Blood Donor Candidates Research Articles

Voluntary blood donation in a rural block of Vellore, South India: A knowledge, attitude and practice study

Context: There is a shortage of voluntary blood donors in developing countries which are, therefore, more dependent on replacement donors. Aim: To study the knowledge, attitude, and practices regarding voluntary blood donation in a rural block in Vellore, South India. Settings and Designs: A cross-sectional survey in randomly selected villages of a rural block in Vellore, South India. Materials and Methods: Knowledge, attitude, and practices were assessed using a pilot-tested, semi-structured, interviewer-administered questionnaire on randomly chosen rural adults aged between 18 and 60 years. Results: Of the 104 individuals interviewed, 90% were aware of voluntary blood donation, the main source of this awareness being television. Nearly, two-thirds of the participants felt they would fall sick by donating blood and that women and manual laborers were not capable of blood donation. Among the interviewed, 70.3% were of the opinion that blood can purchased with money. Only 44% were willing to donate blood on a voluntary basis. Perceived weakness and a misconception on the apparent lack of blood were the major reasons for unwillingness to donate blood. There was a significant association between willingness to donate blood and educational status as well as occupation, with the less educated and manual laborers unwilling to donate blood on a voluntary basis (odds ratio [OR] = 3.758, confidence interval [CI] = 1.54–9.156; OR = 5.333, CI = 1.429–19.90, respectively). Conclusions: The study found that although awareness on voluntary blood donation among individuals in the rural community was widespread, hesitancy to donate blood in real life situation was high. Since voluntary unpaid donors are the best candidates for blood donation, community being the best available source, education, and motivation of the community should play a greater role in increasing voluntary blood donation.

Mandatory Blood Donor Screening for Human T-Cell Lymphotropic Virus Type I and Type II in Saudi Arabia: Need for Review

Background: HTLV blood donor screening is recommended practice in high prevalence countries. However, although studies of HTLV seroprevalence in Saudi Arabia agree these viruses present limited threat in the country, serological screening of HTLV-I/-II in all prospective blood donor candidates is mandatory practice. Since the last publication of HTLV seroprevalence in Saudi Arabia 10 years ago, we review 2014-2015 data of 23,668 blood donors attending King Khalid University Hospital (KKUH) Riyadh, to determine whether this mandatory practice needs review. Materials and methods:Serology screening was performed on the Abbott Architect system running the rHTLV assay. Repeat reactive results were confirmed by Western Blot analysis. Results: This study revealed zero HTLV-I/-II seroprevalence amongst 23,668 donors over the study period. Discussion: We further support Saudi Arabia as a HTLV non-endemic region, and review more cost-effective strategies to minimize HTLV risks as an alternative to mandatory blood donor screening.

PERFIL SOCIODEMOGRÁFICO E EPIDEMIOLÓGICO DE CANDIDATOS DE A DOAÇÃO DE SANGUE

Introdução: Um dos desafios das instituições de saúde é conservar a captação de sangue, uma vez que os doadores representam apenas 1,8% da população brasileira. É de fundamental importância o papel do profissional de enfermagem na conscientização, na captação e na triagem de doadores voluntários. Objetivos: Identificar a representação epidemiológica dos pretendentes à oferta de sangue do Hemocentro de uma unidade hospitalar no Sul de Minas Gerais. Material e Métodos: Estudo retrospectivo e descritivo, com abordagem quantitativa. A coleta foi executada da apreciação do Hemocentro no ano de 2011, com uma amostra de 2.680 candidatos. Foi utilizado o instrumento do próprio Sistema que contém as Fichas de Triagem do Candidato a Doador de Sangue. Para a análise dos dados, fez-se a tabulação no Microsoft Excel Windows 7 Ultimate®, 2011, e a elaboração de tabelas e gráficos com valores absolutos e percentuais. Resultados: Observou-se que 82% candidatos foram aptos e 18%, inaptos, prevalecendo o sexo masculino, entre 18 a 29 anos e doadores de repetição. Diante do perfil dos doadores desta pesquisa, vale ressaltar a importância da elaboração de campanhas educacionais quanto à doação de sangue, a fim de diminuir o número de inaptos, melhorando a qualidade dos candidatos. Conclusão: Os achados demonstram a importância de campanhas que conscientizem os indivíduos sobre as características ideais para quem pretenda a oferecer sangue, para que, assim, ocorra um aumento de sujeitos aptos.

Prevalence of dog erythrocyte antigens 1, 4, and 7 in galgos (Spanish Greyhounds).

