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Transfusion-Transmitted Infections. Introduction. Blood transfusion is the process of receiving blood or blood products into circulation intravenously. Used in a variety of medical conditions to replace lost components of the blood such as:

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Transfusion-Transmitted Infections

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Transfusion transmitted infections

Transfusion-Transmitted Infections



  • Blood transfusion is the process of receiving blood or blood products into circulation intravenously

Transfusion transmitted infections

Used in a variety of medical conditions to replace lost components of the blood such as:

  • Inherited blood diseases: Thalassemia, hemophilia, sickle cell anemia

  • Hemolytic anemia of newborn.

  • Bleeding: Post –traumatic, operative

  • Malignancy: leukemia

  • Other conditions: hepatic coma, kidney failure

Procedure for voluntary blood donation

Procedure for Voluntary Blood Donation


  • Donor Screening

  • Donor Consent Form

  • Medical examination

    Blood Donation:

  • Blood donation procedure

    Post donation

  • Rest, advice & refreshment

  • Donor Certificate, Donor ID card

Criteria for blood donation who recommendations

Criteria for Blood Donation(WHO Recommendations)

Donors are evaluated for safety according to the following criteria:

  • Age: 18-55 years old

  • Weight: 50 Kg or above

  • Pulse Rate: Normal 60–100 per minute and a regular rhythm

  • Body temperature: Normal 36- 37.6°C

Transfusion transmitted infections

  • Blood pressure: Normal(systolic 120–129 mmHg, diastolic 80–89 mmHg)

  • Hemoglobin concentration: 12.5 g/dl for females and 13.5 g/dl for males

  • Medical History, epilepsy, psychotic disorders, bleeding tendencies, thalassemia, sickle cell anemia, malignancy

  • Infections: HIV, hepatitis, malaria, syphilis

How much blood can be taken during blood donation

How much blood can be taken during blood donation?

  • The amount of blood drawn varies from 200 milliliters to 550 milliliters depending on the country, but 450-500 milliliters is typical

  • The blood is usually stored in a flexible plastic bag that also contains sodium citrate, phosphate, dextrose, and sometimes adenine

Factors that play a role in establishment of blood transfusion infection

Factors that play a role in establishment of blood transfusion infection

  • Viral Window Period: period between the onset of infection and the appearance of detectable antibodies to the virus(3-6 weeks up to 6 months)

  • Donor immune status (Asymptomatic immunocompetent donor)

  • Laboratory and personal error

  • Bacterial contamination

Transfusion transmitted infections

The Infectious Microbes Transmitted by Blood Transfusion

Transfusion transmitted infections tti

Transfusion Transmitted Infections (TTI)

  • HIV

  • HTLV

  • Hepatitis B and C

  • Cytomegalovirus

  • Epstein-Barr virus

  • Human Parvovirus (B19)

  • Human Herpesvirus 8

  • Bacterial contamination of blood products

  • Syphilis

  • Malaria

  • prions

Human immunodeficiency virus hiv

Human Immunodeficiency Virus (HIV):

  • Classification

    • Family: retroviridae

    • Genus: lentivirus

    • Specie (types): HIV-1, HIV-2

  • Lentivirusesare single-stranded, positive-sense, enveloped icosahedral RNA viruses.

Transfusion transmitted infections


Hiv replication cycle

HIV Replication Cycle

  • attachment (interaction b\w gp120 and CD4) then interact with CCR5 and CXCR4

  • Entry and Uncoating

  • Formation of Ds DNA by reverse transcriptase enzyme, and integration by integrase.

  • Stay latent or reproduce (produce RNA and proteins)

  • Assembly

  • release by budding destroying the cell

Routs of hiv transmission

Routs of HIV Transmission

  • Unprotected sexual transmission

  • Blood transfusion

  • From mother to child (late in pregnancy, during birth and breast feeding)

  • Needle-sharing injection drug use

  • Percutaneous needle stick

  • Tissue transplantation

Human t cell lymphotropic viruses htlv type i and type ii

Human T cell Lymphotropic Viruses (HTLV) type I and type II


  • Single stranded ss RNA

  • enveloped

  • Icosahedral

  • Family: retroviridae

  • Genus: deltaretrovirus

  • Oncovirus



  • The virus infect T cells and, activate some host cell genes; and places the infected cell in an uncontrolled mode of growth

  • The majority of infected patients stay as carriers.

