Screening Donated Blood for Transfusion Transmitted Infections by Serology along with NAT and Response Rate to Notification of Reactive Results: An Indian Experience
Background. Transfusion safety begins with healthy donors. A fundamental part of preventing transfusion transmitted infections (TTIs) is to notify and counsel reactive donors. Donor notification and counselling protect the health of the donor and prevent secondary transmission of infectious diseases. Methods. 113,014 donations were screened for TTIs, namely, HIV, HBV, HCV, and syphilis, by serology and nucleic acid testing. All reactive donors were retested (wherever possible) and notified of their status by telephone or letter. All initial reactive screens were followed over six months. Results. We evaluated 2,838 (2.51%) cases with reactive screening test results (1.38% HBV, 0.54% HCV, 0.27% HIV, and 0.32% syphilis). Only 23.3% of donors (662) responded to notification. The response among voluntary donors was better as compared to the replacement donors (43.6% versus 21.2%). Only 373 (56.3%) responsive donors followed their first attendance at referral specialties. Over six months, only 176 of 662 (26.6%) reactive donors received treatment. Conclusion. Our study shed light on the importance of proper donor counselling and notification of TTI status to all reactive donors who opt to receive this information. There is also an urgent need to formulate the nationally acceptable guidelines for notification and follow-up of reactive donors. 1. Introduction Blood transfusion is safer than ever before through continuous improvements in donor recruitment, screening, testing of donated blood with increasingly sensitive assays, and appropriate clinical use of blood [1]. Serologic testing for transfusion transmitted diseases had historically been the foundation of blood screening, while newer strategies like nucleic acid testing (NAT) have helped further shorten the “window period” [2]. Currently, no technology exists to completely detect all window period donations. No matter how sensitive NAT becomes, we will never be able to completely close the exposure-to-seroconversion window period. The general public and media might believe that with the advancement in testing technologies zero risk blood products are currently available. This generalization is far from reality as judged by our current experience with new testing methodologies. Breakthrough transmissions of viruses (HIV-1 and HCV) had occurred as late as 2009 due to NAT failures because of low level of viraemia and/or suboptimal amplification efficiency [3]. Moreover, threat of infectious agents entering the blood supply is not static and may evolve as new pathogens emerge or as old ones change their
References
[1]
Z. S. Bharucha, “Safe blood transfusion practices,” Indian Journal of Pediatrics, vol. 68, no. 2, pp. 127–131, 2001.
[2]
R. Hans and N. Marwaha, “Nucleic acid testing-benefits and constraints,” Asian Journal of Transfusion Science, vol. 8, no. 1, pp. 2–3, 2014.
[3]
C. M. Nübling, M. Heiden, M. Chudy et al., “Experience of mandatory nucleic acid test (NAT) screening across all blood organizations in Germany: NAT yield versus breakthrough transmissions,” Transfusion, vol. 49, no. 9, pp. 1850–1858, 2009.
[4]
F. Bihl, D. Castelli, F. Marincola, R. Y. Dodd, and C. Brander, “Transfusion-transmitted infections,” Journal of Translational Medicine, vol. 5, article 25, 2007.
[5]
L. M. Kucirka, H. Sarathy, P. Govindan et al., “Risk of window period HIV infection in high infectious risk donors: systematic review and meta-analysis,” The American Journal of Transplantation, vol. 11, no. 6, pp. 1176–1187, 2011.
[6]
D. P. Patel, D. S. Patel, D. J. Bhatt, D. N. Bhatnagar, and D. M. G. Shah, “Evaluation of response to donor notification of reactive transfusion transmitted infections (ttis) result,” National Journal of Integrated Research in Medicine, vol. 3, no. 2, pp. 20–25, 2012.
[7]
L. A. Bashawri, “A review of predonation blood donor deferrals in a university hospital,” Journal of Family and Community Medicine, vol. 12, no. 2, pp. 79–84, 2005.
[8]
K. A. Munsterman, A. J. Grindon, M. T. Sullivan et al., “Assessment of motivations for return donation among deferred blood donors,” Transfusion, vol. 38, no. 1, pp. 45–50, 1998.
[9]
T. M. Roshan, H. Rosline, S. A. Ahmed, M. Rapiaah, and M. N. Khattak, “Response rate of malaysian blood donors with reactive screening test to transfusion medicine unit calls,” The Southeast Asian Journal of Tropical Medicine and Public Health, vol. 40, no. 6, pp. 1315–1321, 2009.
