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Abstract

Background: Beyond their established importance in transfusion medicine, ABO and Rh blood group antigens have been implicated in susceptibility to various infectious and non-infectious diseases. Transfusion-transmitted infections (TTIs) such as hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), syphilis, and malaria remain critical public health concerns, particularly in low-resource settings. Understanding the association of these infections with blood group phenotypes contributes to enhancing blood safety under the One Health approach and supports Sustainable Development Goals (SDGs) 3 and 17.
Objective: This study aimed to determine the prevalence of TTIs among blood donors and assess their association with ABO and Rh blood groups, as well as with donor age categories.
Methods: A retrospective cross-sectional analytical study was conducted at the Rehber Thalassemia Center and Railway General Hospital, Rawalpindi, analyzing data from 46,453 blood donors between January 2020 and December 2024. Donor eligibility was based on standard screening criteria, and 5 mL of blood was collected from each participant. TTIs were screened using an automatic chemiluminescent microparticle immunoassay (CMIA), and malaria was screened using enzyme-linked immunosorbent assay (ELISA). ABO and Rh typing were performed using slide agglutination. Statistical analysis was conducted using the Chi-square test, with p-values <0.05 considered significant.
Results: TTIs were detected in 1,437 donors (3.09%), with HCV being the most prevalent (1.20%), followed by HBV (1.08%), syphilis (0.61%), HIV (0.20%), and malaria (0.002%). Blood group B was most common (33.7%), followed by O (31.6%), A (24.6%), and AB (10.1%), while 91% of donors were Rh positive. No significant association was found between ABO blood groups and TTI markers (HCV p=0.60; HBV p=0.27; HIV p=0.17; syphilis p=0.08), whereas Rh factor showed a significant association with all TTIs (p<0.00001). The highest TTI prevalence was observed in donors aged 26–35 years (n=717, 50.0%) with a statistically significant association (p<0.05).
Conclusion: While ABO blood groups showed no significant association with TTI prevalence, a notable relationship was identified with Rh factor. These findings underscore the importance of enhancing donor screening strategies, especially for high-risk age groups, to improve transfusion safety.