Seroprevalence of hepatitis B and hepatitis C viral infections in thalassemia patients undergoing multiple blood transfusions in a Tertiary Care Hospital

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Thalassemia is one of commonest hereditary disease worldwide, prevalent in humid climates and affects all races. The Transfusion Dependent Thalassemias require regular blood transfusion to survive. The thalassemia patients require lifelong blood transfusion on regular basis- usually administered every 2 to 5 weeks. Due to regular blood transfusion, transfusion transmitted disease e.g. Hepatitis B Virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency Virus (HIV) infections can occur.

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Nội dung Text: Seroprevalence of hepatitis B and hepatitis C viral infections in thalassemia patients undergoing multiple blood transfusions in a Tertiary Care Hospital

Int.J.Curr.Microbiol.App.Sci (2021) 10(03): 1339-1346 International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 10 Number 03 (2021) Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2021.1003.164 Seroprevalence of Hepatitis B and Hepatitis C Viral Infections in Thalassemia Patients Undergoing Multiple Blood Transfusions in a Tertiary Care Hospital Anupriya Yadav*, Rameshwari Bithu, Manju Yadav and Rakesh K. Maheshwari Department of Microbiology, Sawai Man Singh Medical College and Attached Hospitals, Jaipur, Rajasthan, India *Corresponding author ABSTRACT Thalassemia is one of commonest hereditary disease worldwide, prevalent in humid climates and affects all races. The Transfusion Dependent Thalassemias require regular blood transfusion to survive. The thalassemia patients require lifelong blood transfusion on regular Keywords basis- usually administered every 2 to 5 weeks. Due to regular blood transfusion, transfusion Hepatitis B and transmitted disease e.g. Hepatitis B Virus (HBV), Hepatitis C virus (HCV) and Human Hepatitis C Viral Immunodeficiency Virus (HIV) infections can occur. Aim of the study is to evaluate the Infections, prevalence of Hepatitis B & C viral infections transmitted by blood transfusion among Seroprevalence thalassemia patients. Observational study conducted over a period of one year, a total of 118 thalassemia patients were studied. Patients were screened for Hepatitis B and Hepatitis C viral Article Info infections by rapid test kits and the conformation was done by ELISA. Out of 118 thalassemia Accepted: patients, 74 (62.7%) were male and 44 (37.3%) were females. Out of them 36 (30.5%) patients 12 February 2021 were anti–HCV reactive and none was reactive for HBsAg. Multi transfused patients must be Available Online: regularly tested and monitored to ensure safe blood transfusion practices. The patients should 10 March 2021 be encouraged to stick to one thalassemia management centre. Stringent donor screening, use of modern advents such as NAAT (nucleic acid amplification test) and PCR for screening of blood bags for HBV and HCV infection and bringing awareness in community will help in reducing the problem statement. Introduction of normal globin chain in blood due to defect in chromosome 11 (Cappellini et al., 2014). Thalassemia is one of commonest hereditary According to the chain whose synthesis is disease worldwide, generally prevalent in impaired, thalassemia are called α,β,γ and δ humid climates but affects all races (Belayet thalassemia. β thalassemia is then divided into Hossain et al., 2017). This disease causes major and minor depending on severity of morbidity, mortality, lot of financial and symptoms and requirement of blood emotional miseries to the family. Thalassemia transfusion. Thalassemia major is inherited in refers to a group of blood disease an autosomal recessive pattern (chromosome characterised by decreased or absent synthesis 11) and thalassemia minor is inherited in 1339
