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Background:
Blood transfusion
is a lifesaving intervention but the risk of transmitting transfusion
transmissible infections (TTI) still remains even after use of sensitive
techniques in TTI screening of blood units. Donor’s notification and counseling
is an important and efficient method of preventing TTI transmission.
Aim: The present study was undertaken to
determine the response rate and attitude of the reactive blood donors to post-donation
notification and counseling.
Materials and methods: This a retrospective study
conducted in the Department of Blood Transfusion, in a Tertiary Care Hospital,
Haryana, India over a period of one year. A total annual blood donation of 8354
units were collected and were subjected to routine TTI screening during the
study period.
Results: Among these, 251 (3%) donors were found to
be seroreactive for TTI diseases. 11 (0.13%) donors were HIV positive, 79
(0.94) donors were reactive for HBsAg, 105 (1.26%) donors were HCV positive, 51
(0.61%)were VDRL positive and 5 (0.06%) donors showed co-infection, (3
HbsAg+HCV,1 HIV+VDRL, 1 HIV+HCV). No blood donors were found positive for
malaria parasite. All the 251 TTI reactive donors were informed telephonically
and by letters, out of which 174 (69.3 %) were contacted and 77 donors (30.7%)
could not be contacted. Out of 174 informed donors 108 responded by attending
the counseling in the blood bank, i.e., response rate of 62.06%.
Discussion:
In present study
the main reasons for non-responding donors include wrong or incomplete phone
numbers and postal addresses, lack of awareness and already known reactive
status. National guidelines for notification of reactive donors need to be
formulated and trained and efficient counselors should be appointed to improve
the donors’ understanding about the TTI and importance of correct and complete
demographic data to achieve 100% response rate of contacted reactive donors.
Keywords: Reactive donor, Notification,
Counseling, Transfusion Transmitted infections
INTRODUCTION
Blood transfusion plays an essential role in
patient management in both routine and emergency situations and is a
life-saving intervention in which millions of lives are saved each year
globally through this procedure [1]. However, blood transfusion is
also associated with the potential risk of transmitting transfusion-transmitted
infections (TTIs) and imposes serious challenges to the medical personnel to
ensure availability of safe blood products. According to the National AIDS
Control Organization (NACO) guidelines it is mandatory to screen donated blood
for HIV 1 and 2, hepatitis B, hepatitis C, syphilis and malaria [2].
Many blood donors are asymptomatic carriers of TTIs, and blood donation by such
infected donors during the window period further increases the risk of TTI
transmission [3]. TTI disease transmission can also be prevented by
another tool of donors’ notification and post donation counseling about the
status of TTI reactivity and thus preventing them from donating blood in
future. The main responsibility of Blood banks is to provide safe blood to the
recipient, but in addition they also have a responsibility towards donor safety
by means of donor notification and counseling. But
it is not
a universal
MATERIALS AND
METHODS
It was a retrospective study conducted at
Blood Transfusion Department, in a tertiary care hospital, Haryana, North
India, over a period of one year to evaluate the response of TTI reactive
donors after notification of their abnormal test results during the year 2018.
All the donations were screened for transfusion transmissible infections namely
human immunodeficiency virus (HIV 1 and 2) by 4th generation
Enzyme-Linked Immunosorbent Assay (ELISA) (Merilisa), Hepatitis B (HBV) and
Hepatitis C (HCV) by third generation (ELISA) (Merilisa), malaria by rapid test
kit (Meril) and Syphilis by rapid test strip for TPHA (Meriscreen Syphiline).
If the results were found to be positive, blood unit was discarded as per
hospital standard operating procedures and reactive donors were called by the
blood bank counselor telephonically to report to the blood bank for repeat
sampling, one-to-one counseling and referral to the appropriate center for
further management. At least three telephonic calls were made, and for those
who could not be contacted on phone, letters were posted thrice on the donors'
given addresses by the department. Reactive donors reporting to the blood bank
were retested using fresh sample, informed about their status, counseled and
were referred to the respective department. HBV or HCV reactive donors were
referred to the gastroenterologist and malaria reactive donors to the medicine
OPD, syphilis reactive to the Dermatology and venereal diseases OPD and HIV
reactive to the integrated counseling and testing center.
RESULTS
A total annual blood donation of 8354 units
were collected and subjected to routine TTI screening during the study period
(January 2018-December 2018). Among these, 251 (3%) donors were found to be
seroreactive for TTI diseases. 11 (0.13%) donors were HIV positive, 79 (0.94%)
donors were reactive for HBsAg, 105 (1.26%) donors were HCV positive, 51
(0.61%)were VDRL positive and 5 (0.06%) donors showed co-infection, (3
HbsAg+HCV, 1 HIV+VDRL, 1 HIV+HCV) (Table
1). Prevalence of hepatitis C infection (1.26%) formed the majority of the
total TTI’s over the study period (Figure
1). No blood donors were found positive for malaria parasite. In our study
out of the reactive donors 251 were males and only 2 were females. Seroreactive
donors were classified into donors who could be contacted and donors who could
not be contacted, donors who were contacted were again divided into donors who
responded/returned back and donors who did not respond or return back. All the
251 TTI reactive donors were informed telephonically and by letters, out of
which 174 (69.3%) were contacted and 77 donors (30.7%) could not be contacted (Table 2) as either their number could
not be reached or switched off or incorrect address. Out of 174 informed donors
108 responded by attending the counseling in the blood bank and 66 donors were
non responders as some of them attended the call but did not report to blood
bank, some already knew their status and were undergoing treatment and others
were not interested in getting tested again. Overall response rate of the
communicated donors was 62.06% (Table 3).
