Risk Of Transfusion-transmitted Infections Research Articles

Implementing pathogen reduction technology while discontinuing blood donor deferral criteria for sexual risk behaviors: A simulation study.

Combining pathogen reduction technology (PRT) with blood screening may alleviate concerns over the risk of transfusion-transmitted infections (TTI) and support changes in blood donor selection to potentially increase blood availability. This study aimed to estimate the residual risk of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) transfusion-transmission in Canada after implementing PRT, while eliminating deferrals for sexual risk behaviors. A probabilistic approach that combined Bayesian networks with Monte Carlo simulations was used to estimate the risk of transfusing HIV-, HBV-, or HCV-contaminated blood components. Different scenarios were considered to compare the current residual risk after PRT implementation, with and without donor deferral criteria for sexual risk behaviors. Donor profiles and blood component outcomes were simulated based on a literature review including the prevalence and incidence of HIV, HBV, and HCV in the Canadian blood donor population; the use of current blood screening assays; and HIV, HBV, and HCV blood donor viral loads. In the universal PRT scenario (i.e., with PRT/without deferral criteria), the estimated risks of HIV, HBV, and HCV transmission were significantly lower than those in the currently observed scenario (i.e., without PRT/with deferral criteria). This risk model suggests that PRT for platelets and plasma (and eventually for RBCs when available) significantly reduces the residual risks of HIV, HBV and HCV transfusion-transmission and could enable the removal of blood donor deferral criteria for sexual risk behaviors.

Seroprevalence of transfusion -transmitted infections among blood donors in a tertiary care hospital in and around Koodapakkam, Puducherry, India

Introduction: Even though blood transfusion safety has come a long way, Transfusion-Transmitted Infections (TTI), which include bacterial, viral, parasitic, and prions, can still spread with each transfusion. The main goal of this study was to determine the seroprevalence of the five TTIs that are required to be tested in India among blood donors at our facility. Accurate estimates of the risk of TTIs are essential for monitoring the safety of the blood supply. Methodology: This was a retrospective descriptive study conducted in the blood centre of a tertiary care teaching hospital in Puducherry, from 2017 to 2023. Records from blood banks were reviewed to collect data on all donors who underwent appropriate testing for HIV, hepatitis C, Hepatitis B, syphilis, and malaria. Enzyme-linked immunosorbent assay was done for HIV, HCV, HBsAg/hepatitis B surface antigen, and rapid card testing was done for syphilis and malaria. Results: There was a total of 2570 donors during the study period. In the present study, the overall seroprevalence of TTIs was 1.40%. The individual seropositivity rates were 0.03% for HIV, 0.93 % for HBsAg, and 0.43 % for syphilis. There were no cases of malaria and HCV detected in the study period. The highest percentage of prevalence was observed for HBV, followed by Syphilis and HIV. Conclusion: The overall seroprevalence of TTI in Puducherry was smaller than those reported elsewhere in the country. It was comparatively lesser than the national average for HIV, HCV, and HBV and much higher for syphilis.

Should men who have ever had sex with men be allowed to donate blood in Brazil?

Many countries have modified their policies on banning or deferring blood donation by men who have sex with men (MSM) in light of ethical concerns and new evidence about transfusion risks. In Brazil, MSM were not eligible to donate blood unless they had been celibate for the previous 12 months. However, in May 2020, the Brazilian Federal Supreme Court overturned this restriction. Many authors have attempted to stress possible risks of transfusion-transmitted infection under various scenarios of changes in bans or restrictions on donations by MSM using mathematical models, but we consider that it is a difficult task due to the wide variety of sexual behaviors, attitudes, and practices. Among these factors, we highlight sex under the influence of illicit drugs, and the fact that people with an undetectable human immunodeficiency virus viral load have the potential to transmit should their blood be transfused. Despite these possible risks, we believe that some MSM can donate blood regardless of the time elapsed since their last sexual contact, especially because blood donations by MSM were occurring even when there were time-based deferral rules. Blood banks should always seek to use screening algorithms to identify high-risk sexual behaviors using gender-neutral criteria, and education about transfusion risks should be offered to healthcare workers and MSM.

