<p>A Systematic Review of Transfusion-Transmissible Infections Among Blood Donors and Associated Safety Challenges in Pakistan</p>

Abstract

The blood transfusion (BT) system in Pakistan is fragmented, demand-driven and depends on weakly regulated transfusion practices. There is a considerable possibility that transfusion-transmissible infections (TTIs) are contributing to the current epidemic of hepatitis B virus (HBV) and hepatitis C virus (HCV) (affecting 7.4% of the general population) in the country. To study this issue, we conducted a systematic review to identify articles related to TTIs and transfusion safety in Pakistan from January 1, 2010 to January 31, 2020. A review of 33 articles met the final criteria for qualitative synthesis. Analysis of these studies showed a cumulative frequency of HBV 2.04%, HCV 2.44%, HIV 0.038%, syphilis 1.1% and malaria 0.11%. The frequency of coinfections among blood donors varied from 0.0099% to 0.35%. The highest number of coinfections were HCV and syphilis, followed by HCV and HBV infections. Syphilis and malaria were tested in only 38% and 46% of all the blood donations in one study. The rate of voluntary non-remunerated donations (VNRDs) was less than 13%, and male donors were 95% to 100% in these studies. There was a significant difference in the frequency of HBV and HCV in VNRDs (0.48%) as compared to replacement donors (RDs) (4.15%). In short, this review shows a high frequency of TTIs, especially HBV, HCV and syphilis in the blood donor population in Pakistan. There is a high dependency on RDs, 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 donor health. Without standardized safe transfusion practices, there will be an ongoing increase in transmission of TTIs, especially HBV, HCV, syphilis, and HIV leading to a significant adverse public health impact.

Prevalence of Transfusion-Transmitted Infections (HCV, HIV, Syphilis and Malaria) in Blood Donors: A Large-Scale Cross-Sectional Study

“…The prevalence of anti-malarial antibodies among blood donors in the current study is 0.7%, which was consistent with the findings of Hoque et al (0.76%) [49]. Meanwhile, a lower prevalence was reported by Ehsan et al in Pakistan (0.11) [50] and Patel et al [46] in Nepal (0.02%). Several studies conducted in Ethiopia (4.1%) [51] and Tanzania (8%) [52] reported high levels of anti-malarial antibodies.…”

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.…”

Prevalence and risk factors for hepatitis C virus infection in an informal settlement in Karachi, Pakistan

“…This includes inadequate initial screening of donors for high-risk behaviors due to insufficient training of blood bank staff coupled with a lack of universal quality assured serological screening procedures. Additionally, infection control for blood transfusion has been poor, especially in Karachi, where practices depart from infection control standards, especially in reference to waste management, disposal and staff safety [ 51 , 52 ].…”