Confidential Unit Exclusion (CUE) was introduced when earlier-generation assays had lower sensitivity and longer infectious window periods for transfusion-transmitted infections. Improvements in serological and molecular testing have raised questions about its contemporary utility. This study evaluated the use and predictive performance of CUE at São João Local Health Unit Blood Bank, Porto - Portugal. A retrospective descriptive study assessed all donations with CUE between January 1, 1999 and August 5, 2025. Donor demographics, CUE outcomes, and laboratory results were retrieved. Confirmed reactive serological and nucleic acid testing (NAT) findings were reviewed. The main analytical focus was on findings suggestive of possible window-period infection after a CUE-excluded donation. Sensitivity, specificity, and positive predictive value (PPV) were calculated; associations between CUE status and reactivity were assessed with Fisher's exact test and odds ratios (OR) with 95% confidence intervals. Among 533,227 donations, 2289 (0.429%) underwent CUE self-exclusion. Twenty-four (1.05%) showed initially reactive markers at the time of the CUE-excluded donation or during follow-up, but none were confirmed as findings suggestive of window-period infections. CUE demonstrated a sensitivity of 0%, specificity of 0.7%, and PPV of 0%. In the 2009-2025 cohort (n = 344,666), no reactive results occurred in the CUE group, whereas 149 (0.043%) occurred in the non-CUE group. No significant association was found between CUE and reactivity (p = 0.388; OR = 2.045; 95% CI 0.286-14.627). In this retrospective single-center cohort, CUE showed no measurable diagnostic or predictive value beyond routine screening and identifying possible window-period infections.

Blood transfusions which save lives through their essential function bring infection risks to users especially in areas with limited medical resources. The research study aimed to determine the main factors that cause blood transfusion-transmitted infections in donated blood. This was a cross-sectional study among voluntary blood donors. Blood tests were conducted on samples from the study to detect common transfusion-transmitted infections which included Hepatitis B (HBV) Hepatitis C (HCV) HIV Syphilis and Malaria. Data on demographic characteristics and health history information was collected using a structured questionnaire. Descriptive statistics and multivariate logistic regression were used to identify the risk factors for association with TTI. The study discovered that TTIs exist in low levels because they found Hepatitis B in 1.85% of samples and Malaria in 2.78% of samples. The study identified three main risk factors which led to transfusion infections through previous surgery (odds ratio [OR] = 2.1), multiple blood donations (OR = 1.8), and unscreened donor history (OR = 3.4). The research identified three main factors which determine blood transfusion infection risk. The implementation of better donor screening processes together with educational programs and infection control strategies will effectively decrease the risk associated with transfusions. N/A.

Several Tanzanian regions fall short of annual whole blood donation targets. Understanding what motivates first-time and repeat donors, and whether certain recruitment and retention strategies may affect blood safety, is essential to improving retention and ensuring a safe blood supply. This study aimed to identify variables associated with pre-donation deferral, donor retention and transfusion-transmitted infection (TTI) prevalence in Tanzanian (candidate) blood donors. Between February and April 2023, 1471 (candidate) donors were surveyed at 43 mobile blood collections across 5 Tanzanian regions to collect data on socio-demographics, motivations, incentives received after donation and recruitment methods used. Multivariable logistic regression modelling was performed on a dataset of 675 participants to identify predictors of pre-donation deferral, retention and TTI rates. Pre-donation deferral was more likely among females, first-time donors, those recruited via multiple methods and those attending collections at public places (all p < 0.05). Donor retention was positively associated with increasing age, having received an incentive and donating at Nyarugusu refugee camp (all p < 0.05). Donors mainly motivated by receiving test results had significantly higher TTI rates than those wanting to save lives. TTI rates were lower in those donating at schools/universities and Nyarugusu compared to public places. This study revealed multiple important predictors of pre-donation deferral, retention and TTI rates in Tanzanian (candidate) blood donors. Further research is needed to identify the most effective donor recruitment and retention strategies and to assess the value of targeting specific populations for a more stable blood supply in Tanzania.