Response rate for HIV, HBV, HCV, syphilis and co-infections were 77.8, 60.9%,
58.1%, 69.4% and 50%, respectively (Figure
2).
DISCUSSION
Although transfusion of blood and its
components is lifesaving and plays a vital role in the management of many
diseases, it always carries a risk of TTI transmission and many other adverse
reactions. Proper pre donation counseling and TTI screening along with post
donation counseling and notification to the TTI reactive donors are important
pre-requisites in providing safe blood transfusion. The main aim is to protect
and safeguard the health of both the donor and the recipient of blood and blood
products. Post donation counseling and notification is beneficial to both
society and the donor, as after confirmation of results, donor can take proper
treatment and it also prevents reactive donors from donating blood again. The
present study was done Blood Transfusion Department, in a tertiary care
hospital, Haryana, North India, over a period of one year (January 2018-December
2018) to evaluate the response of TTI reactive donors after notification of
their abnormal test results. In this study, a total annual blood donation of
8354 units were collected 251 donors were found to be seroreactive for TTI
diseases. The seroreactivity rate of all five mandatory TTIs markers was 3%
which is comparable to studies done by Kumari et al. [9] and Kotwal et al.
[10], i.e., 2.81% and 3.02%, respectively. Whereas other studies in India done
by Agarwal et al. [11], Leena et al. [12] and Singh et al. [13] showed lower
TTI rates (0.87%, 1.35% and 1.7%, respectively). As our hospital is based in a
rural area of Haryana, the reason behind higher rate of TTIs in our study could
be due to rural donor population with lack of awareness, high risk sexual
activities and endemicity of transmissible diseases among donor population. Out
of the 251 TTI reactive donors who were informed telephonically and by letters,
174 (69.3%) could be contacted and 77 donors (30.7%) could not be contacted. Out
of 174 informed donors 108 (62.06%) responded by attending the counseling in
the blood bank for retesting and referring to ICTC or physicians and 66 (37.2%)
donors were non responders. Similar response to the reactive donors
notifications were also observed by Agarwal et al. [11] (59.8%). however low
response rate was observed in studies by Mukherjee et al. [14] (34%). Other
studies have reported higher responding rate of 98.2% and 88%, respectively
[10,15]. In present study the main reasons for non-responding donors
include lack of understanding as some of them attended the call but considered
it unimportant did not report to blood bank, some already knew their status and
were undergoing treatment and others were not interested in getting tested
again. Response rate for HIV, HBV, HCV, syphilis and co infections were 77.8,
60.9%, 58.1%, 69.4% and 50%, respectively. Among all TTI response rate for HIV
was highest 77.8%. Higher response rate for HIV was also noticed in other
studies [9,16]. Higher response rates for HIV reactive donors might be due to
the higher awareness and fear of HIV/AIDS among the general population [16].
In present study 30.7% of reactive donors could not be contacted, which is
lower as compared to Kotwal et al. [10], i.e., 49.4% and Moyer et al., i.e.,
[17] 65.52%. In a study conducted by Kaur et al. [16], about 10.5% of the
donors could not be contacted as either their phones were switched off or
unavailable when contacted during the day time and due to wrong phone numbers
and address were given by the donors. In present study, reasons for failure of
communication with donors were due to wrong or incomplete phone numbers and
postal addresses given by donors or donors do not pick calls even after
multiple attempts of calling. Donor’s tendency to give false information
reflects lack of awareness towards TTIs and its routes of transmission and
possibility of known reactive status and donating blood just to cross check
their reactivity by purposely giving wrong phone numbers and address in attempt
to conceal their identity. Thus it is recommended to procure government
provided I-cards from donors for their proper identification and to obtain
correct address for communication. It is also recommended to lay emphasis on
strict pre-donation screening and counseling by well trained and competent
counselors with a special focus to increase the donors’ awareness of TTI and
routes of transmission. Privacy and confidentiality should be maintained to
gain the donor confidence. It gives the opportunity of self-deferral to people
having history of high-risk behavior and who are coming only for TTI testing
(test seekers) [11]. However, proper pre-donation counseling is
still a challenge due to limited number of staff and suitable facilities to assure
privacy and confidentiality especially in the outdoor blood donation camps [14].
Therefore reactive donor notification and counseling for abnormal TTI test
result is an important tool to prevent asymptomatic donors from considering
blood donation again thus reducing the spread of TTI through blood transfusion.
Information, education and awareness need to be created among the donors during
both pre-donation and post donation counseling, so that they understand the
importance of being called for TTI reactive status.
CONCLUSION
Donor notification and counseling is an
important tool for curtailing TTI as counseled donors get inclined toward
adaptation of healthy lifestyle and behavior and understand the importance of
self-deferral and this also helps in promoting the development of healthy donor
pool. But its limitations are failure of communication with the donors or false
information provided by donors themselves to avoid social stigma and they
continue to donate blood even after notification of reactive status resulting
in persistent load of blood transmissible infectious risk. In this regard, it
is recommended that government authorized valid identity card should be made
mandatory for donor registration. National guidelines for notification of
reactive donors need to be formulated and trained and efficient counselors
should be appointed to improve the donors’ understanding about the TTIs and its
routes of transmission, screening tests done and importance of correct and
complete demographic data for informing them the test results to achieve 100%
response rate of contacted reactive donors.
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(2000) WHO Guidelines of Blood Transfusion Safety Appia, CH-1211. Switzerland:
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AIDS Control Organization (2007) Standards for Blood Banks and Blood
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S, Bhattacharya P, Bose A, Talukder B, Datta SS (2014) Response to
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