PA21.1-6 | Transfusion-Transmitted Infections — Summary & Reflection

REFLECT

Consider this scenario: You are posted in a district hospital blood bank. A 32-year-old donor presents. During the health questionnaire he mentions he had a fever three weeks ago that resolved on its own. He lives in a malaria-endemic district.

1. Would you defer this donor? Which deferral category applies — temporary or permanent?
2. If he had received a tooth extraction one week ago, does that change your decision?
3. He insists his blood is 'healthy' and the family needs it urgently for his sister's emergency surgery. How do you explain the deferral to him in a way that is honest and does not discourage him from donating in the future?

Reflect on the tension between urgent clinical need, donor motivation, and blood safety. There is no single right answer to question 3 — the skill is in the communication.

KEY TAKEAWAYS

Transfusion-Transmitted Infections — Key Takeaways:

• TTIs are iatrogenic and preventable — their reduction is a measurable index of blood bank quality.

• Five mandatory NACO screening tests: HIV (4th-gen ELISA), HBsAg (Hepatitis B), anti-HCV (Hepatitis C), VDRL/TPHA (Syphilis), Malarial antigen/smear. No unit is issued without a negative result on all five.

• Window period: The interval between infection and test positivity. NAT shortens it significantly by detecting nucleic acid directly (HIV window: 18–45 days serology → 9–11 days NAT; HCV: 54–70 days → 7–10 days).

• CMV: Transmitted via leukocytes. Use leukoreduced or CMV-seronegative products for immunocompromised patients and CMV-seronegative neonates.

• Bacterial contamination of platelets (room-temperature storage) is the commonest infectious cause of transfusion death. Classic organisms: coagulase-negative staphylococci, S. aureus. Classic red cell organism: Yersinia enterocolitica (cold-storage psychrotolerant).

• Emerging agents: dengue, chikungunya, Zika (deferral-based mitigation), vCJD (lifetime deferral for UK residence 1980–1996), Babesia (not endemic in India), HEV (emerging concern in immunosuppressed).

• Prevention is multi-layered: Voluntary donation → serological screening → NAT → pathogen reduction → appropriate use → haemovigilance/look-back. Residual risk after all measures is real but very small (1–2 per million donations for HIV with NAT).