A Systematic Review of Transfusion-Transmissible Infections Among Blood Donors and Associated Safety Challenges in Pakistan

Figures & data

Figure 1 PRISMA flow diagram showing a summary of selection process.

Note: Copyright © 2009, Public Library of Science. Adapted with permission from Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

Table 1 Characteristics of Studies (n=33) Included in a Systematic Review

Author, Year	Design	Duration	Age in Years (Range)	Male (%)	No. of Donors	Investigation	Diagnostic Methods
Shah et al, 2010^Citation9	Retrospective cross-sectional	Jan 2007–Dec 2008	(18–52)	100	32,042	HBsAg, anti-HCV Abs	ELISA
Ansari et al, 2012^Citation10	Cross-sectional	Jan 2010–Dec 2010	NA	NA	5517	HBsAg	ELISA, Bio kit, Spain
						Anti-HCV Abs, anti-HIV Abs	ELISA kit, General Biological Cooperation, Taiwan
Waheed et al, 2012^Citation11	Retrospective cross-sectional	Jan 2010–Dec 2011	NA	NA	10,145	Anti-HCV Abs	ELISA NANBASE C-96 3.0
						HBsAg	ELISA
						Anti-HIV Abs	DIMS’s ELISA
						Syphilis RPR	RPR IMMUTREP
						Malarial parasite	Biotech ICT
Attaullah et al, 2012^Citation12	Retrospective	Jan 2008–Jun 2011	NA	99.96	127,828	HBsAg, anti-HCV Abs, anti-HIV Abs, VDRL	ELISA BEST 2000, Biokit, Spain
Irfan et al, 2013^Citation13	Cross-sectional	Jan 2004–Dec 2011	28.9 (17–55)	99.85	108,598	HBsAg, anti-HCV Abs, anti-HIV Abs	MEIA, Axsym system, till 2011 then CIA, Architect i2000, Abbott Diagnostic, USA
Tunio et al, 2013^Citation14	Retrospective cross-sectional	Jan 2012–Jun 2012	NA	NA	2696	Anti-HBs, HBsAg, HBeAg	MEIA, Architect, Abbott Diagnostic, USA
Tufail et al, 2013^Citation15	Descriptive	One year	(20–40)	NA	1833	HBsAg, anti-HCV Abs, anti-HIV Abs	Chemiluminescence assay
Sulehri et al, 2013^Citation16	Cross-sectional	2010–2011	NA	78	600	Anti-HCV Abs	ELISA kits, Human Diagnostics, Germany
Chaudhary et al, 2013^Citation17	Cross-sectional	Jan 2011–Apr 2011	NA	92.7	2155	NA	NA
Ghafoor et al, 2016^Citation18	Cross-sectional	Nov 2015–Jan 2016	(20–50)	94.67	1500	HBsAg, anti-HCV Abs, anti-HIV Abs	ICT SD BIOLINE kits
						Anti-HIV-1, anti-HIV-2 Abs	Tri line HIV rapid test device
						Treponema pallidum IgM and IgG Abs	Rapid Treponema pallidum/syphilis test
Waheed et al, 2016^Citation19	Retrospective	Jan 2015–Dec 2015	NA	NA	65,376	HIV, hepatitis B, hepatitis C, syphilis, malarial parasite	(n=44,538) CIA, (n=6524) ELISA, (n=14,036) NAT, (n=560) manual devices
Sial et al, 2016^Citation20	Observational	Jan 2011–Dec 2013	27.8 (17–50)	90.4	29,522	HBsAg, anti-HCV Abs, anti-HIV Abs, syphilis	CIA, Architect Ci4100, Abbott Diagnostic, USA
Raza et al, 2016^Citation21	Cross-sectional observational	Jul 2014–Jun 2016	29.58	NA	33,595	HBsAg, anti-HCV Abs, anti-HIV 1/2 Abs	CIA, Architect Ci2000, Abbott Diagnostic, USA
							NAT, Cobas Taq screen MPX, Roche Molecular Diagnostics
						Syphilis	CIA, Architect Ci2000, Abbott Diagnostic, USA
						Malarial parasite	ICT
Niazi et al, 2016^Citation22	Descriptive	Jan 2010–Dec 2012	29 (18–60)	98.5	160,552	HBsAg, anti-HCV Abs, anti-HIV Abs	Architect i2000, Abbott Diagnostics USA
						Anti-syphilis Abs	Rapid ICT kit, InTec Products, Inc., Xiamen
Nadeem et al, 2016^Citation23	Descriptive	Jun 2012–May 2013	33 (18–60)	99.4	4662	HBsAg, anti-HCV Abs, anti-HIV Abs	ELISA
						Syphilis	RPR
						Malarial parasite	Biotech Immunochromatographic (ICT)