The safety of donated blood during transfusion is important; however, blood donation can entail risks owing to contamination of the blood with transfusion-transmitted infections (TTIs). Ensuring the safety of blood and blood components is a major global goal to guarantee their availability to patients. Unsafe blood not only affects the patients but also extends the risk to their partners, contributing to the spread of TTIs and posing a burden on society. This review emphasizes the trends and prevalence of TTIs among blood donors in Saudi Arabia over the years. A systemic search of the main electronic databases were conducted for publications on TTIs among blood donors in Saudi Arabia. The overall prevalence of TTIs among blood donors varies from province to province with a higher incidence observed among older individuals. Despite an overall decline in TTIs among blood donors in the country, the frequency of these infections persists among donors. In addition, screening tests for occult HBV should be considered. The overall findings regarding TTIs in Saudi Arabia vary by province, with a higher incidence observed among older individuals. Comprehensive investigations into the overall incidence of TTIs in Saudi Arabia are warranted, with extensive studies from different regions and blood donation centers.

IntroductionTransfusion is a critical life-saving intervention, but the safety of the blood supply remains a major public health concern, particularly in sub-Saharan Africa, due to the risk of transfusion-transmitted infections (TTIs). This study aimed to determine the burden and correlates of bloodborne pathogens among blood donors in Muchinga Province, Zambia.MethodsA cross-sectional study was conducted using records from 2,667 blood donors at the Chinsali General Hospital Blood Bank between January and December 2021. Data on demographic characteristics, donation type, and ABO/Rhesus blood group were collected. Screening for Hepatitis B (HBV), Hepatitis C (HCV), HIV, and Syphilis was performed using the Abbott Alinity i platform. Logistic regression was used to identify factors associated with infection status.ResultsThe overall prevalence of TTIs among donors was 25.7% (686/2,667). The most prevalent single infections were HBV and Syphilis 8.0% (213/2,667), followed by HCV 7.8% (207/2,667), and HIV 7.7% (206/2,667), with notable co-infection rates, particularly HIV/Syphilis (4.9%). In the composite multivariable analysis, donors with blood group O had 36% lower adjusted odds of any TTI compared to those with blood group A (AOR = 0.64; 95% CI: 0.52–0.79; p < 0.0001) and individuals aged over 45 years had 45% higher adjusted odds of TTIs compared to those aged 16–24 years (AOR = 1.45; 95% CI: 1.04–2.00; p = 0.026). Furthermore, multivariable pathogen-specific analyses revealed distinct risk profiles: donors aged ≥45 years had significantly higher odds of syphilis (AOR = 2.38; 95% CI: 1.49–3.80; p < 0.0001), female sex was associated with lower odds of HBV (AOR = 0.69; 95% CI: 0.52–0.93; p = 0.016), blood group O was protective against HCV (AOR = 0.49; 95% CI: 0.35–0.69; p < 0.0001), and donors from Mpika district had higher odds of HIV (AOR = 1.82; 95% CI: 1.03–3.21; p = 0.037).ConclusionThis study highlights a substantial burden of TTIs among blood donors and identifies blood group O as a potential protective factor, suggesting a potential biological basis that requires further study. Strengthened donor screening and public health interventions are critical to improving blood safety.

