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)
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.
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)
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.
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.
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.
• 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
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