  • Some patients develop Adult T-cell leukemia (ATL) after 20-30 years.

Transfusion transmitted infections

  • EpidemiologyIt is endemic in Japan (15-30%), Caribbean (3-6%), Guinea and some parts of Africa

  • Transmission:

  • Sexual route

  • Blood transfusion

  • Vertical transmission and breast-feeding

  • Laboratory diagnosis:

    • PCR for detection of provirus genome

    • Anti-HTLV antibodies by ELISA

  • Hepatitis b virus

    Hepatitis B Virus

    • Family: Hepadnaviridae

    • Icosahedral enveloped Ds DNA virus

  • One of the smallest enveloped animal viruses.

  • Pleomorphic forms exist, including spherical and filamentous bodies lacking a core (none infectious lipids and proteins surface antigen (HBs Ag))

  • Transfusion transmitted infections

    incomplete forms



    • Highly infectious

    • Sexual Route

    • Vertical Route: Transmission of virus from mother to child during childbirth perinatal, transmission of viral genetic material within the cells.

    • Parenteral Route:

      Blood transfusion and contaminated syringes

    Transfusion transmitted infections


    • Hepatitis B virus surface antigen (HBs Ag) detection by ELISA for diagnosis

    • Differentiation between acute and chronic infection

    Hepatitis c virus

    Hepatitis C virus

    • Virology: enveloped, Ss RNA virus

    • Classification

      • Family: flaviviridae, Genus: hepacivirus

    • Transmission

      • Blood\blood products transfusion

      • Injection drug use

      • Needle sticks or sharps exposure:1.8% (range 0%-7%)

      • Sexual exposure

    Transfusion transmitted infections

    • In developing countries, the primary sources of HCV infection are inadequately screened blood and blood products

    Hepatitis C transmission in developedcountries

    Epstein barr virus ebv

    Epstein - Barr virus: (EBV)

    • Virology

      • Family: Herpesviridae

      • Enveloped, Icosahedral, Ds DNA

      • Derives envelope from nuclear membrane

      • Establishes Latency in B lymphocytes.

    • Transmission

      • Direct person-person contact (Saliva)

      • Blood transfusion.

        • Most adults are seropositive.



    • EBV infects nasopharyngeal epithelial cells, salivary and lymphoid tissues

    • The virus binds to CD21 of B-Lymphocytes and acts as mitogen (encourages a cell to commence cell division)

    • This will stimulate the production of atypical reactive T cell (Downey cells=70% of the total WBC count)

    Downey cells

    Downey cells

    Ebv diseases and malignancies

    EBV Diseases and malignancies

    • Diseases: asymptomatic in infants and young children

    • Heterophilepositive mononucleosis (infectious mononucleosis) (kissing disease)Fatigue, fever, sore throat, lymphadenopathy, and splenomegaly

    • Lymphoproliferative disease: Uncontrolled B-Cell growth in immunocompromised patients

    • hairy leukoplakia: nonmalignant, white-gray lesions on the tongue in AIDS patients.

    Hairy leukoplakia

    Hairy leukoplakia

    Transfusion transmitted infections

    • Malignancies

      • Burkitt lymphoma

      • Nasopharyngeal carcinoma

      • Hodgkin lymphoma

    • Diagnosis (serology)

      • Anti-E.B virus IgM antibodies detected by ELISA test



    Cytomegalovirus cmv

    Cytomegalovirus (CMV)

    • Virology

      • Belongs to the Herpesviridae family like EBV

    • Transmission: Saliva, sexual, blood transfusion, vertical (during pregnancy, breast milk)

    • Pathogenesis

      • Latency in monocytes and macrophages (mononuclear cells).

      • Approximately 50% to 80% of the adult population are infected with the virus

    Transfusion transmitted infections

    • Mononucleosis syndrome (like IM): usually asymptomatic or mild symptoms.

