Testing Of Blood Donors Research Articles

Pre-donation screening of blood for transfusion transmissible infections: the gains and the pains - experience at a resource limited blood bank.

To determine whether or not pre-donation testing of blood donors affords substantial cost savings without compromise to blood transfusion safety. Pre-donation testing of blood donors for Transfusion Transmissible Infections (TTIs) is done in most developing countries because substantial cost savings are made from resources, materials and man-hours which would have been spent to procure infected blood units. Simple rapid test kits used in pre-donation testing is not as sensitive as the Enzyme Linked Immuno-sorbent Assay (ELISA) method used in post-donation screening in a quality assured manner. It is a retrospective study where records of pre- and post-donation tests done in donor clinic of University of Ilorin Teaching Hospital, between January and December 2010 were retrieved. All processes and inputs were evaluated and costs calculated for pre-donation testing by simple rapid techniques and post donation screening by ELISA. 5000 prospective donors were tested in the study period. The cost of single rapid Pre-donation testing was less than that of single ELISA Post-donation screen. The cost of double rapid Pre-donation and Post donation ELISA screen exceeded the cost of single post donation ELISA screen. Substantial cost savings were made when single rapid Pre-donation testing is relied on. More blood units were found reactive for the TTIs with the more expensive Post-donation ELISA. Pre-donation testing of blood donors was not cost effective. Although, there is an apparent savings if pre-donation testing is not followed by post-donation ELISA testing, it is done at a compromise to blood transfusion safety.

Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014.

Since October 2013, French Polynesia has experienced the largest documented outbreak of Zika virus (ZIKAV) infection. To prevent transmission of ZIKAV by blood transfusion, specific nucleic acid testing of blood donors was implemented. From November 2013 to February 2014: 42 (3%) of 1,505 blood donors, although asymptomatic at the time of blood donation, were found positive for ZIKAV by PCR. Our results serve to alert blood safety authorities about the risk of post-transfusion Zika fever.

Sensitivity of individual and mini-pool nucleic acid testing assessed by dilution of hepatitis B nucleic acid testing yield samples

Introduction:For nucleic acid testing (NAT) of blood donations, either the blood samples can be pooled together in a batch of six or eight prior to testing (mini-pool-NAT [MP-NAT]), or the tests can be run on every individual sample (individual donor-NAT [ID-NAT]). It has been debated in various studies whether pooling of samples results in decreased sensitivity of detection as the volume of individual samples gets lesser in a pool. The objective of this study was to investigate the effect of dilution on the sensitivity of tests.Materials and Methods:The study was performesd on nine plasma samples which were hepatitis B reactive exclusively by Procleix Ultrio Plus and not by Procleix Ultrio or serology. These nine exclusive UltrioPlus ID-NAT yield samples were diluted in 1:2, 1:4. 1:6 and 1:8 dilutions using previously tested negative plasma and each dilution of every sample along with archived undiluted sample were retested in three replicates with Procleix Ultrio Plus Assay.Results:Among NAT yield samples, 88.88% of the samples were detected when retested in ID-NAT in undiluted form. Samples with higher viral load (sample 5 and 6) were detected by all dilutions. When samples with viral load below 20 IU/mL were tested in dilutions of 1:6 or 1:8, only 9 out of 27 replicates (33.33%) were detected. This means that more than 67% of low viral load samples were missed by MP-NAT of 1:6 or 1:8 dilution out of total NAT yield samples.Conclusion:Individual Donor NAT is ideal methodology for NAT as dilution due to pooling may miss samples with low viral load as evident in this study.

