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International Journal of Recent Scientific Research Vol. 4, Issue, 7, pp.1133 1135, July, 2013 ISSN: 0976-3031

International Journal of Recent Scientific Research

RESEARCH ARTICLE STUDY OF TRANSFUSION TRANSMISSIBLE INFECTIOUS DISEASE MARKERS IN OVER 5000 SCREENED UNITS OF BLOOD
1Begum
1Chairperson

Saidunnisa., 2Agarwal. A., 3Chudasama. M and 4Shafi, E

Biochemistry, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates 2Chairperson Pathology, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates 3Doctor, LVIV National Medical University, UKRAINE 4Final year Medical student, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates ARTICLE INFO
Article History:
Received 10th, June, 2013 Received in revised form 22th, June, 2013 Accepted 10th, July, 2013 Published online 30th July, 2013

ABSTRACT
In recent years there has been increased public concern about the safety of blood transfusion with respect to transfusion transmissible infectious diseases (TTIs) like HIV, hepatitis B, hepatitis C, and human T cell leukemia/lymphoma virus. Every effort should be made to minimize the risk of disease transmission. All donations are screened for hepatitis B surface antigen, antibodies to HIV and hepatitis C, and syphilis with assays of steadily increasing sensitivity. A 5-year retrospective study ( 2007-2011) of TTIs in over 5 000 screened units of blood was done from the records available in the blood bank data base in SAQR Hospital, Ras Al Khaimah UAE. These were screened by assays approved for blood donation screening. It was calculated that the risk of transmission through blood was 0.3% in 5 000 units of red cells for hepatitis B virus; 3% in 5 000 units for hepatitis C virus; and 0% in 5 000 units for HIV. This study shows no data regarding transfusion transmission of Syphilis & HIV in Ras Al Khaimah. The reduced TTI prevalence rate is an encouraging sign, which shows the effectiveness of the changes introduced in the local government in line with the WHO strategy for blood safety. Copy Right, IJRSR, 2013, Academic Journals. All rights reserved.

Key words: Transfusion transmissible infectious diseases (TTIs), HIV, hepatitis B, hepatitis C, and human T cell leukemia/lymphoma virus, antigen, antibodies

INTRODUCTION
Blood donation saves millions of lives; however, although blood transfusion plays an important role in the supportive care of medical and surgical patients, unsafe transfusion practices also put millions of people at risk of transfusion-transmissible infections (TTIs) (10). Every effort should be made to minimize the risk of disease transmission. All donations are screened for hepatitis B surface antigen, antibodies to HIV and hepatitis C, and syphilis with assays of steadily increasing sensitivity. A theoretical possibility of transmission remains if the donor is in the "window period" of an infection (that is, infectious but has not developed detectable markers of infection) or if the donor is a "low level carrier" in whom the level of markers of chronic infection is below the sensitivity of currently used assays (for example, for hepatitis B surface antigen). In addition, rare strain variants of a virus may not be detectable by certain routine tests, and possibilities of technical or clerical errors in screening or quarantining blood components remain. This retrospective study aimed to estimate directly the incidence of transfusion transmitted infections: hepatitis B, C, Syphilis and HIV, for which donated blood is tested, and also human T cell leukemia/ lymphoma virus, for which blood is not currently tested in Ras Al Khaimah.

MATERIAL & METHODS

A 5-year retrospective study (2007-2011) of TTIs in over 5 000 screened units of blood was done from the records available in the blood bank data base in SAQR Hospital, Ras Al Khaimah. These were screened by assays approved for blood donation screening.

RESULTS
Among the 5000 units of red cells, 2400 were males (48%) and 2600 were females (52%). [Figure:1] It is calculated that the risk of transmission through blood was 0.3% in 5 000 units of red cells for hepatitis B virus; 3% in 5 000 units for hepatitis C virus; and 0% in 5 000 units for HIV.

Figure 1

* Corresponding author: Begum Saidunnisa Chairperson Biochemistry, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates

International Journal of Recent Scientific Research, Vol. 4, Issue, 7, pp. 1133 - 1135, July, 2013 This study shows no data regarding transfusion transmission of Syphilis & HIV in Ras Al Khaimah. [Figure:2] People with certain genotypes could harbour the infection in a transmissible but undetectable form for decades. Syphilis was one of the first infections to be recognized as transfusiontransmitted and some form of testing of donated blood has been in place for well over 50 years (15) . Syphilis is a sexually transmitted disease, caused by the spirochete bacterium Treponema pallidum . The bacterium may circulate in the blood during the early primary phase of infection. Donor testing is usually conducted through a combination of treponemal and nontreponemal tests, with one method used for primary screening and the second for preliminary confirmation of reactive results. Among blood donors in the USA, it has been shown that 0.5--1% of individuals with anti-HBc also have detectable levels of HBV DNA in their circulation (18) ; this has been termed occult HBV infection. Studies from Japan suggest that blood from a small proportion of these individuals may be infectious for HBV if transfused. This supports the concept that testing donors for the presence of anti-HBc may have a limited impact upon blood safety (19). In the USA and some other countries, blood donors are tested for anti-HBc in addition to anti-HBs. This reflects the fact that, although antiHBc testing was introduced for a different purpose, it does identify a small number of individuals who are circulating infectious HBV in the absence of detectable HBsAg. AIDS and its potential association with blood transfusion was recognized in the early 1980s and by 1984, HIV, the causative virus, had been identified and isolated by Montagnier and Gallo and their colleague (5, 11,17) . A test for antibodies to the virus was also described and in March 1985, the first tests for blood screening were licensed and made commercially available. Malaria has long been recognized as a transfusiontransmissible disease caused by parasites of the genus Plasmodium. Four human-infecting species of the parasite exist (Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae and Plasmodium ovale ) and, recently, a species thought to be confined to monkeys (Plasmodium knowlesi ) has been shown to infect humans (21). There has long been concern that transfusion-transmitted malaria may occur as a result of donations from recently infected travelers, but currently, there is fewer than one such case recognized per year (14). This is largely attributed to the current practice of deferring travelers with a history of travel to, or residence in, malarious areas, or with a history of recent malaria (13). In addition to these agents, for which there are established interventions there are many emerging infections -- those that have increased in prevalence over the past 20 years, which have the capacity to be transmitted by transfusion ( 12-14). Currently, emerging infections of most concern include variant Creutzfeldt Jakob (vCJD), dengue, chikungunya and babesia. It is important to note that none of these infections have the epidemiologic characteristics of the ''classic'' transfusiontransmitted agents.

