Abstract
Blood transfusions play an essential role in the treatment of severe sickle cell disease. However, they carry a cumulative risk of transmitting blood-borne viral infections, especially hepatitis B virus (HBV) and hepatitis C virus (HCV), in patients receiving multiple transfusions. The prevention of these infections largely depends on the biological assessment of blood donations, which in the Democratic Republic of the Congo (DRC) primarily relies on serological tests. In Kinshasa, the particular impact of PCR on this preventive strategy is not well documented. This study seeks to gather and analyze existing data regarding the prevalence of HBV and HCV among sickle cell disease patients who have received transfusions in Kinshasa and assess the specific contribution of PCR, in conjunction with serology, to the biological qualification of blood for transfusions aimed at preventing these infections. A systematic review was conducted in accordance with the PRISMA 2020 guidelines. We explored biomedical databases and Congolese grey literature published between 2010 and 2025, with one notable exception for a publication from January 2026. The search strategy included keywords related to sickle cell disease, hepatitis B/C, blood transfusion, and Kinshasa/DRC. After a two-phase screening process, 20 studies were selected for inclusion. In Kinshasa, among sickle cell disease patients who received transfusions, the prevalence of hepatitis B surface antigen (HBsAg) ranged from 1.6% to 6%. The prevalence of anti-HCV antibodies varied from 4% to 13.5%, depending on the screening method used, with molecular detection via RT-PCR reaching 11.1%. HCV was consistently the most frequently occurring infection associated with transfusions. The only Congolese study providing a temporal reference indicated that all identified HCV cases were present in patients who had been transfused prior to the implementation of systematic screening in 2004. Local data on the biological screening of blood donations suggest that the rapid diagnostic tests commonly utilized have lower sensitivity compared to ELISA, and PCR has not yet been systematically incorporated into the Congolese transfusion framework. However, its documented sporadic contribution among patients with multiple transfusions in Kinshasa indicates specific preventive potential. While there has been a general enhancement in national safety measures for blood transfusions, the findings from Kinshasa, which are still limited and heterogeneous, should be interpreted cautiously. Strengthening prevention through the biological qualification of blood donations, particularly by strategically integrating PCR for patients receiving multiple transfusions, presents a promising area for further evaluation rather than a definitive recommendation based on the results of this review.
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