Original article / research
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Distribution of ABO, Rhesus Blood Groups, Transfusion Transmitted Diseases and Adverse Donor Reactions in a Blood Bank of a Tertiary Care Hospital: A Five Year Study |
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Lekha Mandodar, Archana Shetty, Vijaya Chowdappa 1. Assistant Professor, Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, India. 2. Assistant Professor, Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, India. 3. Professor and Head, Department of Pathology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, India. |
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Correspondence
Address : Dr. Archana Shetty, Mythili, FF3, Sai Durga Apartments, Padmavathi Meenakshi Kalyana Mantapa Road, Rajarajeshwari Nagar, Bangalore 560098, India. E-mail: archanashetty2924@gmail.com |
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ABSTRACT | |||||||||||||||||||||||||||||||||||||||||||||||
: Study of the distribution of A, B, O blood group systems is essential for genetic studies, medico – legal issues and importantly for efficient delivery of blood bank services. Also important is the immunologic safety of the donated blood and safety of the donor, hence the need for documentation of transfusion transmitted diseases and adverse donor reactions. Aim: To study the distribution of A, B, O and Rh blood groups in donors from Jan 2011 to December 2015, in a blood bank of a semi – urban tertiary care teaching hospital. Document the frequency of various transfusion transmitted diseases (TTDS) and adverse donor reactions. Materials and Methods: Total of 16455 donors was eligible for blood donation, fulfilling the NACO guidelines. A, B, O and Rh grouping were done by standardized commercially available kits. The blood was screened for TTDS – HIV, HBsAg, HCV and VDRL by standard procedures. A register was maintained to note the adverse donor reactions. Results: Of the total 16455 donors male donors (15979 - 97.11%) outnumbered the female donors. Voluntary donors constituted only 8.00% of the total donors the rest being replacement donors. When categorized according to the age, 8016 of donors were in the age group of 21- 30 years, and the least number of donors were seen above the age of 45 years. The commonest blood group was O with 6511 donors (39.57%), followed by B, A, the least being AB (6.8%). Rhesus positivity was seen in 94.12 % of donors. It was seen that the negative blood groups are the ones in which higher percentages of these transfusion transmitted diseases are documented. HIV was seen majorly in B-ve group, HBsAg in A –ve, HCV in group B –ve and VDRL most commonly in A –ve blood group. Adverse events were recorded in 371 (2.25%) of donors. Conclusion: Updating Knowledge and awareness of the regional distribution of blood groups is essential for providing good transfusion services and better community care. Donor safety is of prime importance, thereby the staff must be aware of potential adverse reactions that can happen and be on alert to identify and attend them. Also, awareness of frequency of the various transfusion transmitted diseases helps in keeping an eye on potential high risk donors. | |||||||||||||||||||||||||||||||||||||||||||||||
Keywords : HBsAg, HIV, Replacement donors | |||||||||||||||||||||||||||||||||||||||||||||||
INTRODUCTION | |||||||||||||||||||||||||||||||||||||||||||||||
Human blood groups are genetically inherited and exhibit varying degrees of polymorphism. There is significant difference in the frequency of distribution of the various blood groups in population. Of the various blood group systems, the ABO blood group system is the most important blood group system in health and disease (1). There is some co-relation between various diseases like duodenal ulcer, diabetes mellitus, ovarian cancer, coronary artery disease (CAD) Rh incompatibility and ABO incompatibility of the new born, as documented in literature till date (2). The incidence of ABO and Rh groups varies markedly in different parts of the world. Awareness of the distribution of ABO & Rh blood groups in various regions aids in the efficient and timely delivery of blood transfusion services. Hence, it is of vital importance to have information on the distribution of these blood groups in any given population (3). Although of utmost importance in blood transfusion practices in blood banks, the ABO &Rh blood groups are also useful in population based studies, studying migration patterns as well as resolving certain medico legal issues, like disputed paternity case (3),(4). At the same time, blood donation carries with it the potential risk of transfusion transmitted diseases, which can be minimized by effective donor selection and screening. Also many healthy donors get exposed to discomfort and rarely complications during blood donation. In the present study we have documented the distribution of various blood groups in donors along with a note on the prevalence of donor adverse reactions and sexually transmitted diseases in our blood bank. | |||||||||||||||||||||||||||||||||||||||||||||||
MATERIAL AND METHODS | |||||||||||||||||||||||||||||||||||||||||||||||
