Blood discard rate in a blood center in Curitiba - Brazil. Ten years of study

Serologic screening for viral infections among blood donors: a study in a blood bank in southern Brazil

BACKGROUND

Routine screening for viral infections at blood donation is important to avoid transfusion-transmitted infections. It also offers an opportunity to detect an asymptomatic infection.

OBJECTIVE

To study changes in serology positivity for viral infections (B and C hepatitis, HTLV-1/2, and HIV) at blood donation in a blood bank from Southern Brazil, comparing two periods of 5 years: the period from 2013 to 2017 with the period from 2018 to 2022. In addition, data on the donor fidelity rate during the studied period were sought.

METHODS

Retrospective study using data from 2013 to 2022 from a single blood center electronic database from Curitiba, Southern Brazil.

RESULTS

A significant drop in positive serology for all studied viruses was observed: highest in HIV (OR=0.39; 95% CI=0.27-0.57) and lowest in total anti HBc (0.56; 95 CI=0.50-0.63). Anti HBc serology became more commonly seen in women in the period of 2018-2022 when compared to men. No changes in the distribution of positive serology according to donors' ages were observed. Loyalty rates had a median of 70%, with the lowest being 60% in 2013, while the highest was 73% in 2018 and 2022.

CONCLUSION

A significant reduction in discarded blood bags due to viral serology was observed when the period of 2013-2017 was compared to 2018-2022 on this blood bank; the highest reduction was observed in HIV serology and the lowest in HBc serology, which became more common in women in the second period. High rates of donor fidelity were observed during the period studied.

Drastic reduction in the notification of acute cases of Chagas disease in the Northeast region of Brazil. Epidemiological evaluation in the period 2001-2021

Chagas disease (CD), caused by the protozoan Trypanosoma cruzi (T. cruzi), is a neglected disease endemic to some Latin American countries, including Brazil. Soon after infection, individuals develop an acute phase, which in most cases is asymptomatic and may go undetected. However, when CD is detected early, notification in the Notifiable Diseases Information System (SINAN), is mandatory. This study aimed to evaluate the information registered in the SINAN database and to determine the epidemiological profile of acute CD in Northeast Brazil, an endemic region, from 2001 to 2021. According to this survey, 1,444 cases of acute CD were reported in the Northeastern region of Brazil during this period. During the first six years, referred to as period 1, 90.24% of the notifications were registered, while the number of notifications significantly decreased in the subsequent years, referred to as period 2. Most individuals diagnosed with acute CD were Afro-Brazilian adults. All known routes of infection by the parasite were reported. Vector-borne transmission was predominant during period 1 (73.29%) and oral transmission during period 2 (58.87%). All nine states in Northeast Brazil reported cases in both periods. A higher incidence of disease was reported in Rio Grande do Norte (RN) during period 1, and in Maranhão (MA) during period 2. Our results show that CD remains a significant public health challenge.

Prevalence and clinical consequences of Hepatitis C virus infection in patients undergoing hematopoietic stem cell transplantation

Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality among hematopoietic stem cell transplant (HCT) recipients. In Brazil, its occurrence in HCT recipients remains undetermined. We now report on HCV prevalence in HCT recipients and its clinical consequences. The medical records of all HCT recipients seen at Hospital das Clinicas, Sao Paulo University Medical School, from January 2010 to January 2020 were reviewed to determine HCV serostatus. A retrospective analysis of medical charts was undertaken on all seropositive cases to determine HCV genotype, presence of liver fibrosis, co-infections with other viruses, previous treatments, and clinical evolution of liver pathology after HCT. Of the 1,293 HCT recipients included in the study, seven (0.54%) were HCV antibody-positive and five (0.39%) were also viremic for HCV-RNA. Four of these individuals had moderate to severe liver fibrosis (METAVIR F2/F3) and one was cirrhotic. Two of the viremic patients developed acute liver dysfunction following transplantation. All patients had their acute episode of liver dysfunction resolved with no further complications. Four of the viremic patients were treated for HCV infection with direct acting agents (DAA). Information regarding HCV treatment was lacking for one of the viremic HCV patients due to loss of follow up. Sustained anti-virologic responses were observed in three cases after the use of DAA. The detection of HCV in hematological adults undergoing HCT and its successful treatment with DAA highlight the necessity of testing for HCV both prior to and following transplantation.

