Blood transfusion, an integral part of medicine and surgery, also carries the risk of transfusion-transmissible infections like Hepatitis B and C, HIV and Syphilis, malaria and infrequently toxoplasmosis, brucellosis and viral infections like CMV, Epstein Barr Virus and Herpes . Measuring their severity, WHO has recommended pre-transfusion blood test for HIV, HBV, HCV and Syphilis as mandatory . All these diseases are capable of causing significant mortality, morbidity along with a financial burden for both the affected person and the country.
With every one unit of blood transfusion there is 1% chance of transfusion related complications including Transfusion transmitted infections . An increase in Transfusion related infection has been reported in India . India is already carrying a burden of 50 million of HBV carriers  and 2.27 million of HIV cases . Keeping in mind the grave consequences of these infections and to restrain the transmission to minimum, it is very important to remain vigilant about the possible spread of these diseases through blood transfusion.
In our study, we aimed to estimate the prevalence of HIV, HBV, HCV and Syphilis among blood donors. It would also reflect on the blood safety measurements and can be carefully extended to provide estimation about the disease burden in the community. We included two consecutive years in our study to identify the trend of increase or decrease among these diseases.
MATERIALS AND METHODOLOGY
Blood was collected from healthy voluntary donors through blood camps organized by various voluntary organizations and student bodies including the students of Medical College, Kolkata. Name, age (18-60 years), Sex, date of birth, address and contact number were recorded for each donor, while giving them a unique identification number. Donors with history of any febrile illness in the recent past, weight loss, uncontrolled diarrhea, recent jaundice, liver disease, cardiovascular disease, pulmonary disease, malignancy, epilepsy, malaria, unusual or excessive bleeding, recent donation of blood, receipt of blood, and taking contraindicated drugs were excluded. Detailed history of immunization was taken. Weight, pulse, blood pressure and temperature were recorded for each patient. Screening for anemia was done clinically along with copper sulfate specific gravity method. Inspection was made for any marks of drug abuse or any skin lesions/ infections at the venepuncture site. A written informed consent was taken from each patient before the blood donation. Proper sterilization and other precautions were taken during the blood collection and blood units were stored by appropriate methods.
After collection all samples were screened for Human Immunodeficiency Virus I & II: By microwell ELISA to detect antibodies against HIV I & II in plasma. Hepatitis B Virus: By microwell ELISA, Hepatitis C Virus: By microwell ELISA and Treponema Pallidum: Detection of Treponemal Antibodies (Reagin) by Rapid Plasma Reagin Test.
RESULTS AND OVSERVATIONS
A total of 44,173 units of blood were collected during the period of 01-01-2007 to 31-12-2008. In 2007 out of total 21,047 units, 19,019 (90.36%) units were from male donors and 2,028 (9.64%) units were from female donors. In 2008 a total of 23,126 units of blood were collected among them 20,715 (89.6%) units were from male donors and 2,411 (10.4%) units were donated by female donors (Table 1).
Male and female donors were subdivided into three age groups between 18-30 years, 30-45 years and 45-60 years. Maximum donors were from the age group of 18-30 years in both 2007 and 2008 (Figure 1, Supplementary Tables).
2007 prevalence rate for HIV, HBV, HCV and Syphilis were 0.62%, 2.04%, 1.53%, and 1.47% respectively. In 2008 respective prevalence rates were 0.66%, 2.47%, 1.70% and 1.15%. In relative risk analysis significant statistical difference were found in case of HBV and Syphilis (Table 2, Figure 2). Frequency of co-infection among these viruses was negligible. When we looked into gender variation of prevalence it was found that in both HBsAg and VDRL the relative risks were significantly different in the male age groups, more specifically male age group above 30 years (Table 3, Figure 3). For other subgroups there was no statistically significant variation in the prevalence of TTIs (Supplementary Tables).
Most of the donors, who were recruited in this study, came from public awareness. It was to be noted that maximum number of donors came from age group 18-30 years. It may reflect proper awareness among the young population about blood donation. Percentages of female donors have been low for both the years. Similar trend has been noted in earlier reports also [3, 6]. Efforts should be made to improve the numbers of female donors. More awareness among female population by holding camps in women’s colleges, training and recruiting more female stuffs and an improvement in privacy of these blood camps should be done to encourage more females to donate blood. Apart from recruiting new donors, measures should be taken to retain previous donors.
In case of HBsAg there was a statistically significant increase in the prevalence (p Value 0.0027) and there was a decrease in the trend for the prevalence of syphilis (p value 0.0033). But it is very important to take care about sex and age distribution of these infections. When we stratified the data on the basis of sex and age we found that for HBsAg the prevalence rate was statistically significant only for male population above 30 years of age. Similar trend was present in the syphilis also. No statistically significant difference was there among female population even among different age groups. (Supplementary Tables). This data suggests we have to be more careful about the prevalence of HBsAg in male population over 30 years. On the other hand, it was an encouraging sign that prevalence of Syphilis decreased in the same population.
A total number of 2578 units of blood were discarded due to presence of infection from the above viruses. More stringent criteria for proper donor selection may help to cut down the wastage.
Testing the blood serum for various antibodies and more conservative guidelines for blood transfusion have been effective and have successfully brought down the transmission rate. Inability of the serological tests to detect the diseases in their window period and virus immunological variants is a major drawback in making the preventive approaches more effective. Earlier studies have shown that even HBsAg negative bloods may be anti-HBc/ HBV DNA positive and may retain the capacity to transmit infection . Presence of occult HBV infection has also been reported from various parts of India [8, 9, 10, 11]. As a result TTI still remains a concern for both the patient and the physician.
Previous studies have reported that prevalence of an infection among the donors reflects the disease burden in the society . The prevalence rate obtained from this study found to be a bit higher from various previous reports [10, 13, 14]. This may be due to variation in the population or may reflect an increased burden of infection in the community. Increased prevalence of HBV among the donors underscores the concern about growing infection of this disease in the community. In India transfusion associated HBV is estimated to be approximately 50% or more in multiple transfused patients and approximately 1.5% in post surgical recipients . Thus the absence of HBsAg in the blood of apparently healthy individuals may not be sufficient to ensure lack of circulating HBV. More appropriate methods need to be applied to find out the exact scenario.
Prevalence of HIV, HBV, HCV and Syphilis among donors blood in 2007-2008, detected the increase in HBV prevalence, especially among male above 30 years of age, and poor women participation in blood donation activities. Aptly taken measures may decrease TTI and improve the ratio of women donors.
CONFLICT OF INTEREST
There was no conflict of interest to declare.
Supplementary MaterialSupplementary Table
Supplementary material supplied by authors.
2012 Ross Science Publishers