Prevalence of Infectious Pathogens Among Voluntary and Replacement Blood Donors in Pakistan: An 18-Year Experience

Blood transfusion is a critical therapeutic intervention; however, transfusion-transmitted infections (TTIs) continue to pose a significant threat to blood safety, particularly in low- and middle-income countries. Pakistan relies heavily on replacement blood donors, which may increase the risk of infectious disease transmission. Long-term surveillance data are essential for assessing trends in TTIs and evaluating the effectiveness of donor screening and blood safety strategies.

This retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore. All blood donors screened between 2006 and June 2024 were included in the analysis. Donors comprised healthy voluntary and replacement donors. Screening for hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency virus (HIV), and syphilis was performed using commercially available assays according to manufacturers' instructions. Demographic and laboratory data were retrieved from the hospital's electronic records. Statistical analysis was carried out using chi-square tests to compare proportions and the chi-square test for trend to evaluate changes in seroprevalence over time.

A total of 168,401 blood donors were screened during the study period. Overall, 7,039 donors (4.17%) tested positive for at least one infectious marker. HCV demonstrated the highest seroprevalence (2.22%), followed by HBV (1.29%), syphilis (0.6%), and HIV (0.1%). The annual prevalence ranged from 1.55% to 0.82% for HBV, 3.94% to 1.34% for HCV, 0.21% to 0.06% for HIV, and 0.9% to 0.17% for syphilis. A statistically significant declining trend in positivity rates was observed for all infectious markers over the 18-year period (p < 0.05).

This 18-year analysis demonstrates a significant reduction in TTIs among blood donors in Pakistan, reflecting improvements in donor selection and screening practices. Nevertheless, the persistently high burden of HCV underscores the need to continue strengthening voluntary blood donation programs and national blood safety initiatives.