Impact of Implementing a Standard Operating Procedure to Reduce Blood Wastage in Blood Centers of Iran

BACKGROUND

Blood wastage leads to additional costs and reduced blood availability to patients. Above all is the moral issue of wasting donor gifts. This study aimed to determine the rate of blood wastage before and after implementing a new standard operating procedure (SOP) in Iran.

METHODS

In this interventional study, a SOP for wastage management was prepared and implemented in all blood centers throughout the country. Data were extracted from the integrated software of the Iranian Blood Transfusion Organization (IBTO). The wastage rate of blood components in the post-intervention years (2016-2017) was then compared with that in the pre-intervention years (2013-2015) using the Z test.

RESULTS

The overall wastage rate decreased by 36.86% (P<0.001, 95% CI [36.84-36.88]) after the intervention. Red blood cell (RBC) wastage decreased from 2.6% to 2.5%, platelet wastage from 19.5% to 10.6% and plasma wastage from 15.5% to 7.3% (P<0.001). The highest percentage of waste reduction pertained to plasma components, which decreased by 52.90% (P<0.001, 95% CI [52.86-52.94]). Expiration was the most common cause of RBC and platelet wastage. The most common causes of plasma wastage were RBC contamination and rupture or leakage of the bags. The intervention resulted in a drop of over 250000 discarded components each year, equal to approximately thirty-six million dollars in savings.

CONCLUSION

This intervention effectively reduced waste and increased efficiency. Ongoing blood wastage reviews, auditing, and receiving feedback from the central headquarters were powerful tools in following the compliance of blood centers. Further studies are recommended, especially concerning blood wastage in hospital blood banks and various wards.

HIV, HTLV, and Hepatitis B and C Infection in Blood Donors in Bahia, Brazil from 2008 to 2017

Although blood transfusion is an important therapeutic resource, transfusion-transmitted infections (TTIs) are still a cause for concern. Measures to mitigate this risk involve improvement of donor screening criteria and improvements in laboratory tests, especially the use of nucleic acid test (NAT). In this retrospective study we evaluated HIV, HTLV, HCV and HBV infection rates in blood donors of the Hematology and Hemotherapy Foundation of Bahia (Hemoba), Brazil, through serological and NAT results and the characteristics of donors. From February/2008 to December/2017, 777,446 blood donations were made. Most donors were male, aged 25-44 years, black and mixed race, and single or divorced. The density-type incidence (DTI; per 100,000) for each virus was 91.1 for HBV; 66.5 for HCV; 54.3 for HIV; and 33.9 for HTLV, with a decreasing trend observed over the period studied, except in the last biennium. NAT detected only 1 donor in immunological window for HIV (0.46/100,000 donations) and 3 donors in immunological window for HBV (1.8/100,000 donations). Serological positivity for all viruses studied was higher in the metropolitan region of Salvador, the state capital. Conclusion: DTI rates show a decreasing trend over the years studied, with a predominance of HBV infection. NAT allowed the detection of donors in immunological window periods, having an important role in improving transfusion safety.

Exploring the Causes of Wastage of Blood and Its Components in a Tertiary Care Hospital Blood Bank

Background

Blood donated by healthy people is extremely important as it is integral in emergent situations. The authors aimed to address and highlight the main causes of the wastage of donated blood and its components.

Methodology

A cross-sectional study was conducted at a blood bank of a tertiary care center between January 2019 and March 2020. All the information regarding blood donated and blood components during the study period was documented on a predefined proforma. The blood bags which were seropositive, reached their shelf-life expiry, expired due to non-utilization, or quantity was non-sufficient were discarded. Blood showing any changes of either hemolysis or turbidity was also discarded. Other reasons for discarding blood units included leakage (damage to or fault in the blood bag), hemolytic reasons, or miscellaneous reasons.