Chagas disease in Australia and New Zealand: risks and needs for public health interventions

International migration has changed the global distribution of Chagas disease, with the emerging importance of non-endemic regions. We aimed at better documenting the Australia and New Zealand risk of Chagas disease and needs for interventions. We reviewed Chagas disease-related evidences, policies and practices in Australia and New Zealand and calculated the estimated prevalence. Australia hosts a rapidly growing population at risk and had 1928 infected residents in 2011; New Zealand had 98 in 2006. These figures underestimate the real situation, as they do not consider non-permanent residents. The only existing policy in both countries is the identification of blood donors with a history of or a risk of infection via questionnaire. There is no programme of detection and care of patients. The lifetime economic burden of disease for society is potentially very high. Chagas disease is an emerging health risk with potential high human and economic costs in Australia and New Zealand in the absence of public health attention. Implementing strategies to screen high-risk groups and prevent transmission should be considered. Moreover, migration between the Western Pacific and Chagas endemic regions and the presence of vectors means this risk applies in the whole region.

Acute hepatitis B in blood donors over a 5‐year period in England and North Wales: who is getting infected?

Hepatitis B virus (HBV) remains the infection most frequently recognized by donation testing in blood donors. It is usually a persistent infection and mostly reflects the country of origin of the donor or the donor's family. There are, however, a minority of acute infections and this study undertook their phylogenetic analysis to determine the likely source of infection. Plasma samples from 11 donors donating between July 2005 and June 2010, whose test results revealed recent infection with hepatitis B, were available for further analysis. Plasma DNA was extracted, amplified, sequenced, and analyzed phylogenetically. Donor and virus characteristics were compared with the overall demography of all hepatitis B-infected donors attending over the same period. Three of the 11 individuals were first-time donors. Nine were male, of whom eight were white British. All had serum markers of very recent infection. Only two indicated known HBV exclusion risk factors at postdonation discussion not declared previously. Genotype A was present in seven, Genotype B in two, and Genotype C in two, contrasting with the pattern in persistently infected persons in the United Kingdom. A single A2 strain was identified in six of the white British male donors, suggesting epidemiologic linkage. Phylogenetic analysis of HBV-infected donors performed in real time can potentially lead to identification of undeclared risk factors that donor health questionnaires may fail to identify.

Low Yield From Hepatitis C Virus (HCV) Lookback At a Large Cancer Center

While chronic hepatitis due to HCV is a major health problem in the USA, blood transfusions pose a low risk of transmission. The federally mandated lookback process is initiated when a blood donor, previously negative or untested for HCV, now has a positive test. The process serves to identify any possible transmission during the “window period.” While there have been publications on lookback series from single institutions and countries, to date there has not been data presented solely from a cancer center. Moffitt Cancer Center (MCC), a large NCI-designated comprehensive cancer center, has had 291 HCV lookback investigations. Although the average age at time of transfusion was 51, this failed to include a number of patients on whom an electronic medical record was not created. Most of the transfusion recipients had advanced age or were ill from their cancer and had died prior to the investigation, accounting for 234 (80.4%) of the cases. Five of the cases were blood components that had expired and were never transfused. Six cases identified blood components that were never received and were actually transfused at other facilities. One case had no documentation of the recipient of the fresh frozen plasma unit. Eight cases were from patients who were alive but not tested either due to patient decision or inability to get in contact with them. Out of the 37 patients that were subsequently tested, 35 (94.5%) of them tested negative for HCV by either anti-HCV enzyme immunoassays (EIA) or nucleic acid amplification tests (NAT), or both. Only 2 patients (or 0.7% of all cases investigated) tested HCV seropositive (EIA and RIBA confirmed). Both transfusion recipients were elderly women who were asymptomatic for chronic hepatitis and who posed no current or past risk for transmission via their blood or body fluids. In our case series, 80.4% of recipients were deceased at the time of the investigation. The seroprevalence rate in our case series, among the 37 recipients tested for HCV and transfused between 1988 and 2012, was 5.4%. In the USA, HCV prevalence continues to be low with current estimates <1.5%. The CDC has recently expanded the recommendations for HCV testing to any persons born between 1945 and 1965, recipients of blood transfusions before July 1992, and patients with abnormal liver enzymes. Since the initiation of blood donor HCV EIA testing in 1990 and NAT testing in 1999, the risk of transfusion-transmitted HCV infection has plummeted. Given the improved public awareness of HCV, improved blood donor testing, and the low yield of the lookback process to both the recipient and society, discontinuation of the HCV lookback requirement should be considered. This case series also highlights that most transfusion recipients are either older or ill. As with HCV, several recent publications document the infrequency of transmitting human immunodeficiency virus (HIV) through modern transfusions; In England and Wales from October 1995 to December 2008, only 1 HIV positive recipient was identified with the lookback procedure. In conclusion, our large cancer center had almost 300 HCV lookback notifications and most transfusion recipients had advanced cancer and died prior to case investigation. The series found 94.5% of recipients tested had no evidence of HCV transmission. Consideration should be given to focusing HCV detection efforts on the general public and to eliminating the HCV lookback requirement in transfusion recipients. Disclosures: No relevant conflicts of interest to declare.

