BLOOD SCREENING IN KARACHI BLOOD BANKS

SLIDE MAP

THE FACTS A VALID DONOR

WHAT IS SCREENED

MAJOR BLOOD BANKS

INDIVIDUAL DISEASES

MY OPINIONAPHERESIS

THE FACTS

• WORLDWIDE 90 million annual transfusions

• 31% NOT a screened for HIV , hep- B, or hep- C.

• Most lapses In developing countries

Source:WHO,GDBS,2001

FACTS CONTINUED

Annually unsafe blood transfusions CAUSE:

• 10,000 new HIV infections• 78,000 new HBV infections• 500,000 new HCV infections

Source:WHO,GDBS,2001

A/C TO JAMA

• 13 million donations-Not screened for HIV or HCV

• 25% of maternal deaths –PREGNANCY related -blood loss

• 70% Worlds nations-No policies FoR safe blood supply.

Source:KLIEN NG,Will Blood Transfusions Ever be safe Enough?JAMA,2000

KARACHI BLOOD BANKS

• National legislation- not working• 50% blood bank- paid donors• 25% - volunteer blood donors• Only 8% - inquire about drug

abuse• Almost None asked about high

risk sexual behavior

KARCHI BOOD BANKS• 95% blood banks had equipment

and reagents to screen HbsAg• 55% - HIV • 25% HCV• Practices – BELOW WHO level.

SOURCE:Evaluation of blood bank practices in Karachi, Pakistan and govt response.Stephen ruby , rafique kahani et alhttp://www.slideshare.net/icsp/blood-screening-antihbc-and-natnecessity-or-luxury/

CRITERIA FOR BLOOD DONATION

• Good health• Atleast 16 yrs. (110 lbs approx)• Some blood banks have medical

history questionarre.

WHO SHOULD NOT DONATE BLOOD

• ILLEGAL IV drugs• HIV +ve• SEX FOR MONEY• Viral hepatitis. (Not cholestatic

Hepatitis)

SCREENING PERFORMED IN KARACHI BLOOD BANKS.

SCREEN FOR

• HbsAg• ANTI HCV• ANTI HIV 1& 2• MALARIA • SYPHILIS• ALT• (Bacterial contamination)

(ALL BLOOD BANKS PERFORM BLOOD GROUPING , CROSS MATCHING AND BLOOD Hb]

HbsAg

• MARKERS FOR INFECTIOUS SCREENING

HbSAg• METHODOLOGY ELISA (recommended) Detects approximately 0.2 -0.7 ng/ml HbsAg or 3 x 107 particles.

HEP-B VIRUS.

ELISA• The Enzyme-Linked ImmunoSorbent Assay, or

ELISA, is a biochemical technique used mainly in immunology to detect the presence of an antibody or an antigen in a sample

• Older ELISAs utilize chromogenic substrates, though newer assays employ fluorogenic substrates with much higher sensitivity. In simple terms, an unknown amount of antigen in a sample is immobilized on a surface. Its then washed with a particular antibody over the surface. This antibody is linked to an enzyme that visibly reacts when activated, the brightness of the fluorescence would then tell you how much antigen is in your sample.

(1)Plate is coated with a capture antibody; (2)Sample is added, and any antigen present binds

to capture antibody; (3)Detecting antibody is added, and binds to antigen; (4)Enzyme-linked secondary antibody is added, and

binds to detecting antibody; (5)Substrate is added, and is converted by enzyme

to detectable form.

ANTI - HCV

• MARKERS OF INFECTION: ANTI HCV,HCV RNA• METHODOLOGY: ANTI HCV BY THIRD GENERATION

ELISA. NAT (NUCLEIC ACID TESTING)

HEP-C VIRUS

ANTI HIV 1 & 2

• MARKERS FOR INFECTIOUS SCREENING

ANTI HIV 1&2 p24 ANTIGEN NULEIC ACID (NAT)• METHODOLOGY ELISA IS THE TEST OF CHOICE

FOR ANTI HIV 1 & 2.

HIV -1

HIV -1

HIV -2

MALARIA

• Asymptomatic carriers with very low parasite load are generally the source of transfusion transmitted malaria.

• Tests available: - screening by smears (in almost

all karachi blood banks) - serologic test for malarial

antigen. - PCR

MALARIA

• Sensitivity for screening very low parasitic load i.e. asymptomatic carriers.

