Seroprevalence of Cytomegalovirus among Voluntary Blood Donors

Background

Primary cytomegalovirus (CMV) infection in immunocompetent host is self limiting infection, leading to latency of virus. However congenital CMV and CMV infections in immunocompromised patients are associated with high morbidity and mortality. Transfusion transmitted-cytomegalovirus (TT-CMV) infection in low birth weight neonate and immunocompromised transfusion recipients is being increasingly reported. Studies recommended transfusion of CMV free or CMV safe blood in prevention of TT-CMV. In this background, the study was undertaken to assess the CMV seroprevalence in blood donor.

Methods

A prospective study was conducted in which 431 voluntary blood donors were screened for CMV IgG and IgM by EIA (Enzyme Immuno Assay).

Result

A total of 379 (87.9 %) voluntary blood donors were seropositive for CMV IgG. There was no statistical difference of CMV seropositivity and age. Further, seven (1.6%) subjects were both CMV IgM and IgG seropositive.

Conclusion

High seroprevalence of CMV in our donor population is a threat to the blood safety. Strategies in reducing the risk of TT- CMV are discussed. Use of prestorage leucodepleted ‘CMV safe’ blood components along with judicious use of blood is recommended in prevention of TT-CMV in high risk recipients.Key Words: Cytomegalovirus, Transfusion transmitted infections, Blood donors, Leucodepletion     

Seroprevalence of human parvovirus B19 in healthy blood donors

Background

Human parvovirus B19 is an emerging transfusion transmitted infection. Although parvovirus B19 infection is connected with severe complications in some recipients, donor screening is not yet mandatory. To reduce the risk of contamination, plasma-pool screening and exclusion of highly viraemic donations are recommended. In this study the prevalence of parvovirus B19 in healthy blood donors was detected by ELISA.

Methods

A total of 1633 samples were screened for IgM and IgG antibodies against parvovirus B19 by ELISA. The initial 540 samples were screened for both IgM and IgG class antibodies and remaining 1093 samples were screened for only IgM class antibodies by ELISA.

Results

Net prevalence of IgM antibodies to human parvovirus B19 in our study was 7.53% and prevalence of IgG antibodies was 27.96%. Dual positivity (IgG and IgM) was 2.40%.

Conclusion

The seroprevalence of human parvovirus B19 among blood donor population in our study is high, and poses an adverse transfusion risk especially in high-risk group of patients who have no detectable antibodies to B19. Studies with large sample size are needed to validate these results.     

Incidence of Hepatitis E Virus Infection in Recipients of Blood or Blood Products Transfusion

Background

Hepatitis E, generally known to be transmitted faeco-orally, has been shown to have significant transmission by blood borne route. Paucity of data on asymptomatic viremia in blood donors and higher incidence of Hepatitis E in haemodialysis patients and thalassemics mandate a prospective study of blood recipients to elucidate the exact incidence and natural history of post transfusion Hepatitis E.

Methods

A total of 2000 recipients of blood or blood products transfusion were followed up for two months to detect development of post transfusion Hepatitis E, by clinical examination, transaminases and immunoglobulin M anti hepatitis E virus (IgM anti HEV). Estimation of hepatitis E virus ribonucleic acid (HEV RNA) was done in patients with elevated levels of transaminases.

Result

Out of 2000 patients, 5(0.25%) were positive for IgM anti HEV at the time of transfusion and were excluded from the study. Rest of 1995 patients were followed up for two months post transfusion. A total of 1303 (65.3%) patients were followed up for two months and 1636 (82.0%) patients at least once in two visits. None of the followed up patients reported development of jaundice or had clinically evident hepatitis, although 62 patients had raised transaminases detected at either one or both the visits.

Conclusion

All followed up patients were tested for IgM anti HEV at both the visits and none were found to be positive. Patients with raised transaminases were subjected to HEV RNA and all were found to be negative.Key Words: Hepatitis E, Post transfusion, Parenteral transmission     

Prevalence of human T cell leukaemia virus amongst blood donors

Background: Human T cell leukaemia virus (HTLV) I/II are retroviruses implicated in transfusion transmitted infection. Present study was undertaken to assess seroprevalence of HTLV in voluntary blood donors along with pattern of blood utilisation.     