Galgos (Spanish Greyhounds), in common with other sighthounds, have higher hematocrits, hemoglobin concentrations, and red blood cell counts than other breeds. In addition to these hematological characteristics, the physical characteristics of these dogs (medium to large dogs with an easily accessible jugular vein and a good temperament) make galgos ideal blood donors. However, to date, there are only published reports concerning dog erythrocyte antigen (DEA) 1 in this breed. Information on DEAs 4 and 7 would be useful when recruiting blood donors to donation programs, as DEA 1 and 7-negative and DEA 4-positive dogs can be considered universal donors. Ethylenediamine tetra-acetic acid-anticoagulated jugular blood samples were collected from 205 galgos. Dogs were aged between 1 and 10 years, 102 were female (49.8%) and 103 male (50.2%), and all were living in South Madrid, Spain. All 205 blood samples were tested for DEA 1 by card agglutination, and 150 of these samples were tested for DEA 4 and DEA 7 by gel column agglutination using polyclonal anti-DEA antibodies. Of the 205 galgos blood samples typed, 112 out of 205 (54.6%) were positive for DEA 1. Of the 150 blood samples tested, all (150/150, 100%) were positive for DEA 4, and 12 out of 150 (8%) samples tested positive for DEA 7. Of these samples, 70 out of 150 (46.7%) were positive only for DEA 4. There was no relationship between blood types and sex. In addition to the hematological characteristics previously reported and the physical characteristics of these dogs, the relative prevalence of blood types DEA 1, 4, and 7 make galgos good candidates for blood donation in blood donor programs.

HCV INFECTION THROUGH PERFORATING AND CUTTING MATERIAL AMONG CANDIDATES FOR BLOOD DONATION IN BELÉM, BRAZILIAN AMAZON

This study evaluated epidemiological factors for HCV infection associated with sharing perforating and cutting instruments among candidates for blood donation (CBD) in the city of Belém, Pará, Brazilian Amazon. Two definitions of HCV infection cases were used: anti-HCV positivity shown by EIA, and HCV-RNA detection by PCR. Infected and uninfected CBD completed a questionnaire about possible risk factors associated with sharing perforating and cutting instruments. The information was evaluated using simple and multiple logistic regressions. Between May and November 2010, 146 (1.1%) persons with anti-HCV antibodies and 106 (0.8%) with HCV-RNA were detected among 13,772 CBD in Belém. Risk factors associated with HCV infection based on the EIA (model 1) and PCR (model 2) results were: use of needles and syringes sterilized at home; shared use of razors at home, sharing of disposable razors in barbershops, beauty salons etc.; and sharing manicure and pedicure material. The models of HCV infection associated with sharing perforating and cutting instruments should be taken into account by local and regional health authorities and by those of other countries with similar cultural practices, in order to provide useful information to guide political and public strategies to control HCV transmission.

Seroprevalence, Demographic and Blood Donation Characteristics of Blood Donors in the Santa Catarina State, Brazil

There is a paucity of publications on regional variations in seroprevalence of infectious diseases in blood donors within Brazilian states, so that suitable time trends can be derived for major demographic groups. A population study of blood donors in the southern state of Santa Catarina, Brazil, was conducted using all computerized records of the blood donors submitted to serologic screening in 2010. The subjects were predominantly male (57.8%), aged 18-25 years (33.5%), did not direct their donation to any specific recipient (55.6%), nor did they provide another blood donation in last 12 months (58.6%). The highest seroprevalence was observed for the hepatitis B markers (3.0% for anti-HBc and 0.2% for HBsAg), followed by those for syphilis (0, 08% VDRL), HIV-1 (0.06%), hepatitis C (0.05%), HTLV1/2 (0.01%) and Chagas disease (0.01%). The risk factors associated with higher seroprevalence were associated with the first time donation, being male and of older age. Large regional variations were observed, with the Far West region reaching 7% of anti-HBc and 0.5% of HBsAg positive, and the Midwest region showing 0.1% HIV-positive donors. Hepatits B markers of both lifetime and recent infection reached a high level among blood donor candidates in Santa Catarina in 2010 and remain the foremost serological deferral criterion, despite some evidence of the reduced transmission rate compared to the beginning of the decade. The seroprevalence of other sexually transmitted infections (HIV, syphilis) also persisted on a level too high for a blood donor population, implying even higher prevalence in the general population.

Transfusion-transmitted malaria in endemic zone: epidemiological profile of blood donors at the Fundação HEMOAM and use of rapid diagnostic tests for malaria screening in Manaus.

