Prevalence of transfusion transmissible infection in blood donors at tertiary care centre of Eastern Uttar Pradesh

Sandip Kumar1, Neeraj Dhameja1, Satendra Kumar*2, Sunil Rao3, Lalit Prashant Meena4, Satyendra Kumar Singh5, Neelam Singh5 1Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India 2Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India 3Department of Paediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India 4Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India 5Department of Blood bank , Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India


INTRODUCTION
On the one hand, blood or component transfusion is a lifesaving modality but on the other hand it can cause great mortality or morbidity in recipient if not used judiciously. Due to implementation of stringent blood donor and other blood safety criteria, the blood or component transfusion is safe but is not of without risk. Microbiological safety is very important aspect of blood transfusion services (BTS). Microbial agents that are transmitted through the blood or component transfu-sion are of great concern even blood is collected from the voluntary donors. Viral infectious agents possess a great risk of transfusion transmitted disease. Asymptomatic carriers in the society, window period of the infectious agents, concealing medical history by the donors carries great risk of transmission of disease (Choudhury and Phadke, 2001). There are numerous viruses, bacteria, and parasites that can be transmitted through blood transfusion. Important ones are Human Immunode iciency Virus (HIV I/II), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Syphilis, and Malaria. Characteristics of infectious agents that can be transmitted through blood or component transfusion are (World Health Organization, 2012 3. Hepatitis C: screening for either a combination of HCV antigen-antibody or HCV antibodies 4. Syphilis (Treponema pallidum pallidum): screening for speci ic treponemal antibodies.
The national blood policy India included mandatory screening of Malaria in addition of WHO recommendation.
Accurate estimate of risk of TTI are essential for the monitoring of safety of blood supply and evaluating the ef icacy of the currently employed screening procedures (Gupta et al., 2011). Globally 2000 million people are infected with HBV and among them 350 million are chronic carriers of the disease. On the basis of prevalence of chronic Hepatitis B Virus infection, world has been divided  (Shah et al., 2013;Puri, 2014). The predominant mode of spread of HCV in India is blood or component transfusion and unsafe therapeutic injections while most common mode of its transmission in developed countries is IV drug abuse (Mukhopadhyaya, 2008). HCV is a single stranded RNA virus of Flaviviridae family. It has 6 genotypes from 1 to 6. The prevalent HCV Genotype in India is 3 (Satendra et al., 2016). Persistence of HBV and HCV infection can lead to chronic liver disease, Cirrhosis of liver and hepatocellular carcinoma (HCC).
As per report of NACO 2017, India has an estimated 21.40 (15.90-28.39) lakh people living with HIV (PLHIV). Uttar Pradesh had 1.34 lakh (1.018-1.776) PLHIV with HIV incidence per 1000 uninfected population less than 0.05 (National AIDS Control Organization , 2017). Syphilis is mostly transmitted through direct contact with a syphilis sore during vaginal, anal or oral sex. It may be transmitted by blood and blood products donated by asymptomatic donors harbouring the infection (World Health Organization, 2014). Prevalence of Syphilis is low in most of the studies related to blood or component transfusion.

MATERIALS AND METHODS
This study was carried out at blood bank, Sir Sunderlal Hospital of Institute of Medical Sciences, Banaras Hindu University from January to December, 2017.
The donors included in this study include all donors of blood donation camps organized by blood bank and coming directly to blood bank. Total donation during that period was 22255 units.
A detailed questionnaire was given to the donors for registration. This includes information regarding previous blood transfusion & illness, occupation, sero-prevalence of HIV, HBV, HCV, and Syphilis were 0.9% (21), 0.79% (177), 0.09% (22), 0.02% (6) respectively. No cases of malaria were detected. Sero-prevalence in male and female is shown in Table 2 . None of the blood group A Negative donors were seropositive. This may be a chance as incidence of this blood group in general population is very low. Blood group-wise Seropositivity was shown in Table 3. No cases of co-infection were found in the study. Most of the reactive samples were in age group 18-30 years (Table 4).
Blood and component transfusion is a lifesaving therapeutic option in many acute and chronic disease conditions. Transfusion of blood and its product is not always safe as it is mandatory screened for only ive infectious agents and thus it is not sterile. Blood collected from the voluntary donors are supposed to be safe as compared to the replacement donors. There are various studies on TTI from the different parts of the India but few studies are seen from the Uttar Pradesh and very few from this region. Studies regarding the sero-prevalence of TTI in various studies from (Arora et al., 2010;Giri et al., 2012;Bhawani et al., 2010;Karmakar et al., 2014;Mandal and Mondal, 2016;Sharma et al., 2018) are shown in Table 5. Our study shows highest prevalence of HBV amongst all donated blood, while overall prevalance of TTI amongst these studies is low. None of the donors were positive for malaria. We have studied several articles from India; none of them have seropositive for malaria parasite except one study from rural Darjeeling by Mandal R et al., 2016 who reported a case of malaria. This may be due to the sensitivity of the testing material or duration of the study. Our study does not show any correlation between sero-prevalence of HIV and Syphilis in but several authors ind a positive correlation between two (Gupta et al., 2011). All the female donors of our blood bank were negative for syphilis.
There is serious concern of CMV TTI in transfusion dependent patients as the donated blood is not screened for this. The prevalence of CMV IgG antibody in Indian population is 90% but many of them are non-infectious. It became very dificult to separate infectious blood unit from noninfectious. Screening of blood products for CMV is not cost effective in country like India. So prevention of transfusion associated CMV can be done by provision of inline leucocyte iltered blood products (Choudhury and Phadke, 2001).

CONCLUSIONS
Although there is decreasing trend of transfusion associated infection, but the donors of window periods are of great concern. Many centers are now using Nucleic Acid ampli ication Testing (NAT) method to reduce this. But, this is a cost limiting factor India. Factors such as, motivating maximum voluntary blood donation, reducing replacement donation, public information and donor education awareness programme, stringent donor screening criteria and vigilance of error will help in reducing TTI.