Donor notification and counseling after reactive screening for transfusion-transmitted infections (TTIs) are critical to transfusion safety and public health, yet practices in low- and middle-income countries (LMIC) remain inconsistent and poorly evaluated. A Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews-guided scoping review was conducted to map evidence on TTI-reactive donor notification and follow-up in LMIC. We searched PubMed, EMBASE, Scopus, and Web of Science for English-language studies published between January 2005 and June 2025. Eligible studies reported notification strategies, donor psychological factors, linkage-to-care outcomes, digital health interventions, or system-level integration. Data were extracted and narratively synthesized across 5 thematic domains, as mentioned in the "Results" section. Notification success and donor response varied widely. Telephone-based notification consistently achieved higher return rates than letters or text messaging, while replacement donors demonstrated lower follow-up than did voluntary donors. Stigma, fear, and inaccurate contact information were major barriers to counseling. Evidence on linkage to confirmatory testing and treatment was limited; digital health approaches were largely absent. No studies evaluated cost-effectiveness or workforce impact. Overall, TTI-reactive donor notification in LMIC remains fragmented, with critical gaps in digital innovation, psychosocial support, and linkage-to-care evaluation. Strengthening system-integrated, technology-enabled, culturally sensitive notification models is essential to improve donor and public health outcomes.

Blood transfusion (BT), red blood cell (RBC) transfusion, patient blood management (PBM), and transfusion-transmitted infections (TTIs) remain central to emergency and routine care in settings where access, safety, and logistics are constrained. Evidence gaps persist due to the cost and time requirements of TTI testing, limited ongoing surveillance within district systems, and diagnostic delays that shift decision-making away from laboratory thresholds. This narrative review aims to synthesise BT indications, operational challenges, and practical solutions relevant to decentralised and remote hospital environments. A structured literature synthesis was conducted using databases including PubMed, Scopus, and Google Scholar, applying predefined search terms related to BT practices, rural healthcare, and transfusion safety for studies published between 2015 and 2025; studies were selected based on relevance to clinical indications, logistical challenges, and safety outcomes in resource-limited settings. Key outcomes included comparative transfusion threshold findings in haemoglobinopathies and sepsis, the feasibility of universal-donor products in trauma, and the role of cold-chain and storage systems in maintaining supply integrity. Practice implications include prioritising physiological criteria for urgent BT when laboratory access is delayed, while strengthening governance through clinical audits and point-of-care electronic verification. The findings support integrated transfusion pathways that combine decentralised preparedness with mandatory pathogen screening and standardised monitoring frameworks. The central takeaway is that safe rural BT systems require coordinated investment in supply resilience, workforce competency, and technology-enabled verification, rather than reliance on isolated interventions.

Epidemiology and safety challenges of major transfusion-transmitted pathogens in Cameroon: A systematic review and meta-analysis.

Bacterial contamination of blood components is an ongoing problem in transfusion medicine. We analysed the bacterial screening data of platelets from England, 2014-2023, and compared this with data on reported near-misses and transfusion-transmitted infections (TTIs). Anonymized data on bacterial screening of pooled and apheresis platelet donations were reviewed, including the number of donations collected yearly, results from bacterial screening and time from sampling to detection. The findings were compared with data on near-misses and TTIs reported during the same period. Screening of 1249,513 apheresis and 1,495,707 pooled platelet donations identified bacterial contamination in 2949 donations, including 78 bacterial species. Over four-fold higher frequency of confirmed bacterial contamination was observed in pooled platelets compared to apheresis donations (0.09% [1096/1,249,513] vs. 0.02% [362/1,495,707], p < 0.0001). Rates of bacterial contamination of pooled platelet doubled during the study period. Staphylococcus aureus was the most commonly detected highly pathogenic bacterial contaminant (29/147, 19.7%; 15/29, 52% in apheresis platelets). It was also implicated in 1 confirmed case of bacterial TTI and in 8 of 10 reported bacterial near-miss cases. Increasing frequencies of bacterial contamination, mostly related to skin flora, were noted in pooled platelets. Furthermore, S. aureus was notably associated with near-miss events. Our findings demonstrate a limitation of bacterial screening, with evidence of bacterial growth after platelets were likely supplied for clinical use.