Donor blood procurement and the risk of transfusion transmissible viral infections in a tertiary health facility in South-South Nigeria

Background:

Blood and blood products are scarce commodities. The demand often outweighs the supply. This study is directed at investigating the blood procurement sources and the risk of viral transfusion transmissible infection.

Materials and Methods:

The records of the blood transfusion unit of a tertiary health facility in south-south Nigeria were studied. The procurement and screening records from 1 January to 31 December 2009 were analyzed.

Results:

7,552 donor records were analyzed, 6,931 were commercial donor and 621 replacement donors. 891 commercial donors were infected, 500 (7.2%) were HIV positive, 323 (4.7%) HBV positive, 42 (0.6%) had HIV and HBV co-infection, while 28 (0.4%) were HCV positive. Twenty-three replacement donors were infected, 16 (2.6%) were HIV positive, 6 (1%) were HBV positive, while 1 (0.2%) were HCV positive. None of the replacement donors had co-infection. The risk of infection was significantly higher with commercial donor procurement (X2=45.07, P<0.001, OD=3.845).

Conclusion:

Commercial blood donors are still the major source of blood to the hospital and they also have the highest prevalence of transfusion transmissible viral infections in this region thus constitute a major risk transmitting infections to potential recipients.     

Transfusion Transmitted Infections in Armed Forces: Prevalence and Trends

Background

This study presents data on the prevalence rate of infectious markers among voluntary and replacement donors in the blood transfusion service in Armed Forces from 2000 to 2004.

Methods

39,646 units of blood were collected from donors during the period from 2000 to 2004. All the samples were screened for hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV) 1&2, hepatitis C virus (HCV), and by venereal disease research laboratory test (VDRL).

Results

24,527 (61.9%) were voluntary donations and 15,119 (38.1%) replacement donations. Prevalence of HBsAg had decreased, amongst voluntary donors from 1.67% to 0.77% but the positivity rate has not showed significant change. Seropositivity of HIV had decreased both in voluntary and replacement donors to 0.22% and 0.86% respectively. The seropositivity for anti-HCV showed steady decrease amongst voluntary donors from 0.46% to 0.20% in 2004, but in replacement donors, there was an increase in reactivity rate from 0.43% to 0.65%.

Conclusion

The increased seropositivity for HCV, HIV and HBsAg could be decreased by introduction of nucleic acid amplification testing (NAT) in minipools for HCV and HIV and introduction of anti-HBcAg (IgM) for hepatitis B virus (HBV) infection. But this may not be possible in near future in developing countries due to financial constraints. At present implementation of strict donor criteria and with use of sensitive laboratory screening tests it is possible to reduce the incidence of transfusion transmitted infections (TTI) in Indian scenario.Key Words: Transfusion transmitted infections, Human immunodeficiency virus, Hepatitis C virus, Hepatitis B virus     

Blood Transfusion Practices in Military Medicine

Background

This observational study was conducted in a small, 45 bed border static hospital, located in a field area, where no blood bank facilities were available. The present study was conducted to elucidate the blood transfusion practices of this hospital. Methods: A retrospective analysis of all blood transfusions performed in this hospital between Dec 2004 and Dec 2006 was carried out. The data collection included blood group patterns, common indications, haemoglobin levels and complications of blood transfusion. Inferences were based on available data and relevant statistical analysis.

Result

A total of 246 blood transfusions were administered to 79 recipients during the study period. Only one patient had an Rh negative blood group. The most frequently transfused blood group was A Rh positive. Majority of transfusions were administered to surgical cases and the commonest indication was gunshot wounds with haemorrhagic shock. The mean haemoglobin at admission was 8.93 g/dl. The mean number of blood transfusions per patient was 3.13. No haemolytic or other transfusion reactions occurred in any of the transfusions.

Conclusion

This study demonstrates that blood transfusions can be safely administered in field conditions despite constraints of not having a blood bank.Key Words: Blood transfusion practices, Haemoglobin, Anaemia     

Psychosocial Variables of Voluntary Blood Donors at Blood Bank of a Medical College

Background

This study was undertaken to study the motivational factors leading to voluntary blood donation and understanding the psychosocial variables of blood donors.

