Prevalence of transfusion transmissible infections in blood donors of Pakistan

Blood transfusion is a life-saving procedure of modern medicine. Stringent screening of blood not only gives us an idea about the prevalence of TTIs in healthy populations but also ensures the safe supply of blood and blood products. [9]. Disease burden estimations based on sound epidemiological research form the basis of public policy. Similarly, the exact evaluations of the risk of TTIs is imperative in order to monitor the safety of blood supply and gauging the effectiveness of the presently employed screening procedures, as discussed by Busch et al. [10]. According to one study, in Pakistan the majority of the blood donors are first timers, which can be considered a true reflection of infection amongst the community [9]. However, according to other studies, blood donors may not represent the general population as the prevalence rate may be underestimated or overestimated due to their different characteristics [11, 12]. Since most of them are male, young or middle-aged, the source of prevalence may underestimate the actual prevalence. This view seems more valid as opposed to the previous one simply because females comprise more than 50% of Pakistan’s population. The prevalence of TTIs among blood donors in a well-structured health care system coupled with a well-organized blood establishment can be used as a reliable tool for statistical calculation of those infectious agents that can be transmitted through blood products in the populations, as discussed by Gharehbaghian and Chandra et al. [1, 13].

In our study, most of the donors were replacement blood donors i.e. 95% which is comparable with other local studies in which majority of blood donations were contributed by replacement donors [4, 14] with the intention to help a friend, relative or acquaintance who needed blood transfusion. The maximum number of donors came from the 18–30 year age group. A similar trend was seen in earlier reports [15, 16]. Furthermore, efforts should also be made to encourage and improve the number of female donors, as our study shows limited number of female donors. In this study, a significant increase in the seroprevalence of syphilis was observed among blood donors over the study period, which was found to be 2.1%. A local study that was done previously had also observed a rising seroprevalence of 0.89% [17]. This finding is consistent with the increasing trend of syphilis seropositivity observed in blood donors of Israel [18]. A study done in Iran also found a rising trend of syphilis frequency in their population; however, the frequency found in this study was 0.04% [19]. Previous local data shows low seroprevalence from 0.22 to 0.89%, which is contrary to that observed in our study [4, 20‐22]. Another study found a downward trend in seroprevalence [3]. Moreover, Moiz et al. observed similar results in their study [23]. Furthermore, studies done in India had very low prevalence as compared to our study [15, 24]. Thus, the seroprevalence of syphilis in blood donors observed in our study was high as compared to the previous local and international data. Since citizens perform blood donation(s), it could provide an updated picture about prevalence of Syphilis in the Pakistani population.

However, one of the limitations in our study is that positivity of Syphilis could not be further validated by confirmatory assay and positivity could only give indication as a surrogate marker.

There is also limited surveillance data for HIV in Pakistan. Current study reports the figure of 0.04%, which is slightly higher than the one reported in studies by Attaullah, Manzoor and Sultan et al. [2, 4, 21]. HIV positive blood units were confirmed with other techniques in the reference HIV laboratory.

Acute and chronic viral hepatitis are the most reported health problems in Pakistan and usually bring with them serious complications. Local data regarding the prevalence of HBV and HCV infections among healthy blood donors is well recognized [12, 14, 17, 25] except by the Mahmood et al. study [26], which shows less percentage of HBsAg and anti HCV.

Risk behavior–based donor selection is the cornerstone of the availability of safe blood. It is dependent on donor education as well as the accurate and truthful disclosure of risk behavior [12]. In our study, risk factors were assessed using a questionnaire but many blood donors were reluctant to disclose any risk behavior(s) because of the potential fear of judgment, embarrassment, test-seeking behavior, or due the genuine belief that their blood was safe [12]. We have over all observed risk factors among the blood donors in our study however they were not analyzed for each blood donor’s category individually. Therefore, we could only simulate risk factors among blood donors based on local studies on HBV and HCV infections [11, 12].

The focus of our study was also to determine the demographic characteristics of reactive blood donors. Positive donors for any infection were informed and requested to visit general physicians. A short interview was conducted to find more details regarding the life styles of reactive blood donors. This is the first local study in our region, which shows detailed demographic characteristics information regarding blood donors.