Arshad et al, 2016^Citation24	Prospective	Jan 2013–Jun 2015	28.6 (18–55)	99.7	16,602	HBsAg, anti-HCV Abs, anti-HIV Abs, syphilis	CIA, Architect Ci2000, Abbott Diagnostic, USA
						Malarial parasite	Thick films and Immunochromatographic (ICT)
Memon et al, 2017^Citation25	Cross-sectional descriptive	Jan 2014–Jun 2015	NA	NA	4683	HBsAg, anti-HCV Abs, anti-HIV Abs	CIA, Architect Ci2000, Abbott Diagnostic, USA
						Syphilis	ICT device with ABON Biopharm (Hangzhou) kit
						Malarial parasite	Thick and thin smear using Romanowsky stain
Zameer et al, 2017^Citation26	Descriptive	Oct 2015–Feb 2016	(18–55)	NA	10,048	HBsAg, anti-HCV Abs, anti-HIV Abs, syphilis, malarial parasite	ICT
Wadood et al, 2017^Citation27	Prospective	Jun 2015–May 2016	NA	97	536	Anti-HCV Abs	Third-generation ELISA
Saeed et al, 2017^Citation28	Prospective	Dec 2014–Nov 2015	(19–59)	99.32	18,274	HBsAg, anti-HCV Abs, anti-HIV Abs, syphilis malarial parasite	ICT
Sultan et al, 2017^Citation29	Prospective	Feb 2015–Feb 2016	29.09	99.5	16,957	HBsAg, anti-HCV Abs, anti-HIV Abs, syphilis	CIA, Architect Ci2000, Abbott Diagnostic, USA
Rehman et al, 2018^Citation30	Cross-sectional	NA	NA	NA	1400	Anti-HCV Abs	ICT and MEIA and ELISA
Raza et al, 2018^Citation31	Cross-sectional	Aug 2014–Jul 2015	NA	NA	16,660	HBsAg, anti-HCV Abs, anti-HIV Abs, syphilis	CIA, Architect Ci2000, Abbott Diagnostic, USA
							NAT, Cobas Taq screen MPX, Roche Molecular Diagnostics
						Malarial parasite	ICT, Rapid SD, Bioline, Korea and Microscopic examination
Awan et al, 2018^Citation32	Cross-sectional descriptive	Jul 2015–Oct 2017	(18–60)	NA	30,470	HBsAg, anti-HCV Abs, HIV 1/2 Ab/Ag	Fully automated immunoassay analyzer and triplex NAT PCR
						Treponema pallidum Abs	CIA
						Malarial parasite	ICT
Naz et al, 2018^Citation33	Cross-sectional	Jan 2013–Jul 2014	28.6± 2	99.8	14,652	HBsAg, anti-HIV Abs, syphilis	CIA, Architect, Abbot
						Anti-HCV Abs	Multisure HCV antibody assay
							NAT, Artus RG RT-PCR kit
							ELISA, Monolisa™ Anti-HCV Plus V2
							Anti-HCV-MPBIO-EIA
							MPD HCV blot 3.0
						Malarial parasite	Microscopy of Leishman’s stained blood films
Abdullah et al, 2019^Citation34	Retrospective cross-sectional	Jan 2016–Dec 2017	(19–60)	NA	76,530	HBsAg	Rapid test kits, Diagnostar
Rauf et al, 2019^Citation35	Retrospective	May 2018–Feb 2019	29	99.97	6594	HBsAg, anti-HCV Abs, anti-HIV Abs, syphilis, malarial parasite	CIA, Roche e611
Masood et al,^Citation36	NA	NA	NA	NA	8517	HBsAg	CIA, Architect Ci2000, Abbott Diagnostic, USA
							PCR using type‑specific primer sequence
Ali et al, 2010^Citation37	Prospective	NA	(15–65)	98.4	1558	Malarial parasite	Thick and thin blood smears with Giemsa stain
Usman et al, 2015^Citation38	Prospective	May 2008–Mar 2014	NA	NA	87,600	Malarial parasite	Thick and thin blood smears with Field’s stain
							ICT test, PL-P MAL, Humasis, Anyang, Korea
Ghani et al, 2015^Citation39	Retrospective	1998–2013	NA	NA	626,413	Anti-HIV Abs	MEIA, Axsym system, till 2007 then CIA, Architect i2000, Abbott Diagnostic, USA
Kousar et al, 2016^Citation40	Observational	Jul 2015–Dec 2015	(17–60)	99.9	6000	Malarial parasite	ICT
							Thick and thin blood smears with Giemsa stain
Zahoor et al, 2020^Citation41	Retrospective cross-sectional	Jan 2016-Dec 2017	NA	NA	76,530	Treponema pallidum Abs	ICT, Nantong Egens Syphilis detection Kits

