A Systematic Review of Transfusion Transmissible Infections Among Blood Donors and Associated Safety Challenges in Pakistan

Abstract

Introduction: The blood transfusion (BT) system in Pakistan is fragmented, demand-driven, and depends on weakly regulated transfusion practices. This is primarily a big problem in smaller cities and remote rural areas. Pakistan has one of the highest hepatitis B virus (HBV) and hepatitis C virus (HCV) prevalence worldwide, estimated around 5 & 10 million cases, respectively. There is a considerable risk that transfusion-transmissible infections (TTIs) may have contributed to the current epidemic of HBV & HCV, affecting 7.4 % of the general population, and potential risk of HIV transmission in the country. In this systematic review, we aim to identify the prevalence of TTIs among the blood donor population and associated safety challenges. Method & Material: We conducted a systematic literature search to identify studies related to TTIs and transfusion safety in Pakistan from January 1, 2010, to January 31, 2020. A search was conducted using PubMed and PakMedinet.com (largest medical database of Pakistan); initial search retrieved 981 articles, 166 met the inclusion criteria, and after review by two independent reviewers, 33 articles met the final criteria for qualitative synthesis. Results: Analysis of 33 studies showed the seroprevalence of HBV of 2.04 % (0.81% to 4.22%), HCV of 2.44% (1.29 % to 10%), HIV of 0.038% (0% to 0.18%), syphilis of 1.1% (0.11-3.01%) and malaria of 0.11% (0.05-1.20). The rate of coinfections among blood donors varied from 0.0099% to 0.35 %. The highest number of coinfections were HCV & syphilis, followed by HCV & HBV infections. The rate of TTIs was dependent on the number of donors, donor types (replacement vs. voluntary), screening techniques used, number, and type of TTIs tested. There was a lack of universal screening for common TTIs. Syphilis and malaria were tested only 38 % & 46 % of all the blood donations. The studies with a high number of replacement donors (RDs) noted a high prevalence of TTIs of 2.5 % to 12 % compared to the studies with a high number of voluntary non-remunerated donations (VNRDs) reported TTIs rates of 1.57% to 6.2 %. There was a significant difference in the prevalence of HBV & HCV in VNRDs (0.48%) compared to RDs (4.15%). The rate of VNRDs was 0.10 % to 13%. The majority of blood donations were from male donors, representing more than 70 % of all donations. The female donations varied from 0.03% to 15 % in government/public blood banks than 29 % in private sector blood banks. The HBV & HCV infections and anemia were the most common causes of blood donation deferral. The 69.5 % of donors who tested positive for TTIs in a study reported previous blood donations. The educational status of donors noted to have an association with knowledge about the risk of TTIs. Odds of having limited knowledge about TTIs (OR: 4.04, CI: 1.567-10.435, p<0.01) were greater if donors had a secondary level of education compared to those with tertiary education. 48 % of blood donors did not know about the risk of TTIs through blood transfusion. There was notification of only about 54.25 % of all donors, who tested positive for any TTIs. This was mainly due to a lack of standardized reporting and follow up systems. Conclusion: This systemic review shows a high prevalence of TTIs, especially HBV, HCV & syphilis in the blood donor population. There is a high dependency on RDs, with minimal use of healthy voluntary blood donation practices, inadequate screening of high-risk donors, repeated collections of the blood from RDs, poor quality of screening methods, and limited knowledge of donors about their health. There is a lack of widespread standardized testing and follow up of patients who tested positive on initial testing. Large prospective multicenter clinical trials are required for a better understanding of the TTIs by testing and creating a follow-up system for both blood donors and recipients. Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.:Honoraria, Research Funding, Speakers Bureau.

Plasmodium in the bone marrow: case series from a hospital in Pakistan, 2007–2015

“…At least in the small sample of bone marrow samples found positive for malaria, the even rarer numbers lacking parasites on peripheral blood smear suggests that infection of bone marrow without parasitaemia may be the exception. A systematic review of infections among blood donors during 2010 to 2020 in Pakistan found 0.11 % positive for malaria [32]. It cannot be known if invasion of blood by the Plasmodium is usually attended by infection bone marrow, the similarities of those rates of infection of blood and bone marrow suggests that may be the case.…”

Transfusion Transmitted Infections: A Present-Day Danger for Pakistan

“…At present, malaria is endemic in the region, with 3.5 million cases reported every year. 11 The unsafe blood transfusion practices resulting in transmission of infected blood are further fueling these numbers. A recent systematic review by Ehsan et al reports that the seroprevalences of HBV and HCV among the blood donor population of Pakistan were 2.04% and 2.44%, respectively, and 70% of all donors who tested positive for TTIs had a history of blood donations.…”

“…Furthermore, the studies included in this review that had a large number of replacement donors reported a higher prevalence of TTIs when compared with the studies with a high number of voluntary nonremunerated donations (VNRDs). 11 Moreover, there have been recent reports of isolated low-scale epidemics of HIV in rural areas of Pakistan, and a systematic review by Rabold et al has identified iatrogenic transmission, such as unsafe blood transfusions and reuse of medical equipment like syringes, as the primary contributing risk factor for the spread of HIV in the country. 12 Regular blood transfusions are the mainstay of treatment of patients with blood disorders such as thalassemia and anemia, and are also widely used for the management of acute trauma, surgeries, hemorrhage, and complications related to childbirth.…”

Applying RT-PCR standard detection procedures of HBV and HCV in Wasit blood bank

“…Also this result was comparatively lower than other countries like, Abdelaziz (2020) detected that the prevalence of HBV among blood donors in Sudan was 1.3%. And Ehsan et al (2020) detected that the prevalence of HBV among blood donors in Pakistan was 2.04% (using ELISA technique detected HBsAg). While the result of HCV in blood donors in Wasit Province was 4.0%, the present study demonstrated an increase in anti-HCV with time which is considerable higher than that reported by other Iraqi researcher like Al-Sadi and Abdul-Jalil in 2016 reported that the prevalence of hepatitis C virus among blood donors was 2.8% in Basra governorate.…”