Methods

300 blood donors were selected by systematic random sampling method.

Result

It was observed that most of the voluntary donors were males (89.3%) and belonged to age group 16-25 years (48%). Most of the donors (93.46%) had studied upto high school and above and 84.33% of the donors belonged to the middle class. 27% of the donors had donated blood previously. The common motivational factors to donate blood were for ‘a good cause'', ‘for the society’ and ‘to save a life''. 4.67% of them donated blood for self satisfaction.

Conclusion

Motivation, recruitment and retention of voluntary blood donors are important criteria to achieve safe blood donation.Key Words: Motivation, Psychosocial, Voluntary, Blood Donors     

Changing trends of transfusion transmitted viral infections among blood donors in the last decade—a 10-year study in a large tertiary care blood bank (2000–2009

Background

The main blood borne viruses'' viz. hepatitis B virus (HBV), human immunodeficiency virus (HIV), and hepatitis C virus (HCV), are a major public health issue, and represent significant causes of morbidity and mortality associated with transfusion. This study analysed the trends of blood borne infections among blood donors in a large blood bank in the last 10 years.

Method

Viral screening results of 80,500 voluntary and replacement donations from 2000 to 2009 were analysed. All donations were screened for HBV, HCV, and HIV. The seroprevalence rate of HBV, HCV, and HIV infections and 95% confidence interval were calculated.

Results

The seroprevalence rate of HBV, HIV, and HCV, decreased during the last 10-years study from 2000 to 2009. There is significant and impressive decrease in HBV seroprevalence rate from 2.39% in 2000 to 1.28% in 2009. The seroprevalence rate of HIV appeared to have decreased with a very significant value from 1.32% to 0.30% in 2009. Hepatitis C virus seroprevalence rate showed a slight decline in blood donations from 0.48% in 2001 to 0.22% in 2009.

Conclusion

There is a general reduction in the seroprevalence rate of viral infections. This is probably because of discouragement of professional or paid donations; better awareness, better prophylactic measures, and availability of vaccines have played a major role.Key Words: transfusion transmitted infections     

Validation of the haemoglobin colour scale for screening blood donors in Malawi

Background

In 2009 Malawi introduced a new protocol to screen potential blood donors for anaemia, using the WHO Haemoglobin Colour Scale (HCS) for initial screening. Published studies of the accuracy of the HCS to screen potential blood donors show varying levels of accuracy and opinion varies whether this is an appropriate screening test. The aim of the study was to assess the validity of the HCS, as a screening test, by comparison to HemoCue in potential blood donors in Malawi.

Study design and methods

This was a blinded prospective study in potential blood donors aged over 18 years, at Malawi Blood Transfusion Service in Blantyre, Malawi. Capillary blood samples were analysed using the HCS and HemoCue, independent of each other. The sensitivity and specificity of correctly identifying ineligible blood donors (Hb≤12g/dL) were calculated.

Results

From 242 participants 234 (96.7%) were correctly allocated and 8 (3.3%), were wrongly allocated on the basis of the Haemoglobin Colour Scale (HCS) compared to HemoCue, all were subjects that were wrongly accepted as donors when their haemoglobin results were ≤12.0g/dL. This gave a sensitivity of 100% and specificity of 96.7% to detect donor eligibilty. The negative predictive value of the HCS was 100% but the positive predictive value to identify ineligible donors on the basis of anaemia was only 20%.

Conclusions

Initial screening with the HCS correctly predicts eligibility for blood donation in the majority of potential blood donors at considerable cost saving compared with use of HemoCue as the first line anaemia screening test, however, by this method a small number of anaemic patients were allowed to donate blood.     

Proportion of Rh phenotypes in voluntary blood donors

Background

The Rh system is the major blood group system besides ABO system. Even after proper blood grouping and cross matching there is a possibility of alloimmunization and antibody production in the recipients against the Rh or minor blood group antigens like Kell, MNSs, Duffy etc. Keeping in view the heavy financial burden of complete phenotyping of blood; the determination of only Rh phenotypes can play a major role in preventing alloimmunization and adverse events in multitransfusion cases. To determine the proportion of Rh phenotypes in voluntary blood donors with a view to generate blood bank data for constitution of panel of blood donors for multipurpose utilities.

