Transfusion transmitted infections
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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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  • 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:

  • 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

  • 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.

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


  • Single stranded ss RNA

  • enveloped

  • Icosahedral

  • Family: retroviridae

  • Genus: deltaretrovirus

  • Oncovirus

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.

  • 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))

  • incomplete forms transfusion infection

    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

    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

    • 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.

    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

    • Malignancies transfusion infection

      • Burkitt lymphoma

      • Nasopharyngeal carcinoma

      • Hodgkin lymphoma

    • Diagnosis (serology)

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

    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

    • 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

    • 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

    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

    • 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.

    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

    • 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 blood products has decreased bacterial contamination in recent years

    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 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

    • 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)

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

    Asexual cycle (Schizogony)

    Diagnosis: blood products has decreased bacterial contamination in recent years

    • Thick and thin blood smears

    • Rapid dip stick tests

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

    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

    Thanks blood products has decreased bacterial contamination in recent years