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  2. 3. INTRODUCTION <ul><li>There is a high prevalence rate of infections in donated blood in many developing countries. There are many Blood borne, transfusion transmitted and related diseases. Following here is a partial and growing list of the most commonly known Blood transfusion  transmitted diseases, but for which no routine cost-effective laboratory testing is available. </li></ul>
  3. 4. Infectious Agents <ul><li>VIRUSES </li></ul><ul><ul><li>HIV </li></ul></ul><ul><ul><li>Hep-B & Hep-C </li></ul></ul><ul><ul><li>West Nile Virus </li></ul></ul><ul><ul><li>CMV </li></ul></ul><ul><ul><li>HTLVs (1 & 2) </li></ul></ul><ul><ul><li>Herpes Virus </li></ul></ul><ul><li>PARASITES </li></ul><ul><ul><li>Plasmodium spp. </li></ul></ul><ul><ul><li>Trypnosoma cruzi </li></ul></ul><ul><ul><li>Bebisia microti </li></ul></ul><ul><ul><li>Toxoplasma gondii </li></ul></ul><ul><ul><li>Leishmania donovani </li></ul></ul><ul><li>MISCELLANEOUS AGENTS </li></ul><ul><ul><li>Prions </li></ul></ul>
  4. 5. VIRUSES
  5. 6. HIV
  6. 7. Human Immunodeficiency Virus <ul><li>HIV is a member of the retroviruses family. </li></ul><ul><li>It is the causative agent of acquired immunodeficiency syndrome (AIDS). </li></ul><ul><li>Blood transfusion, sexual transmission & use of contaminated equipments are major modes of transmission. </li></ul><ul><li>Screening of blood products for HIV has largely eliminated transmission through blood transfusions or infected blood products in the developed world. </li></ul><ul><li>The incidence of human immunodeficiency virus (HIV) ranges from 1:1.4 million to 1:11 million </li></ul>
  7. 8. HBV
  8. 9. Hepatitis B Virus <ul><li>HBV belongs to hepadna virus family. </li></ul><ul><li>HBV is transmitted hematogenously and sexually. </li></ul><ul><li>The outcome of this infection ranges from a complicated viral-host interaction that results in either an acute symptomatic disease, an asymptomatic disease, or a chronic carrier state. Later consequences are cirrhosis and the development of hepatocellular carcinoma (HCC). </li></ul><ul><li>Hepatitis B surface Antigen (HBsAg) & Hepatitis B core Antigen (HBcAg) helps to detect HBV. </li></ul><ul><li>Hepatitis B ranges from 1:6000 to 1:320,000. Acute disease develops in one third of patients infected with hepatitis B, but chronic infections develop in fewer than 10% of those infected. </li></ul>
  9. 10. HCV
  10. 11. Hepatitis C Virus <ul><li>HCV is a spherical, enveloped, single-stranded RNA virus belonging to the Flaviviridae family. </li></ul><ul><li>HCV is predominantly transmitted by means of percutaneous exposure to infected blood. </li></ul><ul><li>Chronic infection can progress to scarring of the liver (fibrosis), and advanced scarring (cirrhosis) </li></ul><ul><li>Hepatitis C testing begins with serological blood tests used to detect antibodies to HCV. Anti-HCV antibodies can be detected in 80% of patients within 15 weeks after exposure, in >90% within 5 months after exposure, and in >97% by 6 months after exposure. </li></ul><ul><li>The incidence of hepatitis C ranges from 1:1.2 million to less than 1:13 million.  </li></ul>
  11. 12. West Nile Virus
  12. 14. West Nile Virus <ul><li>West Nile virus (or WNV) is a virus of the family Flaviviridae . </li></ul><ul><li>WNV-associated with Guillain-Barré syndrome has been identified and other rare effects include multifocal chorioretinits, myocarditis, nephritis, pancreatitis, and splenomegaly. </li></ul><ul><li>Samples must be tested for the presence of West Nile virus antibodies by use of immunohistochemistry (IHC) or Enzyme-Linked Immunosorbent Assay (ELISA). </li></ul><ul><li>West Nile virus has an incidence of 1:3000 to 1:5000. </li></ul>
  13. 15. CMV
  14. 16. Cytomegalo Virus <ul><li>Cytomegalovirus (CMV) is the most common virus transmitted through transfusion. </li></ul><ul><li>It is belongs to the genus of herpes viruses group. </li></ul><ul><li>HCMV infections are frequently associated with salivary glands, though they may be found throughout the body. HCMV infection can also be life threatening for patients who are immunocompromised. </li></ul><ul><li>ELISA, fluorescence assay, indirect hemagglutination technique, latex agglutination & PCR helps to detect CMV. </li></ul><ul><li>Incidence of virus ranging from 1:10 to 1:30. </li></ul>
  15. 17. HTLV
  16. 18. Human T- lymphotropic Virus <ul><li>This is a retrovirus that is endemic in Japan and the Caribbean. </li></ul><ul><li>It is implicated as causing adult T-cell leukemia/lymphoma and a neurological disorder similar to multiple sclerosis. </li></ul><ul><li>Both HTLV-1 and HTLV-2 transmitted by blood transfusion. </li></ul><ul><li>The presence of these agents can be detected by different serologic or nucleic acid–based tests, including enzyme immunoassay (EIA) and PCR. </li></ul><ul><li>The risk of HTLV transmission from screened blood donated during the &quot;window period&quot; has been estimated at 1 per 641,000. </li></ul>
  17. 19. Herpes Virus
  18. 20. Human Herpes Virus <ul><li>HHV belongs to betaherpesvirinae family & have marked similarity in biologic & genome characteristics to HCMV. </li></ul><ul><li>HHV-8 could be transmitted by blood or blood products. </li></ul><ul><li>HHV-8 causes Kaposi’s Sarcoma (KS) & certain rare malignant neoplasms. </li></ul><ul><li>HHV can be detected by PCR, Immunoflourscence, ELISA. </li></ul>
  19. 21. PARASITES
  20. 22. Plasmodium Spp.
