional donors should be out rightly rejected.
With the implementation of strict donor selection criteria, use of sensitive screening tests and establishment of strict guidelines for blood transfusion it may be possible to reduce the incidence of transfusion transmitted infection in the Indian scenario.
What this study add to existing knowledge: Since the present study undertaken aimed to review the seroprevalence of blood donors in our hospital.
Being the largest study on replacement and voluntary donors from India, it is likely to reflect changing trends in TTIs in major cities of the country.
Notes: Contribution of different authors;