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BRIEF RESEARCH ARTICLE
Year : 2014  |  Volume : 58  |  Issue : 1  |  Page : 61-64  

Seroprevalence of transfusion transmissible infections among blood donors at the blood bank of a Medical College of Kolkata


Associate Professor, Department of Community Medicine, R G Kar Medical College, Kolkata, West Bengal, India

Date of Web Publication5-Mar-2014

Correspondence Address:
Prasanta Ray Karmakar
C-75 Amarabati, P.O. Sodepur, Kolkata - 700 110, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.128172

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   Abstract 

Seroprevalence of transfusion transmissible infections (TTIs) among blood donors can be used to monitor the prevalence among apparently healthy adult population. The present study was conducted to determine the profile of blood donors and seroprevalence of TTI among them. Retrospective analysis of the donors of a blood bank attached with a tertiary care hospital of Kolkata in 2011 was carried out. Data were analyzed with SPSS version 17. Majority (85%) of the donors were male, two-third in the age group of 21-40 years. Among the donors 2.79% were positive for any of the screened TTIs. Seroprevalence was highest for hepatitis B (1.41%) followed by human immunodeficiency virus (0.60%) and hepatitis C (0.59%) and least for syphilis (0.23%). Seropositivity increased with age up to 50 years. There was no significant difference in seropositivity between male and female. Highly sensitive donor screening and public awareness program can make transfusion of blood products safe.

Keywords: Blood bank, Blood donors, Seroprevalence, Transfusion transmissible infections


How to cite this article:
Karmakar PR, Shrivastava P, Ray TG. Seroprevalence of transfusion transmissible infections among blood donors at the blood bank of a Medical College of Kolkata. Indian J Public Health 2014;58:61-4

How to cite this URL:
Karmakar PR, Shrivastava P, Ray TG. Seroprevalence of transfusion transmissible infections among blood donors at the blood bank of a Medical College of Kolkata. Indian J Public Health [serial online] 2014 [cited 2019 Jul 20];58:61-4. Available from: http://www.ijph.in/text.asp?2014/58/1/61/128172

A well-organized blood transfusion service (BTS) is an important component of the health care delivery system of any country. An integrated strategy for blood safety is required for elimination of transfusion transmissible infections (TTI) and for provision of safe and adequate BTSs to the people. The main component of an integrated strategy include collection of blood only from voluntary, non-remunerated blood donors, screening for all TTIs and reduction of unnecessary transfusion. [1] According to the National AIDS Control Organization (NACO) guidelines all blood sample must be tested for human immunodeficiency virus (HIV) 1 and 2, hepatitis B, hepatitis C, syphilis and malaria. [2] Donors having history of being HIV, hepatitis B surface antigen/hepatitis C virus antibody positive should be permanently deferred. Donors having history of malaria should be accepted after 3 months. [2] The median prevalence rates of transfusion-transmissible infections in blood donations in high-income countries are considerably lower than in middle- and low-income countries. The median prevalence rate of HIV in blood donations in high-income countries is 0.001%, in comparison with 0.06% and 0.5% in middle- and low-income countries respectively. This difference reflects the variable prevalence among members of the population who are eligible to donate blood, the type of donors (such as voluntary unpaid blood donors from population at lower risk) and the effectiveness of the system of educating and selecting donors. [3] Apart from HIV no regular serosurveillance for hepatitis B and C and syphilis are usually conducted in the adult general population in India. As there was no large scale study on seroprevalence of hepatitis B and C at regular interval seroprevalence among blood donors can be used to monitor the trend of these TTIs in the apparently healthy adult population in community. [4],[5] Studies on seroprevalence of TTI from Kolkata are few. With this background the present study have been planned among the blood donors in a tertiary care health institution of Kolkata to study the profile of blood donors and seroprevalence of TTI among them.

A retrospective record based study was conducted at the blood bank attached to a Medical College Hospital in Kolkata. Ethical clearance was obtained from institutional ethical committee. This blood bank is one of the largest in West Bengal and caters to the need of this medical college and other health institutions. Data were collected for the period January 2011 to December 2011. Data on seropositivity for 2009 and 2010 were also collected to see the trend of TTIs.

Blood was collected by conducting blood donation camps in Kolkata and adjoining districts and also through in house replacement donation mainly from friends and relatives of patients of this hospital and other health care institution. At the time of recruitment of donors, they were counseled about risk behavior and a registration form was filled by interviewing the donors. Registration form had personal and demographic information and medical history regarding risk factors. The donors were then screened by a medical officer according to blood donor's selection criteria (National blood safety) and guideline for NACO.

