Pre-Donation Screening of Blood for Transfusion Transmissible Infections: The Gains and the Pains - Experience at a Resource Limited Blood Bank

Objective: To determine whether or not pre-donation testing of blood donors affords substantial cost savings without compromise to blood transfusion safety. Predonation testing of blood donors for Transfusion Transmissible Infections (TTIs) is done in most developing countries because substantial cost savings are made from resources; materials and man-hours which would have been spent to procure infected blood units. Simple rapid test kits used in pre-donation testing is not as sensitive as the Enzyme Linked Immuno-sorbent Assay (ELISA) method used in post-donation screening in a quality assured manner. Design: It is a retrospective study where records of pre- and post-donation tests done in donor clinic of University of Ilorin Teaching Hospital; between January and December 2010 were retrieved. All processes and inputs were evaluated and costs calculated for predonation testing by simple rapid techniques and post donation screening by ELISA. Results: 5000 prospective donors were tested in the study period. The cost of single rapid Pre-donation testing was less than that of single ELISA Postdonation screen. The cost of double rapid Pre-donation and Post donation ELISA screen exceeded the cost of single post donation ELISA screen. Substantial cost savings were made when single rapid Pre-donation testing is relied on. More blood units were found reactive for the TTIs with the more expensive Postdonation ELISA. Conclusion: Pre-donation testing of blood donors was not cost effective. Although; there is an apparent savings if pre-donation testing is not followed by postdonation ELISA testing; it is done at a compromise to blood transfusion safety

Effect of Hepatitis B Virus Co-Infection on CD4 Cell Count and Liver Function of HIV Infected Patients

Background: Human immunodeficiency virus (HIV)and Hepatitis B virus (HBV) share similar routes of transmission; making it possible for an individual to have a co-infection. HBV infection is well known to be a major cause of chronic liver diseases worldwide. The aim of this study was to determine the prevalence of HBV infection among HIV infected HAART naive patients and investigate the effect of co-infection on CD4 count and liver function. Study design: This was a hospital based descriptive cross sectional study of one hundred consecutive therapy-naive HIV-infected individuals. The CD4 count; Hepatitis B surface antigen; Serum albumin; total Protein; and liver enzymes were determined using standard techniques. Results:The prevalence of HIV and HBV co-infection was 37. The mean serum ALT and ALP were significantly higher in the co- infected patients (Pvalues 0.05). The mean CD4 count of the mono infected patients was significantly higher (p-value of 0.014). The mean serum ALT; AST and ALP of mono and co-infected patients with CD4 count200/?l were significantly higher than those with count ? 200 cells/?l. (p-value of 0.01). The mean ALT and AST of the co -infected patients and all patients with CD4 count 200 cells/?l were higher than the normal reference range. Conclusion : Approximately one third of HIV positive patients had hepatitis B virus co-infection. Coinfection and CD4 count 200 cells/?l are likely to result in abnormal ALT and AST. We recommend that co-infected patients and those with CD4 count 200 cells/?l should be given non-hepatotoxic antiretroviral drug