ABSTRACT Background and Objectives: Blood transfusion is a vital medical procedure, yet it carries the risk of transmitting infectious diseases. This study aimed to assess the demographic characteristics and transfusion-transmitted infection (TTI) profiles of family replacement and voluntary blood donors in Saudi Arabia. Materials and Methods: A retrospective cross-sectional analysis was conducted using records from 49,590 blood donors at King Fahad Medical City, Riyadh, Saudi Arabia. Donors were classified as family replacement or voluntary. Demographic information and results of screening for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), syphilis, and malaria were analysed. Statistical analyses included descriptive statistics, chi-square testing, stratified analysis by nationality, and logistic regression. Results: 49,590 donors were included, 10.6% were family replacement and 89.4% were voluntary. Males accounted for 92.6% of the donor population. No significant differences were observed between the two groups for HBV, HCV, HIV, or syphilis. However, malaria prevalence was significantly higher among family replacement donors (5.3%) compared to voluntary donors (2.9%). Family replacement donation was more common among younger donors, males, and non-Saudi nationals.‏ The higher malaria prevalence among family replacement donors was particularly evident among non-Saudi donors, and regression analysis confirmed that nationality modified the association between donation type and malaria positivity. Conclusion: While rates of major viral TTIs were comparable between donor types, malaria risk was significantly higher among family replacement donors, especially among non-Saudi donors. These findings highlight the importance of continued malaria screening and donor selection strategies to maintain safe blood transfusion practices in Saudi Arabia.

Bacterial contamination in blood components carries a fatal risk in blood transfusion. Despite efforts in preventing transfusion-transmitted bacterial infections, it remains associated with transfusion morbidity and mortality. This study was carried out to evaluate the effectiveness of the Mirasol Pathogen Reduction Technology (MPRT) in platelets and plasma in eliminating bacterial growth by inoculating platelet concentrates with a clinically significant load of Staphylococcus aureus to determine its effect on platelet count, pH, and coagulation factors such as plasma activated prothrombin time, partial thromboplastin time and fibrinogen. For the 10 pooled platelet concentrates samples, the observed mean pH value before MPRT treatment was 7.20, and 7.10, and 6.8 after treatment on both Day 3 and Day 7, respectively. For platelet count, the resulting mean was1296.6 x 103/ul which decreased to 1199 x 103/ul, 1120 x 103/ul, 879.4 x 103/ul on Day 0, Day 3, and Day 7, respectively after MPRT. Also, no aggregates of bacteria were seen on 9 platelet concentrates samples after MPRT. For PT and aPTT, the mean average values of 12.63 seconds and 33.46 seconds were observed after MPRT, while fibrinogen’s mean average value dropped to 1.45g/L and maintained stability at a frozen state with 1.56g/L after 30 days post storage after MPRT treatment. Therefore, MPRT can preserve platelet viability with 90% effectiveness in eliminating bacterial contamination in platelet concentrates, even when changes in pH and platelet count occur through storage. Moreover, plasma integrity can also be preserved with the use of MPRT. This extends the expiry of platelet concentrates from 5 days to 7 days, thus, minimizing the blood wastage yet increasing platelet inventory.

Despite significant improvements in blood safety, the risk of transfusion-transmitted infections persists, particularly from emerging and re-emerging viruses. For red blood cell (RBC) products, this risk is exacerbated by the fact that there is no routine testing for many of these pathogens, and effective, commercially available pathogen inactivation technologies specifically for RBCs are still lacking. This gap in the safety framework means that viruses capable of establishing an asymptomatic viremia-a characteristic of many arboviruses like Zika, dengue, and West Nile virus-present a tangible threat to the blood supply, highlighting the need for broad-spectrum countermeasures. This study aims to investigate the antiviral activity of green tea extract (GTE) and its key catechins, epigallocatechin gallate (EGCG) and epicatechin gallate (ECG), against ZIKV in both cellular models and red blood cell (RBC) products. In vitro antiviral activity was assessed using A549 cells treated with GTE (150 μg/mL) or purified EGCG/ECG (20 μM). Mechanistic studies focused on viral attachment inhibition. Additionally, ZIKV-spiked RBC products were co-incubated with GTE (300 μg/mL) for 1 h to evaluate virucidal effects. Erythrocyte integrity was confirmed via hemolysis assays. Co-treatment with GTE or catechins suppressed ZIKV replication by ≥3.64 logs (p < 0.001) in A549 cells. GTE and catechins primarily inhibited viral attachment. In RBCs, GTE reduced viral infectivity by 99.99% (4-log reduction) without compromising erythrocyte membrane integrity or cellular viability. Furthermore, RBCs with added GTE demonstrated a lower hemolysis rate during storage for up to 60 days. GTE exhibits potent virucidal activity against ZIKV in blood matrices, highlighting its potential as a pathogen reduction agent to enhance transfusion safety. Further development of GTE-based additive solutions or technologies is warranted.