Abbreviations: ELISA, enzyme-linked immunosorbent assay; RPR, rapid plasma regain; PCR, polymerase chain reaction; NAT, nucleic acid test; MEIA, microparticle enzyme immunoassay; NA, not available; Abs, antibodies; CIA, chemiluminescent immunoassay; ICT, immunochromatographic.

Table 2 Summary of Data from Studies Reporting the Frequency of Hepatitis B and Hepatitis C Among Blood Donors

Study	Number of Donors	Type of Donors^a	Frequency of Hep B (HBsAg)	Frequency of Hep C (Anti-HCV Antibodies)	Frequency of Hep B, Hep C Coinfection
Shah et al^Citation9	32,042	VNRDs (100%)	632 (1.97%)	502 (1.57%)	NR
Ansari et al^Citation10	5517	NR	104 (1.8%)	109 (1.9%)	NR
Waheed et al^Citation11	10,145	RDs (94%) VNRDs (6%)	397 (3.91%)	846 (8.34%)	NR
Attaullah et al^Citation12	1,27,828	NR	3432 (2.68%)	3147 (2.46%)	NR
Irfan et al^Citation13	108,598	RDs (98.8%) VNRDs (1.2%)	2068 (1.90%)	2832 (2.61%)	94 (0.084%)
Tunio et al^Citation14	2696	NR	49 (1.82%)	93 (3.45%)	2 (0.074%)
Tufail et al^Citation15	1833	NR	15 (0.81%)	57 (3.1%)	NR
Sulehri et al^Citation16	600	NR	NR	0%^b 60 (10%)^c	NR
Chaudhary et al^Citation17	2155	VNRDs (100%)	21 (1.3%)	77 (3.6%)	NR
Ghafoor et al^Citation18	1500	VNRDs (100%)	22 (1.47%)	62 (4.1%)	NR
Waheed et al^Citation19	65,376	RDs (91.75%) VNRDs (8.25%)	2765 (4.22%)	1083 (1.65%)	NR
Sial et al^Citation20	29,522	RDs (87%) VNRDs (13%)	368 (1.24%)	743 (2.51%)	9 (0.03%)
Raza et al^Citation21	33,595	NR	554 (1.64%)	716 (2.1%)	NR
Niazi et al^Citation22	160,552	RDs (95.4%) VNRDs (4.6%)	2385 (1.48%)	4194 (2.61%)	NR
Nadeem et al^Citation23	4662	VNRDs (10.7%) Directed (85.7%)	58 (1.24%)	99 (2.12%)	NR
Arshad et al^Citation24	16,602	RDs (95%)	290 (1.7%)	307 (1.84%)	NR
Memon et al^Citation25	4683	NR	66 (1.4%)	165 (3.52%)	NR
Zameer et al^Citation26	10,048	NR	160 (1.59%)	387 (3.75%)	12 (0.11%)
Wadood et al^Citation27	536	NR	NR	16 (2.99%)	NR
Saeed et al^Citation28	18,274	RDs (99.89%). VNRDs (0.10%)	210 (1.10%)	480 (2.62%)	22 (0.12%)
Sultan et al^Citation29	16,957	RDs (99.2%) VNRDs (0.7%)	301 (1.78%)	365 (2.15%)	NR
Rehman et al^Citation30	1400	VNRDs (100%)	NR	26 (1.85%)	NR
Raza et al^Citation31	16,660	NR	278 (1.67%)	318 (1.91%)	NR
Awan et al^Citation32	30,470	NR	322 (1.06%)^d 10 (0.03%)^e	392 (1.29%)^d 3 (0.01%)^e	5 (0.02%)
Naz et al^Citation33	14,652	RDs (95%) VNRDs (5%)	NR	229 (1.563%)^d 138 (0.94%)^e	NR
Abdullah et al^Citation34	76,530	NR	1262 (1.65%)	NR	NR
Rauf et al^Citation35	6594	VNRDs (1.12%)	74 (1.12%)	214 (3.24%)	15 (0.22%)
Masood et al^Citation36	8517	NR	200 (2.5%)	NR	NR
Total frequency			16,203/791,356 = 2.04%^f	17,660/723,497 = 2.44%^f

