Introduction Hepatitis C Virus (HCV) recently was identified as a major cause of post transfusion hepatitis world wide. To evaluate the role of blood transfusion on the prevalence of HCV infection, by testing antibody and RNA as well as the genotypes of HCV .Also to detect if Blood transfusion acts as unconfounding risk factor for HCV infection.
Methods Sera from 3491 pregnant women were investigated for the presence of HCV antibodies (anti-HCV) by using third generation enzyme immunoassay (EIA-3) as screening test, followed by immunoblot assay (Lia Tek-III). In addition 94 sera of studied women were subjected to molecular analysis (at laboratories of Sorin BioMedica - Italy) for the detection of viral RNA and genotypes of HCV. Using RT-PCR & DNA Enzyme immunoassay (DEIA) method.
Results Our study revealed, that seroprevalence rate of HCV specific Ab & RNA were significantly higher (16.32 %, 80% respectively) among women with a history of blood transfusion, compared to those (2.53%, 56.5%) with no such history P=0.0001, P=0.01. And there is a significant direct linear correlation between number of blood transfused and the seropositive rate of anti-HCV (r=0.7, p=0.046). Based on multivariate analysis, interestingly, this study confirmed that, blood transfusion significantly acting as unconfounding risk factor for acquiring HCV infection (Adjusted OR=1.938,95% C.I=1.646-2.28). And the risk of exposure is increases with increased number of blood transfused. Although, we found no significant association between, HCV genotypic distribution and history of blood transfusion. However, high proportion of women with a history of blood transfusion were harboring HCV genotype -4 or 1b, 50%,40%, resepctively.
Conclusions Our study shows, evidence that, blood transfusion acts as unconfounding risk factor for acquiring and in a mode of transmission of HCV infection. Therefore strict screening of blood donor for HCV-Abs and / or RNA is highly recommended.
Haemolytic Disease of Foetus and Newborn (HDFN) and Haemolytic Transfusion Reaction (HTR) may occur due to antibodies against Kidd antigen. In Malaysia, the prevalence of RBC alloimmunization due to Kidd antibody for cases of HDFN and HTR have been reported [1-2] however there is insufficient data in Hospital Umum Sarawak (HUS).The aim of this study is to determine whether Kidd alloimmunization causes HDFN and HTR. Indirectly categorize Kidd phenotype blood in regular blood donors.
Introduction: It is mandatory that every blood donor must have their haemoglobin (Hb) values measured before blood donation. High Hb may indicate an underlying hidden pathological condition. The aim of this study is to investigate the occurrence of the JAK2 V617F gene mutation in blood donors with erythrocytosis. Methods: A cross-sectional study was conducted over a nine-month period involving blood donors with high pre-donation Hb. A total of 45 blood donors with total white cell (TWC) > 12.0x 109/l, platelet > 450x109/ l and Hb > 18g/dL were subjected to JAK2 V617F gene mutation analysis. Samples were collected and analysed for haematological tests and detection of JAK2 V617F mutation. Results: From a total of 2238 blood donors, 175 blood donors had high haemoglobin value. Samples from forty-five of these donors were then analysed for JAK2 V617F using allele-specific polymerase chain reaction (PCR). The prevalence of blood donors with erythrocytosis was 7.8%. All samples were negative for the JAK2 V617F mutation. Conclusions: Erythrocytosis can be relative or absolute and the different causes can be distinguished on the basis of clinical signs and symptoms. An absence of the JAK2 V617F mutation cannot by itself excludes the diagnosis of polycyhaemia vera (PV) since erythrocytosis is the single clinical feature that sets PV apart from other types of myeloproliferative neoplasm (MPN). Further study is required for the detection of other gene mutations that activates the JAK-STAT signalling pathway that could be identified in JAK2 V617F-negative MPN patients.