Defining a reference range for cold agglutinin titers.

The cold agglutinin (CAGG) titer is offered at our institution to aid in diagnosing cold agglutinin disease (CAD). Our goal was to create a seasonally adjusted reference range using prospective samples and compare it to a reference range generated retrospectively. Prospective CAGG titer testing was performed on healthy blood donors. Retrospective electronic analysis was performed on patients in two groups defined by current and historical testing methods. Blood donor testing was performed in January and July to determine if seasonal variation existed. Retrospective patients with conditions associated with CAD were excluded from analysis. Additional prospective CAGG testing using reference range program volunteers was performed to verify blood donor and patient result differences. Titers from the blood donor and patient cohorts had no age association (p > 0.44). Titers from those same cohorts did not show winter/summer variation (p > 0.11). No sex association was found with titer reference ranges in the blood donor and historical patient cohort. A sex association was found with titers in the current method patient cohort (male 64 to 512 and female ≤64; p < 0.0001). Blood donor CAGG titer lower 95% reference range was not more than 4 while historical and current patient cohorts ranges were not more than 32 and not more than 64, respectively. Reference range volunteers confirmed the narrow reference range in healthy individuals when compared to patients and blood donors. Prospective blood donor CAGG titers were lower than retrospective patient cohorts. This may be due to blood donors representing a healthier population than the patient cohorts.

The serological evidence in humans supports a negligible risk of zoonotic infection from porcine circovirus type 2

There are two porcine circovirus (PCV) genotypes, PCV-1 and PCV-2. In pigs, PCV-1 infection is asymptomatic but PCV-2 infection can cause severe respiratory disease and other pathology. Although humans ingest PCV-contaminated foods and are exposed to PCV through other sources, the potential of PCV-2 as a zoonotic agent in humans and other species has not been fully explored. Here, four recombinant proteins derived from the PCV-2 capsid gene were examined as antigens using the Luciferase Immunoprecipitation System (LIPS) assay for serological analysis of PCV-2 infection. PCV-2-CAP-Δ1 was the optimum recombinant protein in the LIPS assay with a sensitivity of 93% and specificity of 100% using porcine samples. Testing of healthy human blood donors, equine and bovine serum samples failed to demonstrate the presence of anti-PCV-2 antibodies. Additionally, analysis of two high-risk human groups, cystic fibrosis patients taking porcine derived oral supplements and type I diabetes patients who had undergone porcine islet cell transplantation, showed no evidence of anti-PCV-2 antibodies. These results extend the extensively demonstrated use of LIPS as a robust approach for identifying humoral responses and provide evidence that PCV-2 is likely not infectious in humans.