A retrospective, cross sectional analytical study was carried out, at the blood bank of Sapthagiri Institute of Medical Sciences and Research Centre. Due ethical clearance from the institutional ethical committee was obtained before the study was taken up. The period of study was from January 2011 to December 2015 and included both voluntary and replacement donors. Donors duly filled a questionnaire comprising of personal details, contact details, past and present significant medical history. Eligible donors belonged to age group between 18- 55 years and more than 50 kg of weight and haemoglobin of more than 12.5gm%.The donor screening criteria followed were as per the NACO guidelines. Underweight donors, donors with low Hb, with history of recent illness, and those not fulfilling the above guidelines were deferred from donation. Written consent was also taken prior to donation regarding their acceptability for donation and for the tests that need to be carried out for the transfusion transmitted infections. Blood samples were obtained by standard operative procedure of venipuncture and subjected to determination of ABO and Rh blood grouping using commercially available monoclonal antisera A,B,AB,H & Rh D antisera, monoclonal Tg M & monoclonal (Ig M&I g G) from Tulip Diagnostic Ltd India. ABO blood group was determined by forward grouping (cell grouping) & reverse blood grouping(serum grouping) by slide and test tube agglutination method with pooled known A,B & O cells that are freely prepared in blood bank. Rh negative blood groups were confirmed by Indirect antiglobulin test. Weak D positive results data were recorded on specially formed proforma, tabulated, analyzed and compared with similar studies by other authors. The donor samples were also tested for Anti –HIV 1 and 2, HbSAg and Anti – HCV using ELISA technique supplied by J.Mitra and Co LTD. The possibility of false positives or negative seropositive samples was ruled out by testing the borderline results again using ELISA kits of BIORAD. The Rapid Plasma Reagin test was used for detection of syphilis infection. A separate register was used for the documentation of any adverse reactions in the donor with necessary action taken to rectify the same. Percentages and proportions for each variable was calculated and 95 % confidence intervals were taken to define normal range. | |||||||||||||||||||||||||||||||||||||||||||||||
RESULTS | |||||||||||||||||||||||||||||||||||||||||||||||
A total of 16455 donors were screened during the study period. As shown male donors constituted the majority 15979 (97.11%). When categorized in age groups, it was found that highest percentage of donors were in the age group of 21- 30 years, with the least donors being those above 50 years of age (Table/Fig 1). The distribution of voluntary and replacement donors is as shown in (Table/Fig 2). The commonest blood group in our study was found to be O with 6511 donors ( 39.57%) as shown in (Table/Fig 3), followed by B, A and the least being AB. Rh positive donors constituted a majority (15497), with the rest being Rh negative. Among Rh positive male subjects blood group O was found to be the commonest (36.12%) followed by Group B (26.83%). Amongst Rh positive females also O was found to be the commonest blood group followed by group B (0.82%). Among Rh negative males, also the same pattern of O group dominance was observed both in males and females as shown in (Table/Fig 4).The overall frequency of blood group in our study was O>B>A> AB. The donor blood was screened for transfusion transmitted diseases (TTD), - HIV 1, 2, HbSAg, HCV and VDRL. It was found that the most common was HbSAg , being positive in 103 (0.63% ) of the total donors, followed by HIV, HCV and VDRL. It was seen that the negative blood groups are the ones in which higher percentages of these TTDS occur. HIV was seen majorly in B-ve group, HBsAg in A -ve, HCV in group B –ve and VDRL most commonly in A –ve blood group. However no significant association was seen between the groups and the TTDS, the study findings are just a random documentation of their occurrence during the study period (Table/Fig 5). Adverse reactions were categorized based on the classification scheme suggested by the American Red Cross hemovigilence programme, classified as shown in the (Table/Fig 6). Adverse events were recorded in 371 (2.25%) of total donors during the study period. Only one accidental arterial puncture was recorded. No severe adverse reactions to the extent of needing hospitalization were recorded during the study period. The distribution of the various adverse donor reactions is as given in the table below (Table/Fig 6). | |||||||||||||||||||||||||||||||||||||||||||||||
DISCUSSION | |||||||||||||||||||||||||||||||||||||||||||||||
