BLOOD SCREENING IN KARACHI BLOOD

BANKS
 SLIDE MAP
THE FACTS
A VALID DONOR

WHAT IS SCREENED INDIVIDUAL DISEASES

MAJOR BLOOD BANKS

APHERESIS
MY OPINION
 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 al
http://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 • SYPHILIS
• HIV TYPE 1 • AIDS
• HIV TYPE 2
• HbsAg • HEPATITIS B
• ANTI HCV • HEPATITIS C
• MALARIA
• ALT
• THEY ALLOW PROFESSIONAL DONORS .(paid donors)
• SCREEN VIA ABBOTT’s ASXYM SYSTEM AT KARACHI LAB.
 PWA BLOOD BANK (CIVIL HOSPITAL)
• VDRL • SYPHILIS
• HIV 1/2* • AIDS
• HbsAg • HEPATITIS B
• ANTI HCV • HEPATITIS C
• MP
• ALT
• 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 • SYPHILIS
• HIV 1/2* • AIDS
• HbsAg • HEPATITIS B
• ANTI HCV • HEPATITIS C
• MP
• ALT
• DO NOT ALLOW PROFESSIONAL DONORS
• SCREENING IS DONE WITH THE ELISA METHOD.
 THE LIAQUAT NATIONAL HOSPITAL BLOOD
BANK.
• VDRL • SYPHILIS
• HIV 1/2* • AIDS
• HbsAg • HEPATITIS B
• ANTI HCV • HEPATITIS C
• MP
• ALT

• DO NOT ALLOW PROFESSIONAL DONORS

 THE AGHA KHAN HOSPITAL BLOOD
BANK.
• VDRL • SYPHILIS
• HIV 1/2* • AIDS
• HbsAg • HEPATITIS B
• ANTI HCV • HEPATITIS C
• MP
• ALT
• 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