Method

Identification of Rhesus factors (Rh) was done by the antigen antibody agglutination test by the test tube method on 10,133 healthy voluntary donors.

Results

The phenotypic frequencies of Rh blood groups in the studied population were D-92.25%, C-87.55%, E-26.55%, c-51.06% and e-98.42%. Thus ‘e’ was the most common and E was the least common of all the Rh types. Phenotypically DCCee group was the most common phenotype and dccee was least common type.

Conclusion

Determination of Rh phenotypes can play a major role in preventing alloimmunization and avoiding adverse events in multitransfusion cases.     

Infectious Disease Markers in Blood Donors

Background

The infectious disease markers for which blood donors are screened include anti-human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV), rapid plasma reagin (RPR) card test for syphilis and malarial parasites.

Methods

A total of 6751 donors were screened over three years to assess the prevalence of infectious disease markers. Screening for anti-HIV I and II, HBsAg and anti-HCV was carried out by enzyme linked immunosorbent assay (ELISA). Syphilis was tested using RPR card test. Malarial parasite was tested by detection of genus specific plasmodium lactate dehydrogenase.

Result

The overall seropositivity for anti-HIV I and II was nine (0.13%), for HBsAg 67 (0.99%), for anti-HCV 13 (0.19%) and for syphilis 42 (0.62%). No sample showed malarial parasites. There was no significant difference (p>0.05) in the seropositivity of various markers between voluntary and replacement donors. There was a significant decline (p<0.05) in the prevalence of seropositivity for HCV and syphilis, but not for HIV and HBsAg over the three year period of the study.

Conclusion

The prevalence of infectious disease markers was similar to that reported by other studies. However, no significant difference was seen in the marker positivity in voluntary and replacement donors, which is at variance from other studies.Key Words: Infectious disease, Blood donors     

The Role of anti-HBc IgM in Screening of Blood Donors

Background

Transfusion transmitted hepatitis B has always been a dreaded disease, with incidence of increased transmission through donated blood. The screening test for hepatitis B infection is detection of HBsAg that does not rule out the risk of transmission of hepatitis B as the donor may be in the ‘window period’. During this period, detection of the antibody to the hepatitis B core antigen (anti-HBc) IgM type serves as a useful serological marker. The aim of this study was to screen blood donors for anti-HBc type IgM and anti - HBc Ag total for detection and to find their incidence amongst blood donors.

Methods

2552 voluntary blood donors were screened by the ELISA method for HBsAg and anti - HBc IgM and other mandatory screening markers. 704 of the test blood samples were also screened for anti-HBc total.

Result

Of the 2552 donor, 47 (1.84 %) cases were HBsAg positive. A total of 11 (0.43 %) blood units were reactive for HBcAg IgM and of these, 10 (0.39 %) were HBsAg negative and reactive for anti-HBcAg IgM. Of the 704 samples tested for anti - HBcAg total, 112 (15.9%) samples were reactive.

Conclusion

Screening of blood for anti-HBc total is practical in the western world as the incidence of HBsAg and anti-HBc is low in these countries and these positive blood units for anti - HBcAg total can be discarded. This may not be practical in India as the incidence of anti- HBcAg total is high in our population. It is recommended that all blood units should be tested for anti - HBc IgM for infectivity status of the blood donors in the window period and to discard blood if positive.Key Words: Window period, Hepatitis B surface antigen, Anti hepatitis B core antigen     

No further incidence of sepsis after splenectomy for severe trauma: a multi-institutional experience of the trauma registry of the DGU with 1,630 patients

Objective

Non-operative management of blunt splenic injury in adults has been applied increasingly at the end of the last century. Therefore, the lifelong risk of overwhelming post-splenectomy infection has been the major impetus for preservation of the spleen. However, the prevalence of posttraumatic infection after splenectomy in contrast to a conservative management is still unknown. Objective was to determine if splenectomy is an independent risk factor for the development of posttraumatic sepsis and multi-organ failure.