One of the greatest contributions to medicine by Karl Landsteiner, a physician and a biologist in 1900, was the discovery of the ABO blood group types in 1900.He was awarded the Nobel Prize in 1930 for the same. It was later in 1941 that Landsteiner and Weiner defined the Rh blood group system (1). Following Landsteiner’s discovery wide spectrum of discoveries in the field of immune haematology, blood transfusion related diseases and reactions, unmatched pregnancy, legal medicine, anthropology were documented (5). Our study showed a predominance of male donors, compared to a very small percentage of female donors, which is in comparison with other similar studies (5),(6). Lack of motivation, social taboo, cultural habits on one hand and anaemia leading to underweight leading to donor deferral are some of the few reasons for the sparse percentage of female donors (5). We would like to stress upon the fact that healthcare of our female population needs to be prioritized specially in a developing country like ours as many females in our study although willing for donation were deferred due to reduced Hb and underweight. Voluntary blood donation often overlooked due to various factors like ignorance of the need to donate blood, and advantages to health of the same. Voluntary blood donations also carry less risk of sexually transmitted diseases, hence the need for promoting the same (7). In the present study replacement donors comprised a higher percentage of donors. Among donors, the youth constitute the active and potential source of donors. The 18 – 30 years age group comprised majority of the donors in our study. The least donors were above age of 45. Increasing health issues like Diabetes, Hypertension, medications, systemic diseases etc. These donors, although willing to donate are often filtered during the pre screening session due to the above mentioned factors (6). Our institution conducts motivational lectures and seminars at quarterly intervals to promote more young healthy donors. We compared our study to other similar studies carried out in the various regions of India as shown in table below (Table/Fig 7). “O” blood group was the most common in our study, in accordance with above studies, followed by group B, A and AB. However many studies done in northern, western and central parts of our country show “B” to be the commonest group among donors, followed by O, A and AB as shown in the table no. 5.Western studies show a higher percentage of Rh positivity , which is in contrast with Indian studies. Our study reports a 5.88% of Rh-ve donors, in accordance with Indian studies (9),(10),(11),(12),(13),(14),(15),(16). Studies have shown group B to be associated with higher frequency of diabetes. This awareness implies that people with blood group B can get themselves screened for sugar levels before being diagnosed as diabetics. Also, group A is known to be associated with venous thrombosis, and coronary heart diseases, gastric cancer, the O blood group at the same time being protective against these (2). Although blood donation is generally safe, donors during the process of donating blood, often get exposed to discomforts, uneasiness and rarely health issues. Hence we also documented the adverse events in our donors. The present study documented the percentage of adverse reactions to be 2.4%., occurring in 371 of the total donors. Medical reports have reported percentages varying from 2. 33 % to as high as 21% (19),(20). The commonest adverse reaction was the pre – syncopal or vasovagal reaction, upon which the bleeding was immediately discontinued, patients limbs were lifted and vital parameters like pulse and BP were monitored. Most of the donors in this category were first time donors. This is also the reason why we defer donors who come to donate blood on empty stomach without any food intake. The other adverse reactions were hematoma formation, which resolved flowing local ointment applications, an accidental arterial puncture, which was taken care of immediately. With blood donation comes the risk of transfusion transmitted diseases, hence our study also recorded the prevalence of the same along with a note of the group affected. We conclude that negative blood groups are found to be more prone to transfusion transmitted infections, as proven by similar studies (21). HIV was seen more in donors with blood group O while, HBsAg, HCV and VDRL were seen predominantly in donors with group A. Till date not much studies have confirmed an association between blood groups and the transfusion transmitted diseases (21),(22). LIMITATIONS The study represents only a purposive sampling, and also documents the distribution of blood groups in a semi – urban region, which may not be representative of the entire population in general. | |||||||||||||||||||||||||||||||||||||||||||||||
CONCLUSION | |||||||||||||||||||||||||||||||||||||||||||||||
Timely and efficient delivery of blood bank services in hospitals to a great extent depends on the knowledge of availability and distribution of blood groups in various regions. Donor safety is important as adverse donor reaction has a negative impact on blood donor return rates [BDRR], Blood banks today must working with high alert and vigilance to minimise them leading to better donor satisfaction, this being all the more crucial if we have to increase the percentage of voluntary donors. Although till date the literature has no proven association between the blood groups and transfusion transmitted diseases, large scale studies are needed in the near future to filter high prevalence group donors as high risk cases. | |||||||||||||||||||||||||||||||||||||||||||||||
ACKNOWLEDGEMENT | |||||||||||||||||||||||||||||||||||||||||||||||
We thank Mrs. Vijaya Joseph, our senior blood bank technician and all the staff of our blood bank for their patience and support throughout the study. | |||||||||||||||||||||||||||||||||||||||||||||||
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TABLES AND FIGURES | |||||||||||||||||||||||||||||||||||||||||||||||