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Transfusion transmitted infections (TTIs) have remained a major deterrent to public health, particularly among the patients with transfusion-dependent Beta thalassemia in developing countries. Although proper donor selection through adoption of WHO-advised infection panel has lowered the rate of infections, the multi-transfused patients are not free of risk. The present study screened 148 transfusion-dependent Beta thalassemia patients to determine the frequency of HCV, HBV and HIV using ELISA method. Among these patients, infected cases with HCV, HBV and HIV were 13.51%, 3.37% and 0%, respectively. Moreover, 2% of the patients had co-infections with both HBV and HCV. The percentage of infections in the patients with frequent transfusion interval (≤30 days) was significantly higher (P30 days). Immunochromatography (ICT)-based rapid test kits are usually used to screen and confirm these infections in the blood of the patients. However, ICT-based tests are not sensitive enough to detect the infections. So, a combination of both Nucleic Acid testing (NAT) and serological testing are suggested to significantly reduce the risk of viral infections during blood transfusion.

Different mutations in the beta-globin gene impose clinical heterogeneity in the affected individuals, such as patients with Hb E disease are asymptomatic and non-transfusion-dependent. Conversely, the transfusion-dependent patients with EBT require blood transfusion with varying degrees of transfusion intervals among individuals; whereas the patients with beta-thalassemia major (BTM) must require blood transfusion with chelation therapy. Different mutations are expected to affect red blood cell (RBC) volume and size differently as they impose different levels of heterogeneity. Thus, this present study focused to associate red blood cell distribution width (RDW) with different disease states of beta-globin gene. Accordingly, 31 patients with BTM, 73 transfusion-dependent patients with EBT, and 40 healthy controls were recruited. Hematological indices revealed higher RDWs in both BTM and EBT patients compared to controls. Hematological indices and genetic analysis revealed irrespective of mutational status EBT patients had higher RDWs compared to patients with BTM. Moreover, analysis of EBT patients with different transfusion intervals revealed patients who need blood transfusion less frequently had highest RDW values implying diverse population of microcytic RBCs play an important role in heterogeneous disease manifestations. In conclusion, the RDW has an association with different disease manifestations involving the beta-globin gene mutations.