ObjectiveWith 99% of the cases in Brazil, malaria is endemic in the Amazon region. Transfusion-transmitted malaria, an important risk in endemic areas, has been reported. The aim of this study was to describe the epidemiological profile of blood donor candidates at the Fundação de Hematologia e Hemoterapia do Amazonas and evaluate the efficacy of rapid diagnostic tests used for malaria screening of blood donors within endemic regions.MethodsBetween May 2008 and May 2009, 407 blood donor candidates were selected and grouped based on the Malaria Annual Parasite Index of the geographic area in which they originated: Group 1 (eligible donors – n = 265) originated from areas of low to medium risk of exposure to malaria and Group 2 (ineligible donors – n = 142) originated from high-risk areas. All samples were concurrently screened using two immunochromatic antigen-based rapid tests and by the thick smear test.ResultsAll samples were negative by all three methods. The demographic profile indicated that the majority of participants were male, ages ranged from 18 to 39 years and less than half the candidates had only elementary schooling. Two issues need to be addressed: one is the ineligibility of donors and its impact on blood donor centers as, in this study, 22.7% of the donors were considered ineligible. The other is the limited sensitivity of the parasitological tests used, allowing a risk of false-negative results.ConclusionNew methods are needed to ensure transfusion safety without rejecting potential donors, which would ensure safe transfusion without harming the blood supply.

Serological and molecular prevalence of selected canine vector borne pathogens in blood donor candidates, clinically healthy volunteers, and stray dogs in North Carolina

BackgroundCanine vector borne diseases (CVBDs) comprise illnesses caused by a spectrum of pathogens that are transmitted by arthropod vectors. Some dogs have persistent infections without apparent clinical, hematological or biochemical abnormalities, whereas other dogs develop acute illnesses, persistent subclinical infections, or chronic debilitating diseases. The primary objective of this study was to screen healthy dogs for serological and molecular evidence of regionally important CVBDs.MethodsClinically healthy dogs (n = 118), comprising three different groups: Gp I blood donor candidates (n = 47), Gp II healthy dog volunteers (n = 50), and Gp III stray dogs (n = 21) were included in the study. Serum and ethylenediamine tetraacetic acid (EDTA) anti-coagulated blood specimens collected from each dog were tested for CVBD pathogens.ResultsOf the 118 dogs tested, 97 (82%) dogs had been exposed to or were infected with one or more CVBD pathogens. By IFA testing, 9% of Gp I, 42% of Gp II and 19% of Gp III dogs were seroreactive to one or more CVBD pathogens. Using the SNAP 4DX® assay, Gp I dogs were seronegative for Anaplasma spp., Ehrlichia spp., and B. burgdorferi (Lyme disease) antibodies and D. immitis antigen. In Gp II, 8 dogs were Ehrlichia spp. seroreactive, 2 were infected with D. immitis and 1 was B. burgdorferi (Lyme disease) seroreactive. In Gp III, 6 dogs were infected with D. immitis and 4 were Ehrlichia spp. seroreactive. Using the BAPGM diagnostic platform, Bartonella DNA was PCR amplified and sequenced from 19% of Gp I, 20% of Gp II and 10% of Gp III dogs. Using PCR and DNA sequencing, 6% of Gps I and II and 19% of Gp III dogs were infected with other CVBD pathogens.ConclusionThe development and validation of specific diagnostic testing modalities has facilitated more accurate detection of CVBDs. Once identified, exposure to vectors should be limited and flea and tick prevention enforced.

HAM/TSP in relatives of HAM/TSP cases and in relatives of asymptomatic HTLV-1 carriers

To assess the hypothesis that HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) runs in families, we compared the frequency of HAM/ TSP among HTLV-1-positive relatives of HAM/TSP patients with the frequency of HAM/TSP among HTLV1-positive relatives of asymptomatic HTLV-1 carriers. We reviewed available information at the Instituto de Medicina Tropical Alexander von Humboldt in Lima (period 1990-2012). Index cases with HAM/TSP were defined as unrelated, HTLV-1-positive patients with a clinical diagnosis of HAM/TSP for whom HAM/TSP was the motive for HTLV-1 testing and who brought ≥1 relative (blood relatives and/or partners) for HTLV-1 testing. Asymptomatic index cases were defined as unrelated, asymptomatic HTLV-1 carriers who were tested for HTLV-1 as candidate blood donors and brought ≥1 relative for screening. In the family studies of 334 index cases with HAM/TSP, 1124 relatives were tested, 318/1124 (28%) were HTLV-1 positive, and 30/318 (9%) had HAM/TSP. In the family studies of 230 asymptomatic index cases, 544 relatives were tested, 204/544 (38%) were HTLV-1 positive, and 15/204 (7%) had HAM/TSP. We classified the relatives in groups based on sex and age. HAM/TSP frequency increased with age and was higher in women than in men. We found no significant differences in HAM/TSP frequency between relatives of HAM/TSP index cases and relatives of asymptomatic index cases. In total, there were 21 families with 2 HAM/TSP cases, 4 families with 3 HAM/ TSP cases, and 1 family with 5 HAM/TSP cases. This analysis approach suggests that HAM/TSP usually affects isolated people, but that in some, particular families, HAM/ TSP clusters can occur.

