Risk Factors for Transfusion Transmissible Infections Elicited on Post Donation Counselling in Blood Donors: Need to Strengthen Pre-donation Counselling

Abstract

Donor notification and counselling transforms the legal and ethical requirement of disclosure of transfusion transmissible infection (TTI) in a blood donor into practice. The present study was done to assess the response to the disclosure of TTI reactivity results in blood donors, assess the risk factors in blood donors and follow the compliance of the disclosure and clinical referral in a population of blood donors who are difficult to convince that they may be harbouring infections apparently in a healthy state today but with possible clinical disease consequences in the future. A retrospective study was conducted from April 2011 to November 2012. Screening was done using third generation ELISA kits used according to the manufacturer's directions; these kits were approved for use in blood banks by the Drug Controller General of India. Those testing repeat reactive were referred for further confirmation and management. The total number of TTI reactive donors was 787 (0.93 %, N = 83,865). The observed response rate in the present study is 21.6 % (167, N = 787). The risk factors for acquiring infections in TTI reactive donors were statistically significant history of high risk behaviour (20.3 %) for human immunodeficiency virus infection and history of jaundice in themselves, family or close contacts (16.1 %) for hepatitis B virus infection. One hundred and ten (65.8 %) of the referred donors were on outpatient clinical care when post-referral follow up was conducted. The study emphasises on continuing sensitization of blood donation camp organisers to the need of privacy during blood donor selection. The study also stresses the need to strengthen the pre-donation counselling at outdoor blood donation at the same time raise awareness amongst blood donors about the importance of postdonation counselling and follow up.

Prevalence of Hepatitis B and C Viral Markers in Blood Donors Deferred from Donating Blood on the Basis of a History of Jaundice of Unknown Origin

“…This is two and half times higher to the combined sero prevalence of 1% on serology (HBsAg and anti HCV) in accepted blood donors during the period of study and that of 0.93% reported in the earlier publication from our department. 3,12 Further this is even higher than the observed NAT yield of 0.2% within accepted donors (without elicitable history of jaundice of unknown origin at time of donor selection) during the study period. 12 Therefore in peripheral blood bank setting and in urgent apheresis scenario; where at present only rapid testing is available in majority of blood banks in our country, there is a possibility that blood donors if not deferred strictly and selected for donation would stand a chance of being non reactive, escape infectious disease screening and thus theoretically have the potential of spreading transfusion transmissible infections in recipients.…”

“…These activities are transformed into action during the time tested approach of information, education and communication (IEC) campaigns undertaken to promote voluntary blood donation or at the time of pre donation counselling. 2,3 UDHQ are designed to be able to filter donors who could be at higher risk of harbouring infections that could be transmissible by transfusion. Questions have traditionally been included in the questionnaire on basis of precautionary approach and have been added from time to time in order to increase the deferral of high risk blood donors; even though the questions have not been evaluated for their potential benefit to blood and donor safety.…”

“…2 The need to conduct the study was felt when a statistically significant history of jaundice was noted in blood donors sero-reactive for HBsAg during the post test notification and counselling. 3 The aim of the present study was to know the prevalence of viral hepatitis markers among blood donors deferred on the basis of a history of jaundice of unknown origin and to predict the impact of this deferral on blood safety. This study also aims to compare the prevalence of viral hepatitis markers in donors with a history of jaundice of unknown origin with those with no elicitable history of jaundice therefore selected for blood donation.…”

Review of the Abstracts on Advances in Transfusion Medicine at Hematocon 2018

“…Kesarkhane and colleagues from Miraj, India have brought out the very important role of the BTS, acting as a miniature public health model by diagnosing the undiagnosed infections in apparently healthy asymptomatic people and referring them for treatment thereby reinforcing the secondary prevention [6]. This important aspect has been previously highlighted in the study from Chandigarh India [7].…”

Vox Sanguinis International Forum on donor notification and counselling strategies for markers of transfusion‐transmissible infections: summary

“…Donor notification procedures vary depending on which test is positive and the medical and social implications of the infectious agent. The existing literature on the donor notification and counselling process shows a marked variability in terms of regulatory requirements, confidentiality, contents of notification messages, donor response rates and the follow‐up of notified donors.…”