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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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Introduction
Introduction

  • 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

Pre-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? 80–89

  • 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 tti
Transfusion Transmitted Infections (TTI) transfusion infection

  • 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 transfusion infection):

  • Classification

    • Family: retroviridae

    • Genus: lentivirus

    • Specie (types): HIV-1, HIV-2

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


Transfusion transmitted infections

Integrase transfusion infection


Hiv replication cycle
HIV Replication Cycle transfusion infection

  • 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 transfusion infectionof 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 transfusion infectionT cell Lymphotropic Viruses (HTLV) type I and type II

Virology:

  • Single stranded ss RNA

  • enveloped

  • Icosahedral

  • Family: retroviridae

  • Genus: deltaretrovirus

  • Oncovirus


Pathogenesis
Pathogenesis transfusion infection

  • 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

  • Epidemiology transfusion infectionIt 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 transfusion infection

    • 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 transfusion infection


    Transmission
    Transmission transfusion infection

    • 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

    Diagnosis transfusion infection

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

    • Differentiation between acute and chronic infection


    Hepatitis c virus
    Hepatitis C virus transfusion infection

    • 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 transfusion infectiondeveloping countries, the primary sources of HCV infection are inadequately screened blood and blood products

    Hepatitis C transmission in developedcountries


    Epstein barr virus ebv
    Epstein transfusion infection- 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.


    Pathogenesis1
    Pathogenesis transfusion infection

    • 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 transfusion infection


    Ebv diseases and malignancies
    EBV transfusion infectionDiseases 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 infection


    Transfusion transmitted infections

    • Malignancies transfusion infection

      • Burkitt lymphoma

      • Nasopharyngeal carcinoma

      • Hodgkin lymphoma

    • Diagnosis (serology)

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


    Lymphadenopathy
    Lymphadenopathy transfusion infection


    Cytomegalovirus cmv
    Cytomegalovirus (CMV) transfusion infection

    • 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 transfusion infectionIM): 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 transfusion infection

    • 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 transfusion infection

      • 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 transfusion infectionVirus 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


    Bacterial contamination
    Bacterial patients.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


    Treponema pallidum
    Treponema blood products has decreased bacterial contamination in recent yearspallidum

    • 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 blood products has decreased bacterial contamination in recent yearsintracellular)

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


    Chancre
    Chancre blood products has decreased bacterial contamination in recent years


    Diagnosis
    Diagnosis blood products has decreased bacterial contamination in recent years

    • 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


    Malaria
    Malaria blood products has decreased bacterial contamination in recent years

    • 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 ( blood products has decreased bacterial contamination in recent yearsasexual stage of microbe= Schizogony cycle)

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


    Transfusion transmitted infections

    sexual blood products has decreased bacterial contamination in recent yearscycle (Sporogony)

    Asexual cycle (Schizogony)


    Transfusion transmitted infections

    Diagnosis: blood products has decreased bacterial contamination in recent years

    • Thick and thin blood smears

    • Rapid dip stick tests


    Transfusion transmitted infections

    Blood smear with  blood products has decreased bacterial contamination in recent yearsPlasmodium falciparum


    Transfusion transmitted infections

    Map showing the distribution of malaria in the blood products has decreased bacterial contamination in recent yearsworld:

    ♦Elevated occurrence of chloroquine- or multi-resistant malaria

    ♦Occurrence of chloroquine-resistant malaria

    ♦No Plasmodium falciparum or chloroquine-resistance

    ♦No malaria


    Transfusion transmitted infections

    Thanks blood products has decreased bacterial contamination in recent years


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