Evaluation of serological transfusion-transmitted viral diseases and mutliplex nucleic acid testing in malaysian blood donors

Transmission of infectious diseases is a recognized complication of blood transfusion and blood products. Nucleic acid testing (NAT) may contribute to improved efficiency of blood screening and thereby increase the safety margin for transfused blood. Unscreened blood samples from 1388 randomized donors were selected for this study at the Transfusion Medicine Unit of Hospital Universiti Sains Malaysia (HUSM). Informed consent was obtained from all donors and blood samples were tested for HIV, HBV and HCV serologically and by NAT assay. Of the 1,388 tested samples, 1,360 were non-reactive for both assays. Four samples (0.29%) were both serologically and NAT reactive. The remaining twenty-four samples were divided into two groups. Of these, five samples (0.366%) were NAT reactive and nineteen samples (1.37%) were serologically reactive. However, serology confirmation tests run on the latter nineteen samples were non-reactive. Hence, NAT adds benefit of detecting "false positive" reactions via standard serology, the cost of administering NAT also need further consideration and study.

The integration of high-throughput testing of blood donors for cardiovascular disease risk assessment and prevention

Background and objectivesSome blood centers provide health screening as a public health measure and to encourage donation. The goal of the current study was to provide cardiovascular disease (CVD) screening to donors using high-throughput testing and web-based communications. Materials and methodsCVD risk screening was offered to donors at selected mobile drives in a large metropolitan area. Risk factors were determined by donor questionnaire, laboratory testing (total cholesterol, HDL levels and hemoglobin A1c), and blood pressure measurement. Results were reported to participants via mail and website. A 60-day follow up web-based survey was sent to participants via email to assess the impact of the program on donor’s behavior. Results9435 donors, 17–75years old participated with the following risk factors: 61.3% BMIs>25, 28.8% high total cholesterol, and 31.4% lower than recommended HDL levels. 25.3% of donors that responded to the follow up survey went to see their health care provider based on screening results and 9% of these received new or modified treatment. ConclusionIn our sample, blood donors are healthier than the general population, but many still have CVD risk factors, particularly obesity. CVD screening can be successfully used to make donors aware of this important health information and some donors act on this information.

Donor notification and counseling – Experience and challenges

Background and objectivesIn India, screening of blood for human immunodeficiency virus, hepatitis B surface antigen, and hepatitis C virus is mandatory before issue for transfusion, but donors are not informed of their reactive status. Advising donors who have reactive test results of viral markers is an essential adjunct to blood donor testing and is part of donor care. We realized that donor disclosure is an important public health issue. Therefore, we took the initiative of posttest counseling of blood donors. Materials and methodsThe donors reactive for any transfusion transmitted diseases by enzyme linked immunosorbent assay in duplicate as well as by rapid tests, were notified of their reactive test results and called for counseling. We tried to maintain confidentiality at each step. Counseling and information about confirmation, evaluation, early treatment and prevention of transmission were given to responding donors. ResultsThe results were analyzed for the period from 1st April 2011 to 30th June 2012. Among 15,844 donors, 172 were found to be reactive for various infectious markers. Letters were sent to all reactive donors. Only 60 donors responded and were counseled. The counseling rate was 49%, 45.5%, 50% and 17% for HBsAg, HCV, HIV and syphilis respectively. ConclusionThis study describes our experience and challenges faced in implementing the program of donor counseling in a resource poor setting.