The eligibility criteria for the donors, i.e., age between 18 and 60 years, minimum weight of 45 kg, hemoglobin level of 12 g%, no history of hepatitis B and hepatitis C and sexually transmitted infections, no history of jaundice in past 1 year was strictly adhered to for recruitment of blood donors. Donors were screened for high risk behavior for HIV, hepatitis B and C and syphilis. Data were collected from the records of the blood bank. Age, sex, body weight, blood group and Rhesus typing, result of screening test for HIV, hepatitis B, hepatitis C and syphilis were also noted. Care was taken to maintain confidentiality of data while conducting the study.

Data were collected in excel data sheet and analyzed with SPSS version 17. The associations between categorical variables were tested using Chi-square (χ2 ) test. P < 0.05 was considered to be significant.

All blood units in the blood bank were collected from non-remunerative donors and most of the blood units were collected at camps (93.47%) organized in Kolkata city and in adjacent districts and remaining 6.53% donated blood at the blood bank (in house donors). The in house donors were relatives and friends of the patient requiring blood. Patel et al. [6] from western Ahmedabad reported voluntary blood donors as 95.56%, but Kulkarni [7] from Karnataka and study from Haryana [8] reported it as 58% and 31.4% respectively. Studies [9],[10] in other parts of India also reported lower proportion of voluntary donors.

In the present study majority of the donors were males (85%), similar to Haryana [8] and Karnataka. [9] Among the donors, nearly 68.77% were in the age group of 21-40 years, like other studies. [10],[11]

Group B (36.33%) and O (31.98%) were the two most prevalent blood groups among the donors followed by A (22.70%) and AB (8.99%). Majority (97%) were rhesus factor positive and only 3% were rhesus factor negative.

Transfusion of blood and blood products is an established mode of treatment in many conditions. However unnecessary transfusions and unsafe transfusion practices expose patients to the risk of serious adverse transfusion reactions and transfusion-transmitted infections. [3] This risk can be minimized by encouraging voluntary non-remunerative donation and screening of blood for TTI before transfusion.

In the present study, 2.79% donors were positive for any of the TTIs. Seroprevalence among the donors in the camp was 2.78% and 2.89% among the in-house donors, but no statistically significant difference was seen (χ2 = 0.07, df = 1, P = 0.786). Other studies conducted in different parts of India had reported varying prevalence. Many studies have shown increased prevalence of TTI in replacement donors. [10] Among replacement donors there is a compulsion to donate blood to get blood for their patients and hence there is a possibility of concealing some information regarding high risk behavior or past illnesses.

Seroprevalence was highest for hepatitis B (1.41%) followed by HIV (0.60%) and hepatitis C (0.59%) and least for syphilis (0.23%). Only in 11 persons there was more than one infection. Seroprevalence for hepatitis B was more in replacement donors (1.76%) than camp donors (1.38%), but for other diseases it was more in camp donors than replacement donors. In no cases the differences was statistically significant.

More than two-third seropositive (69.36%) were in the age group of 21-40 years of age [Table 1]. This trend held true for all the infections.
Table 1: Age and sex distribution of blood donors and seropositive

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Seroprevalence was least in the 18-20 year age group and then increased up to 50 years, followed by decline in 51-60 years age group. χ2 for linear trend was statistically significant (χ2 = 5.18, P = 0.022).

As far as sex difference was concerned, majority of seropositives were male (88.22%). Again seroprevalence of all the TTIs was more in male than female. Seroprevalence for HIV, hepatitis B, hepatitis C and syphilis was 0.62%, 1.46%, 0.62% and 0.23% respectively in males and corresponding figures for female were 0.49%, 1.09%, 0.43% and 0.21% respectively. For Individual infection, differences was not statistically significant though the difference in seropositivity as a whole was statistically significant (χ2 = 5.66, P = 0.017). Other researchers [9],[11] also reported higher seroprevalence in male. This higher prevalence might be due to differences in sexual behavior.

Though our concern for blood safety was mainly due to HIV infection, but in the present study the hepatitis B was the most prevalent infection, similar to other studies from India. [9],[10] Hepatitis B is vaccine preventable disease and its prevalence had shown a downward trend in the donors from 2009 to 2011 [Figure 1]. Hepatitis C prevalence in this study (0.59%) was seen higher compared with Patel et al. [6] (0.09%) from western Ahmedabad. Hepatitis C is an important blood borne infection and can progress to chronic stage-ultimately leading to cirrhosis and hepatocellular carcinoma. A downward trend was observed in the prevalence of hepatitis C in the blood bank from 2009 to 2011 [Figure 1].
Figure 1: Comparison of transfusion transmissible infections in different years

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HIV prevalence in the low risk blood donors was 0.60% which was higher than reported by Giri et al. [11] from rural Maharashtra (0.07%), Chandra et al. [12] (0.23%) and Singh et al. [13] (0.54%) from Delhi. They reported higher seropositivity in replacement donors. HIV prevalence was almost same from 2009 to 2011.