Methods

13,433 patients from 113 hospitals were prospective collected from 1993 to 2005. Patients with an injury severity score > 16, no isolated head injury, primary admission to a trauma center and splenic injury were included. Data were allocated according to the operative management into 2 groups (splenectomy (I) and conservative managed patients (II)).

Results

From 1,630 patients with splenic injury 758 patients undergoing splenectomy compared with 872 non-splenectomized patients. 96 (18.3%) of the patients with splenectomy and 102 (18.5%) without splenectomy had apparent infection after operation. Additionally, there was no difference in mortality (24.8% versus 22.2%) in both groups. After massive transfusion of red blood cells (> 10) non-splenectomy patients showed a significant increase of multi-organ failure (46% vs. 40%) and sepsis (38% vs. 25%).

Conclusions

Non-operative management leads to lower systemic infection rates and mortality in adult patients with moderate blunt splenic injury (grade 1-3) and should therefore be advocated. Patients with grade 4 and 5 injury, patients with massive transfusion of red blood cells and unstable patients should be managed operatively.     

Blood Use in Neurosurgical Cases at the University Hospital of the West Indies

Objective:

Many neurosurgical cases are done without the need for blood transfusion, yet blood is unnecessarily cross-matched, resulting in wasted resources. This study was undertaken to document and compare the number of units of blood components requested, cross-matched and transfused in neurosurgical cases at the University Hospital of the West Indies (UHWI).

Methods:

A prospective, observational study was undertaken over one year. Data collected for each patient included demographic information, relevant perioperative data, and blood banking data including blood components requested, cross-matched and transfused. Data were analysed using SPSS version 16.

Results:

Data were analysed on 152 patients, 71 females (46.7%) and 81 males (53.3%). The mean age was 48.7 ± 19.6 years and 100 of the procedures were done electively (65.8%). Blood components were ordered in 114 (75%) cases, red cells more commonly in 113 (74.3%) patients, and plasma in 19 (12.5%) patients. Overall, 20 patients (13.2%) were transfused. Most patients (90.9%) needed one to two units of blood. Of the 236 units of blood components that were cross-matched or prepared, only 62 were transfused. The cross-match/preparation to transfusion ratio (CTR/PTR) was 6.00 for red cells and 1.31 for plasma. Preoperative haemoglobin ≤ 10.0 g/dL (p = 0.001), estimated blood loss of ≥ 1 litre (p < 0.001), higher American Society of Anesthesiologists (ASA) physical status score (p < 0.03) and a resident as lead surgeon (p < 0.05), were significant predictors of blood transfusion.

Conclusion:

The transfusion rate was low with a high cross-match to transfusion ratio, suggesting that less cross-matching is needed. A new approach to blood ordering for neurosurgical cases is recommended.     

A pilot study to determine the normal haematological indices for young Malawian adults in Blantyre,Malawi

Background

Reference ranges for haematological and other laboratory tests in most African countries are based on populations in Europe and America and, because of environmental and genetic factors, these may not accurately reflect the normal reference ranges in African populations.

Aim

To determine the distribution of haematological parameters in healthy individuals residing in Blantyre, Malawi. We also examined the effect of sociodemographic and nutritional factors on the haematological variables.

Methods

We conducted a proof-of-concept cross-sectional study, involving 105 healthy blood donors at Malawi Blood Transfusion Service in Blantyre. Eligible participants were HIV-negative males and females, aged 19 to 35 years, who did not have any evidence of acute or chronic illness, or blood-borne infection. We performed the haematological tests at the Malawi-Liverpool Wellcome Trust laboratory in Blantyre, and the screening tests at Malawi Blood Transfusion Service laboratories.

Results

Out of 170 consenting healthy volunteers, haematological results were available for 105 participants. The proportions of results which were below the lower limit of the manufacturer''s reference ranges were 35.2% (37/105) for haemoglobin, 15.2% (16/105) for neutrophils, 23.8% (25/105) for eosinophils, and 88.6 % (93/105) for basophils. The proportions of results that were above the upper limit of the manufacturer''s reference ranges were 9.5% (10/105) for platelets and 12.4% (13/105) for monocytes. We also observed that the mean leucocyte and basophil counts were significantly higher in males than females (p = 0.042 and p = 0.015, respectively). There were no statistically significant differences in haematological results observed among different ethnic, age, and body mass index groups.