  21. 24. Plasmodium Spp. <ul><li>Plasmodium spp causes malaria in people. </li></ul><ul><li>Plasmodium has four spp, which are; </li></ul><ul><ul><ul><li>Plasmodium falciparum </li></ul></ul></ul><ul><ul><ul><li>P malariae </li></ul></ul></ul><ul><ul><ul><li>P ovale </li></ul></ul></ul><ul><ul><ul><li>P vivax </li></ul></ul></ul><ul><li>Malaria is spread mainly through mosquito bites, but it can be transmitted through blood product. </li></ul><ul><li>Incidence of malaria is 1:4. </li></ul><ul><li>The FDA recommends that donors with a history of malaria be deferred for 3 years after becoming asymptomatic. </li></ul>
  22. 25. Trypanosoma cruzi
  23. 26. Peripheral Blood Picture
  24. 27. Trypanosoma cruzi <ul><li>T cruzi is the causative agent of Chagas disease, which is generally spread by the bite of the reduviid bug. </li></ul><ul><li>The illness has an acute and a chronic & manifests as fever, lymphadenopathy, and hepatosplenomegaly. In severe cases, myocarditis and encephalitis may occur. </li></ul><ul><li>Individuals from endemic areas may become chronic carriers of the T cruzi parasite and are responsible for transmission of T cruzi through blood transfusion. </li></ul><ul><li>Enzyme-linked immunosorbent assay (ELISA)–based screening test use to detect the agent. </li></ul><ul><li>Seroprevalence ranges from 0.12 to 0.20%. </li></ul>
  25. 28. Babesia microti
  26. 29. Panel of Babesia -infected erythrocytes photographed from pretreatment. The forms of the parasite shown in the panel include: (A) ring-like trophozoite; (B) paired merozoites; (C) maltese-cross (tetrad); (D) various dividing forms; (E) multiple merozoites; (F) appliqué (accolé) form on right border of the erythrocyte; (G) and (H) degenerate (crisis) forms.
  27. 30. Babesia microti <ul><li>B microti is an intraerythrocytic protozoan parasite that produces a malarialike illness and is the principal cause of human babesiosis. </li></ul><ul><li>The common mode of transmission is via an  Ixodes tick bite, but  B microti can also be acquired via transfusion of infected blood. </li></ul><ul><li>The clinical spectrum of B microti infection ranges from asymptomatic individuals to severe disease with massive parasitemias that cause hemolytic anemia, thrombocytopenia, shock, and death. </li></ul><ul><li>Leukoreduction does not reduce the transmission risk because B microti is intraerythrocytic. </li></ul><ul><li>No test is currently available for mass screening to detect asymptomatic carriers of  Babesia. </li></ul>
  28. 31. Toxoplasma gondii
  29. 33. Toxoplasma gondii <ul><li>Toxoplasma gondii is a WBC-associated parasite that can survive for several weeks in stored whole blood. </li></ul><ul><li>It causes toxoplasmosis. In immunocompromised individuals this infection can have serious neurological symptoms and can cause fetal death in pregnant women. </li></ul><ul><li>Given the high risk of symptomatic transfusion-transmitted toxoplasmosis, the option of using leucocyte -reduced blood may be considered while providing packed cell or platelet transfusions to the immunocompromised individuals. </li></ul>
  30. 34. Leishmania donovani
  31. 35. Peripheral Blood Picture
  32. 36. Leishmania donovani <ul><li>Leishmaniasis is a group of diseases caused by intracellular protozoan parasites of the genus Leishmania. </li></ul><ul><li>The common mode of transmission is a bite by sand flies of the genus Phlebotomus . </li></ul><ul><li>Causes cutaneous (sore on skin) & visceral (disruption of immune system) leishmaniasis. </li></ul><ul><li>Cases have been reported in highly endemic areas regarding transmission by transfusion of blood products. </li></ul><ul><li>Cases of transfusion-associated Leishmaniasis are growing each year world wide. This increase is increasingly associated with patients who are positive for HIV. </li></ul>
  33. 37. PRIONS
  34. 38. Creutzfeldt-Jakob disease (CJD)
  35. 39. Creutzfeldt-Jakob disease (CJD) <ul><li>Two forms of Creutzfeldt-Jakob disease (CJD), namely classical CJD and variant CJD (vCJD). </li></ul><ul><li>CJD is a degenerative brain disorder. </li></ul><ul><li>vCJD is a form of human Bovine Spongiform Encephalopathy (BSE- commonly known as mad cow diseases) that is transmissible through eating infected tissues or potentially via blood transfusions. </li></ul><ul><li>There is currently no cure for CJD; the disease is invariably fatal. </li></ul>
  36. 40. BACTERIA
  37. 41. Treponema pallidum
  38. 42. Treponema Pallidum <ul><li>Treponema pallidum , the infectious agent causing syphilis. </li></ul><ul><li>Survives at the most for 5 days in blood stored at 4oC. </li></ul><ul><li>It is sexually transmitted disease. Rare cases of transfusion transmitted syphilis have been documented. </li></ul><ul><li>syphilis can damage the heart, aorta, brain, eyes, and bones. In some cases these effects can be fatal. </li></ul><ul><li>The rapid plasma reagin (RPR) test is commonly used for screening the blood product for syphilis. </li></ul>