Human T lymphotropic virus types 1 and 2: a point of view

Reported at the beginning of the 1980s, Human T lymphotropic viruses type 1 and 2 (HTLV1, HTLV 2) were the first retroviruses to have been detected in human beings. HTLV 1 was isolated from adult T-cell leukemia (ATL) and first described by Takatsuki et al. in Japan in 1976, as a malignancy that only affects T cells and only in adults(1, 2). Albeit infrequent, HTLV-1 infection may lead to severe morbidity when it causes malignancy or degenerative conditions. The virus can also cause mild immune deficiency even in the absence of any malignancy. Fatal neurologic diseases, such as HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP), uveitis, iritis, peripheral neuropathies, and arthritis can also be caused by HTLV-1. All these diseases can be autoimmune, but their exact mechanisms are not yet known(3). Human T lymphotropic virus type 2 (HTLV-2) was discovered in a patient with a T-cell variant of hairy cell leukemia. The virus has been associated with increased mortality and morbidity, risk for pneumonia and bronchitis, urinary tract infections, and rare neurologic manifestations. HTLV infection is life-long and disease symptoms can manifest some 20-40 years post-infection(4-6). Recently, an increased prevalence of psychiatric symptoms was described among HTLV-seropositive patients(7,8). Prevalence greatly varies in different regions of the world. HTLV-1 is endemic in southwestern Japan, in the Caribbean Islands, and in Central Africa. Carriers have been identified in South America, Papua New Guinea, the Solomon Islands, South China, and other isolated populations such as the Australia Aborigines. HTLV-2 can also be found in some Native American populations. HTLV-1 is transmitted by blood, through sexual contact, injectable drug use and from mother to offspring through breastfeeding(1-6). HTLV-2 is most often found in injectable drug users and in their sexual partners. As a consequence of the transmission routes, all blood donated at the Red Cross Blood Centers in Japan has been subjected to HTLV-1 antibody screening since November 1986 and carrier mothers have been instructed to refrain from breastfeeding to prevent HTLV-1 transmission(9-11). In the United States, screening began at the end of 1988 and in the entire world since 1990(12-15). At the beginning, blood donor screening was performed with enzyme immunoassays (EIAs) for antibodies against HTLV-1 and later against HTLV-1/2, which led to the unnecessary deferral of a great number of individuals. Confirmatory testing could be performed by Western blot but this was expensive and took a long time. Nowadays screening is performed by chemiluminescent immunoassay with a lower risk of false positives(16). Up to now there is no available licensed confirmatory test. The efficacy of this test reduces the number of indeterminate results and could be better than the lookback procedure for HTLV-1/2(17). Confirmatory testing by polymerase chain reaction (PCR), albeit expensive, is used in the great majority of blood banks around the world. The same serological difficulties are observed in Brazil as confirmatory testing is only performed by research groups in some blood banks. HTLV-1/2 infection is endemic in Brazil(18-22) and testing blood donors has been mandatory since 1993. Recently, Carneiro-Proentti et al.(22) analyzed all blood donations of three regional Brazilian Blood Banks located in Sao Paulo, Minas Gerais and Pernambuco during 2007-2009. Serological results were confirmed by Western blot. Results concerning donor age, gender, education status, and race confirmed the previously published results from other Brazilian blood banks(23,25). Prevalence increased with age, was higher among women and Blacks and was inversely correlated to the level of education. Prevalence variations in different blood banks were expected and probably reflect population origins (higher in Pernambuco than in Sao Paulo and Minas Gerais). The overall incidence rate was 3.59 per 100,000 person-years and the residual risk was 5.0/100,000 per repeat donor blood unit transfused, that is, lower than previously reported in southern Brazil(25). Seroprevalence rates were in the order of 1 to 2 per thousand first time donors which is higher than in the United States and Europe but lower than in the Brazilian general population(24). Besides HTLV screening difficulties, the public health system is also not prepared to confirm and counsel serum-positive donors thus creating a difficult situation as the virus can be transmitted through breastfeeding and the disease can appear almost 30 years after a serological positive result. Preventive measures, the follow up of donors and confirmatory testing procedures must be improved. In this issue of the Revista Brasileira de Hematologia e Hemoterapia, Lima et al. bring new data from the Caruaru Blood Center in Pernambuco(26).

A Case of Vertical Transmission of Chagas Disease Contracted via Blood Transfusion in Canada

Chagas disease is caused by the protozoan parasite Trypanosoma cruzi and is endemic in many countries in Latin America, where infected bugs of the Triatominea subfamily carry the parasite in the gut and transmit it to humans through fecal contamination of a bite. However, vertical transmission and transmission through blood transfusion and organ transplantation is well documented. Increasing immigration from endemic countries to North America has prompted blood operators, including Canadian Blood Services and Hema Quebec, to initiate blood donor testing for Chagas antibody. In the present report, an unusual case of vertical transmission from a mother, most likely infected through blood transfusion, and detected as part of a concurrent seroprevalence study in blood donors is described.