Hemovigilance: a system to improve the whole transfusion chain

Hemovigilance is used to track and reduce the occurrence of adverse events associated with blood donations(1). Hemovigilance programs have now been in existence for about 20 years after being developed in 1993 in France. Although it has emerged as tool to improve transfusion safety, many countries and centers are still in the development stage and have not yet established functioning hemovigilance systems with adequate notification. Hemovigilance is one of the most important activities of professionals in the field of blood transfusion. All professionals who deal with transfusions are involved in blood safety, from the blood bank director to quality managers, donor physicians, nurses, phlebotomists, laboratory technicians, transfusing physicians and hospital nurses. In transfusion medicine, quality starts with the process of attracting, recruiting and informing blood donor candidates and extends through all the transfusion chain to the transfused patient. Even with precise indication and correct administration, blood transfusion procedures have inherent biological risks related to health with the potential of transfusion incidents (TI), whether immediate or delayed. TI are defined as injuries occurring during or after blood transfusion that are related to the procedure. All professionals involved in prescribing and administrating blood products must be trained to identify and manage TI and to establish measures to prevent future incidents. Thus, the notification of immediate and delayed TI is essential to minimize risk(2). The safety of blood products from their source, the blood donor, until their use in the recipient is of the utmost importance. Today, the field of hemovigilance is very extensive covering blood components, tissues and cell preparations including donor vigilance, material vigilance and the safety of the patient. While hemovigilance is well known to those who work in the field of transfusion medicine, there are important differences between countries when it comes to the implementation of national hemovigilance programs. In Brazil, the blood-surveillance system was implemented by the National Health Service in 1999(3-5). Resolution number 57 of the Brazilian National Surveillance Agency, ANVISA, defines hemovigilance as a set of surveillance procedures covering the cycle of blood, from the donation to the transfusion, generating information about adverse events resulting from the donation and the therapeutic use of blood and blood components. And follows: information is used to identify risks, improve the quality of products and processes and increase the donor and patient safety by preventing the occurrence or reoccurrence of these events(4). Although regulations and laws are in place, there is concern about underreporting undesired reactions to blood and blood products. This is still common problem in Brazil, which shows reporting rates much lower than in countries such as France and the United Kingdom where the systems are consolidated(2). There is an international effort to establish common definitions and in bringing together the different national policies. These are pooled by diverse international and national associations that make concentrated effort to standardize definitions and measures around the world(6). The paper on hemovigilance in the current issue of the Revista Brasileira de Hematologia e Hemoterapia illustrates how local attempts to evaluate information on adverse and unexpected reactions in the use of blood products may function in order to prevent the onset or recurrence of reactions(7). It shows that after initial resistance, there was growing trend in the number of hemovigilance processes opened followed by downward trend, variation that is explained by statistical analysis. Human immunodeficiency viruses (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV) seroconversion cases in donors were tracked and associated to infection in the blood recipient. These cases are not dealt with unless there is an active hemovigilance system in place which shows the importance of this instrument in increasing transfusion safety. There are currently technologies that capture and analyze donor reaction information, focusing on donor hemovigilance, including monitoring, analyzing and investigating the risks involving donors at the time of blood donation or following the blood donation event. Some enable users to track the different reaction rates, provide baseline metrics and help analyze the trends and changes in reaction rates over time, thereby giving clues to the factors that affect reaction rates. They may facilitate the ability to hypothesize, design and analyze interventions, as well as to assess their impacts with the goal of improving donor and donation safety. In conclusion, there is continuous need to work on hemovigilance; the laws and tools are in place, but there is still the need of establishing the correct awareness system in order to ensure that the procedures will be followed and that hemovigilance will help to prevent undesired reactions to blood transfusions.