For syphilis the prevalence was lowest (0.23%) of all the TTI in the present study but Singh et al. [13] and Arora [8] had reported higher prevalence from Delhi (2.6%) and Haryana (0.9%), whereas Giri et al. [11] had reported it lower.

The seropositivity of TTI at 2.79% among apparently healthy adults points to the need for highly sensitive donors screening program and public awareness and education so that infected persons can self-select themselves and opt out from donating blood due to problem of asymptotic carriers, window period, false negative tests. Behavior change communication should be targeted to young generation to keep them free of these infections.

Blood donors are a highly selective population with motivation for social works. Result obtained from donors cannot be generalized to general population. However, it can be used as to monitor the trend of infection in apparently healthy adult population.

The present study has been conducted in one tertiary care center of Kolkata; hence it does not give a complete picture of West Bengal regarding TTI. Moreover, as there is no catchment area of donors in tertiary care setting especially donors for the patients, hence it does not depict the picture of a particular area even. Hence, similar studies should be conducted in other large blood bank of West Bengal on a periodic basis to have the trend on TTI in the state.

 
   References Top

1.National blood policy, 2003. Available from: http://www.unpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN009847.pdf. [Last accessed on 2012 Jun 15].  Back to cited text no. 1
    
2.National AIDS Control Organization. Standards for Blood Banks and Blood Transfusion Services. New Delhi: Ministry of Health and Family Welfare Government of India; 2007.  Back to cited text no. 2
    
3.WHO blood safety. Available from: http://www.who.int/mediacentre/factsheets/fs279/en/index.html. [Last accessed on 2012 Sep 15].  Back to cited text no. 3
    
4.Shukla RS, Bhuyan KK. Can data on HIV sero-reactivity among blood donors provide an insight into HIV prevalence in the general population? Indian J Public Health 2007;51: 14-21.  Back to cited text no. 4
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5.Shrestha AC, Ghimire P, Tiwari BR, Rajkarnikar M. Transfusion-transmissible infections among blood donors in Kathmandu, Nepal. J Infect Dev Ctries 2009;3:794-7.  Back to cited text no. 5
    
6.Patel PA, Patel SP, Oza HV. Seroprevalence of transfusion transmissible infections (TTI) in blood donors at Western Ahmedabad - A secondary care hospital based study. Int J Biol Med Res 2012;3:1806-10.  Back to cited text no. 6
    
7.Kulkarni N. Analysis of the seroprevalence of HIV, HBsAg, HCV, & Syphilitic infections detected in the pre transfusion blood: A short report. Int J Blood Transfus Immunohematology 2012;2:1-3.  Back to cited text no. 7
    
8.Arora D, Arora B, Khetarpal A. Seroprevalence of HIV, HBV, HCV and syphilis in blood donors in Southern Haryana. Indian J Pathol Microbiol 2010;53:308-9.  Back to cited text no. 8
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9.Unnikrishnan B, Rao P, Kumar N, Ganti S, Prasad R, Amarnath A, et al. Profile of blood donors and reasons for deferral in coastal South India. Australas Med J 2011;4: 379-85.  Back to cited text no. 9
    
10.Kaur G, Basu S, Kaur R, Kaur P, Garg S. Patterns of infections among blood donors in a tertiary care centre: A retrospective study. Natl Med J India 2010;23:147-9.  Back to cited text no. 10
    
11.Giri PA, Deshpande JD, Phalke DB, Karle LB. Seroprevalence of transfusion transmissible infections among voluntary blood donors at a teaching Hospital in a rural area of India. J Fam Med Prim Care 2012;1:48-51.  Back to cited text no. 11
    
12.Chandra T, Kumar A, Gupta A. Prevalence of transfusion trasnmissible infection in blood donors: An Indian experience. Transfusion 2009;49:2214-20.  Back to cited text no. 12
    
13.Singh B, Verma M, Kotru M, Verma K, Batra M. Prevalence of HIV and VDRL seropositivity in blood donors of Delhi. Indian J Med Res 2005;122:234-6.  Back to cited text no. 13
    


    Figures

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    Tables

  [Table 1]


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