The prevalence of antibodies to hepatitis E virus (HEV) has been examined in many countries, but such studies have generally been limited to majority populations such as those represented in healthy blood donors or cross sections of urban populations. Due to its major route of enteric transmission, large differences in HEV prevalence might be expected between populations in the same country but with different living conditions. Using an ELISA based on GST-ORF2.1 antigen, the prevalence of IgG-class antibodies to HEV was examined in three distinct populations in Malaysia: the normal (urban) blood donor population and two aboriginal communities located at Betau, Pahang and Parit Tanjung, Perak. IgG anti-HEV was detected in 45 (44%) of 102 samples from Betau and 15 (50%) of 30 samples from Parit Tanjung, compared to only 2 (2%) of 100 normal blood donors. The distribution of sample ELISA reactivities was also consistent with ongoing sporadic infection in the aboriginal communities, while there was no significant relationship between HEV exposure and age, sex, or malaria infection. The high prevalence of antibodies to HEV in the two aboriginal communities indicates that this group of people are at high risk of exposure to HEV compared to the general blood donors, and the results suggest that studies of HEV seroprevalence within countries must take into account the possibility of widely varying infection rates between populations with marked differences in living conditions.
Hepatitis C virus infection is a major health problem worldwide. The current study estimated seroprevalence of Hepatitis C virus (HCV) and evaluated associated factors among volunteer blood donors of the Northwest Frontier Province (NWFP), Pakistan. Of 1,131 volunteer blood donors enrolled, 46 (4.1%) were positive for anti-HCV antibodies. Multivariate logistic regression analysis revealed that positive donors were more likely to be 27-32 years old or >32 years old, have had 1-2 injections or >2 injections in the past year, or 1-5 intravenous (IV) drips or >5 I/V drips in the past 5 years. Positive donors had a family history of jaundice and were more likely to have been shaved (facial and armpit) by barbers. There was high prevalence of anti-HCV antibodies among blood donors of the NWFP. Public awareness programs should target the identified risk factors to prevent HCV transmission. We highlight the weakness of the health care system for blood donation, as it does not offer any record management for donors.
Malaysia is a medium endemic country for hepatitis B virus (HBV) infection but little is known about HBV strains circulating in Malaysian blood donors. Viral load, HBsAg concentrations and nested PCR products from 84 HBV surface antigen (HBsAg) positive samples were analysed in detail. Median viral load was 3050 IU/mL and median HBsAg 1150 IU/mL. Fifty-six full genome, 20 pre-S/S, 1 S gene and six basic core promoter/precore-only sequences were obtained. Genotypes B and C were present at a ratio of 2:1, and two genotype D samples were obtained, both from donors of Indian background. Phylogenetically, genotype B was more diverse with subgenotypes B2-5, B7 and B8 present, while most genotype C strains were from subgenotype C1. Genotypes B and C were equally frequent in ethnic Malays, but 80% of strains from Chinese were genotype B. HBsAg concentrations were higher in genotype C than in genotype B, in Chinese than Malays and in donors under the age of 30. HBV vaccine escape substitutions (P120S/T, I126N and G145G) were present in six strains. In the large surface protein, immuno-inactive regions were more mutated than CD8 epitopes and the major hydrophilic region. Strains of genotype B or from ethnic Malays had higher genetic diversity than strains of genotype C or from Chinese donors. Hence HBV strains circulating in Malaysia are phylogenetically diverse reflecting the ethnic mix of its population. Ethnic Malays carry lower HBsAg levels and higher genetic diversity of the surface antigen, possibly resulting in more effective immune control of the infection.
Blood donation is important for lives saving and the need is unceasing. However, the shortage of blood supply
is a common issue. While the public is the main source of blood donation, it is unknown whether they are
aware about it. This study was carried out to determine the public's knowledge, perceptions and barriers
towards blood donation. Atotal of 384 male and female respondents were conveniently selected to participate
in this study. Data was collected through self-administered questionnaire and analyzed with SPSS software
version 22.0. Most of the respondents (60.9%) had never donated blood but their knowledge towards blood
donation was high (79.9%). Some misconceptions were indicated among respondents. Afraid of the needle
prick, pain or discomfort were the top barriers among non-donors respondents (45.3%). The majority of the
respondents believed that blood donation is a practice or selfless concern for the well-being of others (98.7%).