Brucellosis is a common zoonotic disease caused by Brucella and remains a globally concerning public health issue. Timely and effective detection methods are crucial for clinical diagnosis. We developed a novel Brucella detection platform (MCDA-CRISPR) by integrating multiple cross displacement amplification (MCDA) with a CRISPR-Cas12a-based biosensing system, and preliminarily applied it for the first time to screen for Brucella in voluntary blood donors from Xinjiang, China. This technology enables amplification under isothermal conditions at 64°C using only a water bath, requires no specialized equipment, and completes detection within 60min. Amplification products can be directly visualized under UV light without complex interpretation. Performance results demonstrated a minimum detection limit of 1fg/μL for Brucella DNA, making the method 100 times more sensitive than conventional PCR. The assay showed 100% specificity for Brucella detection with no cross-reactivity to non-Brucella pathogens. The assay could also detect Brucella in blood donors samples and showed the same sensitivity and specificity as the culture method. The assay is a visual, sensitive, and highly specific detection technique. When applied to routine blood transfusion screening in areas with high prevalence of brucellosis, such as Xinjiang, can effectively reduce the risk of transfusion-transmitted brucellosis, and hold broad application prospects in resource-limited primary or field testing scenarios.

This study aimed to assess the prevalence and patterns of HIV, HBV, HCV, and syphilis among blood donors in Pakistan. Data records of all registered blood donors (n = 63,847) during August 2020-April 2025, at a blood transfusion center in a tertiary care hospital were retrospectively analyzed. Prevalence of the seropositive donors for HIV, HCV, HBV and Syphilis was analyzed. The donors ranged in age from 18 years to over 65 years, with the vast majority being male (99.47%). Overall prevalence of TTIs was 2.04% in the donor population. Hepatitis B virus (HBV) was the most prevalent TTI (1.12%; 95% CI: 1.04–1.20), followed by hepatitis C virus (HCV) (0.49%; 95% CI: 0.44–0.55), syphilis (0.36%; 95% CI: 0.32–0.41), and human immunodeficiency virus (HIV) (0.07%; 95% CI: 0.05–0.09) respectively. Replacement donations accounted for 59.34% of the total. The largest proportion of donors (48.7%) were aged 26–35 years. The highest annual donation volume occurred in 2023, with 13,534 donors. The most frequent coinfections were HBV–HCV and HBV–syphilis, with seven cases each. Among blood donors, HBV was the most prevalent transfusion-transmitted infection, followed by HCV. Not applicable.

Pathogen-Reduce Cryoprecipitate: An Overview of Method(s) in Pathogen Reduction, Transfusion-Transmitted Infection Risk, and Inventory Management Considerations.