COVID-19 impact on blood donor characteristics and seroprevalence of transfusion-transmitted infections in southern Thailand between 2018 and 2022

Blood safety is a critical aspect of healthcare systems worldwide involving rigorous screening, testing, and processing protocols to minimize the risk of transfusion-transmitted infections (TTIs). The present study offers a comprehensive assessment of the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis among blood donors in southern Thailand. It explores the consequences of the COVID-19 pandemic on the blood transfusion service, donor characteristics, and the prevalence of TTIs. A retrospective analysis of 65,511 blood donors between 2018 and 2022 was conducted at Songklanagarind Hospital, Thailand. The socio-demographic characteristics of the donors were examined using the Chi-square test to assess the relationship between TTIs serological positivity and donor characteristics. The donors were divided into pre-COVID-19 (2018–2019) and during COVID-19 (2020–2022) groups to evaluate the impacts of COVID-19. The study found that HBV had the highest overall prevalence at 243 per hundred thousand (pht), followed by syphilis (118 pht), HCV (32 pht), and HIV (31 pht) over a five-year period of study. After COVID-19, the prevalence of HBV decreased by 21.8%; HCV decreased by 2.1%; HIV increased by 36.4%; and syphilis increased by 9.2%. The socio-demographic characteristics and TTIs prevalence were significantly altered over time. This study provides insights into blood donor characteristics and TTIs prevalence in southern Thailand, highlighting the understanding of the impact of COVID-19 on the spread of TTIs.

Association of ABO, Rh-D and Kell blood groups with transfusion transmitted infections among blood donors from the Asir Region, Saudi Arabia: A retrospective observational study.

To evaluate the association between transfusion-transmitted infections (TTIs) and ABO, Rh-D, and Kell blood systems among blood donors. This was a retrospective study of 10,095 donors who visited the Blood Bank at Asir Hospital, Abha, Saudi Arabia. Data including demographic information, ABO, Rh-D, and Kell blood groups, and serological and molecular test results of TTIs (the TTIs were obtained from each donor's records). Chi-squared and Fisher's exact tests were employed to establish possible associations between blood groups and TTIs. The prevalence rate of TTIs among donors was 6.3%, with HBcAb (70%) being the most prevalent biomarker among positive donors. Donors with the O blood group were at a higher risk of contracting TTIs. Significant associations were observed between HIV and blood group A (χ2=6.30, p=0.01), HBsAg and group AB (χ2=17.3193, p=0.00003), malaria and group A (χ2=5.0567, p=0.02), and HBV-DNA and group AB (χ2=12.3163, p=0.0004). Also, Kell blood group was significantly associated with HIV (χ2=14.5, p=0.0001), HBcAb (χ2=78.51, p<0.0001), and syphilis (χ2=25.225, p<0.00001). ABO and Kell blood groups are associated with TTI markers. These findings highlight the need for improved strategies and approaches in screening and managing blood donations to minimize the risk of TTIs.

Neonatal Blood Transfusion in Africa; Towards Optimizing Scarce Resource

Neonatal transfusion is a common practice in Africa, where many infants are born with low birth weight and require blood transfusions. The use of paediatric packs for neonatal blood transfusions has been recommended. However, the optimal use of these packs in Africa is not clearly understood by some healthcare practitioners. This review aims to provide insights into the optimal use of paediatric packs in neonatal transfusion in Africa.The World Health Organization (WHO) recommends restrictive transfusion practices for paediatric patients, including neonates, based on expert opinion. Transfusion triggers in neonates are controversial and mainly based on expert clinical opinion, although recent randomized controlled trials of ‘liberal’ versus ‘restrictive’ red cell transfusion policies in very low birth weight preterm babies are starting to influence clinical guidelines. Many neonatal red cell transfusions are given to replace losses from frequent blood sampling. This can be reduced by avoiding non-essential tests, using low-volume sample tubes, validated near patient testing, micro-techniques in the laboratory, and non-invasive monitoring where possible.The use of CMV-seronegative blood products for transfusion in low birth weight neonates is not deemed necessary. The primary rationale is that the risk of transfusion-transmitted infections should be reduced by stringent screening of donors, restrictive transfusion practice and certain interventions like irradiation of blood units before transfusion. A recent international survey of transfusion practices for extremely premature infants showed that factors considered “very important” regarding the need to administer blood transfusions included degree of oxygen requirement and need for respiratory support. Donor exposure can also be reduced by allocating single donor units, split into paedipacks, to babies predicted to need more than one transfusion episode within the expiry date of the donation. Implementing a program to improve compliance with neonatal intensive care unit transfusion guidelines was accompanied by a reduction in transfusion rate. The implementation of guidelines to improve compliance with neonatal intensive care unit transfusion guidelines can also reduce the transfusion rate.