A significant relationship was indicated between age and level of education with status of blood donation
(p
Introduction:Transfusion Transmitted Infections is occurring worldwide. The common organisms related reported in literature were Human Immunodefiency Virus, Hepatitis B and C Virus, bacterial contamination and Malaria par-asites. Meanwhile, Melioidosis is endemic disease in Malaysia and especially Sabah. Mortality due to Melioidosis septicaemia was also high. It ranges between 60%-80%. In Sabah, 74% of Thalassemia children were diagnosed with Bacteraemia Melioidosis and 50% had died due to the organisms. The incidence of Melioidosis Transfusion Transmitted Infection is rarely reported in the literature. Case Description: A 17-year-old girl was diagnosed having Beta thalassemia major since 5 years old and splenectomised 8 years ago. Currently on prophylaxis Penicillin and Ex-jade. She was admitted into hospital for monthly blood transfusion. Two days prior to admission, patient complained of having sore throat and cough but no fever and other complained. On examination, the tonsil enlarged and was treated as exudative tonsillitis. She was transfused with 2 pint packed cells within 2 days. No transfusion reaction noted. Day seven admission, she had high grade fever and redness of the right hand cannulation site and was treated as right hand cellulitis with intravenous Cloxacillin. Full blood count shows Total White Cell count was 24.9 x109 /L, Haemoglobin level was 9.3 g/dl and Platelets was 462x109/L. Blood for culture and sensitivity was taken and Chest X-ray noted haziness over the left mid and lower zone of the lung and was treated as Hospital Acquired Pneumonia. She was referred to tertiary hospital for further management. Her conditioned deteriorated and died at the casualty unit in the tertiary hospital. Blood culture was positive for Burkholderia pseudomallei. The case was reported to Dis-trict health office for further investigation. Blood donor tracing was done and was positive for Melioidosis through Elisa Antibody titre IgM for Melioidosis (1:320). The patient’s house and school were visited and investigated. All environmental samples were negative for Burkholderia pseudomallei. Conclusion: Its shows a relationship between blood donations infected with Burkholderia pseudomallei causing mortality of Beta Thalassemia patients. It is highly recommended to screen all blood products for communicable disease fatal organisms.
Blood supply shortage is a worldwide problem including Malaysia. According to statistical data from 2011 to 2015, Terengganu which is one of the states in Malaysia has the lowest blood donation rate. The objective of this study was to determine the knowledge and attitude score towards blood donation and their associated factors among nondonors of Kuala Terengganu. Methods: This was a cross-sectional study using a self-administered questionnaire involving systematically random sampling of 320 nondonors attending Hospital Sultanah Nur Zahirah. Data were analysed using Multiple Logistic Regression and Pearson correlation. Results: The mean knowledge and attitude scores were 5.19 (1.87) and 70.79 (8.19), respectively. Sixty-four percent (64.69%) and 92.81% of the participants have good knowledge and attitude, respectively. Gender, education level, and occupation have a significant association with knowledge, while education level and occupation were found to be significantly associated with attitude. No significant association found between the knowledge and attitude level. Most reported barriers to blood donation were a refusal to give blood to other religion and race. The main source to acquire information pertaining to blood donation was mainly from social media. Conclusion: Refusal of giving blood to other religion and race is recognised as the main issue that hinders participants to donate their blood. Thus, proper education and aggressive promotion regarding blood donation are needed especially among the nondonor in this region of Malaysia.
Introduction: Glucose-6-phosphate dehydrogenase (G6PD) deficiency causes red blood cell destruction due to oxi- dative stress. G6PD is essential for NADPH conversion; which is critical for glutathione reductase to prevent damage to cellular structures. In Malaysia, blood donors are not routinely screened for G6PD deficiency. We hypothesise that G6PD-deficient red blood cells are more likely to haemolyse during storage due to increased oxidative molecules. The objectives of this study were to determine the prevalence of G6PD deficiency among blood donors, describe their characteristics and to evaluate the effects of storage on G6PD-deficient donated blood. Methods: This study was conducted at selected mobile donation centres in Terengganu. Consented blood donors were screened for G6PD sta- tus using fluorescent spot tests (FST). G6PD enzyme activities were measured for donors who were G6PD deficient. Effects of storage on haemolysis from G6PD-deficient donors were compared with non G6PD-deficient group. Sixty ml of blood was collected from blood unit to transfer pouch for estimation of haemoglobin (Hb), plasma Hb, per- centage of haemolysis and plasma potassium. Serial sampling with a 7-day interval was done from Day 1 to Day 35. Statistical analysis was considered significant if p 0.05. Results: A total of 440 blood donors were screened and 12 male donors were found to be G6PD deficient by FST. Enzymatic activities were measured in 11 donors as one donor sample failed to be sent to the centre due to logistic problem. Their enzymatic activities ranged from 1.66-2.93 U/g Hb whereby 6 have severe deficiency and the other 5 were categorised as partial deficiency. Donors were asymp- tomatic for haemolytic episode. Serial sampling showed there was no significant difference of haemolytic parameters in blood units of G6PD-deficient donors as compared to control (p>0.05). Conclusion: Prevalence of G6PD blood donors in Terengganu mobile centres was 2.7%. G6PD enzyme activities did not correlate with clinical symptoms. Haemolytic parameters were not affected in blood units which were G6PD-deficient.