Figure 2

DISCUSSION
The prevalence of the Transfusion transmitted infection varies worldwide, In Ethiopia the seroprevalance of HIV, HCV, HBsAg and Syphilis is 4.5%, 5.8%, 8.2% and 1.2%, in Tanzania the seroprevalence of HIV, HBV, HCV and Syphilis is 8.7%, 11% , 8% and 12.7%, in Thailand the seroprevalence of HIV, HBV and HCV is 0.69%, 4.61% and 2.96%, and 0.48%, the seropervalence of HIV in Katmandu, Nepal is 0.33% to 0.4 %. The seroprevalence for syphilis among blood donors was 1.2% in Nigera, 1.2% in Kenya and 0.75% in Pakistan (1, 2, 4, 20, 16, 6)m . In the present study at RAK the risk of transmission through blood was 0.3% in 5 000 units of red cells for hepatitis B virus; 3% in 5 000 units for hepatitis C virus; and 0% in 5 000 units for HIV. This study shows no data regarding transfusion transmission of Syphilis & HIV in Ras Al Khaimah. Lower prevalence of TTIs during this study may be attributed to lower infection rates in UAE as compared to the other countries. Transfusion transmissible infections share a number of characteristics. All result in chronic, long-term infections, often in the absence of obvious disease for many years, or even for life. All are transmissible parenterally: a common route is via sexual exposure. In addition, (with the exception of syphilis) they are transmitted by needle exposure. As a result, a great deal of reliance has been placed upon assessment of donor suitability by questioning for behavioral and other risk characteristics associated with these infections. More specifically, in the USA, the prevalence of HBV, HCV and HIV markers among donors is one third to one thirteenth of that among the general population and the incidence rate is one tenth or less than that for the population at large (8). Second, the viral infections in this group are characterized by a window period in early infection, during which the infectious agent is present in the blood, but not detectable through the use of available screening tests (12) ; appropriate questioning should result in the deferral of individuals who are aware of recent risk and potential exposure. Blood-associated TSE infectivity presents unique challenges to risk management absent from other blood-borne pathogens. The low concentration of infectivity, although difficult to detect, has nevertheless been sufficient for efficient transfusion transmission of these fatal diseases.

CONCLUSIONS
We conclude that the potential benefits of routine testing for antibodies to hepatitis B and C are considered not to outweigh the disadvantages (such as uncertainties in confirmation of infection and wastage of falsely reactive units). Irrespective of the wastage of falsely reactive units routine testing for TTIs is mandatory and should be continued following standard algorithms developed by the WHO and government.

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International Journal of Recent Scientific Research, Vol. 4, Issue, 7, pp. 1133 - 1135, July, 2013

References
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13. Leiby DA, Nguyen ML, Notari EP: Impact of donor deferrals for malaria on blood availability in the United States. Transfusion 48(10), 2222--2228 (2008). 14. Mungai M, Tegtmeier G, Chamberland M, Parise M: Transfusion-transmitted malaria in the United States from 1963 through 1999. N. Engl. J. Med. 344(26), 1973--1978 (2001). [black square] Reviews the US situation with respect to transfusion-transmitted malaria; excellent source material, even though it was published almost 10 years ago. 15. Orton S: Syphilis and blood donors: what we know, what we do not know, and what we need to know. Transfus. Med. Rev. 15(4), 282--291 (2001). 16. Olokoba AB, Olokoba LB, Salawu FK, Danburam A, et al Syphilis in voluntary Blood donors in North-Eastern, Nigeri. European Journal of Scientific Research. 2003; 31( 3): 335-340. 17. Sarngadharan MG, Popovic M, Bruch L, Schupbach J, Gallo RC: Antibodies reactive with human Tlymphotropic retroviruses (HTLV-III) in the serum of patients with AIDS. Science 224, 506--508 (1984). 18. Stramer SL: Pooled hepatitis B virus DNA testing by nucleic acid amplification: implementation or not. Transfusion 45(8), 1242--1246 (2005). [black square] Discusses the pros and cons of implementing nucleic acid amplification tests for HBV DNA as an additional safety measure. 19. Satake M, Taira R, Yugi H et al. : Infectivity of blood components with low hepatitis B virus DNA levels identified in a lookback program. Transfusion 47(7), 1197--1205 (2007). [black square] Excellent studies on the infectivity of blood with detectable levels of HBV DNA. 20. Tiwari BR, Karki S, Ghimire P, Yadav P, Raj Karnikar M. Prevalence of HIV in blood donors. J. Nepal Health Res. Counc. 2008; 6(13):93-97 21. White NJ: Plasmodium knowlesi : the fifth human malaria parasite. Clin. Infect. Dis. 46(2), 172--173 (2008).

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