Despite the fact that blood transfusion saves millions of lives every year, unsafe blood remains as a threat for the spread of infections. Moreover, it’s also important to address the fact that safe blood is considered a universal right, and it should not cause any harm. Thus, it should be fully screened and ensured not be contaminated by any transmissible infection.(9)
Blood donation centers are among valuable sources of data, as the prevalence of transfusion transmissible infections among blood donors differs throughout the world, and it can reflect the burden variations among these populations. This is due the fact that blood donors are usually representing the healthy members of the community, so it can have its inferences on the general population. Currently, the number of registered donors at Blood Donor Center in Hamad Medical Corporation had increased noticeably as a result of the continuous promotion, motivation, guidance, and education efforts about the importance of blood donation, which led to overall rise in the general public awareness.
In this study, it was found that around 90% of blood donations were by male donors, which was consistent with several studies, in which blood donations were predominantly by male donors.(10,11) However, some studies showed that this difference in number of donations between gender is much less.(12,13) The change in the country’s population composition could have its implications on these findings, as large proportion of the country’s population are expatriate residents, and mostly been male working immigrants.
Similarly, the literature showed that women contribute less to blood donations than men due to a number of factors, and physiological factors are among the important ones, which include weight difference between men and women, the concurrent losses due to menstruation in women, in addition to lactation and pregnancy for child bearing women. Therefore, men can give blood every 12 weeks, but women can donate every 16 weeks or more, with a variation of 4–6 donations per year for men and 3–4 donations for women.(14) In addition to that, some studies discussed other factors such as social and cultural norms that are less empowering women, developing countries as an example. These include, lack of access to education, employment and independent income.(15)
The predominance of males’ contribution to blood donations was also observed in regards transfusion transmissible infections positivity rates, as this study showed a consistent predominance throughout most of the years, in which rates were higher in male donors. These was similar to the findings from studies in the region.(16–19)
In general, younger population seems to contribute more to blood donation, as it was shown in several studies, as most of donors were less than 30 years in age.(10,20,21) However, in this study most of the blood donors found to be aged 31–40 years old. This was also shown in regards the positivity rate for transfusion transmissible infections, as the highest proportion of positivity rate among all positives was found among the same age group. However, the rates were found to be highest among younger population (20–29 years) age group, from other studies in countries from different regions.(20–22)
In literature, it has been discussed that young males are more to be involved in risky behaviors than females and older age groups. Moreover, results from a number of studies showed that some donors are involved in risky behaviour activities, yet, they contribute to blood donation. The reason is that they are using it as a way to check if they were infected with any of the infections that can be related to their risky behaviours.(23–25)
In this study, the positivity rate of the combined tests including serological and NAT tests were assessed throughout the years 2013 to 2017. By assessing these rates through five years period, we were able to identify the trend for these infections, as a gradually increased trend for the positivity rate of the combined tests was identified. Despite this increase in the trend throughout the years, yet, the rates were less than what was found in other countries from the region, e.g. Saudi Arabia, where the positivity rates ranged between 6.8 and 7.4 from 2011through 2014.(26)
Moreover, the trends for each infection of the TTs were also assessed in this study. The results showed a declining trend for HBsAg throughout the years, form 0.34 in 2013 to 0.29 in 2017. These rates are less than what have been found in studies from countries in the region including Saudi Arabia, Kuwait, Jordan and Egypt.(27) The decline in these rates can be attributed to the effective prevention and control strategies including vaccination programs.(28)
On the contrary, the rates for HCV Ab showed a slightly increasing trend from 0.58 in 2013 to 0.70 in 2017. These rates were less than the reported from Egypt and Saudi Arabia,(29) which can be attributed to the high prevalence of the disease among general population and the migration from these countries to other countries with lower prevalence.(30) This was consistent with the findings from this study, as the rates were higher among the Non-Qataris throughout the years. However, the rates were higher than what was reported from other countries in the same region (i.e. middle east region), like Iran and Turkey.(29)
Furthermore, screening for HTLV is also among the recommended screening for transfusion, this include two viruses: I and II that differs in their geographical distribution and clinical disease association. HTLV is endemic in some parts of the world, and in some regions, prevalence of the virus is very low or it may be totally absent, as the situation here in Qatar.
The cost effectiveness of the universal screening strategies for HTLV has been argued. This was especially for the screening implementation by high income countries with low prevalence of the infection.(31,32) Qatar is among these countries, however, it is a destination for working force from all around the world, including areas endemic with the virus. Therefore, HTLV is among the screening requirements for blood safety in the country. The positivity rate for HTLV I/II Ab in 2017 found to be 0.23, which represents an increasing trend from 0.08 in 2103. Further analysis for the findings showed that the positivity rates were more in Non-Qataris than Qataris for the viral antibodies screening, in addition to zero positivity among Qataris for the viral confirmatory test (i.e. INNO-LIA), which is consistent with the epidemiological distribution of the disease, considering Qatar as a low prevalence area for HTLV.(33)
The blood safety can be threatened by donors with risky behavior as they may potentially acquire syphilis, among other infections. In this study, the positivity rates for Syphilis Ab among donors throughout the years showed a fluctuating trend that reported to be 0.48 in 2013, and to be 0.45 in 2017, and these rates were higher in Non-Qatari throughout the years. Yet, these rates were less than what was found in studies in neighboring countries, such as Saudi Arabia.(10,34) Moreover, it’s important to consider the fact that a specific assay is been used to screen for syphilis (i.e. Treponema pallidum Ab), which leads to identifying who ever has been infected with syphilis, whether it is a recent or past infection, and whether it was treated or not, which may result in overestimation of the disease burden.(31)
Another serious infectious agent that remains to risks blood safety is the transfusion associated malaria. In which the country is free from a local transmission of malaria and all reported cases are imported from abroad, through migrants and travelers from endemic countries. Findings from our study are consistent with the situation among the general population, as the rates of positivity for Malaria Ag were found to be higher among Non-Qataris throughout the years. Moreover, assessing these rates throughout the year revealed a fluctuating trend, ranged between 0.10 and 0.14 in most of the years, with exception of the years 2014 and 2015, as the rates were 0.24 and 0.42, respectively. In addition to that the overall positivity rate found to be 0.18, almost the same to what was found in Saudi Arabia.(35)
In summary, the overall positivity rate of transfusion transmissible infections among blood donors were assessed through combined serological in addition to NAT tests, and results revealed a gradually increasing trend throughout the years, for these infections when combined together. However, this study also revealed a decreased trend for HBV, Syphilis and Malaria and increasing trends were identified for HCV and HTLV, with further analysis revealed that the rates were higher among Non-Qataris throughout the years. Despite the important study findings, there are a number of limitations that are worth to be mentioned. Among which, is the fact that this is a retrospective study conducted by utilizing records in the blood donor center, therefore, the study was limited to the data in these records only, which include results of the screening tests in addition to basic demographics (i.e. age, gender, nationality). Moreover, these records were limited to short time period, i.e. five years, from 2013 to 2017. Another limitation of this study is not including data about HIV, due to the sensitivity and the complexity of these data. Finally, it was not possible to assess the outcome of donors with positive results for any of the infections, as the donation records is not connected with the medical records.