Introduction: Unsafe blood products cause transfusion-transmissible infections. A good knowledge and perception about blood safety issues is crucial to ensure safe blood supply. The objective is to develop and validate a question- naire about the knowledge and perception among blood donors on blood safety issues. Method: A cross-sectional study was conducted among 130 blood donors who attended the National Blood Centre, Kuala Lumpur in April and May 2018. The questionnaire was developed in the Malay language after extensive literature search. The self-admin- istrated questionnaire consisted 39 items which required around 20 minutes to complete. The validation involved content validity, construct validity using exploratory factor analysis and reliability using test-retest analysis in IBM SPSS statistics. The same group of respondents was retested after two weeks using the same questionnaire. Results: Content validity was established through multidisciplinary expert meeting and two content reviewers. The factors loadings of all questionnaires were more than 0.40. Knowledge questions were divided into three domains; percep- tion questions were divided into four domains. The intraclass correlation (ICC) values of the test-retest were more than 0.80 for the three knowledge domains and more than 0.60 for the four perception domains. The third domain of the perception section which consisted two questions had the lowest ICC value of 0.686 (95% CI 0.583-0.767). One of the questions was restructured to improve clarity. Conclusions: The questionnaire on knowledge and perception on blood safety issues has good validity and reliability, with appropriate items which warranted its utilization among blood donors.
Introduction: Reduction or complete absence of α-globin chain production may result α-thalassemia. Alpha thalassemia carrier may have normal haemoglobin level and thus will be eligible as blood donor. Few complications may happen in which the carrier who donated the blood might be at risk of hypoxia and their blood components might not suitable for transfusion. Thus, it is important to screen for α-thalassemia to prevent any complications happen
after donation. The objective of this study is to investigate the interaction of red blood cell indices and α-globin genotypes among eligible blood donors in a private university, Universiti Tunku Abdul Rahman (UTAR), Malaysia. Methods: A total of 270 eligible blood donors were recruited for this study. Red cell indices were analysed using Horiba hematology analyser and α-globin genotyping was performed for seven alpha deletions, six alpha point mutations
and two alpha triplications. Results: Our study showed high prevalence of α-thalassemia carriers among the eligible blood donors (7.7%, 21/270), with all of them showed normal Hb level (>12 gm/dl). Five genotypes were detected consisting of 249 αα/αα (92.2%), 9 -α3.7/αα (3.3%), 9 --SEA/αα (3.3%), 2 -α4.2/αα (0.7%) and 1 ααCS/αα (0.4%). All α-globin genotypes showed normal Hb level with no significant difference between genotypes (p=0.167). Different
α-globin genotypes showed significant difference in RBC, MCV, MCH, MCHC, RDW and Hct/Hb ratio at the p
Introduction: This preliminary cross-sectional study aimed to investigate the prevalence of toxoplasmosis among blood donors in Kelantan, Malaysia. Methods: A total of 56 blood donors were screened by an enzyme-linked immu- nosorbent assay (ELISA) for anti-T. gondii Immunoglobulin G (IgG) and Immunoglobulin M (IgM) antibodies. Positive
T. gondii IgG and IgM were further tested for IgG avidity ELISA. All extracted deoxyribonucleic acids (DNAs) from whole blood samples were analyzed for the presence of the Toxoplasma B1 gene and the ITS1 region by polymerase chain reaction (PCR). The socio-demographic data of donors was assessed using a data collection form. Results: Out of 56 blood donors, 24 (42.86%) donors were IgG+/IgM-, and 2 (3.57%) donors were IgG+/IgM+ with one of them having a high avidity index indicating as past infection for more than 20 weeks and the other with a low avidity index indicating as recent infection within 20 weeks. None of the samples tested positive for the presence of the Toxoplasma B1 gene and the ITS1 region. A univariate analysis showed that only employment status was significantly associated with Toxoplasma seropositivity. Conclusion: The seroprevalence of toxoplasmosis among blood donors in Kelantan, Malaysia, was 46.43%. Nevertheless, direct detection by PCR showed that this parasite was absent in the blood. These results highlight that the blood donors in this study had previously been exposed to T. gondii infection. The parasite may still remain in certain tissues but does not freely circulate in the blood.