[10]
L. P. Choudhury and S. Tetali, “Ethical challenges in voluntary blood donation in Kerala, India,” Journal of Medical Ethics, vol. 33, no. 3, pp. 140–142, 2007.
[11]
Global blood safety and availability. Key facts and figures, 2010.
[12]
P. Kaur and S. Basu, “Transfusion-transmitted infections: existing and emerging pathogens,” Journal of Postgraduate Medicine, vol. 51, no. 2, pp. 146–151, 2005.
[13]
D. Arora, B. Arora, and A. Khetarpal, “Seroprevalence of HIV, HBV, HCV and syphilis in blood donors in Southern Haryana,” Indian Journal of Pathology and Microbiology, vol. 53, no. 2, pp. 308–309, 2010.
[14]
P. Pallavi, C. K. Ganesh, K. Jayashree, and G. V. Manjunath, “Seroprevalence and trends in transfusion transmitted infections among blood donors in a University Hospital blood bank: a 5 year study,” Indian Journal of Hematology and Blood Transfusion, vol. 27, no. 1, pp. 1–6, 2011.
[15]
K. Chatterjee, P. Coshic, M. Borgohain, R. M. Thapliyal, S. Chakroborty, and S. Sunder, “Individual donor nucleic acid testing for blood safety against HIV-1 and hepatitis b and c viruses in a tertiary care hospital,” National Medical Journal of India, vol. 25, no. 4, pp. 207–209, 2012.
[16]
T. Chandra, S. N. F. Rizvi, and D. Agarwal, “Decreasing prevalence of transfusion transmitted infection in Indian scenario,” The Scientific World Journal, vol. 2014, Article ID 173939, 4 pages, 2014.
[17]
M. Meena, T. Jindal, and A. Hazarika, “Prevalence of hepatitis B virus and hepatitis C virus among blood donors at a tertiary care hospital in India: a five-year study,” Transfusion, vol. 51, no. 1, pp. 198–202, 2011.
[18]
N. Agarwal, K. Chatterjee, P. Coshic, and M. Borgohain, “Nucleic acid testing for blood banks: an experience from a tertiary care centre in New Delhi, India,” Transfusion and Apheresis Science, vol. 49, no. 3, pp. 482–484, 2013.
[19]
L. Gürtler, A. Mühlbacher, U. Michl, et al., “Reduction of the diagnostic window with a new combined p24 antigen and human immunodeficiency virus antibody screening assay,” Journal of Virological Methods, vol. 75, no. 1, pp. 27–38, 1998.
[20]
C. Bianco and D. Kessler, “Donor notification and counseling management of blood donors with positive test results,” Vox Sanguinis, vol. 67, no. 3, pp. 255–259, 1994.
[21]
N. Agarwal, “Response rate of blood donors in the uttarakhand region of india after notification of reactive test results on their blood samples,” Blood Transfusion, vol. 12, no. 1, pp. s51–s53, 2014.
[22]
S. Dontula, A. Mathur, T. Kamaladoss, S. Adimurthy, and L. Jagannathan, “Donor disclosure—a donor's right and blood bank's responsibility,” Transfusion Alternatives in Transfusion Medicine, vol. 12, no. 3-4, pp. 44–50, 2012.
[23]
N. Choudhury, P. Singh, and H. Chandra, “AIDS awareness in blood donors in north India,” Transfusion Medicine, vol. 5, no. 4, pp. 267–271, 1995.
[24]
S. Kleinman, B. Wang, Y. Wu et al., “The donor notification process from the donor's perspective,” Transfusion, vol. 44, no. 5, pp. 658–666, 2004.
[25]
V. P. Torane and J. S. Shastri, “Comparison of ELISA and rapid screening tests for the diagnosis of HIV, hepatitis B and hepatitis C among healthy blood donors in a tertiary care hospital in Mumbai,” Indian Journal of Medical Microbiology, vol. 26, no. 3, pp. 284–285, 2008.
[26]
C. A. Ciesielski and R. P. Metler, “Duration of time between exposure and seroconversion in healthcare workers with occupationally acquired infection with human immunodeficiency virus,” The American Journal of Medicine, vol. 102, no. 5, pp. 115–116, 1997.
