DOI: https://doi.org/10.53350/pjmhs22162269 ORIGINAL ARTICLE P J M H S Vol. 16, No.02, FEB 2022 269 The Analysis of Transfusion Transmitted Infections (TTIs) in Thalassemia Patients TAYYABA BATOOL 1 , SHAHEENA NAWAB 2 , BADAR MEHMOOD 3 , NADEEM SHAHID YOUNAS 4 , MUHAMMAD IRFAN KHAN 5 , KHADIJA NADEEM 6 1 Assistant Professor, Department of Biochemistry, Quaid-e-Azam Medical College / Bahawal Victoria Hospital, Bahawalpur. 2 Senior Demonstrator, Department of Physiology, Quaid-e-Azam Medical College, Bahawalpur. 3 Medical Officer, Department of Hematological diseases, Thalassemia & Bone Marrow Transplant Centre. Quaid-e-Azam Medical College / Bahawal Victoria Hospital, Bahawalpur. 4 Registrar, Department of Hematological diseases, Thalassemia & Bone Marrow Transplant Centre. Quaid-e-Azam Medical College / Bahawal Victoria Hospital, Bahawalpur. 5 Assosiate Professor, Department of Hematological diseases, Thalassemia & Bone Marrow Transplant Centre. Quaid-e-Azam Medical College / Bahawal Victoria Hospital, Bahawalpur. 6 A-Levels Roots IVY Science Society, Bahawalpur Corresponding author: Tayyaba Batool, Email: drtayyababatool@yahoo.com, Cell: +923346489449 ABSTRACT Objective: To find out the analysis of transfusion transmitted infections (TTIs) in β-thalassemia patients at a tertiary care hospital of South Punjab, Pakistan. Study Design: A cross-sectional study. Place and Duration of the Study: The Department of Hematological Disorder, Thalassemia and Bone Marrow Transplantation Centre, and Department of Biochemistry, “Bahawal Victoria Hospital, Quaid e Azam Medical College”, Bahawalpur, Pakistan from February January 2020 to December 2021. Methodology: Patients of blood transfusion-dependent -thalassaemia of both genders and aged 5 to 12 years were analyzed. Blood was collected from patients aseptically and serum separated in Eppendorf tubes and stored at –20 0 C. Screening for hepatitis C virus (HCV), hepatitis B virus (HBV), syphilis and human immunodeficiency virus (HIV) were performed through Chemiluminescence Immunoassay (CLIA) technique. Results: In a total of 1212 patients, 745 (61.5%) were male. Overall, mean age was calculated to be 8.7±4.6 years while 874 (72.1%) patients were below 10 years of age. There were 866 (71.5%) patients who belonged to rural areas of residence. Parental consanguineous marriages were reported in 951 (78.5%) cases. There were 205 (16.9%) patients who were found to have TTIs. Out of these 205 patients, 169 (13.9%) were having HCV, 11 (0.9%) HBV, 20 (1.7%) syphilis whereas HIV was noted in 5 (0.4%) patients. Conclusion: Prevalence of TTIs was found to be high among multi-transfused patients of β-thalassemia. Most common types of TTIs were HCV which is consistent to what has previously been reported in the local literature. Identification of HIV in 0.5% cases in the present study is pointing towards disturbing development regarding spread of HIV in our region. Keywords: β-thalassemia, blood transfusion, hepatitis C, hepatitis B, human immunodeficiency virus. INTRODUCTION Thalassemia is the World's most common disorder of single gene, which is involved in the synthesis of hemoglobin chain. 1 It comprises of a group of hemolytic disorders where approximately 1.5 percent of the World population are considered to be beta thalassemia carriers. 2 Further, the number of new born thalassemia patients range between 50,000-60,000. 3 This disease is prevalent mostly in Mediterranean region, in South East Asia, Africa and Middle East. 4 In Pakistan the prevalence of thalassemia is maximum among other genetic disorders. Its carrier form, also referred to as thalassemia minor prevails about 5 to 7 percent (8-10 Million) in Pakistan and the severe form of the disease; thalassemia major causes 100,000 patients in the country to suffer from thalassemia major. Unfortunately, this figure increases every year by 5000- 9000. 5,6 The management of thalassemia major mainly comprises of sufficient but safe transfusions of blood along with regular timed therapy for iron-chelation. Providing adequate treatment facilities for children suffering from thalassemia exceeds the resources available by the government. 7 Hence, the services of blood transfusion provided to thalassemia patients in Pakistan are quite fragmented, mainly because of increase in several forms of blood centers. It is estimated in a report that more than 1800 blood centers are functional in the country and private organizations dominate here. 8 So, the majority of thalassemia patients turn to NGOs who have insufficient resources and poor facilities. This poses severe challenge on the lives of these thalassemia patients in the form of transfusion transmitted infections (TTIs). Most significant and lethal TTIs include Hepatitis C virus, Hepatitis B, HIV and syphilis. 9 The magnitude of TTI depends on the prevalence of a disease or an infection among the community involved in donating blood. In Pakistan the burden of infection causing liver cirrhosis have increased in the recent decades. 10 This study was conducted to find out the analysis of TTIs in β- thalassemia patients who turn to a tertiary care hospital, BVH, in Southern Punjab for blood transfusion. METHODOLOGY This cross-sectional study was done at “The Department of Hematological Disorder, Thalassemia and Bone Marrow Transplantation Centre, and Department of Biochemistry, Bahawal Victoria Hospital, Quaid e Azam Medical College”, Bahawalpur, Pakistan from February January 2020 to December 2021. Approval from “Institution’s Ethics Committee” was taken. Informed written consent was acquired from parents/guardians of all study participants at the time of enrollment. A total of 1212 blood transfusion-dependent -thalassaemia patients of both genders and aged 5 to 12 years were analyzed. All patients were receiving regular transfusions every month to aim hemoglobin level between 9 to 10 g/dl. All patients having other coexisting hemoglobinopathies were excluded. At the time of enrollment, gender, age and area of residence were noted. Blood was collected from patients aseptically and serum separated in Eppendorf tubes and stored at –20 o C. Screening for HIV, HBV, HCV and syphilis were performed through Chemiluminescence Immunoassay (CLIA) technique on Abbott ARCHITECT i2000 system. A special proforma was made to record all study data. For data analysis, SPSS version 26.0 was used. Qualitative data was represented as frequency and percentages. Quantitative variables were shown as frequency and percentages. Study variables were compared between patients with and without TTIs applying chi-square test considering p<0.05 as statistically significant.