Conclusions

Over half of otherwise healthy study participants had at least one abnormal haematological result, using previously established foreign standards. More detailed studies are needed to establish locally relevant normal ranges for different age groups and other demographic characteristics of the Malawian population. This will lead to accurate interpretation of laboratory results.     

Leucodepletion and Blood Products

Background

Leucoreduction of blood products is increasingly being employed to produce blood products with residual WBCs < 5 × 10⁶ per unit (99.9 percent or a log 3 leucoreduction). Clinical data suggests that non-haemolytic febrile transfusion reactions can be prevented by leucodepletion. The procedure also prevents alloimmunisation to HLA antigens in patients who will repeatedly require transfusion of blood/blood products.

Method

Of the methods available to reduce the number of WBC in blood products washing of red cells, freezing and deglycerolisation are effective and yield a product with only a 24 hour shelf life. Other methods such as leucodepletion filters are relatively inexpensive, simple and the final product has a normal shelf life. Modern generation of leucoreduction filters and apheresis machines can provide greater than 4 log reduction of WBC.

Results

After the introduction of leucodepletion of blood for Thalassemics at our center in 2003, the incidence of non haemolytic febrile transfusion reactions (NHFTR) fell from 4% in 2002 to 1% in 2003.

Conclusion

In patients undergoing long-term blood transfusion therapy e.g. Thalassemics, alloimmunisation against the HLA antigens on donor white cells is prevented by leucodepletion and prevents NHFTRs.Key Words: Leucoreduction, leucodepletion, alloimmunisation     

Use of marginal organs in kidney transplantation for marginal recipients: too close to the margins of safety?

Objective

Due to organ shortage, average waiting time for a kidney in Germany is about 4 years after start of dialysis. Number of kidney grafts recovered can only be maintained by accepting older and expanded criteria donors. The aim of this study was to analyse the impact of donor and recipient risk on kidney long-term function.

Methods

All deceased kidney transplantations were considered. We retrospectively studied 332 patients between 2002 and 2006; divided in 4 groups reflecting donor and recipient risk.

Results

Non-marginal recipients were less likely to receive a marginal organ (69 of 207, 33%) as compared to marginal recipients, of whom two-thirds received a marginal organ (p < 0.0001). Graft function significantly differed between the groups, but detrimental effect of marginal recipient status on eGFR after 12 months (-6 ml/min/1.73 qm, 95% CI -2 to -9) was clearly smaller than the effect of marginal donor status (-10 ml/min/1.73 qm, 95% CI -7 to -14).

Conclusions

As we were able to show expanded criteria donor has a far bigger effect on long-term graft function than the "extra risk" recipient. Although there have been attempts to define groups of recipients who should be offered ECD kidneys primarily the discussion is still ongoing.     

Seroprevalence of human parvovirus B19 in healthy blood donors

Background

Human parvovirus B19 is an emerging transfusion transmitted infection. Although parvovirus B19 infection is connected with severe complications in some recipients, donor screening is not yet mandatory. To reduce the risk of contamination, plasma-pool screening and exclusion of highly viraemic donations are recommended. In this study the prevalence of parvovirus B19 in healthy blood donors was detected by ELISA.

Methods

A total of 1633 samples were screened for IgM and IgG antibodies against parvovirus B19 by ELISA. The initial 540 samples were screened for both IgM and IgG class antibodies and remaining 1093 samples were screened for only IgM class antibodies by ELISA.

Results

Net prevalence of IgM antibodies to human parvovirus B19 in our study was 7.53% and prevalence of IgG antibodies was 27.96%. Dual positivity (IgG and IgM) was 2.40%.

Conclusion

The seroprevalence of human parvovirus B19 among blood donor population in our study is high, and poses an adverse transfusion risk especially in high-risk group of patients who have no detectable antibodies to B19. Studies with large sample size are needed to validate these results.