Download MBBS Transfusion Medicine and Blood Bank Presentations 13 Transfusion Transmitted Diseases Lecture Notes

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? TTI ?
? Characteristics of TTI
? Mandatory TTI
? Methods/Technologies for TTI Testing
? TTI Notification

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? Why & How To Notify
TRANSFUSION CHAIN

Human

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being

Blood donors

(Donor)

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Each link consists of

several

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Collection

smaller links

(primary processes)

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Processing
Screening

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and testing

The quality of the BTS is

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Blood cold

influenced by the quality

chain

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of each of the links

Transfusion

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Human

being
(Patient)

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TTI = TRANSFUSION TRANSMISSIBLE INFECTIONS


A pathogen :
? Able to transmit through blood or blood components

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? Able to survive outside human body
? Able to survive through range of temperatures
? Able to replicate and re-establish following transfusion
? Exists naturally either free in plasma or in cellular component
INFECTIOUS AGENTS

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1. Virus ? most commonly transmitted
2. Bacteria
3. Protozoa
4. Fungi ? not accepted as blood donor(too sick)

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5. Parasite
6. Prion

VIRUS

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1. Hepatitis: Hep B, Hep C, Hep D
2. Human immunodeficiency virus (HIV)
3. Human T-cell Lymphotrophic virus (HTLV-1,2)
4. Epstein barr virus (EBV)
5. Cytomegalo virus (CMV)

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6. West nile virus (WNV)
7. Human herpes virus (HHV)
BACTERIA

1. Treponema pallidum

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2. Yersinia enterocolitica
3. Pseudomonas
4. Propionibacterium acnes
5. Staphylococcus epidermidis
6. Bacillus cereus

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PARASITES

1. Plasmodium species
2. Babesia microti

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3. Trypanosoma Cruzi
4. Leishmania species
5. Toxoplasma gondi

PRIONS

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Creutzfeld Jacob disease / Variant Creutzfeld Jacob disease

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CHARACTERISTICS OF TTI

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? Asymptomatic or only mild symptoms in donors ?hence pass

donor screening criteria

? Long incubation period before clinical signs and symptoms

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appear

? Stability in blood at 4OC or lower

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? Might cause a carrier state of infection (HBV, HCV)

HOW AND WHAT TO TEST ?

? Identify structural protein

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? Identify antibody produced

? Identify antigen

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? Identify nuclear material

HOW TO TEST?

? Rapid tests

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? ELISA

? Chemiluminescence assay(CLIA)

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? Nucleic Acid Amplification Testing (NAT)
SELECTION OF SCREENING ASSAYS

? What is the test?

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? Who is going to use it?

? Is the staff experienced or newly recruited?

? What are the constraints?

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? Are resources available?

? Are results needed in a very restricted period of

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time?

? How is it to be used? Large or small number of

specimens?

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? What are the existing systems?

MANDATORY TTI TESTING

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Under Drugs and Cosmetic Act 1940

Rules 1945 amendments thereafter, (SCH. F, Part XI B)

Ministry of Health And Family Welfare

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Government of India

Screening of each blood & blood components is Mandatory

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? HBsAg
? Anti HIV 1 & 2
? Anti HCV
? VDRL
? Malarial parasite

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MANDATORY TTI TESTING

HIV 1 & 2, Hepatitis C,, Hepatitis B Syphilis & Malaria

1. Screening for antibodies to HIV-1 & 2

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( Rapid/3rd or 4th generation ELISA /Chemiluminescence and / NAT )
2. Screening for antibodies to HCV
( Rapid/3rd or 4th generation ELISA /Chemiluminescence and / NAT )
3 Hepatitis B Surface Antigen
( Rapid/ 3rd or 4th generation ELISA /Chemiluminescence and / NAT )

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4. Syphilis ( TPHA/VDRL/RPR )

5. Malarial parasite (PBF / Rapid card test )

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MANDATORY BLOOD SCREENING FOR INFECTIOUS MARKERS

Infectious

Year of

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Mandatory Testing

Newer Technologies

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Markers

Enforcement Technology

Syphilis

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1975

RPR/VDRL/TPHA

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ELISA

Hepatitis B

1975

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ELISA/Rapid

Chemiluminescence/NAT

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virus

Malaria

1975

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Smear/Rapid

ELISA

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HIV

1988

ELISA/Rapid

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Chemiluminescence/NAT

Hepatitis C

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2001

ELISA/Rapid

Chemiluminescence/NAT

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Virus
RECENT CONCERNS

? Latency and carrier state leading to persistent infections: HIV,

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HBV, HCV were major concerns but Hep A and Hep E

? Emerging infections like Dengue Virus ,West Nile Virus, Zika Virus,

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and others are posing risk for infection

VARIOUS TESTING TECHNOLOGIES

Technology

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Window Period

HIV

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HCV

HBV

ELISA-I I Generation

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20.6 days

58.3 days

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36.3 days

ELISA-IV

13.7 days

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9.4 days

24 days

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Generation

ID NAT

5.6 days

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4.9 days

20.6 days

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IDEAL ELISA PLATE(96 wells) LAYOUT
RAPID TESTS

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Employ a variety of techniques

? Dot blot assays

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? Particle agglutination

? Spot tests

? Immuno- chromatographic tests or Card Tests

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? Most have sensitivities and specificities of 99% and 98%

respectively

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Applications of Rapid tests
? Useful in small blood banks
? Useful in emergency

RAPID IMMUNOCHROMATOGRAPHIC ASSAY

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POSITIVE

NEGATIVE

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INVALID
MALARIA CARD TEST

NEGATIVE

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POSITIVE

INVALID

CHEMILUMINESCENCE IMMUNOASSAY

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? Principle: It is the production of light [Luminescence] from an

oxidation-reduction chemical reaction.

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? Two chemicals react to form an excited (high-energy) intermediate,

which breaks down releasing its energy as photons of light and

interpreted as Optical density value.

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NAT

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NAT TESTING

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DONOR NOTIFICATION

Why should the donors be informed of test results?

? Results are significant to their health

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NBTC/NACO

? Ensures no further donations

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Recommendation

? Unethical to hold information
? Informing about Pathology - acute and chronic

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? Secondary transmission - sexual, mother to child, close physical contact

? Mode of infection-why not excluded by donor selection

? Treatment and management

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? General surveillance and epidemiology

? acute infection (WP)

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? To improve testing methodology



HOW TO NOTIFY ?

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? Follow NACO/NBTC policy on how to notify donors about positive TTI
? Tell the results on a face-to-face basis
? Counsellor - well-trained in counselling skills

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? Given in person, never on telephone

? Maintain confidentiality

? Opportunity to ask questions / discussion

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? Further appointment offered
REFERRAL

? Refer the donor to other sources of advice and support

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HIV - ICTC (Integrated Counselling and Testing Center)
HBV/HCV - Medicine / Gastro/ Hepatologist
Syphilis - Dermatology / STD Clinic
Malaria - Physician /Medicine

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IMPACT ON BLOOD DONORS

? What will the test result mean?
? Will I become ill?

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? What about my partner / offspring?
? Am I infectious?
? How did I become infected?
? Is infection treatable?