Notes: ^aTypes of donors were considered not reported if they did not characterize patients into replacement donors, paid donors, or voluntary non-remunerated donors. ^bRoutine lab test. ^cELISA. ^dSerology. ^eNAAT. ^fTotal frequency of a single TTI was calculated based on the total number of donors positive for a particular TTI such as HBV or HCV divided by the total number of donors screened for that TTI multiplied by 100.

Abbreviations: ELISA, enzyme-linked immunosorbent assay; KPK, Khyber Pakhtunkhwa; NAAT, nucleic acid amplification test; RD, replacement donors; NR, not reported; VNRDs, voluntary non-remunerated donors.

Table 3 Summary of Data from Studies Reporting Frequency of HIV, Syphilis, and Malaria in Blood Donors

Study	No. of Donors	Type of Donors^a	Frequency of HIV	Frequency of Syphilis	Frequency of Malaria
Ali et al^Citation37	1558	VNRDs (100%)	NR	NR	9 (0.577%)
Waheed et al^Citation11	10,145	RDs (94%) VNRDs (6%)	0%	90 (0.89%)	121 (1.20%)
Ansari et al^Citation10	5517	NR	0%	NR	NR
Attaullah et al^Citation12	1,27,828	NR	77 (0.06%)	544 (0.43%)
Irfan et al^Citation13	108,598	RDs (98.8%) VNRDs (1.2%)	111 (0.10%)	NR	NR
Tufail et al^Citation15	1833	NR	3 (0.16%)	NR	NR
Ghafoor et al^Citation18	1500	VNRDs (100%)	2 (0.13%)	7 (0.46%)	NR
Usman et al^Citation38	87,600	NR	NR	NR	38 (0.04%)
Ghani et al^Citation39	626,413	NR	66 (0.01%)	NR	NR
Waheed et al^Citation19	65,376	RDs (91.75%) VNRDs (8.25%)	45 (0.06%)	71 (0.11%)	24 (0.04%)
Sial et al^Citation20	29,522	RDs (87%) VNRDs (13%)	20 (0.07%)	531 (1.79%)	NR
Raza et al^Citation21	33,595	NR	34 (0.10%)	582 (1.73%)	2 (0.005%)
Niazi et al^Citation22	160,552	RDs (95.4%) VNRDs (4.6%)	26 (0.02%)	1520 (0.95%)	NR
Nadeem et al^Citation23	4662	VNRDs (10.7%) Directed (85.7%)	NR	36 (0.8%)	NR
Arshad et al^Citation24	16,602	RDs (95%)	7 (0.04%)	357 (2.1%)	12 (0.07%)
Kousar et al^Citation40	6000	NR	NR	NR	30 (0.5%)
Memon et al^Citation25	4683	NR	3 (0.06%)	141 (3.01%)	5 (0.10%)
Zameer et al^Citation26	10,048	NR	12 (0.11%)	209 (2.08%)	39 (0.39%)
Saeed et al^Citation28	18,274	RDs (99.89%) VNRDs (0.10%)	4 (0.02%)	284 (1.55%)	20 (0.10%)
Sultan et al^Citation29	16,957	RDs (99.2%) VNRDs (0.7%)	14 (0.08%)	287 (1.69%)	2 (0.01%)
Raza et al^Citation31	16,660	NR	12 (0.07%)	294 (1.76%)	2 (0.01%)
Awan et al^Citation32	30,470	NR	49 (0.16%)	228 (0.75%)	5 (0.02%)
Rauf et al^Citation35	6594	VNRDs (1.12%)	12 (0.18%)	73 (1.10%)	59 (0.89%)
Zahoor et al^Citation41	76,530	NR	NR	1720 (2.25%)	NR
Total frequency^b			497/1,291,167 = 0.038%^b	6974/629,998 = 1.1%^b	368/309,562 = 0.11%^b

Notes: ^aTypes of donors were considered not reported if they did not characterize patients into replacement donors, paid donors, or voluntary non-remunerated donors. ^bTotal frequency for a single TTI was calculated based on the total number of donors positive for that TTI such as HIV, syphilis, or malaria divided by the total number of donors screened for that TTI multiplied by 100.