Current challenges of blood transfusions in patients with thalassemia in India and future perspectives

The introduction of regular red blood cell transfusions transformed thalassemia major from a fatal childhood disease into a chronic disorder. Thalassemia is highly prevalent in South Asia, including the Indian subcontinent, and blood transfusion remains the cornerstone of management for these patients. But safe blood transfusions still remain a major problem in India. Difficulties in maintaining adequate blood inventory, a lack of a national blood act, and fragmented blood transfusion services are some of the major contributing factors for the delay in blood supply. In most of the blood centers, alloantibody detection facilities and extended red cell antigen typing are unavailable. Awareness is the key to reducing alloimmunization, which limits the effectiveness of transfusions and the potential availability of blood. Patients with thalassemia are also at high risk of transfusion-transmitted infections unless appropriate blood screening is in place. Hence, many patients remain under-transfused, resulting in decreased health and quality-of-life outcomes. Facilities such as leucoreduction and immunohematological monitoring following a blood transfusion are often lacking in India, especially at the sub-district level. Continuous efforts to raise community awareness, regular training of health-care workers, and proper utilization of available resources are essential to ensuring safe blood transfusions for patients with thalassemia. Access to the new treatments at an affordable cost may reduce the blood transfusion burden for thalassemia patients in India.

Blood Donor Selection Profile an Important Tool for Blood Safety: An Institutional Experience

Background and Aim: Blood transfusions can be a crucial, life-saving treatment in modern medical and surgical practice. The primary objective of blood transfusion services worldwide is to guarantee the availability of a sufficient and safe supply of blood and blood products. Meticulous donor screening and use of highly sensitive techniques for the detection of transfusion-transmitted infections (TTIs) may help reduce the risk of TTIs and, hence, are important steps to ensure safety for both donor and recipient. Materials and Methods: This is a retrospective record-based study done at Hamdard Institute of Medical Sciences and Research. The blood donors’ data from January 2012 to December 2022 (10 years) were collected from the blood bank registry at the study site and were analyzed. Results: Males dominated the donor population (98.2%) with females comprising only (1.8%). In total, 10.9% were found unfit for donation for various reasons. Voluntary donors were (6.3%) and replacement donors were (93.7%). Out of the reasons for deferral, majority 497/1223 (40.6%) donors were deferred due to hemoglobin &lt;12.5 g/dl, followed by 156/1223 (12.8%) deferrals due to alcohol intake within the past 72 h. Conclusion: Safe donor selection is the first step toward safe transfusion services. Identification of population groups that can be targeted to enhance the pool of willing blood donors is made easier by studying and analyzing the blood donor profile.

A comparative analysis of blood-borne infections among sickle cell anemia patients and first-time donors in Gabon

Managing sickle cell disease often requires transfusions, exposing multi-transfused sickle cell patients to a heightened risk of transfusion-transmitted infections. This study aimed to assess the seroprevalence of the human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) in multi-transfused sickle cell patients and first-time donors in Libreville. The serological testing for HBsAg, anti-HIV, and anti-HCV antibodies was conducted using commercial enzyme immunoassays and confirmed by the COBAS modular analyzer (Roche Diagnostics). The seroprevalence of HIV, HCV antibodies, and HBsAg was 4%, 10%, and 10%, respectively, in multi-transfused sickle cell patients and 5%, 0%, and 8% in first-time donors. Interestingly, HIV and HBsAg seroprevalence were similar in both groups, indicating that transfusion was not associated with these infections. However, HCV antibody seroprevalence was significantly higher in multi-transfused sickle cell patients than in first-time donors (10% vs. 0%, p&lt;0.001). Furthermore, the presence of anti-HCV antibodies in multi-transfused sickle cell patients was significantly associated with the number of donations received (7.20±2.37 vs. 3.96±2.06, p=0.042). These findings suggest that while blood transfusion is not a significant risk factor for HIV and HBsAg transmission, it may increase the risk of HCV transmission, particularly in multi-transfused sickle cell patients.