The Utilization of NET Promoter System As a Blood Supply Management Strategy

AbstractAbstract 4378 Introduction:Despite the increasing development of medicine there is no safe and practice substitute for blood. However the demand for blood are rising every day, due to increases in the number and complexity of procedures that require transfusions The greatest challenge of the hemotherapy service is to provide the blood supply needed “assuring” the safety of them. To meet the potential needs for adequate blood supplies, it is beneficial to increase the number of blood donors and the blood donation rate, without enhancing the risk of blood transmitted diseases. Many strategies have been used to achieve this goal, but most of than concluded that the results of blood donors satisfaction surveys have poor correlation with blood donation process performance. This problem is present in many other fields of the economy, such as hotels, air transportation and day-to-day industrial needs. In the beggining of the last decade developed a strategy called “Net Promoter Score”, that had the intention to establish a direct correlation between customers loyalty and enterprise/process performance. This methodology was based in several researches that could link the customers consuming behavior and the retaining issues. The survey were made with only one question, that was “Would you recommend this company/service for your family or friends” (The Ultimate Question). The customers could answer in a numeric scale from 0 to 10, where 0 was “No, I wouldn’t” and 10 was “Yes, I would”. From that score the clients were stratified in three groups: 0–6 were called “Detractors”, the ones that would be the bad marketing of the company; 7–8 were called “Passive”, the ones that do not have a strong experience neither good or bad; and those 9–10, that were called “Promoters”, that were the ones that would be the marketing department of the company, and in our case, the ones that would recruit and retain more donors. To calculate the so called “NET Promoter Score” (NPS), the percentage of detractors were subtracted from the promoters. This score were than used prospectively to follow the enterprise performance, and to be the main guide to adjust customer services. When the NPS were used as the “core” of the strategy, and all the others management tools were taken together with it, we could call it the “Net Promoter System”. In this way the score is a tool that can be used to develop the system. Nowadays this methodology is widely used in the industry, commerce and other fields, and since its publication there were many economy activities that no company could optimize its performance without improving its score. There is no published research looking for its use in the Hemotherapy practice, and specifically in blood donor recruitment and retention. The objective of this study was to establish the feasibility of the utilization of the Net Promoter Score in the blood donation area. Methodology:The satisfaction survey were offered to the customers at the end of the blood donation process. The candidates to blood donation were analyzed and divided in the described groups according to the so called ultimate question (Detractor, Passive or Promoter) and the blood donations behavior (Clinical unfit for blood donation, First time donor and Repetition donor). These data were pulled together and were used as a guide to adapt customer relations strategy and blood supply optimization. Results:From may of 2011 until july of 2012, there were six thousand nine hundred and eight one researches available for analysis derived from seven thousand three hundred and thirty candidates for blood donation (95,23%). From those 11,9% were from unfit patients that were unable to donate, 44,2% of first time donors and 43,8% of repetition donors. The groups were analyzed according to the score, and the NPS were than calculated as follow: 97,66% ±1,30 (SD) for First time Donors; 98,66% ± 0,84 (SD) for Repetition donors and 90,80% ±4,42 (SD) for unfit candidates. Conclusion:The development of a tool to optimize the blood management is an on course task. Several methodologies have been trying to establish a strong link between donor satisfactions and blood donation behavior. In this study we concluded that NPS is an effective tool, with high feasibility and great potential impact in process performance. The efficacy of the score, the development of the NET Promoter System and the correlation between its methodology with blood donor recruitment and retention must be study in a prospective trial. Disclosures:No relevant conflicts of interest to declare.

Seroprevalence of hepatitis C virus infection among surgical nurses, their patients and blood donation candidates in Poland

To assess the prevalence of anti-hepatitis C virus (HCV) in surgical nurses and midwives, to compare the rate with other female groups (their patients from the same hospitals and blood donation candidates) in a cross-sectional serosurvey, and to evaluate the alleged risk factors for acquiring an occupational infection. Between February 2008 and June 2009, participants from 16 hospitals selected at random in West Pomerania, Poland completed a written questionnaire detailing potential risk factors for HCV infection. Serum samples were assayed for anti-HCV using third-generation testing methods. Of 414 staff members, six were found to be anti-HCV positive [1.4%, 95% confidence interval (CI) 0.7-3.1%]. The seropositive status of staff was discovered during this one-off screening. A logistic regression model indicated that for anti-HCV seropositivity, only the length of employment was associated with increased odds of being infected [odds ratio (OR) 2.8; P < 0.006]. The prevalence of anti-HCV was 1.1% (12/1118, 95% CI 0.6-1.9%) in 1118 female patients, and 0% (0/801, 95% CI 0-1.1%) in 801 female blood donation candidates. A significant staff/patient difference in anti-HCV prevalence was observed among those aged >50 years (6.9% vs 1.0%; P < 0.007). For this age group, being a nurse was associated with higher odds (OR 8.8; P < 0.005) of being infected with HCV. Comparison of HCV prevalence rates pointed to a decreasing trend in the order: surgical nurses/midwives, patients and blood donation candidates; this may indicate occupational risk. The greatest risk factor for contracting HCV infection was length of employment, suggesting a possible effect of accumulated exposure to contaminated blood and other body fluids. There is a need for better recognition of HCV infection as a consequence of prolonged blood exposure among surgical and gynaecological staff.