Abbreviations: ELISA, enzyme-linked immunosorbent assay; KPK, Khyber Pakhtunkhwa; NAAT, nucleic acid amplification test; RD, replacement donors; NR, not reported; VNRDs, voluntary non-remunerated donors.

Shah SM, Khattak IU, Ali A, Tariq M. Seropositivity for hepatitis B and C in voluntary blood donors. J Ayub Med Coll Abbottabad. 2010;22(3):149–151.22338442

 PubMedGoogle Scholar

Ansari SH, Shamsi TS, Khan MT, et al. Seropositivity of Hepatitis C, Hepatitis B and HIV in chronically transfused ββ-thalassaemia major patients. J Coll Physicians Surg Pak. 2012;22(9):610–611.22980623

 PubMed Web of Science ®Google Scholar

Waheed U, Khan H, Satti HS, Ansari MA, Malik MA, Zaheer HA. Prevalence of transfusion transmitted infections among blood donors of a teaching hospital in Islamabad. Ann Pak Inst Med Sci. 2012;8(4):236–239.

 Google Scholar

Attaullah S, Khan S, Khan J. Trend of transfusion transmitted infections frequency in blood donors: provide a road map for its prevention and control. J Transl Med. 2012;10(1):20. doi:10.1186/1479-5876-10-2022293125

 PubMed Web of Science ®Google Scholar

Irfan SM, Uddin J, Zaheer HA, Sultan S, Baig A. Trends in transfusion transmitted infections among replacement blood donors in Karachi, Pakistan. Turk J Hematol. 2013;30(2):163. doi:10.4274/Tjh.2012.0132

 Web of Science ®Google Scholar

Tunio SA, Bano S, Laghari ZA, Ali W, Shamim H, Afreen U. Seroprevalence of hepatitis B and hepatitis C among blood donors in Hyderabad, Pakistan. Gomal J Med Sci. 2013;11(2).

 Google Scholar

Tufail S, Babar F, Ikram N, Raza M, Abdul-Shakoor H. Blood donors’ deferral-causes. J Rawalpindi Med Coll. 2013;17(1):119–121.

 Google Scholar

Sulehri MA, Hussain SJ, Mehmood Q, Javed SH. Incidence of false sero-negative blood donor cases for Hepatitis-C in public and private hospitals of city district Faisalabad. Ann Punjab Med Coll. 2013;7(1):10–16.

 Google Scholar

Chaudhry MA, Malik JR, Ashraf MZ. Seropositivity of hepatitis B and C in blood donors at CMH Lahore, Pakistan. Ann Punjab Med Coll. 2013;7(1):1–5.

 Google Scholar

Ghafoor B, Hussain M, Leghari AR, Mehwish A, Zulfiqar S, Mustafa G. Major transfusion-transmissible infections among blood donors in Rahim Yar Khan, a district of Southern Punjab, Pakistan. Isra Med J. 2016;8(4).

 Google Scholar

Waheed U, Hasan SI, Wazeer A, Zaheer HA. The status of blood safety in Islamabad, Pakistan. Ann PIMS. 2016;12(4):209.

 Google Scholar

Sial GR, Khan S, Shahid SU, Bhatti S, Farooq F. Prevalence of transfusion transmitted infections in asymptomatic blood donors: is Syphilis alarming? Biomedica. 2016;32(1).

 Google Scholar

Raza N. Revisiting reactive blood donor demographics-A single center experience. J Liaquat Univ Med Health Sci. 2016;15:208–212.

 Google Scholar

Niazi SK, Mahmood A, Alam M, Ghani E. Seroprevalence of transfusion transmissible infections in blood donors: a three-year experience. Pak Armed Forces Med J. 2016;66(2):190–193.

 Google Scholar

Nadeem A, Salamat N, Iqbal N, et al. Demographic features of donors and causes of blood donor deferral at Armed Forces Institute of Transfusion, Rawalpindi. Pak Armed Forces Med J. 2016;66(6):898–902.

