Transfusion Transmitted Infections In Patients With Hemophilia: A Study From A Tertiary Care Hospital In Western India.

摘要

Transfusion transmitted infections (TTI) continue to endanger safe blood supply. The risk for acquiring TTI is even higher in multiply transfused patients. This study is aimed to estimate the prevalence of TTI in 80 multiply transfused patients of Hemophilia. 80 male patients of hemophilia and 320 normal voluntary blood donors were included in the study. Screening for anti-HIV, HBsAg and anti-HCV was carried out by enzyme linked immunosorbent assay (ELISA). Syphilis was tested using RPR card test. Out of 80 multiply transfused patients, 10 (12.5%) were infected with TTI. Seroreactivity for 7.5% for HCV and 5 % for HBV. No patient was found reactive for HIV and syphilis. In blood donors seroprevalence of viral markers was 0.31% for HCV and HIV, 0.94% for HBV whereas 1.25% donors showed reactive RPR test for syphilis. This study showed that HCV and HBV infection were more frequently identified than HIV in multitransfused hemophiliacs. Promoting voluntary blood donation, adopting sensitive screening methods and use of virally inactivated or recombinant factor concentrate will decrease the prevalence of TTI in people with hemophilia (PWH). Introduction The earliest written references to what appears to be hemophilia are found in Jewish texts from the second century AD in which Rabbinical rulings exempted male boys from circumcision if two previous brothers had died of bleeding after the procedure.1 First medical professional to describe a bleeding disorder corresponding to hemophilia was Arab physician Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi (936-1013 AD) who, in his book “Kitab al-Tasrif”, or Methods in Medicine documented an illness localized to males of a particular village in which patients bleed profusely after minor trauma.2 By 12th century, Hebrew physician Moses Maimonides recognized that these familial bleeding tendencies were transmitted through the mother.3 The term, haemophilia, originated with a German, Friedrich Hopff (1828), who coined the name "haemorrhaphilia" which was later abbreviated to hemophilia.4Haemophilia is the commonest X-linked recessive hereditary bleeding disorder, arising due to absence of, decrease in, or deficient function of plasma coagulation factor VIII or factor IX.5 The disease affects 1 in 10,000 males worldwide, in all ethnic groups; hemophilia A represents 80% of all cases. Male subjects are clinically affected; women, who carry a single mutated gene, are generally asymptomatic.6Primary modality of treatment in hemophilia is factor replacement therapy. Unlike developed nations, where factor concentrates are virally inactivated or are made by recombinant technology, patients in developing nations like India heavily depend upon “wet” blood products like Fresh Frozen plasma or cryoprecipitate for the prophylaxis and management of bleeding episodes. These products are usually not treated to eliminate blood-borne viruses. Therefore, Transfusion-transmitted infections (TTIs) such as Hepatitis B (HBV), and C (HCV) and HIV continue to thwart safe blood transfusion practices in healthcare facilities dealing with management of hemophilia patients. National blood supply heavily relies on replacement blood donors. Various studies done in India shows high incidence of HIV, HBV, HCV and syphilis in replacement blood donors as compared to voluntary non-remunerated blood donors.7, 8 Further, widespread use of less sensitive “Rapid Kits” to screen blood units in Blood Banks leads to release of infectious units into the circulation.9A survey conducted by Kapoor et al. in 2000 involving 604 blood banks revealed that testing for transfusion-transmitted infections is unsatisfactory and poorly regulated in India.10 Prevalence of anti-HIV, hepatitis B surface antigen (HBsAg), anti-HCV and syphilis positivity in Indian blood donors is 0.084-3.87%, 0.66-12%, 0.5-1.5% and 0.85-3% respectively.11Although government of India has made mandatory to screen donated blood for HBV (since 1971), HIV (since 1989), HCV (s