HTLV-1/2 seroprevalence and coinfection rate in Brazilian first-time blood donors: an 11-year follow-up

The seroprevalence and geographic distribution of HTLV-1/2 among blood donors are extremely important to transfusion services. We evaluated the seroprevalence of HTLV-1/2 infection among first-time blood donor candidates in Ribeirão Preto city and region. From January 2000 to December 2010, 1,038,489 blood donations were obtained and 301,470 were first-time blood donations. All samples were screened with serological tests for HTLV-1/2 using enzyme immunoassay (EIA). In addition, the frequency of coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), Chagas disease (CD) and syphilis was also determined. In-house PCR was used as confirmatory test for HTLV-1/2. A total of 296 (0.1%) first-time donors were serologically reactive for HTLV-1/2. Confirmatory PCR of 63 samples showed that 28 were HTLV-1 positive, 13 HTLV-2 positive, 19 negative and three indeterminate. Regarding HTLV coinfection rates, the most prevalent was with HBV (51.3%) and HCV (35.9%), but coinfection with HIV, CD and syphilis was also detected. The real number of HTLV-infected individual and coinfection rate in the population is underestimated and epidemiological studies like ours are very informative.

Trends in hepatitis B and hepatitis C virus seropositivity among blood donors over 15 years screened in the blood bank of a university hospital

Blood transfusion carries well defined risks including hepatitis B and hepatitis C virus transmission. In this study, records of blood donation candidates between the years 1996–2010 were retrospectively reviewed. A total of 220 841 apparently healthy adult donors were screened for hepatitis B surface antigen, anti-HCV with enzyme linked immunosorbent assay (ELISA) method. The overall prevalence of HbsAg and HCV were 1.07% and 0.39%, respectively. HBV seroprevelance decreased through years 1996–2010 but HCV seroprevelance showed a fluctuant course decreasing from 1996 to 2002. In order to decrease transfusion transmitted infections there should be centralized blood collection systems having qualified staff, equipment and non-remunerated voluntary blood donations must be strongly encouraged.

Hepatitis B virus genotypes from European origin explains the high endemicity found in some areas from southern Brazil

Southern Brazil is considered an area of low Hepatitis B endemicity, but some areas of higher endemicity have been described in the Southwest of Paraná and Santa Catarina states. The aim of this study was to evaluate viral genotypes circulating throughout Paraná state. PCR amplification and partial sequencing of the S gene was carried out in 228 samples from HBsAg positive candidate blood donors. Samples have been collected in seven different counties (Cascavel, Curitiba, Foz do Iguaçu, Francisco Beltrão, Maringá, Londrina and Paranaguá). The most common HBV genotype in Paraná state was D (82.9%; 189/228), followed by A (14.1%; 32/228). Genotypes F (1.3%; 3/228), C (1.3%; 3/228) and H (0.4%; 1/228) were also found. Distribution of genotypes was different in the studied counties, but genotype D was the most frequent in all of them. In Francisco Beltrão, all studied samples belonged to genotype D. The high prevalence of HBV genotype D in South of Brazil is explained by the intense migration of settlers from Europeans countries. Subgenotypes A1 and A2 were identified circulating in all cities where HBV/A was found. As observed in other areas of Brazil, HBV/A1 is more frequent than the HBV/A2 in Paraná state and its presence was significantly larger in black and mulatto individuals. Genotype C was found only in individuals with Asian ancestry from Londrina and Maringá. Most HBV/F sequences identified in this study were classified as subgenotype F2a that was previously described in Brazil. The sole case of subgenotype F4 was from Foz do Iguaçu city, near to Northern Argentina, where F4 is highly prevalent. The single genotype H sample was from Curitiba. This is the first case of this genotype described in Brazil. Further studies should be carried out to determine if more genotype H samples can be found in other populations from Brazil.

Prevalence of markers of hepatitis B virus infection or vaccination in HBsAg-negative subjects.

