One in 20 blood donations in Sindh infected with TTIs

SBTA data shows 5.7pc of blood donations in 2025 detected reactive for at least one infection

By Mukhtar Alam

KARACHI: Thousands of donated blood units in Sindh were discarded in 2025 after screening detected transfusion-transmissible infections (TTIs), highlighting continuing public health challenges and gaps in safe donor recruitment, this emerged lately.

Data compiled from four regional blood centres (RBCs) and blood banks registered with the Sindh Blood Transfusion Authority (SBTA) show that 47,375 blood units were rejected after testing positive for infections such as HIV, hepatitis B, hepatitis C, syphilis and malaria.

The figures indicate that 5.7 per cent of the 833,050 blood donations screened during the year were found reactive for at least one infection, meaning roughly one in every 20 donated blood units could not be used for transfusion.

According to SBTA records, 209 licensed blood banks across Sindh collectively received 932,966 donors in 2025 -- 920,585 males and 12,381 females (1.3 per cent). Of these, 99,916 donors were deferred for medical or eligibility reasons.

Voluntary donors accounted for 138,268 donations (15 per cent), while the vast majority — 794,701 donations — came from replacement or family-arranged donors.

The infection pattern detected during screening showed hepatitis C as the most prevalent infection at 2.36 per cent (19,689 units), followed by hepatitis B at 1.73 per cent (14,458), syphilis at 1.31 per cent (10,927), HIV at 0.15 per cent (1,249) and malaria at 0.12 per cent (1,052 units).

A comparison of blood collection data also revealed differences between government-run regional blood centres and privately operated blood banks.

The four RBCs — located in Jamshoro, Karachi, Shaheed Benazirabad and Sukkur — collectively received 204,772 donors -- 203,239 males and 1,533 females. Of these, 31,141 donors (15.2 per cent) donated voluntarily, while 173,630 were replacement donors.

By contrast, registered blood banks across the province collected 728,198 donations -- 107,127 voluntary donations (14.7 per cent) and 621,071 replacement or family donations.

Among the regional facilities, the Jamshoro Regional Blood Centre recorded the highest number of donors at 110,037, of which 5,611 blood units were discarded after testing positive for TTIs, including 2,359 hepatitis C, 1,430 hepatitis B, 130 HIV and 581 syphilis.

Overall, the four RBCs detected 358 HIV-reactive blood units, compared with 891 HIV-positive samples identified in other blood banks across the province.

In total, 204,771 donors approached the four regional centres, of whom 38,014 were deferred while 166,757 samples were screened, leading to 13,054 blood units being discarded due to TTIs.

Officials say the government-supported regional blood centres are responsible for blood collection, screening, testing, storage management, coordination with hospitals and public awareness campaigns aimed at promoting safe blood donation practices.

Year-to-year comparison

A comparison with the previous year shows that the prevalence of transfusion-transmissible infections among blood donors has remained a persistent concern.

Official SBTA data indicate that in 2024, blood banks and regional blood centres across Sindh collectively received 934,760 donors. Of these, 105,785 donors were deferred, while 828,975 blood samples were screened, leading to 46,158 units (5.56 per cent) being discarded after testing positive for TTIs.

The infection pattern recorded that year showed hepatitis C at 1.9 per cent, syphilis at 1.6 per cent, hepatitis B at 1.5 per cent, HIV at 0.1 per cent and malaria at 0.1 per cent among screened donors.

Experts call for stronger safeguards
Public health specialists say the continued detection of TTIs among blood donors reflects broader gaps in infection control, donor awareness, and safe medical practices in the community. While screening systems prevent infected blood from entering the transfusion chain, each reactive donation not only represents a discarded unit but also signals infections circulating silently among otherwise healthy individuals.

Health experts underline the fragile balance between rising demand for blood transfusions and the need to maintain uncompromising safety standards. They stress that blood banks serve as critical surveillance points for detecting undiagnosed infections in the population.