Implementation of amotosalen plus ultraviolet A-mediated pathogen reduction for all platelet concentrates in France: Impact on the risk of transfusion-transmitted infections.

Pathogen reduction (PR) technology may reduce the risk of transfusion-transmitted infections (TTIs), notably transfusion-transmitted bacterial infection (TTBI) associated with platelet concentrates (PCs). PR (amotosalen/UVA treatment) was implemented for all PCs transfused in France in November 2017. No bacterial detection was in place beforehand. The study aimed to assess the impact of PR PC on TTI and TTBI near-miss occurrences. TTI and TTBI near-miss occurrences were compared before and after 100% PR implementation. The study period ran from 2013 to 2022. Over 300,000 PCs were transfused yearly. No PC-related transmission of human immunodeficiency virus, hepatitis C virus, hepatitis B virus and human T-cell lymphotropic virus was reported throughout the study period. PC-mediated hepatitis E virus and hepatitis A virus infections occurred irrespective of PR implementation. Mean PC-mediated TTBI occurrence before PR-PC implementation was 3/year (SD: 1; n = 15; 1/92,687 PC between 2013 and 2016) with a fatal outcome in two patients. Since PR implementation, one TTBI has been reported (day 4 PC, Bacillus cereus) (1/1,645,295 PC between 2018 and 2022; p < 0.001). Two PR PC quarantined because of a negative swirling test harboured bacteria: a day 6 PC in 2021 (B. cereus and Staphylococcus epidermidis) and a day 7 PC in 2022 (Staphylococcus aureus). Five similar occurrences with untreated PC were reported between 2013 and 2020. Transfusion of 100% PR PC resulted in a steep reduction in TTBI occurrence. TTBI may, however, still occur. Pathogen-reduced PC-related TTI involving non-enveloped viruses occurs as well.

Risk of transfusion-transmitted infection with severe acute respiratory syndrome coronavirus 2 from blood donors in Japan.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) essentially affects respiratory organs and tissues. SARS-CoV-2 RNAemia is often associated with more severe cases of coronavirus disease 2019 (COVID-19) compared to cases without RNAemia. To determine the impact of the pandemic on transfusion medicine, particularly transfusion-related infection, we examined the frequency of blood donation with RNAemia, the viral RNA (vRNA) concentration, and any possibility of transfusion-transmitted infection (TTI) among transfusion recipients. vRNA was examined in plasma/serum samples from 496 of 513 blood donors who reported having been infected with SARS-CoV-2 within 2 weeks of donation among a total of ca. 9.9 million blood donations in Japan between January 15, 2020, and December 31, 2021. The clinical course of patients transfused with the blood component containing vRNA was also examined. vRNA was detected in 23 of 496 samples. The median period from blood donation to COVID-19 onset was 1 day in 16 RNAemia-positive donors. Most samples had vRNA concentrations below the limit of quantification. Three patients were transfused with either a packed red blood cell or platelet concentrate that tested positive for vRNA, showing no COVID-19 symptoms and testing negative for vRNA in post-transfusion blood. The rate of RNAemia was 4.6% among blood donors who were found to be infected with SARS-CoV-2 shortly after donation, and vRNA concentrations in their donated blood were extremely low. There was no evidence of TTI in the recipients transfused with RNAemia-positive blood components. TTI risk in SARS-CoV-2 is negligible.

Evaluation of the efficacy and safety of amustaline/glutathione pathogen-reduced RBCs in complex cardiac surgery: the Red Cell Pathogen Inactivation (ReCePI) study—protocol for a phase 3, randomized, controlled trial