• Smears : 20 parasite/ul• Serologic tests: No practical serologic

tests available in asymptomatic donors

• PCR : shows promise but cost is the issue.

PLASMODIUM IN BLOOD

PLASMODIUM IN BLOOD

SYPHILIS

• CAUSATIVE AGENT = Traponema palladium (spirochete)

• Phase of spiochetemia is brief and organism survives only 4 days at 4* centigrade

• Performane of selogic test for syphilis is still a requirement .

• TEST IS CALLED VDRL TEST.

VDRL

• The Venereal Disease Research Laboratory test (VDRL) is a nontreponemal serological screening for syphilis, the monitoring of the response to therapy, and as an aid in the diagnosis of congenital syphilis

• BASIS OF TEST

BASIS OF TEST

• The basis of the test is that an antibody produced by a patient with syphilis reacts with an extract of ox heart (diphosphatidyl glycerol). It therefore detects anti-cardiolipin antibodies (IgG, IgM or IgA).

• This test is very useful as as a very good sensitivity for syphilis, except in late tertiary form.

SYPHILIS SPIROCHETE

SYPHILIS SPIROCHETE

ALT

• diagnostic liver function test• (SGPT) or (ALAT).• International units/ litre (U/L).

• Alcoholic or viral hepatitis• Congestive heart failure• Liver damage• Myopathy.

• American red cross society -DONOT test blood for ALT

BACTERIAL CONTAMINATION

• Yersinia enterocolitica• Serrata liquifacians• Staphylococcus• Enterobacteriaceae• Streptococcus• Bacillus• Pseudomonas.

MAJOR BLOOD BANKS IN KARACHI

• FATMID FOUNDATION• HUSSAINI’S BLOOD BANK• PWA BLOOD BANK (CIVIL HOSPITAL)• PAKISTAN RED CRESCENT SOCIETY• THE LIAQUAT NATIONAL HOSPITAL BLOOD

BANK• KKF BLOOD BANK (ABBASI HOSPITAL)• AGHA KHAN HOSPITAL BLOOD BANK

FATMID FOUNDATION

• VDRL• HIV TYPE 1• HIV TYPE 2• HbsAg• ANTI HCV• MALARIA• ALT

• SYPHILIS• AIDS

• HEPATITIS B• HEPATITIS C

• THEY ALLOW PROFESSIONAL DONORS .(paid donors)• SCREEN VIA ABBOTT’s ASXYM SYSTEM AT KARACHI LAB.

PWA BLOOD BANK (CIVIL HOSPITAL)

• VDRL• HIV 1/2*• HbsAg• ANTI HCV• MP• ALT

• SYPHILIS• AIDS• HEPATITIS B• HEPATITIS C

• DO NOT ALLOW PROFESSIONAL DONORS• SCREENING IS DONE WITH THE COMPLETELY NEW AUTOMATIC 4TH GENERATION SCREENING UNIT ELISA B4• USE ES-300 TECHNOLOGY

HUSSAINI BLOOD BANK

• VDRL• HIV 1/2*• HbsAg• ANTI HCV• MP• ALT

• SYPHILIS• AIDS• HEPATITIS B• HEPATITIS C

• DO NOT ALLOW PROFESSIONAL DONORS• SCREENING IS DONE WITH THE ELISA METHOD.

THE LIAQUAT NATIONAL HOSPITAL BLOOD BANK.

• VDRL• HIV 1/2*• HbsAg• ANTI HCV• MP• ALT

• SYPHILIS• AIDS• HEPATITIS B• HEPATITIS C

• DO NOT ALLOW PROFESSIONAL DONORS

THE AGHA KHAN HOSPITAL BLOOD BANK.

• VDRL• HIV 1/2*• HbsAg• ANTI HCV• MP• ALT

• SYPHILIS• AIDS• HEPATITIS B• HEPATITIS C

• DO NOT ALLOW PROFESSIONAL DONORS• Have to organize voluteer blood donation camps to keep up with the demands of their patients

What is APHERESIS?

APHERESIS

Apheresis, is the process of removing a specific component of the blood, such as platelets, and returning the remaining components, such as red blood cells and plasma,back to the donor.

BETTER BLOOD BANKING

• National legislation

• STANDARD ELISA METHODS.

• MOTIVATE HEALTHY VOLUTEER DONORS.

• Aware PHYSICIANS & PATIENTS

THANK YOU