ABSTRACTS FOR INTERNATIONAL HEALTH AND MEDICAL SCIENCES CONFERENCE 2019 (IHMSC 2019)
Held at Taylor’s University Lakeside Campus, Subang Jaya, Selangor, Malaysia, 8-9th March, 2019
Introduction: Unsafe blood products cause transfusion-transmissible infections among blood receivers. The knowledge and perception of blood donors is important as it is associated with their donation behaviour and hence the safety of blood products. There was no previous study that assessed the knowledge and perception on blood safety issues among blood donors to date. The objective of this study was to assess the knowledge and perception of blood
donors on blood safety issues.
Methods: This was a pilot study conducted to pilot test the self-developed questionnaire by the researchers. The questionnaire was available in the Malay language. One-hundred-thirty donors at the National Blood Centre were recruited to complete the self-administered questionnaire. Health sciences professionals, medical students and non-Malaysians were excluded in this study.
Results: A total of 130 donors comprising of 70 males (53.8%) and 60 females (46.2%) responded. The mean age of the respondents is 32.48±8.86 years. Most of the respondents were Malay (55.4%), single (49.2%), working in private sector (46.9%) and regular donor (68.5%). More than half of the respondents did not know that dengue, Zika and mad-cow disease can be contracted through blood transfusion. Ten percent of the respondents answered that bisexual people are eligible to donate blood. 40.7% of the donors agreed to check their HIV status through blood donation. Majority of the donors (60.7%) agreed that the donors’ blood is safe if the screening test is negative. Whereas, 33.9% of the donors disagreed that they shall be responsible if their blood causes infection.
Conclusion: Several knowledge gaps and inappropriate perception among the respondents were identified and these might affect the safety of the blood products. Targeted measures should be taken to rectify donors’ knowledge and perception in order to minimise inappropriate blood donor behaviours and reduce unsafe blood products.
Introduction: The healthy, active, and receptive huge student population is potential blood donors to meet safe blood requirements. The study aimed to assess the current level of knowledge regarding blood donation of nursing students of the Faculty of Medicine & Health Sciences, UMS and to observe their attitude towards voluntary blood donation and to explore their practice as a voluntary blood donor. Methods: This cross-sectional study was con- ducted from July 2015 to June 2018 among one hundred and eight (108) nursing students who were included in this study by simple random sampling. The researchers explained the study design, objectives, and methodology to the selected subjects and obtained written consent from them. The study assessed the current level of knowledge and observed their attitude towards voluntary blood donation and explored their active involvement in donating blood through a validated questionnaire. Results: There were 89 female and 19 male participants in the study. Almost ev- ery student (96%) knew their blood group and most of them were correct about the health status of a blood donor. They had a lack of knowledge regarding the time required for blood donation and the amount of blood collected in each bag. Although most of the students were very favourable to donate blood, only 34% had previous experience of donating blood out of them; only 6% regularly donated voluntarily and on demand. Conclusion: From this finding, it can be recommended that measures for increasing knowledge regarding blood donation should be taken, and that would result in increased blood donation.
Objective: This study was done to identify blood donors with thalassaemia and iron deficiency. A cross sectional study was carried out at Pusat Darah Negara (PDN), Kuala Lumpur in November 2003.
