SYSTEMATIC REVIEW OF THE INCIDENCE OF TRANSFUSION-TRANSMITTED INFECTIONS IN THALASSEMIA PATIENTS RECEIVING MULTIPLE BLOOD TRANSFUSIONS

Abstract

Background: Transfusion-transmitted infections (TTIs) pose a serious threat to thalassemia patients who rely on lifelong blood transfusions. Despite advancements in donor screening and testing methods, infections such as hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis continue to impact patient outcomes, particularly in resource-limited settings. Existing literature shows regional variation in the prevalence of TTIs, with developing countries experiencing higher rates due to inconsistent transfusion protocols and lack of advanced screening technologies. There remains a gap in comprehensive global data assessing the burden of TTIs in thalassemia populations.

Objective: This systematic review aims to evaluate the global incidence and distribution of TTIs—specifically HBV, HCV, HIV, and syphilis—among thalassemia patients undergoing multiple blood transfusions, with a focus on identifying geographic disparities and gaps in transfusion safety practices.

Methods: A systematic review was conducted following PRISMA guidelines. Literature published between January 2010 and December 2024 was searched across PubMed, Scopus, and Web of Science. Studies were included if they reported prevalence or incidence of TTIs in transfusion-dependent thalassemia patients. Exclusion criteria included case reports, reviews, and non-English articles. Data were extracted using a standardized form and assessed for quality using the Newcastle-Ottawa Scale.

Results: Eight studies were included, spanning regions such as Southeast Asia, the Middle East, and Europe. HCV was the most commonly reported infection, with prevalence rates up to 52% in Egypt and 46% in Pakistan. HBV infection ranged between 10–19% in several low-resource settings, while HIV remained less common, especially in countries with established nucleic acid testing (NAT). Co-infections and regional discrepancies in TTI prevalence were prominent, primarily due to varying screening methods and donor selection practices.

Conclusion: TTIs remain a significant health concern for thalassemia patients, particularly in low- and middle-income countries where transfusion safety protocols are suboptimal. Although advanced screening techniques like NAT have reduced TTI risks in developed nations, their limited accessibility in resource-poor areas perpetuates infection risks. Standardized global protocols, widespread NAT implementation, and targeted education are essential to improve transfusion safety and patient outcomes. Further longitudinal studies are needed to assess the long-term impact of TTIs in this vulnerable population.