HTLV infection and the eye

Human T-cell lymphotropic virus (HTLV) is the first discovered retrovirus causing malignancy in human. HTLV infection affects host's ocular tolerance and causes various diseases in the eye. Here we discuss the manifestations, mechanisms, treatments, and future directions of HTLV-related ocular diseases. RECENT FININGS: Recent serological researches showed that the number of HTLV-1 carriers in metropolitan area was increasing, although seroprevalence of HTLV-1 in general population was decreased after screening serological tests in blood donors started. The most common clinical entity of uveitis was still HTLV-1 uveitis in HTLV-1 highly endemic area, but prevalence of HTLV-1 uveitis varies in different parts of the world. As for treatment of inflammation, tacrolimus and 5-azacytidine were reported to be effective for autoimmune manifestations in HTLV-1-related overlap syndrome (deratomyositis/Sjogren's syndrome) and HTLV-1-related myelodysplastic syndrome. Interleukin-2 receptor targeted therapies improved scleritis in patients with adult T-cell leukemia/lymphoma caused by HTLV-1. Basic researches identified that HTLV-1 tax and HTLV-1 basic leucine zipper factor play critical roles in the HTLV-1-related disease and are now being investigated as targeted therapies. Development of modern molecular biology makes it possible to reveal deep insights of HTLV-1-related ocular diseases. Although effective therapies based on basic researches have been reported, further endeavor is necessary to establish much more specific treatments of the ocular diseases.

Seroprevalance of Hepatitis B and Hepatitis C in Blood Donors in the Konya Region

Viral hepatitis infections are the most common transfusion-transmitted infections. In blood centers, sera of donors are screened for hepatitis B and hepatitis C by HBsAg and anti-HCV tests. The aim of this retrospective study was to determine the seroprevalence of hepatitis B and hepatitis C in Konya region by evaluating the serologic screening tests in blood donors. Anti-HCV and HBsAg test results of blood donors admitted to the blood center of Necmettin Erbakan University Meram School of Medicine Hospital, for the last seven years, were evaluated. After questionnaires were completed by donors, bloods were collected and sera were separated. Sera of blood donors were analyzed for HBsAg and anti-HCV in the automated device by chemiluminescence microparticle immunoassay principle. Out of 165006 blood donors 2138 (1.3%) was found to be HBsAg positive and 594 (0.4%) was positive for anti-HCV. HBsAg positivity (2.1%) was found the highest rate in 2007. Anti-HCV positivity was higher in 2010 than other years (0.6%). HBsAg seroprevalence decreased over the years, on the contrary that increased seroprevalence of anti-HCV. We thought that vaccination have an effect on these results. To prevent transfusion-transmitted infections, avoiding unnecessary blood transfusion, effective use of donor questionnaire, donor screening for hepatitis viruses, determining the regional seroprevalance of hepatitis B and hepatitis C infections are issues to be emphasized.

