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Ehsan H, Wahab A, Shafqat MA, Sana MK, Khalid F, Abdullah SM, Jaan A, Sheikh MM, Muneeb A, Ehsan S, Khan AY, Iftikhar R, Anwer F. A Systematic Review of Transfusion-Transmissible Infections Among Blood Donors and Associated Safety Challenges in Pakistan. J Blood Med 2020; 11:405-420. [PMID: 33173367 PMCID: PMC7646486 DOI: 10.2147/jbm.s277541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/15/2020] [Indexed: 01/08/2023] Open
Abstract
The blood transfusion (BT) system in Pakistan is fragmented, demand-driven and depends on weakly regulated transfusion practices. There is a considerable possibility that transfusion-transmissible infections (TTIs) are contributing to the current epidemic of hepatitis B virus (HBV) and hepatitis C virus (HCV) (affecting 7.4% of the general population) in the country. To study this issue, we conducted a systematic review to identify articles related to TTIs and transfusion safety in Pakistan from January 1, 2010 to January 31, 2020. A review of 33 articles met the final criteria for qualitative synthesis. Analysis of these studies showed a cumulative frequency of HBV 2.04%, HCV 2.44%, HIV 0.038%, syphilis 1.1% and malaria 0.11%. The frequency of coinfections among blood donors varied from 0.0099% to 0.35%. The highest number of coinfections were HCV and syphilis, followed by HCV and HBV infections. Syphilis and malaria were tested in only 38% and 46% of all the blood donations in one study. The rate of voluntary non-remunerated donations (VNRDs) was less than 13%, and male donors were 95% to 100% in these studies. There was a significant difference in the frequency of HBV and HCV in VNRDs (0.48%) as compared to replacement donors (RDs) (4.15%). In short, this review shows a high frequency of TTIs, especially HBV, HCV and syphilis in the blood donor population in Pakistan. There is a high dependency on RDs, minimal use of healthy voluntary blood donation practices, inadequate screening of high-risk donors, repeated collections of the blood from RDs, poor quality of screening methods and limited knowledge of donor health. Without standardized safe transfusion practices, there will be an ongoing increase in transmission of TTIs, especially HBV, HCV, syphilis, and HIV leading to a significant adverse public health impact.
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Affiliation(s)
- Hamid Ehsan
- Biohazardous Threat Agents and Emerging Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Ahsan Wahab
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Muhammad Ammar Shafqat
- Department of Internal Medicine, Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan
| | - Muhammad Khawar Sana
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Farhan Khalid
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Syed Maaz Abdullah
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ali Jaan
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Muhammad M Sheikh
- Department of Internal Medicine, Faisalabad Medical University, Faisalabad, Pakistan
| | - Ahmad Muneeb
- Department of Internal Medicine, Faisalabad Medical University, Faisalabad, Pakistan
| | - Sajid Ehsan
- Department of Internal Medicine, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Ali Younas Khan
- Department of Internal Medicine, St. Joseph Mercy Hospital, Oakland, Pontiac, MI, USA
| | - Raheel Iftikhar
- Department of Hematology/Oncology, Armed Forces Bone Marrow Transplant Center/NIBMT, Rawalpindi, Pakistan
| | - Faiz Anwer
- Department of Hematology/Oncology, Cleveland Clinic, Taussig Cancer Center, Hematology-Oncology, BMT, Cleveland, OH, USA
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Asadi F, Ramezanghorbani N. Proposing a Model for the National Hemovigilance Information System in Iran. J Med Life 2020; 13:211-218. [PMID: 32742516 PMCID: PMC7378330 DOI: 10.25122/jml-2019-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The present study aimed to propose a model for the national hemovigilance information system with a database approach, considering the importance and necessity of developing an information system for such a network. This is an applied, descriptive, and cross-sectional study, which was conducted in 2018. The research population comprised hemovigilance information systems in advanced countries, including the USA, UK, Australia, and France. Data were collected from library sources and the Internet from 2000 to 2018. The proposed model for the national hemovigilance information system was introduced using comparative tables and based on the similarities and differences of systems in the studied countries. The proposed model was then validated using the two-step Delphi technique through a researcher-made questionnaire whose validity was confirmed, and reliability was approved by a Cronbach’s alpha of 94%. The final model of the national hemovigilance information system comprised five main components: goals, organizations involved in the blood transfusion process, databases of blood transfusion organizations, data transfer flow between the databases of blood transfusion organizations, and transferable datasets, and hemovigilance-related committees. This model was approved by experts with an >85% agreement coefficient. The national hemovigilance information system with a database approach can improve blood transfusion health by providing access to reliable sources on blood transfusion complications to everyone, especially the medical community. Thus, it is essential to implement this standard accurately and precisely control the practical methods of this process based on international guidelines.
