Burden of transfusion-transmitted infections among patients with thalassaemia and sickle cell anaemia in India: A systematic review and meta-analysis.

Lifelong blood transfusions, crucial for severe cases of thalassaemia and sickle cell disease (SCD), contribute to a high risk of transfusion-transmitted infections (TTIs). The current systematic review and meta-analysis determined the prevalence of transfusion-transmitted infections (TTIs) among patients with thalassaemia and sickle cell anaemia in India. A systematic search was conducted in PubMed, Scopus, ProQuest, EMBASE and Web of Science for articles published up to September 13, 2025. Title abstract screening followed by full-text review and data extraction was done by two independent reviewers. Risk of bias was assessed for the included studies. Meta-analysis was conducted to estimate the pooled prevalence of TTIs. The systematic review and meta-analysis identified 397 unique articles, with 39 selected for full-text review. After exclusions, 24 studies spanning from 1990 to 2023 were included. All 24 studies included patients with beta thalassaemia, whereas only one study had data on sickle cell anaemia patients, so this review focuses mainly on the prevalence of TTI in patients with beta thalassaemia. The pooled prevalence of Hepatitis C was 22% (95% CI: 14%-30%; I2 = 96%), Hepatitis B was 8% (95% CI: 2%-16%; I2 = 96%) and HIV was 4% (95% CI: 2%-7%; I2 = 77%) in beta-thalassaemia patients, all showing high heterogeneity. Meta-regression revealed a statistically significant decline over time in HBV (Beta = -0.0194, p = <0.01) while Hepatitis C prevalence (Beta = -0.0025, p = 0.6642) and HIV showed no significant trend (Beta = -0.0001, p = 0.9839). Significant burden of TTIs is present among transfusion-dependent thalassaemia and sickle cell anaemia patients in India. Strengthening screening protocols, improving vaccination coverage and implementing targeted healthcare interventions are essential to mitigate this preventable risk.