Chagas disease: a threat to safe blood transfusion

Chagas disease affects approximately 8 million infected people in Mexico and Central and South America and causes 12 500 deaths annually; 41 200 new cases are reported annually (2006). Coordinated multicenter programmes have decreased about 70% of new infections in South America due to the interruption of vectorial and decreased blood transfusion transmissions. Migration of the infected population from rural areas to urban centres in endemic and non‐endemic countries led to the urbanization and globalization of Chagas disease. Chagas disease is now an emerging disease in non‐endemic areas, where congenital, blood and organ transplant transmissions are associated with reactivation of chronic Chagas disease in patients under immunosuppression or HIV infection. Recent initiatives in non‐endemic countries have been implemented to control its transmission by blood transfusion and transplants of organs. Most of the infected people were asymptomatic individuals in the chronic phase of the disease, characterized by and low and intermittent parasitemia and diagnosed by serological tests. In endemic countries, universal mandatory screening tests for detection of Trypanosoma cruzi antibodies dramatically reduced blood transfusion transmission. In non‐endemic countries, where transfusion represents the most important way of transmission, different strategies have been registered: (1) blood donor selection and deferral; (2) blood donation testing; (3) blood donation testing in people who lived in endemic areas. Questionnaires containing well‐defined questions help to identify patients from endemic areas and their epidemiological data but are of limited value since they depend on donor information. High‐performance serologic tests were reported for the detection of anti‐T. cruzi antibodies like ELISA with epimastigotes or trypomastigotes or recombinant antigens, chemiluminescent, immunoblot and radioimmunoprecipitation assays. Almost 100% of sensitivity and specificity were registered when tested in samples of well‐defined chronic chagasic patients but gold standards are not validated in circumstances of low prevalence of the disease. Additionally, their value in cases of inconclusive results (one positive test and other negative or doubtful results) was not known. Unfortunately, molecular methods are less sensitive than serology for the chronic phase of the disease (45–100% sensitivity) and were not reliable for screening tests in blood banks. Perspectives of the reduction of parasites by photochemical treatment and ultraviolet (crystal violet, methylene blue, amotosalen, riboflavin, thiopirilium) were reported sometimes with slight changes in the blood products. However, the main challenge is to demonstrate their value for prevention of a broad spectrum of agents transmitted by blood transfusion (including príon disease) and inactivation of low parasite load. In summary, questionnaires including specific questions about donor epidemiology and high‐performance serologic tests have been useful for blood bank screening. The cost–benefit–effectiveness analyses of universal serologic screening vs. serologic screening of selected donors depend on the prevalence of positive donors and should be evaluated in different regions. Finally, as pathogen inactivation methods may represent remarkable improvement in blood bank transfusion, efforts from the academia are necessary to prove their safety and effectiveness, and from blood banking–transfusion medicine community and public regulators to their implementation aiming to increase the safety of blood transfusion for patients around the world.

Blood transfusion practice in a rural hospital in Northern Ghana, Damongo, West Gonja District

Blood transfusion in rural sub-Saharan Africa presents special challenges. Transfusions are primarily given for emergencies--life-threatening blood loss or anemia; blood is usually collected from family or replacement donors; and facilities to store an adequate reserve in a hospital bank are constrained. We report the everyday and organizational practices in a medium-sized district hospital in Northern Ghana. Information and data on blood transfusion practices at West Gonja Hospital, Damongo, were available from the laboratory reports, from day books and workbooks, and from direct observation in the following four areas: blood collection and blood donors; blood donation testing; blood storage and logistics; and clinical transfusion practice, adverse events, and follow-up. The hospital serves a rural community of 86,000. In 2009, a total of 719 units of whole blood were collected, a rate of 8.36 units per 1000 population. All donors were family or replacement donors. Positivity rates for infectious disease markers were 7.5% (64/853) for hepatitis B surface antigen, 6.1% (50/819) for hepatitis C virus, 3.9% (33/846) for human immunodeficiency virus, and 4.7% (22/468) for syphilis. Supply of laboratory materials was sometimes problematic, especially for temperature-critical materials. Difficulties in sample labeling, storage of blood and laboratory supplies, and disposal of waste were also incurred by operational, material, and financial constraints. Follow-up for outcomes of transfusion is not currently feasible. The operational, demographic, and financial environment pertaining in a rural hospital in Northern Ghana differs substantially from that in which much of current blood transfusion practice and technology evolved. Considerable effort and innovation will be needed to address successfully the challenges posed.

Trypanosoma cruzi infection in North America and Spain: evidence in support of transfusion transmission (CME)