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Affiliation(s)
- Farkhondeh Asadi
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahid Ramezanghorbani
- Department of Development & Coordination Scientific Information and Publications, Deputy of Research & Technology, Ministry of Health & Medical Education, Tehran, Iran
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Abstract
Hemovigilance plays an essential role in ensuring patient safety with regard to blood transfusions. The data generated through the hemovigilance system helps in framing important changes in the whole blood transfusion process which are useful for better patient safety. This article briefly describes the history of hemovigilance, why the need of hemovigilance was felt and also illustrates about the Hemovigilance Program of India.
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Affiliation(s)
- Jaspreet Kaur Boparai
- Department of Pharmacology, Gian Sagar Medical College and Hospital, District Patiala, Punjab, India
| | - Surjit Singh
- Department of Pharmacology, AIIMS Jodhpur, Rajasthan, India
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Agnihotri N, Agnihotri A. Active Hemovigilance Significantly Improves Reporting of Acute Non-infectious Adverse Reactions to Blood Transfusion. Indian J Hematol Blood Transfus 2015; 32:335-42. [PMID: 27429527 DOI: 10.1007/s12288-015-0568-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 06/30/2015] [Indexed: 11/25/2022] Open
Abstract
One of the key purposes of a hemovigilance program is to improve reporting of transfusion related adverse events and subsequent data-driven improvement in blood transfusion (BT) practices. We conducted a study over 3 years to assess the impact of healthcare worker training and an active feedback programme on reporting of adverse reactions to BTs. All hospitalized patients who required a BT were included in the study. Healthcare workers involved in BT to patients were sensitized and trained in adverse reaction reporting by conducting training sessions and meetings. All the transfused patients were 'actively' monitored for any acute adverse reaction by using a uniquely coded blood issue form. A total of 18,914 blood components transfused to 5785 different patients resulted in 61 adverse reaction episodes. This incidence of 0.32 % in our study was found to be significantly higher (p < 0.005) than that reported from the same region in the past. Red blood cell units were the most frequently transfused component and thus most commonly involved in an adverse reaction (42.6 %), however apheresis platelets had the highest chance of reaction per unit transfused (0.66 %). There was no mortality associated with the BT during the study period. An active surveillance program significantly improves reporting and management of adverse reactions to BTs.
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Affiliation(s)
- Naveen Agnihotri
- Department of Transfusion Medicine, Fortis Hospital, A-block, Shalimar Bagh, Delhi, 110088 India
| | - Ajju Agnihotri
- Department of Transfusion Medicine, Max Hospital, Shalimar Bagh, Delhi, 110088 India
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Abstract
A centralized hemovigilance program to assure patient safety and to promote public health has been launched for the first time in India on Dec 10, 2012 in 60 medical colleges in the first phase along with a well-structured program for monitoring adverse reactions associated with blood transfusion and blood product administration. National Institute of Biologicals (NIB) will be the National Coordinating Centre for Hemovigilance. This program will be implemented under overall ambit of Pharmacovigilance Program of India (PvPI), which is being coordinated by Indian Pharmacopoeia Commission (IPC). All medical colleges of the country will be enrolled in this program by the year 2016 in order to have a National Centre of Excellence for Hemovigilance at NIB, which will act as a global knowledge platform.
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Affiliation(s)
- Akanksha Bisht
- Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India, Ghaziabad, India
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Abstract
Although the risk of transfusion-transmitted infections today is lower than ever, the supply of safe blood products remains subject to contamination with known and yet to be identified human pathogens. Only continuous improvement and implementation of donor selection, sensitive screening tests and effective inactivation procedures can ensure the elimination, or at least reduction, of the risk of acquiring transfusion transmitted infections. In addition, ongoing education and up-to-date information regarding infectious agents that are potentially transmitted via blood components is necessary to promote the reporting of adverse events, an important component of transfusion transmitted disease surveillance. Thus, the collaboration of all parties involved in transfusion medicine, including national haemovigilance systems, is crucial for protecting a secure blood product supply from known and emerging blood-borne pathogens.
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Affiliation(s)
- Florian Bihl
- Partners AIDS Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Damiano Castelli
- Swiss Red Cross Blood Transfusion Service of Southern Switzerland, Lugano, Switzerland
| | | | - Roger Y Dodd
- American Red Cross, Holland Laboratory, Rockville, MD, USA
| | - Christian Brander
- Partners AIDS Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Verdú-Belmar JJ, Verdú-Verdú J, Soler-Martínez S. Hemovigilancia activa: un sistema que evalúa los efectos adversos postransfusionales no detectados por el sistema de hemovigilancia convencional. Med Clin (Barc) 2006; 127:156. [PMID: 16831398 DOI: 10.1157/13090385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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