BackgroundRed blood cell (RBC) transfusion is a critical supportive therapy in cardiovascular surgery (CVS). Donor selection and testing have reduced the risk of transfusion-transmitted infections; however, risks remain from bacteria, emerging viruses, pathogens for which testing is not performed and from residual donor leukocytes. Amustaline (S-303)/glutathione (GSH) treatment pathogen reduction technology is designed to inactivate a broad spectrum of infectious agents and leukocytes in RBC concentrates. The ReCePI study is a Phase 3 clinical trial designed to evaluate the efficacy and safety of pathogen-reduced RBCs transfused for acute anemia in CVS compared to conventional RBCs, and to assess the clinical significance of treatment-emergent RBC antibodies.MethodsReCePI is a prospective, multicenter, randomized, double-blinded, active-controlled, parallel-design, non-inferiority study. Eligible subjects will be randomized up to 7 days before surgery to receive either leukoreduced Test (pathogen reduced) or Control (conventional) RBCs from surgery up to day 7 post-surgery. The primary efficacy endpoint is the proportion of patients transfused with at least one study transfusion with an acute kidney injury (AKI) diagnosis defined as any increased serum creatinine (sCr) level ≥ 0.3 mg/dL (or 26.5 µmol/L) from pre-surgery baseline within 48 ± 4 h of the end of surgery. The primary safety endpoints are the proportion of patients with any treatment-emergent adverse events (TEAEs) related to study RBC transfusion through 28 days, and the proportion of patients with treatment-emergent antibodies with confirmed specificity to pathogen-reduced RBCs through 75 days after the last study transfusion. With ≥ 292 evaluable, transfused patients (> 146 per arm), the study has 80% power to demonstrate non-inferiority, defined as a Test group AKI incidence increase of no more than 50% of the Control group rate, assuming a Control incidence of 30%.DiscussionRBCs are transfused to prevent tissue hypoxia caused by surgery-induced bleeding and anemia. AKI is a sensitive indicator of renal hypoxia and a novel endpoint for assessing RBC efficacy. The ReCePI study is intended to demonstrate the non-inferiority of pathogen-reduced RBCs to conventional RBCs in the support of renal tissue oxygenation due to acute anemia and to characterize the incidence of treatment-related antibodies to RBCs.

Part II: Blood Transfusion and Donor Exposure in the Surgical Management of Trigonocephaly Patients: A Protocol From Alder Hey Craniofacial Unit.

Trigonocephaly is a craniofacial malformation caused by premature fusion of the metopic suture. Surgical correction frequently results in the need for blood transfusion. Transfusion complications include transfusion-transmitted infections (TTIs), immune-mediated reactions, and volume overload. Donor exposure (DE) describes the number of blood products from unique donors with increasing DE equating to an increased risk of TTI. We evaluate data on 204 trigonocephaly patients covering 20 years of practice with respect to blood transfusions and DE. This represents the largest series from a single unit to date. A protocol based on our experiences has been devised that summarizes the key interventions we recommend to minimize blood transfusions and DE in craniofacial surgery. Patients operated on between 2000 and 2020 were included. DE and a range of values were calculated including estimated red cell loss (ERCL) and estimated red cell volume transfused (ERCVT). Groups were established by relevant interventions and compared using the Mann-Whitney U test. Mean DE fell from 1.46 at baseline to 0.85 ( P <0.05). Median allogenic transfusion volume fell from 350mL at baseline to 250mL ( P <0.05). Median ERCL fell from 15.05mL/kg at baseline to 12.39mL/kg and median ERCVT fell from 20.85 to 15.98mL/kg. Changes in ERCL and ERCVT did not reach statistical significance. DE can be minimized with the introduction of key interventions such as a restrictive transfusion policy, preoperative iron, cell saver, tranexamic acid, and use of a matchstick burr for osteotomies.

Study of iron deficiency in a population of blood donors in Tlemcen - Algeria

Blood transfusion is an essential substitutive therapy for multiple diseases. To minimize a potential risk of transfusion-transmitted infections, the WHO recommends using regular blood donors. However, regular donors constitute a population at risk of anaemia due to subclinical iron deficiency which is not covered by most hemovigilance donor systems. Thus, the aim of the present study is to determine the prevalence of the deficiency among donors from Tlemcen, Algeria. These donors were selected to perform a blood count and a dosage of ferritinemia. Statistical analyses using SPSS software, and Excel was performed. The prevalence of iron deficiency was calculated at 35.2% and anaemia at 22%. Ferritinemia was strongly related to the different characteristics of the donation, mainly in women population. Hemovigilance systems should integrate blood donor safety focus their efforts on protection against iron deficiency. Unlike Haemoglobin, serum ferritin remains the most sensitive and early marker for donor protection against this deficiency.

