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BLOOD SCREENING :AntiHBc and NAT-Necessity or Luxury

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By Brig Muhammad Ayyub MBBS, Ph.D (London) FRC Path (London) Professor of Haematology Commandant Armed Forces Institute of Transfusion Rawalpindi BLOOD SCREENING :AntiHBc and NAT-Necessity or Luxury
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Historical perspective ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Microbial Testing in England and North Wales ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Residual Microbial Risk of Allogeneic blood transfusion ,[object Object],[object Object],[object Object],[object Object]
Risk of Transfusion- transmitted Infection (Italy) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TRANSFUSION-RELATED INFECTION TRANSFUSION-RELATED INFECTION
Transfusion transmission risks HIV HBV HCV 1996 1994 1992 1990 1988 1986 1984 1:100 1:1000 1:10 000 1:100 000 1:1 000 000 1998 2000 Transmission risk, per unit 2002
Residual risk of transfusion-transmitted viral infections ,[object Object],[object Object],[object Object]
New Discoveries Have Vastly Improved Blood Safety ,[object Object],1980s ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Today Window Period Serologic Testing NAT HIV-1 22 days 11 days HCV 70 days 10 days Sources: Busch MP, Kleinman SH, Nemo GJ. Current and emerging infectious risks of blood transfusions. JAMA . 2003;289:959-962. Goodman JL. The safety and availability of blood and tissues – progress and challenges. NEJM . 2004;351:819-821. Jackson BR, Busch MP, Stramer SL, AuBuchon JP. The cost-effectiveness of NAT for HIV, HCV, and HBV in whole-blood donations. Transfusion . 2003;43:721-729. Busch MP, Dodd RY. Nucleic acid amplification testing and blood safety: what is the paradigm? Transfusion . 2000:40:1157-1160. Cited in Busch MP, Kleinman SH, Nemo GJ.
Relevance of Blood Transfusion Safety Activities ,[object Object],[object Object],[object Object],[object Object],Source: WHO, GDBS 2001
Relevance of Blood Transfusion Safety Activities ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Developing World Faces Special Challenges When It Comes to Blood Safety ,[object Object],[object Object],[object Object],[object Object],Approximately 70% of the World’s Nations Do Not Have Policies in Place to Ensure A Safe Blood Supply Source: Klein HG. Will blood transfusions ever be safe enough? JAMA . 2000;284:238-240. 13 million donations a year are not tested for HIV or HCV -- Mostly in high-risk areas with pressing need for blood 25% of maternal deaths related to pregnancy in developing nations are due to blood loss
Research report Evaluation of blood bank practices in Karacki,Pakistan,and the govt response Stephen Ruby,Rafique Khanani et al . ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hepatitis B Virus
Geographic Distribution of Chronic HBV Infection HBsAg Prevalence  8% - High 2-7% - Intermediate <2% - Low
Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course Weeks after Exposure Symptoms HBeAg anti-HBe Total anti-HBc IgM anti-HBc anti-HBs HBsAg 0 4 8 12 16 20 24 28 32 36 52 100 Titer
Screening results-AFIT HBsAg snd Anti-HCV 4.25 2.15 34538 2004 3.91 1.84 39312 2005 4.17 2.34 32136 2003 4.20 2.44 30124 2002 4.19 2.39 28745 2001 4.02 2.51 25824 2000 Anti-HCV Positive (%) HBsAg Positive (%) Total donors screened Year
AFIT study : Impact of Anti-HBc test in HBsAg Negative donors ,[object Object],[object Object],[object Object],[object Object],[object Object],Article published in Transfusion and available online December 2006
NAT- Nucleic Acid Test- Evaluation as screening test in our setup AFIT on-going study ,[object Object],[object Object],[object Object],[object Object]
Conclusion ,[object Object],[object Object],[object Object]
 

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BLOOD SCREENING :AntiHBc and NAT-Necessity or Luxury

  • 1.  
  • 2. By Brig Muhammad Ayyub MBBS, Ph.D (London) FRC Path (London) Professor of Haematology Commandant Armed Forces Institute of Transfusion Rawalpindi BLOOD SCREENING :AntiHBc and NAT-Necessity or Luxury
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 9. Transfusion transmission risks HIV HBV HCV 1996 1994 1992 1990 1988 1986 1984 1:100 1:1000 1:10 000 1:100 000 1:1 000 000 1998 2000 Transmission risk, per unit 2002
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 17. Geographic Distribution of Chronic HBV Infection HBsAg Prevalence  8% - High 2-7% - Intermediate <2% - Low
  • 18. Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course Weeks after Exposure Symptoms HBeAg anti-HBe Total anti-HBc IgM anti-HBc anti-HBs HBsAg 0 4 8 12 16 20 24 28 32 36 52 100 Titer
  • 19. Screening results-AFIT HBsAg snd Anti-HCV 4.25 2.15 34538 2004 3.91 1.84 39312 2005 4.17 2.34 32136 2003 4.20 2.44 30124 2002 4.19 2.39 28745 2001 4.02 2.51 25824 2000 Anti-HCV Positive (%) HBsAg Positive (%) Total donors screened Year
  • 20.
  • 21.
  • 22.
  • 23.