The United States, Canada, and Spain perform selective testing of blood donors for Trypanosoma cruzi infection (Chagas disease) to prevent transfusion transmission. The donor, product, and patient characteristics associated with transfusion-transmitted infections are reviewed and the infectivity of components from donors with serologic evidence of infection is estimated. A systematic review of transfusion-transmitted T. cruzi cases and recipient tracing undertaken in North America and Spain is described. Cases were assessed for the imputability of the evidence for transfusion transmission. T. cruzi infection in 20 transfusion recipients was linked to 18 serologically confirmed donors between 1987 and 2011, including 11 identified only by recipient tracing. Cases were geographically widely distributed and were not associated with incident or autochthonous infections. Index clinical cases were described only in immunocompromised patients. All definite transmissions (n = 11) implicated apheresis or whole blood-derived platelets (PLTs), including leukoreduced and irradiated products. There is no evidence of transmission by red blood cells (RBCs) or frozen products, while transmission by whole blood transfusion remains a possibility. Recipient tracing reveals low component infectivity from serologically confirmed, infected donors of 1.7% (95% confidence interval [CI], 0.7%-3.5%) overall: 13.3% (95% CI, 5.6%-25.7%) for PLTs, 0.0% (95% CI, 0.0%-1.5%) for RBCs, and 0.0% (95% CI, 0%-3.7%) for plasma and cryoprecipitate. T. cruzi is transmitted by PLT components from some donors with serologic evidence of infection. Evidence of transmission before the implementation of widespread testing in the countries studied is sparse, and selective testing of only PLT and fresh whole blood donations should be considered.

Estimated prevalence of dengue viremia in Puerto Rican blood donations, 1995 through 2010

Dengue virus (DENV) nucleic acid amplification testing of blood donations during epidemics in endemic locations, including Puerto Rico, has suggested possible sizable transfusion transmission risk. Estimates of the long-term prevalence of DENV viremic donations will help evaluate the potential magnitude of this risk in Puerto Rico. Estimates of the prevalence of DENV viremia in the Puerto Rican population at large from 1995 through 2010 were derived from dengue case reports and their onset dates obtained from islandwide surveillance, estimates of case underreporting, and extant data on the duration of DENV viremia and the unapparent-to-apparent dengue infection ratio. Under the assumptions that viremia prevalence in blood donors was similar to that of the population at large and that symptomatic persons do not donate, statistical resampling methods were used to estimate the prevalence of dengue viremia in blood donations. Over the 16-year period, the maximum and mean daily prevalences of dengue viremia (per 10,000) in blood donations in Puerto Rico were estimated at 45.0 (95% confidence interval [CI], 36.5-55.4) and 7.0 (95% CI, 3.9-10.1), respectively. Prevalence varied considerably by season and year. These data suggest a substantial prevalence of DENV viremia in Puerto Rican blood donations, particularly during outbreaks.

HIV/AIDS and other sexually transmitted infections among military members of the armed forces of Serbia

Military personnel is a population group at special risk of exposure to sexually transmitted diseases (STD). In peacetime, STD infection rates among service members are generally 2 to 5 times higher than among civilian population. In time of conflict, the differences can be 50 or more times greater. This study describes sexual behavior as a risk factor for STD in the Armed Forces of Serbia. The sample of 5 617 voluntary blood donors from the Armed Forces of Serbia gave blood and filled World Health Organization Questionnaire about sexual behavior within January 2007 - December 2008 period. The mandatory testing of voluntary blood donors was performed in the Institute of Transfusiology Military Medical Academy in Belgrade, by the specific immunoenzyme tests and polymerasa chain reaction tests for HIV, hepatitis B, C and syphilis. Statistical analysis of data was done using State for Windows 93, USA, 1996. We identified 36 soldiers with some form of STDs. This study showed that 1 668 (29.7%) tested soldiers reported always using condoms, 1 725 (30.72%) almost always, 1 238 (20.04%) sometimes, 495 (8.81%) almost never and 490 (8.73%) never. Among the sample, 449 (7.99%) soldiers reported sexual contacts with partners with high risk of sexual behavior, whilst 22 (0.37%) of them reported homosexual and bisexual contacts. This study reported STDs found in voluntary blood donors among the service members of the Armed Forces of Serbia, but none of them was identified to be HIV positive. Soldiers with the most frequent risk behavior were reported to be those with inconsistent condom use. In the future, the STD Control and Prevention Program should be more intensively conducted among the members of the Armed Forces of Serbia.