Overview on Blood Transfusion-Transmitted Diseases

As it is important for the Blood transfusion to be extremely safe, some measures have to be taken long safeguarded the blood supply from the major transfusion transmissible diseases (TTIs). The risk of transfusion-transmitted infection (TTI) rises with the number of donors exposed, and the effects of TTI are frequently more severe in immune compromised people. TTIs (hepatitis B virus [HBV], HIV, and hepatitis C virus [HCV]) are examples of typical transfusion-transmitted infectious agents. As a result of the gradual application of nucleic acid-amplification technology (NAT) screening for HIV, HCV, and HBV, the residual risk of infected window-period donations has been minimized. Nonetheless, infections emerge far more frequently than is commonly acknowledged, needing ongoing surveillance and individual assessment of transfusion-associated risk. Although there is a constant need to monitor present dangers owing to established TTI, the ongoing issues in blood safety are mostly related to surveillance for developing agents, as well as the creation of quick reaction systems when such agents are detected.

Biochemical and functional characteristics of stored (double-dose) buffy-coat platelet concentrates treated with amotosalen and a prototype UVA light-emitting diode illuminator.

Pathogen reduction of platelet concentrates (PCs) using amotosalen and broad-spectrum UVA illumination contributes to the safety of platelet transfusion by reducing the risk of transfusion-transmitted infections. We evaluated the in vitro quality of stored buffy-coat (BC) PCs treated with amotosalen and a prototype light-emitting diode (LED) illuminator. Double-dose BC-PCs collected into PAS-III/plasma or SSP+ /plasma (55/45%) were treated with amotosalen in combination with either conventional UVA lamps (INT100 Illuminator 320-400 nm) or LED illuminators at 350 nm. Platelet quality and function were evaluated over 7 days. Platelet counts were conserved during storage in all groups, as was platelet swirling without appearance of macroscopic aggregates. Integrin αIIbβ3 and glycoprotein (GP) VI expression remained stable, whereas GPIbα and GPV declined similarly in all groups. UV lamp- and LED-treated PCs displayed similar glucose consumption, lactate generation, and pH variation. Comparable spontaneous and residual P-selectin and phosphatidylserine exposure, activated αIIbβ3 exposure, mitochondrial membrane potential, lactate dehydrogenase release, and adhesive properties under flow conditions were observed during storage. The use of SSP+ /plasma compared with PAS-III/plasma better preserved most of these parameters, especially during late storage, irrespective of the type of illuminator. Replacing the UVA lamp for photochemical treatment by LED illuminators had no impact on platelet metabolism, spontaneous activation, apoptosis or viability, or on the in vitro function of BC-PCs stored for 7 days in SSP+ or PAS-III/plasma. These findings support improved procedures for the pathogen reduction and storage of PCs, to ensure transfusion safety and retention of platelet functional properties.

Transmission of yellow fever vaccine virus through blood transfusion and organ transplantation in the USA in 2021: report of an investigation

In 2021, four patients who had received solid organ transplants in the USA developed encephalitis beginning 2-6 weeks after transplantation from a common organ donor. We describe an investigation into the cause of encephalitis in these patients. From Nov 7, 2021, to Feb 24, 2022, we conducted a public health investigation involving 15 agencies and medical centres in the USA. We tested various specimens (blood, cerebrospinal fluid, intraocular fluid, serum, and tissues) from the organ donor and recipients by serology, RT-PCR, immunohistochemistry, metagenomic next-generation sequencing, and host gene expression, and conducted a traceback of blood transfusions received by the organ donor. We identified one read from yellow fever virus in cerebrospinal fluid from the recipient of a kidney using metagenomic next-generation sequencing. Recent infection with yellow fever virus was confirmed in all four organ recipients by identification of yellow fever virus RNA consistent with the 17D vaccine strain in brain tissue from one recipient and seroconversion after transplantation in three recipients. Two patients recovered and two patients had no neurological recovery and died. 3 days before organ procurement, the organ donor received a blood transfusion from a donor who had received a yellow fever vaccine 6 days before blood donation. This investigation substantiates the use of metagenomic next-generation sequencing for the broad-based detection of rare or unexpected pathogens. Health-care workers providing vaccinations should inform patients of the need to defer blood donation for at least 2 weeks after receiving a yellow fever vaccine. Despite mitigation strategies and safety interventions, a low risk of transfusion-transmitted infections remains. US Centers for Disease Control and Prevention (CDC), the Biomedical Advanced Research and Development Authority, and the CDC Epidemiology and Laboratory Capacity Cooperative Agreement for Infectious Diseases.