Int.J.Curr.Microbiol.App.Sci (2021) 10(03): 1339-1346 autosomal dominant pattern. Regular blood Transfusion transmitted disease (TTD) is a transfusion is required in beta thalassemia major challenge to the transfusion services all major (Standards of care guidelines for over the world. Hepatitis B and Hepatitis C Thalassemia. 2012). infection carrier rate is about 1-5% and 1% respectively, so post transfusion Hepatitis is a Thalassaemia is a major problem in the major problem in India. countries around the Mediterranean Sea, the Middle East and Trans-Caucasus, India, and Hepatitis B has a worldwide distribution with the Far East (Kheya Mukherjee et al., 2017). marked geographical variation in prevalence. India is second most populous nation in world Current estimates suggest that 300-400 and carry approx. 30 million cases of million people worldwide have HBV thalassemia. Maldives (18%), Cyprus (14%), infection leading to 250000 deaths per year Sardinia (10.3%) and Southeast Asia (3-5%) (Willium et al., 1992). It is estimated that have the highest number of carriers (Flint J. et about 2billion people have serological al., 1998). Due to regular blood transfusion, a evidence of current or past HBV infection series of complications like iron toxicity, worldwide, of which more than 350million hypersplenism, venous thrombosis, have chronic HBV and 1.2 million die osteoporosis and transfusion transmitted annually from chronic hepatitis, cirrhosis and disease e.g. Hepatitis B Virus (HBV), hepatocellular carcinoma (Lavanchy et al., Hepatitis C virus (HCV) and Human 2004). Global prevalence of HBV range from Immunodeficiency Virus (HIV) infections can 2% to more than 8% (Burnett et al., 2005). occur (Neeraj H. Shah et al., 2016) HbsAg carrier rate in India is 2%-7%. Approx. 43million people are HBV positive The decision to transfuse patients chronically in India and the number of HBV carrier is should include a plan for blood administration estimated to be 50million (Martin C et al., and for evaluation of its efficacy and safety. 2001). Seroprevalence of HBV in Only in this way does the patient receive Thalassemia patients in India is 3.38% maximal benefit from the use of precious and (Kheya Mukherjee et al., 2017). The limited human resource. In India the distribution patterns of HBV genotype and infections for which effective screening of mutants is characteristically distinct in eastern blood products are currently mandatory are part as compared to other part of India, where HIV, HBV, HCV, Syphillis and Malaria in addition to HBV genotype A and D, (Narayan, 2001). genotype C is also present in comparable proportion (Sibnarayan Datta, 2008) The viral agents transmitted by blood transfusion share certain characteristics and Natural infection occurs in humans only and hall mark is persistence of infection: carriers maintain the virus in their blood. HBV infection is transmitted by parenteral, Long incubation period sexual and perinatal modes. Carrier or latent state Asymptomatic sub clinical infection Blood transfusion is responsible for majority Viability in stored blood of the cases of hepatitis C, it is a major source of preventable cause in post transfusion cases. These characteristics enable viruses such as Nearly 180 million people are infected with HBV, HCV and HIV to be transmitted by hepatitis C worldwide (Simmonds P et al., blood transfusions (Margolis HS et al 1991). 1994). Out of 6 main groups of sequence 1340
Int.J.Curr.Microbiol.App.Sci (2021) 10(03): 1339-1346 variants (type 1-6), genotype 3 is most antibodies will be performed in a batch along prevalent genotype in north and central India with two negative and two positive controls (Goyal et al., 2006). Hepatitis C virus is a by Rapid tests and by third generation ELISA major cause of post transfusion hepatitis kits. Tests will be performed according to the infection which leads to long term directions given in kit insert. The complications like cirrhosis and demographic variables were recorded on a hepatocellular carcinoma. Prevalence of HCV predesigned proforma. It included name, age, in beta thalassemia patients ranges from 3- sex, address, blood group, Rh factor, no. of 67% (Emothal, 2007). Approximately transfusion, age of starting transfusion, 15million people are HCV positive in India. Hepatitis B immunization. Seroprevalence of HCV in India is 0.9% and among blood donor is 0.7%. HCV infection Results and Discussion has gained importance as one of major complications in multiple transfused patients, In our study, conducted on 118 Thalassemia specially in countries where HCV is more patients, we evaluated the seroprevalence of prevalent in general population and also Hepatitis B and Hepatitis C in thalassemia amongst blood donors (Hamid Hussain et al., patients. The important observations in the 2008). Seropositivity of HCV increases with study were as follow: the number of transfusions. However, since no vaccine is available against hepatitis C, the In our study males (62.7%) were affected only effective measure against the virus is more as compared to females (37.3%). Mean provision of HCV negative blood for age of study population was 7.31±4.09 years transfusion in thalassemia patients. HCV and median age was 7 years. hepatitis is more threatening than HBV hepatitis due to greater risk of chronic liver Out of total 118 patients of thalassemia, disease (Satia et al., 2016). 