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Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
Safe Blood
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Safe Blood

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  • 1. Safe Blood; Facts, Challenges and Future Directions Dr. Saba Jamal Ziauddin University Hospital
  • 2. Facts
    • Advances in infectious disease testing continue to improve the safety of blood supply
    • However viral, bacterial & parasitic disease can still be transmitted by transfusions
    • Novel infectious agents may also appear at any time eg. HIV in the 1980’s
  • 3. International Standards For Screening of Blood
  • 4. Hepatitis B - Virus
    • Markers of infectious screening; HBsAg, Anti- HBc Total
    • Methodology; - ELISA ( recommended),
    • detects approx. 0.2-0.7ng/ml HBsAg or >3x10 7 particles
  • 5. Rationale for Anti-HBc Testing
    • Early convalescent phase acute HBV infection
    • Low level chronic HBV/tail-end infection
    • Mutants
    • Will not detect pre-seroconversion window period
  • 6. Hepatitis C - Virus
    • Markers of infection ; Anti-HCV, HCV RNA
    • Window Periods ; - Anti – HCV by Third Generation ELISA/EIA; 70 – 80 days - NAT; 10 – 30 days
  • 7. Human Deficiency Virus (HIV) ELISA/ EIA is the test of choice for Anti HIV 1 & 2
    • 20- 25 days
    • 16 days
    • 11 days
    • Anti- HIV 1 & 2
    • p24 antigen
    • NAT Testing
    Window Periods Markers of infection
  • 8. SYPHILIS
    • Phase of spirochetemia is brief & organisms survive only 4 days at 4 o C
    • Performance of serologic test for syphilis is still a requirement
  • 9. Malaria
    • Asymptomatic carriers with very low parasite load are generally the source of transfusion - transmitted malaria
    • Tests available; - Screening by smears - Serologic Testing for malaria antigen or LDH - PCR
  • 10. Malaria
    • Sensitivity for screening very low parasitic load i.e. asymptomatic carriers; - Smears, 20 parasites /ul - Serologic tests; No practical serologic tests available in asymptomatic donors
    • - PCR; Shows promise but cost is the issue
  • 11. Bacterial Contamination;
    • Yersinia enterocolitica,
    • Serratia Liquifaciens,
    • Staphylococcus,
    • Enterobacteriaceae,
    • Streptococcus,
    • Bacillus,
    • Psuedomonas
  • 12. Infectious Risks of Blood Transfusion in the United States
    • HBV
    • HCV
    1:1,900,000 1:63,000 1:1,600,000
    • RBCs
    • Platelets
    1:1,000 1:2,000
    • Malaria
    <1:1,000,000 Infectious agent or outcome Estimated Risk per Unit transmited
    • HIV-I&2
    Virus Bacteria Parasite
  • 13. Screening Performed in Pakistan
    • HBsAg
    • Anti-HCV
    • Anti- HIV 1 & 2
    • Malaria
    • Syphilis
  • 14. Challenges in Pakistan
    • Absence of screening in certain centers
    • Substandard Methods of screening eg. Latex based, sub-standard ELISA
    • Pooling of Donor Sera; - Increases the risk of transmission. Bigger the pool, higher the risk
    • Anti-HBc Total Antibody & NAT testing for HCV & HIV ; NOT PERFORMED
  • 15. Future Directions
    • Across the board implementation of infectious disease screening by Standard ELISA methods
    • Minimize residual risk of transfusion-transmitted viral infections
    • Motivate young healthy volunteer donors
    • Awareness of Physicians as well as the patients in risks of transfusion transmitted diseases
  • 16. Thank You

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