The implementation of mass vaccinations against hepatitis B virus (HBV) has significantly reduced the prevalence of HBsAg-positive subjects. At the same time, the prevalence of the other markers of infection has decreased, but there has been an increase in the percentage of subjects with markers of a successful vaccination. It has been suggested that increasing immigration from countries in which this virus is highly endemic is changing the epidemiology of HBV infection. The aim of this study was to assess the prevalence of the serological markers of HBV in Italian and non-Italian HBsAg-negative subjects. In the years 2007-2008, 8,018 samples from HBsAg-negative subjects (7,521 Italians and 497 non-Italians) were received for detection of anti-HBs and/or anti-HBc. The findings in the 1,358 samples from candidate blood donors were compared with those obtained in 1991 and 1999. The rate of anti-HBc positivity was 18.3% in the Italian samples and 32.8% in the non-Italian samples; the corresponding percentages of anti-HBs/anti-HBc positive samples (indicating past infection), anti-HBs positive only samples (vaccination) and anti-HBc positive only were, 11.3% vs. 22.5%, 25.8% vs. 17.2%, and 6.9% vs. 9.9% in Italians and non-Italians, respectively. The differences were more marked when stratified by age. In relation to candidate blood donors, simultaneous positivity for anti-HBs and anti-HBc decreased from 11.0% in 1991 to 8.1% in 1999 and 3.9% in 2007-2008, whereas isolated anti-HBs positivity increased from 2.2% in 1991 to 21.4% in 1999 and 42.9% in 2007-2008. The frequency of markers of past infection among Italians has decreased over time as a result of mass vaccination and is significantly lower than that observed in non-Italians. The increasing number of immigrants from countries in which HBV is highly endemic is changing the epidemiology of HBV infection in Italy.

Prevalence and trends of hepatitis C virus among blood donors in Antananarivo, from 2003 to 2009

Purpose of the studyDue to anemia and maternal, childhood and infancy diseases, blood transfusion is one of the most important medical cares given in sub-Saharan Africa, including Madagascar. World Health Organization encourages worldwide countries to maximize transfusion security. Until now, there was no data within a large population of blood donors. Therefore, the aim of this study was to assess the prevalence and time trends of hepatitis C virus (HCV) among all first-time blood donors coming into the National Centre of Transfusion Supply in Antananarivo. Material and methodsThis retrospective study was conducted at the National Centre of Transfusion Supply in Antananarivo from 2003 to May 2009. We looked up to all recorded results of systematic screening of blood donor candidates and we took data about all first-time blood donors, including age and gender. Forty-seven thousand five hundred and ten of 47,636 first-time blood donors were retained, the others were excluded due to lack of some data. ResultsThe mean age of our donors was 33.3years (35.8 for male, and 32.6 for female; P<<0.05). Eighty percent were male (38,225/47,510). HCV prevalence was 0.65% during the period of study and HCV positive donor candidates were older than HCV negative (mean age: 39.1 vs. 33.2; P<<0.05). It was in fact stable from 2003 to 2007, and then decreased. HCV prevalence was higher in women than in men (0.9 vs. 0.6; P<0.05), and it increased by age (P<0.05). ConclusionOur study found a low prevalence of HCV among blood donors compared to many countries in Africa.

Logistic model for determining factors associated with HIV infection among blood donor candidates at the Fundação HEMOPE

ObjectiveTo determine factors associated with HIV infection in blood donor candidates in Recife, Brazil.MethodsA transversal study was performed of 106,203 blood donor candidates found eligible by the routine clinical screening process in the blood bank in Recife of the Fundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE) in the period from January 1998 to November 2003. Additional indirect immune and western blot confirmation tests for HIV infection were performed and the candidates were classified as HIV positive or negative. The Chi-squared test and stepwise multiple logistic regression were conducted to examine any association between HIV infection and age, gender, place of residence, schooling, number of donations and serological tests for core hepatitis B antigen virus (anti-HBc), the hepatitis C antivirus (anti-HCV), human T-type antivirus lymph cells (anti-HTLV 1 and 2), serological tests for syphilis (VDRL) and the hepatitis B virus surface antigen (HBsAg).ResultsIn the observed sample, 0.204% of blood donor candidates were found to be HIV positive. Among the studied variables, the age, education level, residency, donation type, and serologic status for anti-HBc and VDRL tests were found to be associated with HIV infection.ConclusionsThe younger, spontaneous donor candidates living in the Recife metropolitan area with a low level of education and positive for anti-HBc and VDRL have an higher risk of HIV infection than the other candidates. Data such as these are useful to understand the dynamics of infection and to guide healthcare policies.