Transfusion Audit and Targeted Education as Tools to Improve Clinical Practice of Fresh Frozen Plasma Transfusions: An Interventional Study

Background and Objectives: The transfusion of fresh frozen plasma (FFP) is an essential modality of treatment but carries a residual risk of transfusion-transmitted infections and other adverse events. Continuous education and promotion of evidence-based practice are essential among clinicians to follow good clinical practices with respect to transfusion. This study aims to assess the impact of transfusion audit and educational interventions on the appropriateness of FFP transfusions with respect to indications, by comparing the proportion of appropriate FFP requests before and after the intervention. The study was an interventional study done on all medical professionals who requested FFP for various reasons from the department of transfusion medicine, for 1 year from April 01, 2011, to March 31, 2012. Methods: The study was done in three phases, preintervention audit; intervention including continuous education, one-to-one interactions, and hospital transfusion committee-mediated regulations; and postintervention audit. Statistical analysis was done by SPSS version 16. A paired t-test was used to compare quantitative variables which were continuous. Chi-square test was used for associations in categorical data. Results: A total of 3281 units of FFP were transfused in the preintervention period, and 2480 units in the postintervention period. Out of a total of 823 appropriate indications 75.6% indications were definitely indicated in the preintervention period. This increased to 81.8% of total 1290 requests after the intervention. The increase in definite indications was found to be statistically significant. Conclusion: Transfusion audits and educational interventions can create an impact on the appropriateness of FFP Transfusions especially if targeted to particular specialties and continued to follow-up.

Generation of Red Blood Cells from Human Pluripotent Stem Cells-An Update.

Red blood cell (RBC) transfusion is a lifesaving medical procedure that can treat patients with anemia and hemoglobin disorders. However, the shortage of blood supply and risks of transfusion-transmitted infection and immune incompatibility present a challenge for transfusion. The in vitro generation of RBCs or erythrocytes holds great promise for transfusion medicine and novel cell-based therapies. While hematopoietic stem cells and progenitors derived from peripheral blood, cord blood, and bone marrow can give rise to erythrocytes, the use of human pluripotent stem cells (hPSCs) has also provided an important opportunity to obtain erythrocytes. These hPSCs include both human embryonic stem cells (hESCs) and human induced pluripotent stem cells (hiPSCs). As hESCs carry ethical and political controversies, hiPSCs can be a more universal source for RBC generation. In this review, we first discuss the key concepts and mechanisms of erythropoiesis. Thereafter, we summarize different methodologies to differentiate hPSCs into erythrocytes with an emphasis on the key features of human definitive erythroid lineage cells. Finally, we address the current limitations and future directions of clinical applications using hiPSC-derived erythrocytes.

Seroprevalence of HAV and Mandatory Markers of Transfusion- Transmitted Infections in Blood Donors from Chiapas, Mexico: an Exploratory Study

Introduction: Blood transfusion saves millions of lives annually. However, blood transfusion is one of the leading risk factors for Transfusion-Transmitted Infections (TTIs). Therefore, the objective of this study was to explore the seroprevalence of both HAV and mandatory markers of TTIs in blood donors from Chiapas, Mexico. Materials and Methods: The study included 3,067 blood donors from the Dr. Domingo Chanona Rodríguez Blood Bank located in Tuxtla Gutiérrez, Chiapas, and from 9 collection centers located in different regions of Chiapas. Screening was performed using Enzyme immunoassay (anti-HAV IgM) or Chemiluminescent microparticle immunoassay (HBV HBsAg, anti-HCV IgG/IgM, HIV Ag/Ab, anti-T. pallidum IgG/IgM, and anti-T. cruzi IgG). Results: The seroprevalence of T. pallidum was the highest at 1.3%, followed by the seroprevalence of HAV and T. cruzi, both with 0.7%. Regions X and XV of the state of Chiapas presented the six markers of the analyzed TTIs. Blood donors at risk of being TTI reactive donated in regions IX and X. However, donors with qualified and unqualified employment and those who have donated more than 2 times are considered protective factors against TTIs. Conclusion: We observed a high seroprevalence of HAV in this exploratory study. It is indispensable to increase the sample size of blood donors from the state of Chiapas because HAV is endemic to Mexico and it is probably transmitted through blood transfusion. Also, it is necessary to augment voluntary non-remunerated blood donations in the state of Chiapas, mainly in the Southern border regions, to decrease the risk of TTIs.