Methods: Full blood counts were done on 242 blood donors (166 males and 76 females) Hb analysis and serum ferritin assay were done for all the samples. The first time donors were used as controls.
Results: Only 20 (8.3%) donors had MCV <80 fL and MCH <26pg. Six of the 25 donors with iron deficiency had a low MCV <80 fL) and low MCH <26 pg) but all the 8 (40%) donors with thalassaemia or HbE had a low MCV and MCH! The mean ferritin levels were found to be lower among regular blood donors (95.3 ug/L) compared to first time blood donors (116.6 ug/L) but this was not statistically significant. There were 25 donors who were iron deficient: one was a first time donor and 24 were regular donors - 12 (50%) had donated 3 times a year in the last two years. Iron deficiency was seen in 12 Malays, and 9 Chinese, and 4 Indians. 13.3% of the males (22 out of 166 donors) and 4% (3 of 76) of female donors were iron deficient. Thalassaemia and HbE were found in 8 donors. HbE trait was identified in 5 Malay donors. One Malay and 1 Chinese donor had beta-thalassaemia trait. Another Chinese had alpha (a^o) thalassaemia trait. Neither HbE nor thalassaemia were seen in the Indian donors.
Conclusion: In this study thalassaemia and RbE were seen in 3.3% and iron deficiency in 10.3% of the 242 blood donors at PDN. Iron deficiency was present in 3.2% of the first time donors and 12.8% of the regular donors. Regular donors should have the serum ferritin done for their iron status and if their MCV and MCH are low, Hb analysis for thalassaemia or haemoglobinopathy.
Keywords: Blood donors, serum ferritin, iron deficiency, haemoglobinopathy
Hepatitis B virus (HBV) infection is one of the major public health problems in Malaysia. It remains the most common permanent deferral among blood donors. In Malaysia, the national vaccination programme has been introduced since 1989 to prevent HBV transmission. The objective of this study is to determine the prevalence and associated risk factors of HBV infection among first-time blood donors after the implementation of the national hepatitis B vaccination programme. Methods: This is a retrospective cohort study involving tracing of the database of National Blood Centre Malaysia. The record of first-time blood donors who had donated between 1st January 2010 and 31st December 2015 and were screened HBV positive was reviewed and analysed. Results: There were 376,737 first-time donors who had donated blood and 575 of them screened positive for HBV. The overall prevalence of seropositive for hepatitis B was 0.15%. The prevalence was higher at 0.23% among donors born before the year 1989 (pre-vaccination era) compared to 0.05% among donors born in and after the year 1989 (post-vaccination era). Perinatal transmission was found to have 15 times higher odds of developing HBV infection as compared to those who had the combination of risk factors among those born after the year 1989 (adjusted OR=14.95, 95% CI 1.80=124.01). Conclusion: The implementation of the national vaccination programme reduced the prevalence of hepatitis B among donors who received vaccination at birth compared to those who did not.
Dengue virus is one of the emerging agents that can be transmitted via blood transfusion from infected blood donors to recipients. In Malaysia, the increase in dengue infection may contribute to the existence of asymptomatic blood donors and increase the risk of blood supply contaminated with this virus. The aims of this study were to investigate the prevalence of NS1 dengue antigen among blood donors and to ascertain the demographic data of blood donors in Penang and and Perak. Methods: A total of 374 voluntary blood donors were recruited from two blood donation campaigns organised by Hospital Pulau Pinang, Penang and Hospital Raja Permaisuri Bainun, Ipoh, Perak from April to May 2016. From each centre, 187 voluntary blood donors were enrolled, blood was collected and Dengue NS1 Ag was screened on all the samples using Platelia dengue antigen test kit from Bio-Rad Laboratories, France. Results: All 374 samples were found to be negative for the Dengue NS1 antigen. Demographic data of these blood donors showed that the most common blood group was O Rh positive, men donated more than women and Chinese blood donors were the biggest group of donors. Conclusion: Even though dengue is endemic in Malaysia, none of the blood donors was screened positive for dengue NS1 antigen in the areas studied. This indicates that none of the blood donor at the time of donation was in viraemia stage. The established donor screening program ensures that the dengue transmission through transfusion is minimal in the areas studied.