الفهرس 
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Abstract
Blood transfusion saves millions of lives worldwide each year. Blood transfusion has never been associated with zero risk and there is 1% chance of complications associated with it, which includes transfusion transmitted viral infections (TTVIs). The goal of any transfusion service is to provide adequate and safe blood and blood products that meet the needs of patients. Transfusion transmitted infections (TTIS) is a recognized complication of blood transfusion and blood products. Many of these infectious agents may cause lifetime morbidity and/or mortality. The three major viral TTIs associated with blood transfusion are human immunodeficiency (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) viruses. The safety of blood and blood components continues to raise debate all over the world. In the past few decades, many measures have been introduced in order to reduce the risk of transfusion transmitted infections (TTVIs). Human immunodeficiency virus (HIV), Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are important global public health problems. Regarding the disease burden, the World Health Organization estimates that more than 350 million and 170 million people are chronic carriers of HBV and HCV, respectively. In the last few decades through an awareness of TTIs, a majority of countries have mandated serology based blood screening assays for HIV, HCV, and HBV. However, despite improved serological assays, the transfusion transmission of HTV, HCV, and HBV continues, primarily due to release of serology negative units that are infectious because of the window period (WP). Quality-guaranteed screening of all donated blood for TTVIs, including HIV, HBV, and HCV, is recommended by the WHO for the provision of safe and efficacious blood and blood components. This includes the selection of eligible blood donors, the collection of blood, the processing and testing of the donated blood, the issuing of compatible blood, and safe administration of the blood to recipients. Nucleic acid testing (NAT) is a molecular technique for screening blood donations to reduce the risk of transfusion transmitted viral infections (TTVIs) in the recipients, thus providing an additional layer of blood safety. Nucleic acid amplification tests (NAT) have the advantage of earlier detection because viral RNA/DNA appears in the bloodstream before serological markers. However, NAT are comparatively expensive requiring high levels of automation and skilled staff. While optimal screening strategies for HIV, HCV and HBV generally include NAT for its superior ability to identify donors with early infection, there are alternative strategies which can provide almost equivalent sensitivity. The cost-effectiveness of adding NAT testing is uniformly poor, especially where the prevalence of infection is low, although triplex assays for HIV RNA, HCV RNA and HBV DNA conveniently allow screening for all three TTIs and help to make the cost more affordable, especially in low risk populations. where the risk of window period donations is judged high enough to justify the additional cost, for example in South Africa and Thailand, individual-donation testing is used. Our retrospective study was done in the Blood Bank Laboratory of Assuit University Hospitals from January 2017 to June 2019. Trained personnel carefully screened donors. This study was included 66,998 donors who met the donor selection criteria of Egyptian National Transfusion Services. The donor selection takes place in a pre-donation interview with a trained stuff personnel with insurance of privacy and confidentiality. The donation selection process include pre-donation counseling, medical history, health checkup, health assessment and laboratory investigations including: Serological assays: Routine for all blood donors: HBsAgs, HCV antibodies, HIV Ag/Ab and Syphilis Trepanoma pallidum (TP) antibodiesFor the reactive HBV assay by NAT: confirmation of HBV infection by additional HBV serum markers (i.e., total anti-hepatitis B core antibody [anti-HBc], immunoglobulin M [IgM] anti-HBcNucleic acid amplification test (NAT): for HBV –DNA, HCV-RNA and HIV-RNA. In the present study, the overall seroprevalences of HBsAg, HCV, syphilis and HIV were 536 (0.8%), 1193 (1.7%); 47 (0.07%) and 11(0.06%) respectively. The prevalence of NAT yield cases (NAT reactive/seronegative) for HBV among routine donors was 36 in 65,211 donations tested (0.05), for HCV (NAT reactive/seronegative) was 18 in 65,211 donations tested (0.02%) and no HIV NAT yield. In countries with high incidence of infection with significant number of window period donations, NAT can serve as a valuable tool along with other serological testing in high prevalence, resource constrained countries to achieve the goal of zero risk TTIs of blood. Lastly, most of comparative studies similarly reported NAT yield samples, which were negative by serological screening and carrying risk of TTIs even to more than one recipient as the single whole blood unit can be processed at least 3 units of blood components.