 Google Scholar

Arshad A, Borhany M, Anwar N, et al. Prevalence of transfusion transmissible infections in blood donors of Pakistan. BMC Hematol. 2016;16(1):27. doi:10.1186/s12878-016-0068-227891232

 PubMedGoogle Scholar

Memon FA, Ujjan ID, Memon AI, Shaikh AR, Rao AR, Naz A. Seroprevalence of transfusion transmitted infections among different blood group donors at Blood Bank LUMHS, Hyderabad. Pak J Med Sci. 2017;33(2):443. doi:10.12669/pjms.332.1169128523053

 PubMed Web of Science ®Google Scholar

Zameer M, Shahzad F, Khan FS, Ali H, Saeed U, Farooq M. Transfusion transmissible infections among healthy blood donors at blood bank from Children’s Hospital & Institute of Child Health Lahore. Pak Armed Forces Med J. 2017;1(1):131.

 Google Scholar

Maeesa W, Muhammad U, Khansa Q, Muhammad R, Iram N. Seroprevalence of hepatitis C among the apparently healthy blood donors of Karachi. Baqai J Health Sci. 2017;20(1):19–24.

 Google Scholar

Saeed M, Hussain S, Rasheed F, Ahmad M, Arif M, Rahmani MT. Silent killers: transfusion transmissible infections-TTI, among asymptomatic population of Pakistan. J Pak Med Assoc. 2017;67(3):369–374.28303984

 PubMed Web of Science ®Google Scholar

Sultan S, Nasir MI, Rafiq S, Baig MA, Akbani S, Irfan SM. Multiplex real-time RT-PCR assay for transfusion transmitted viruses in sero-negative allogeneic blood donors: an experience from Southern Pakistan. Malays J Pathol. 2017;39(2):149.28866696

 PubMed Web of Science ®Google Scholar

Rehman N, Orakzai MB, Hayat A, et al. Prevalence of Hepatitis C virus and its risk factors in blood donors in district Peshawar. Pak J Pharm Sci. 2018;31(1):83–87.29348088

 PubMed Web of Science ®Google Scholar

Raza N, Qureshi H, Qureshi A. Reactive blood donor notification; their responses and perceptions: experience from southern Pakistan. J Ayub Med Coll Abbottabad. 2018;30(3):351–355.30465364

 PubMedGoogle Scholar

Awan SA, Junaid A, Sheikh S. Transfusion transmissible infections: maximizing donor surveillance. Cureus. 2018;10(12).

 Web of Science ®Google Scholar

Naz A, Mukry SN, Naseer I, Shamsi TS. Evaluation of efficacy of serological methods for detection of HCV infection in blood donors: A single centre experience. Pak J Med Sci. 2018;34(5):1204.30344577

 PubMed Web of Science ®Google Scholar

Abdullah S, Zahoor S, Rao MA, et al. Seroprevalence of hepatitis B virus in blood donors at a large teaching hospital of Pakistan: a potential health policy concern. J Appl Hematol. 2019;10(1):29. doi:10.4103/joah.joah_10_19

 Google Scholar

Rauf R, Cheema A. Potential risk of transfusion-transmissible infections among blood donors in district Faisalabad of Pakistan. Clin Med (Northfield Il). 2019;19(Suppl 3):27. doi:10.7861/clinmedicine.19-3-s27

 Google Scholar

Masood I, Usman Waheed MA, Saeed M, et al. Molecular epidemiology of hepatitis B virus genotypes in blood donors in Islamabad, Pakistan. J Lab Physicians. 2019;11(3):240. doi:10.4103/JLP.JLP_150_1831579261

 PubMed Web of Science ®Google Scholar

Ali N, Ahmed J, Ali N, Jehan F, Saleem S. Transfusion transmitted malaria in three major blood banks of Peshawar, Pakistan. Afr J Biotechnol. 2010;9(33).

 Google Scholar

Usman M, Mahmood H. Frequency of malarial parasite infection in healthy blood donors of Pakistan. Baqai J Health Sci. 2015;18(1).

 Google Scholar

Ghani E, Rathore MA, Khan SA. Trends in human immunodeficiency virus seroprevalence in blood donors in northern Pakistan. Public Health. 2016;131:71–74. doi:10.1016/j.puhe.2015.10.010

 Web of Science ®Google Scholar

Kousar R, Saqlain N, Ahmed N. Malarial parasite screening in blood donors; experience at the Children’s Hospital & Institute of Child Health, Lahore. Pak Pediatr J. 2016;40(3):143–147.

 Google Scholar

Zahoor S, Hameed S, Iqbal W, ur Rehman H, ur Rehman N, Jaral J. Seroprevalence of Syphilis in healthy blood donors of Lahore during year 2016 and 2017; An upcoming problem for Pakistan. Professional Med J. 2020;27(01):138–142. doi:10.29309/TPMJ/2019.27.01.3823

 Google Scholar