To report Oropouche virus (OROV) infections in asymptomatic blood donors who attended HEMORIO. The BIO-MANGUINHOS MAYV/OROV Molecular Kit was used to screen samples from asymptomatic blood donations collected in Recreio dos Bandeirantes (February 10, 2025) and Barra Mansa (April 29, 2025), both located in Rio de Janeiro State. The samples were subsequently sent to the National Reference Laboratory for Arboviruses at the Evandro Chagas Institute (Pará State) for confirmatory molecular testing and genomic characterization using high-throughput sequencing (HTS). OROV RNA was detected in samples HRIO-1 and HRIO-3, with cycle threshold values of 39.58 and 28.99, respectively, in a pool of six plasma samples. HTS, using a probe-enrichment approach, enabled the recovery of one complete OROV genome from the HRIO-3 sample. Phylogenetic analysis showed clustering within the AMACRO II clade, forming a subclade with sequences from Rio de Janeiro, Espírito Santo, and Pernambuco. To the best of our knowledge, this is the first study to detect and genomically characterize, through whole-genome sequencing, OROV RNA in an asymptomatic blood donor in Southeastern Brazil.

Review of Established and Emerging Infectious Diseases in Transfusion Medicine.

Pathogen reduction (PR) using amotosalen-UVA was implemented for 100% of platelet concentrates (PCs) in France in November 2017. No bacterial testing was in place earlier. The impact of PR on the risk of transfusion-transmitted infections (TTIs) from November 2017 to December 2022 (vs. January 2013 to October 2017) has been published previously. To further assess the impact of PR implementation, the evaluation period was expanded to December 2024. PC-associated TTIs occurring in 2023 and 2024 were analysed and included in the assessment. Two cases of PC-associated transfusion-transmitted bacterial infections (TTBIs) were reported. The first involved Bacillus mobilis in a split pooled whole blood-derived PC. This Grade 2 TTBI was diagnosed following identification of the same pathogen in the second PC unit, quarantined for failed swirling test. The second involved Staphylococcus ureilyticus in an apheresis PC transfused to a patient who subsequently died. TTBI frequency decreased from 1/97,098 PC (n = 15 over 5 years, 2 deaths) to 1/787,662 PC (n = 3, over 7 years, 1 death) after PR implementation (p < 0.001). No human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), human T-cell lymphotropic virus (HTLV) or arboviruses TTI were reported from 2013 to 2024. No further cases of PC-associated hepatitis E virus (HEV) TTI were reported, concomitantly to HEV-nucleic acid testing implementation. A PC-associated parvovirus B19 TTI occurred in 2024. The use of PR PCs facilitated PC supply during arboviral outbreaks. The reduction in PC-related TTBIs following PR implementation is confirmed. However, the recent occurrence of two severe TTBI cases highlights a persistent risk. Prevention of PR-PC-associated TTIs by non-enveloped viruses requires specific screening.

Association between ABO/Rh blood groups and transfusion-transmitted infections among Turkish blood donors: a comprehensive demographic analysis (2015-2021).

Abstract Blood transfusion is indispensable in the management of hematological malignancies, trauma, obstetric complications, and congenital bleeding disorders. Despite rigorous donor screening and nucleic acid testing, residual risks of transfusion-transmitted infections (TTIs) remain, particularly with emerging and re-emerging pathogens and bacterial contamination of platelets. These challenges underscore the need for proactive safety strategies. Pathogen reduction technologies (PRTs) provide a universal and complementary safeguard by inactivating viruses, bacteria, parasites, and leukocytes, thereby preventing transfusion-associated graft-versus-host disease (TA-GvHD). Four major PRT platforms are currently in use or advanced development: INTERCEPT (amotosalen/UVA), MIRASOL (riboflavin/UV), THERAFLEX-UVC (short-wavelength UVC), and methylene blue plasma. Clinical studies confirm the safety and efficacy of this product, despite some storage limitations. During outbreaks and in endemic settings, PRT has been used as an adjunct mitigation strategy to maintain transfusion support when pathogen-specific testing or donor deferrals were insufficient or not immediately available. Challenges to widespread adoption include cost and infrastructure requirements, but efforts aim to expand RBC coverage, integrate cold-stored platelets, and automate for broader accessibility. PRTs represent a paradigm shift in transfusion medicine, moving from reactive detection to proactive, broad-spectrum protection. Their broader implementation will be essential for advancing global blood safety and ensuring preparedness against emerging infectious threats.