36(30.5%) patients were positive for anti- HCV and 82(69.5%) negative for anti-HCV Materials and Methods by rapid screening method -TRIDOT. None of the thalassemia patients was HBsAg It was a retrospective study conducted over a positive. Out of 36 anti-HCV positive period of one year (June 2019 to June 2020) patients, 24 (66.7%) patients were males and in the Department of Microbiology, SMS 12(33.3%) patients were females. In 0 -5 year Medical College and attached Hospitals. The age group-2(8.3%) patients were anti-HCV study population included the thalassemia positive males. In 5.1-10 years age group- patients of age less than 18 years and received 9(37.5%) patients were male and 5(41.7%) more than 6 blood transfusion. The blood patients were anti- HCV positive females. In from 118 multiple transfused Thalassemic 10.1-14 years age group- 8(33.3%) and patients is collected in plain vial and tested by 6(50%) patients were anti-HCV positive rapid test and then confirmed by ELISA for males and females respectively. In 14.1-18 antibodies to HCV and HBs Antigen.5ml years age group- 5(20.8%) and 1(8.3%) blood sample of Thalassemia patients will be patients were anti-HCV positive males and collected under aseptic precautions by a clean females respectively (p -value
Int.J.Curr.Microbiol.App.Sci (2021) 10(03): 1339-1346 starting transfusion in thalassemic patients not immunized.1 (0.8%) patient was of was 13.69±15.93 months and median was unknown immunization status. Infection of 7years. The mean number of blood HBV was not seen in any patient, not even in transfusion in HCV positive unimmunized patients. Majority of patients patients=101.39±51.15 (p- value100. group respectively. Out of 23 A+ ve thalassemia patient, 4 (13.7%) patients were Mean hemoglobin level of study population anti- HCV positive. Out of 43 B+ ve was 8.19±1.30 gm% and median was thalassemia patients, 13 (30.2%) patients were 8.25gm%. anti-HCV positive (Table 4). Rural population (77.1%) was more affected All thalassemia patients (1) of B- ve blood than urban population (22.9%).63.9% (n=23) group were anti- HCV(1) positive. Out of 38 anti- HCV patients were from rural area and O+ ve thalassemia patients, 15 (39.5%) 36.1% (n=13) from urban area with p -value patients were anti-HCV positive. Out of 5 O- 0.023, which is significant at 5%. Out of all ve thalassemia patients, 3 (60%) patients were anti-HCV positive patients 8.3% (n=3) anti- HCV positive. patients had splenomegaly. p- value for anti – HCV positive patients of In our study 82.2% patients were immunized various blood group =0.048, significant at with Hepatitis B vaccine, 16.9% patients were 5%. Table.1 Association of anti- HCV and HBsAg seroprevalence with age interval Sex Male(24) Female(12) anti- HCV by HBsAg anti- HCV by HBsAg Positive Positive Positive Positive N % N % N % N % Age 0 to 5 years(42) 2 8.3% 0 0% 0 0% 0 0% intervals 5.1 to 10 years(46) 9 37.5% 0 0% 5 41.7% 0 0% 10.1 to 14 8 33.3% 0 0% 6 50.0% 0 0% years(22) 14.1 to 18 years(8) 5 20.8% 0 0% 1 8.3% 0 0% 1342
Int.J.Curr.Microbiol.App.Sci (2021) 10(03): 1339-1346 Table.2 Association of blood transfusion with HCV infection Anti- HCV Positive HbsAg Positive N=36 N=0 No of Transfusion 6-25 0 0 0% 0% 26-50 5 0 13.9% 0% 51-75 8 0 22.2% 0% 76-100 8 0 22.2% 0% Above 15 0 100 41.7% 0% Total 36 0 100.0% 0% Table.3 Association of Hepatitis B immunization with HBV infection Hep B immunization Total Anti HCV HBsAg Positive Thalassemia Positive patients N % N % Yes 97(82.2%) 29 80.6 0 0 No 20(16.9%) 6 16.7 0 0 Don't know 1(0.8%) 1 2.8 0 0 Table.4 Association of blood group with thalassemia and anti-HCV patients Blood Rh Total Anti HCV HBsAg group factor Thalassemia Positive N=36 Positive patients N=0 No. % No. % A +ve 23(19.4%) 4 13.7 0 0 -ve 1(0.8%) 0 0 0 0 AB +ve 7(5.9%) 0 0 0 0 -ve 0 0 0 0 0 B +ve 43(36.4%) 13 30.2 0 0 -ve 1(0.8%) 1 100 0 0 O +ve 38(32.2%) 15 39.5 0 0 -ve 5(4.2%) 3 60 0 0 1343
Int.J.Curr.Microbiol.App.Sci (2021) 10(03): 1339-1346 Table.5 Complete profile of thalassemia patients having anti-HCV and HBsAg infection anti- HCV by Tridot p-value Positive Negative Mean SD Mean SD Age (in years) 10.58 3.33 5.87 3.54
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