Etiology of anemia of blood donor candidates deferred by hematologic screening

Objective: Iron deficiency is the most common cause of anemia and one of the main factors in the clinical deferral of blood donors. This fact prompted the current study that aimed to determine the prevalence and etiology of anemia in blood donor candidates and to evaluate the hematological screening technique used for the exclusion of these donors. Methods: This was a prospective study that compared two groups (Anemic and Non-anemic). Initially screening for anemia was performed by manually measuring hemoglobin (Bioclin® Kit); the results were subsequently compared with an automated screening method (Coulter T-890). The etiology was investigated by hemoglobin electrophoresis in alkaline and acid pH, Hb A2 dosage and measurement of the ferritin concentration by immunoagglutination. Differences and associations of interest were analyzed using the Yates and McNemar's Chi-square tests and the Fisher, Mann-Whitney, Wilcoxon and Kruskal-Wallis tests. Results: The deferral rate due to anemia was 4.2%; iron deficiency was identified in 37.5% and beta thalassemia in 9.3% of the excluded candidates. There was a significant discrepancy between the two techniques used to measure hemoglobin with 38.1% of initially deferred donors presenting normal hemoglobin levels by the automated method. Conclusion: The results show a high rate of blood donors being deferred for anemia and confirm that iron deficiency is the most prevalent cause. The discrepancies found by comparing screening methods suggest that hemoglobin and hematocrit levels should be confirmed before deferring a donor due to anemia; this may increase supplies in blood banks.

Anemia and the Blood Donor

The World Health Organization recommends a collection rate of 10-20 whole blood units per 1000 inhabitants to address transfusion needs(1). However, demand for blood is ever-increasing as medicine continuous to develop(2). Donor selection is critical to blood transfusion safety and blood donor eligibility policies are designed to protect both the donor and the recipient(1,3). Donors with relatively low hemoglobin (Hb) levels are not allowed to donate to prevent them from developing iron deficiency anemia (IDA). In addition, deferral of these donors guarantees that blood units for transfusion meet the required standards for Hb content(4). Deferral for low Hb accounts for 35% to 75% of total deferrals, with the vast majorityoccurring in women(5-7). At the New York Blood Center, 92.7% of these deferrals were women(6,7). Iron deficiency is the world's most widespread nutritional disorder, affecting both industrialized and developing countries(8). In Brazil, there are no consistent studies to show the real problem, although some studies showed 25% of anemia in women of childbearing age(9,10). On the other hand, because IDA is the last stage of iron-deficiency, Hb measurement alone is inadequate to detect blood donors with iron deficiency but without anemia. Recent publications have suggested that serum ferritin levels could be a reliable indicator for body iron stores since they provide a determination of iron deficiency at an early stage(11,12). As ferritin testing is comparatively costly, various red blood cell (RBC) parameters have been proposed as markers for low ferritin/iron depletion(13). Significant correlations between ferritin and RBC parameters were shown in these analyses, but no study has determined which marker is the most useful to identify donors at risk of developing anemia(13). Beta-thalassemia trait (BTT) is the second most common cause of microcytic anemia and, for this reason, the possibility of this disease must be discarded when anemia or microcytosis is present(12,14). An interesting paper by Tiwari et al.(14) suggested that it could be useful to routinely perform a complete blood count (CBC) for all blood donors and further analyze the microcytic samples for ferritin and Hemoglobin A2 to differentiate between IDA and BTT. This approach, however, is relevant only in areas where there is an elevated prevalence of BTT. These authors, also, reviewed nine indices to differentiate IDA and BTT. (Table 1) Table 1 Formulae and cut-off point of nine indices to differentiate iron deficiency anemia (IDA) and beta-thalassemia trait (BTT)(14) In order to fulfill their necessities, blood centers have long recognized that it is more effective and less expensive to collect blood from existing donors than to recruit new donors and in the United States, 71% of donors are repeat donors. But, this strategy has come at a price: iron depletion of these donors(5). After donation of 450 mL of blood, a male donor loses 242 ± 17 mg and a female 217 ± 11 mg of iron(5,15). Since the 1970s, various investigators documented the decrease in serum ferritin levels in association with blood donation(5,11,13,16-18). The lost iron is not readily repleted. It has been common practice for blood centers to recommend iron-rich diets to donors who have been rejected for low Hb. However, even with excellent compliance, it requires 6 months or longer to positively impact ferritin levels(5). Because of this, many researches have prescribed iron supplementation with good results(15,19,20). However, the majority of regular blood donors with low or absent iron stores will never develop IDA(13). It is important to remember that avoiding unnecessary deferrals, keeps donors engaged with the blood center(6). In fact, Boulton demonstrated that only 25% of first-time donors return to the blood donation facility after rejection, while 47% of first-time donors come back within 6 months when accepted at their first visit(21). Anemia is an important topic for blood donor candidates and effort has to be made to identify these individuals, prevent iron depletion in regular blood donors, and engage these individuals with blood donation.