    • cytomegalic inclusion body disease , jaundice, hepatosplenomegaly, pneumonitis, CNS damage (loss of hearing & mental retardation), death. (most sever in vertical transmission)

    • Interstitial pneumonitis to severe systemic infection (immunocompromised patients : AIDS, tissue transplant)

    Parvovirus b19

    Parvovirus B19

    • Virology

      • Ss DNA virus, non enveloped, icosahedral virus

    • Transmission

      • Respiratory, vertical (from mother to child), blood transfusion

      • This virus has been transmitted to patients with hemophilia through infusion of clotting factors

    Transfusion transmitted infections

    • Pathogenesis

      • It infects immature erythroid progenitor cells, resulting in cell lysis

      • The resulting anemia is clinically significant in patients with sickle cell anemia

    • Disease

      • In children and adults

        • Fifth disease; erythema infectiosum (slapped cheek disease)

      • In fetus

        • Severe anemia, hydrops fetalis (anaemia & edema)

    Human herpes virus 8 hhv 8

    Human Herpes Virus 8 (HHV-8)

    • Virology: enveloped Ds DNA virus, family: herpesviridae

    • Transmission: Sexual contact, Saliva, vertical, transplantation & transfusion

    • Pathogenesis

      • It has a gene that turns on vascular endothelial growth factor (VEGF), which plays a direct role in the development of Kaposi Sarcoma

    Transfusion transmitted infections

    • Disease: Kaposi Sarcoma in immunosuppressed esp. AIDS patients.

    • Diagnosis

      • Serology: ELISA

      • Molecular genetics: PCR

    Bacterial contamination

    Bacterial contamination

    • The most common and severe infectious complication associated with transfusion

    • It has been estimated that 1 in 38,500 units of red cells, 1 in 3,300 units of random donor platelets, are contaminated with bacteria

    Transfusion transmitted infections

    • Gram–positive bacteria normally found on the skin, such as S.epidermidisor S.aureus, are the most common bacterial contaminants of blood products.

    • Gram negative bacteria, such as E.coli, may contaminate the donation when blood is collected from donors who have bacterial infection without symptoms.

    Transfusion transmitted infections

    • Improved methods of collection, handling, and storing of blood products has decreased bacterial contamination in recent years.

    Treponema pallidum

    Treponema pallidum

    • Transmission: Sexually, transplacentanllyand by blood transfusion (rare; 6 in million; can not survive more than 48 hrs. in refrigerator)

    • Bacteriology

      • Thin spirochete; Basically it has Gram’s negative cell wall

      • Axial filaments present (endoflagella)

      • Can not be cultivated in vitro; serodiagnosis

    Transfusion transmitted infections

    • Obligate pathogen (but not intracellular)

    • PathogenesisPrimary: genital chancre of skinSecondary: skin lesionsLatent infectionTertiary: CNS and cardiovascular infection





    • Direct:

      Examination of microbe by Dark field or immunofluorescent microscopes.

    • Indirect (Serology)

      • Non treponemal antibodies (non-specific antibodies): Anti-cardiolipin by VDRL or RPR test

      • Treponemal antibodies (specific): by TPHA or IFA



    • About 300-500 million people are infected, over 1 million people die each year

    • Transmission

      • bite of infected female Anopheles mosquito, transplacentanlly, and by blood transfusion

    • Microbiology

      • Etiology: Plasmodium species (P.vivax , P.malariae , P.ovale , P. falciparum)

      • Classification: Sporozoa

    Transfusion transmitted infections

    • Man is the intermediate host (asexual stage of microbe= Schizogony cycle)

    • Anopheles is the definitive host (sexual stage = Sporogony cycle)

    Transfusion transmitted infections

    sexual cycle (Sporogony)

    Asexual cycle (Schizogony)

    Transfusion transmitted infections


    • Thick and thin blood smears

    • Rapid dip stick tests

    Transfusion transmitted infections

    Blood smear with Plasmodium falciparum

    Transfusion transmitted infections

    Map showing the distribution of malaria in the world:

    ♦Elevated occurrence of chloroquine- or multi-resistant malaria

    ♦Occurrence of chloroquine-resistant malaria

    ♦No Plasmodium falciparum or chloroquine-resistance

    ♦No malaria

    Transfusion transmitted infections


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