Serological monitoring of thalassaemia major patients for transfusion associated viral infections.

A total of 39 patients with thalassaemia major who received multiple blood transfusions were followed up clinically and serologically for 3 successive years (1993, 1994, 1995). They were screened for hepatitis B surface antigen (HBsAg), and antibodies to hepatitis B core (HBc-total), hepatitis C virus (HCV), human immunodeficiency virus I and II (HIV-I/II) and cytomegalovirus (CMV-total). In spite of transfusing HBsAg screened (by third generation ELISA) blood from voluntary non-remunerated donors, there was a significant increase of HBsAg positivity (P < 0.001) from 17.9 per cent (1993) to 35.9 per cent (1994) to 69.2 per cent (1995). This was probably due to the prevalence of undetectable HBV infection in the population. Anti HBc was present in 17 (43.6%), 14 (35.9%) and 16 (41%) patients in consecutive years. An increase in the units of blood transfused was observed every year. Blood units were not screened for anti HCV antibodies but a gradual increase in positivity [9 (23%), 12 (30.7%) and 14 (35.9%) patients] was seen in consecutive years. Anti-HIV antibodies were found in a 16 yr old male who was included in the study without any clinical evidence of AIDS. Anti CMV antibody was found in 30 (76.9%), 32 (82%) and 29 (74.3%) patients without any apparent clinical infection. Some patients showed change of antibody pattern (from negative to positive or vice versa) and a few patients showed inconsistent results probably due to immune modulation. Recruitment of 'repeat' non-remunerated voluntary blood donors may reduce the risk of high HBV transmission.

Effectiveness of mandatory transmissible diseases screening in Indian blood donors.

This study was undertaken to determine the prevalence of transfusion transmitted diseases (TTDs) among local blood donors, the safety offered by the four mandatory tests (for HIV, HBsAg, syphilis and malaria) and to assess alanine aminotransferase (ALT) as a surrogate test. A total of 313 blood donors were tested for HBsAg, hepatitis B core (HBc) antibody, hepatitis C (HCV) antibody, HIV antibody, and IgM antibody to cytomegalovirus (CMV-IgM). The serum alanine aminotransferase levels were also done on each unit of blood. The prevalence of various markers was 7(2.2%) for HBsAg, 57 (18.2%) for anti HBc (total), 1 (0.3%) for anti HCV, 16 (5.1%) for anti CMV. None of the donors were positive for HIV, VDRL or malaria. ALT level was raised in 16.5 per cent of donors and showed no correlation with hepatitis markers. ALT was not found to be useful as a surrogate marker for routine screening of donors. Sensitive tests like ELISA and immunofluoresence for malaria antigen should be applied for screening for malaria. VDRL test may be used to detect high risk donors rather than detection of syphilis when stored blood is used. HBsAg and HIV tests should be routinely done on every unit of blood and anti HCV tests should be done regularly, if possible.