Dr Abdul Ghafoor Shoro

Dr Abdul Ghafoor Shoro, Secretary General of the Pakistan Medical Association (PMA), described the five per cent infection rate among donors as “highly concerning.”

“In many high-income countries this rate is often below 0.1 per cent. At five per cent, it means that roughly one in every 20 donors is carrying a serious infection,” he said.

He noted that such levels reflect the high background prevalence of hepatitis B, hepatitis C and HIV in the community, placing immense pressure on blood screening systems to ensure infected blood never reaches patients.

Dr Shoro also pointed to Pakistan’s continued reliance on replacement donors, who account for more than 80 per cent of blood donations.

“These donors are often under social pressure to donate and may hide high-risk behaviours,” he said, adding that voluntary non-remunerated donors generally show significantly lower infection rates.

The PMA secretary warned that blood collection outside formal regulatory systems — including unlicensed or poorly equipped facilities — poses a major safety threat, particularly where sub-standard rapid tests replace laboratory-grade screening.

Hidden reservoir of infection

Dr Uzma Ata, Director of the Regional Blood Centre project at Dow University of Health Sciences, said the findings point to a large pool of undiagnosed infections in the community.

“At this rate, one in every 20 individuals presenting to donate blood is carrying a potentially life-threatening pathogen,” she said.

She explained that weaknesses in donor screening procedures often represent the first breach in the transfusion safety chain.

Dr Uzma Ata

“When donor histories are not properly evaluated and physical assessments are superficial, infected but asymptomatic individuals may be cleared for donation,” she said.

Dr Ata emphasised that blood safety depends on rigorous donor questionnaires, sensitive screening technologies such as ELISA, CLIA and nucleic acid testing, and proper counselling and referral systems for reactive donors.

“Blood safety is not a single test,” she remarked. “It is a system that must function correctly at every step.”

Infection control gaps

From an infectious disease perspective, Prof Dr Rafiq Khanani, President of the Infection Control Society of Pakistan, said the findings should be viewed as an important epidemiological warning.

“When nearly one in 20 donations shows seroreactivity for infections such as hepatitis B, hepatitis C or HIV, it reflects the broader burden of these infections in society,” he said.

He attributed the prevalence to multiple factors including unsafe medical injections, unsterile barber procedures, intravenous drug use and the absence of a strong voluntary donor pool.

Prof Khanani also pointed to the overuse of blood transfusions, noting that many cases could be prevented through early diagnosis and treatment of anaemia.

He stressed the need for strict donor screening policies, universal testing of blood units using validated assays and the establishment of a comprehensive “vein-to-vein” hemovigilance system to track blood safety from donor to recipient.

Prof Dr Rafiq Khanani

According to him, pre-donation screening and risk assessment, when conducted properly by trained personnel and supported by confidential self-exclusion systems, are highly effective. However, practical gaps frequently emerge due to inadequate interviewer training, time pressures in busy centres, cultural stigma that discourages honest disclosure, and the inherent vulnerabilities of replacement donation models.

“Blood safety must not be viewed merely as a laboratory function,” he said. “It is an integrated public health responsibility.”

Risks for chronically transfused patients

Dr Saquib H Ansari, a senior haematologist and bone marrow transplant physician, emphasised the need for stronger regulatory oversight and better-trained blood bank personnel.

He noted that Pakistan lacks a structured training programme for many blood bank staff, leaving technicians to learn critical procedures informally after entering the profession.

Dr Ansari, who also heads a charity thalassaemia care centre, expressed concern over the potential consequences of unsafe blood transfusions for children requiring frequent transfusions.

Dr Saquib H Ansari

“Our slackness or compromises over blood safety may expose innocent child recipients to additional diseases,” he warned.

He stressed that increasing voluntary blood donation remains essential to improving blood safety, although repeat donors must still undergo proper screening each time they donate.

“Paid donors have largely been discouraged, but voluntary donors still account for only around 10 per cent of donations in the country,” he said.

 (Published by Social Track, Karachi (February 27, 2026)