Results

A total of 9308 blood donations were received as donations during the study period. Out of the total donations, 7,988 (85.8%) were subjected for component formation including red cell component (RCC), fresh frozen plasma (FFP), and platelets. A total of 23,964 components were prepared using the donated blood. Out of these 2128 (8.87%) units were discarded. Upon stratifying the discarded blood according to the type of component, it was found that platelets made up 1148 (53.9%) units, red cell component composed 324 (15.2%) units, and fresh frozen plasma composed 313 (14.7%) units of discarded blood. Seropositive was reported to be 32.3%. Of this, the red cell component made up 276 (85.2%) units.

Conclusion

The present study reported a discard rate of 8.87%. Of these, the majority was composed of platelets due to the shortest shelf life. Leakage of blood bags remained a predominant cause for the discard of blood components. Seropositivity for hepatitis B, C, and human immunodeficiency virus (HIV) was reported in almost 30% units of donated blood. Further large-scale studies should be conducted to reassess how wastage of donated blood can be minimized.

Seropositivity for syphilis among Brazilian blood donors. A retrospective study 2015-2020

INTRODUCTION

Syphilis is a transfusion-transmitted infection and the disease re-emerged in many countries, including Brazil, as a public health risk.

OBJECTIVE

Evaluate the prevalence of positive serology in blood donations rejected by Hemobanco (Curitiba- PR) from January 2015 to December 2020, with special focus in syphilis.

METHODOLOGY

In the studied period, we analyzed the number of blood donations discarded annually for each serological test performed on blood donors' samples, according to gender and donors age.

RESULTS

Within the studied period, 134,741 blood donation were analyzed. 54.5 % of sample were male. Otherwise, it was observed a significant increase in the number of donations by females (P < 0.0001). There was an increase of 437 % in the prevalence of syphilis positive serology made by donors with ≥ 60 years. Besides that, it was noticed a significant increase in donations by aged people throughout these six years (P < 0.0001). The percentage of total blood donation deferred had a significant reduction, although it was observed an increase in the rate of discarded blood bags due to positive serology in the first 4 studied years. It was observed an increase of 20 % in positive syphilis serology.

CONCLUSION

The greatest cause of discard of blood donations changed during the analyzed 5-years; there was an increase in seropositivity donations from donors with ≥ 60 years old. In 2015, Hepatitis B (0.8 %) was the most prevalent and in 2020, syphilis became more prevalent (0.82 %). The medical community should be aware of the rising number of cases of syphilis infection. There is an urgent need to implement actions against the dissemination of this disease.

Evaluation of the Seroprevalence of Infectious Diseases in 2,445 in vitro Fertilization Cycles

OBJECTIVE

 To evaluate the seroprevalence of positive markers for syphilis, human immunodeficiency virus (HIV) I and II, human T cell lymphotropic virus (HTLV) I and II, and hepatitis B and C among women undergoing in vitro fertilization (IVF).

METHODS

 We conducted a retrospective analysis among patients who underwent IVF, between January 2013 and February 2016, and who had complete screening records.

RESULTS

 We analyzed 1,008 patients who underwent IVF, amounting to 2,445 cycles. Two patients (0.2%) tested positive for HIV I and II and none for HTLV I and II. Three patients (0.3%) had positive screening for syphilis, and two (0.2%) had positive hepatitis C antibody test (anti-HCV). A positive hepatitis B virus surface antigen (HbsAg) test was observed in 4 patients (0.4%), while 47 (4.7%) patients were positive for IgG antibody to hepatitis B core antigen (anti-HbC IgG), and only 1 (0.1%) was positive for IgM antibody to hepatitis B core antigen (anti-HbC IgM). The anti-HbS test was negative in 659 patients (65.3%). Only 34.7% of the patients had immunity against the Hepatitis B virus. Patients with an anti-HbS negative result were older than those with a hepatitis B test (anti-HbS) positive result (36.3 versus 34.9; p < 0.001).

CONCLUSION

 The present study showed lower infection rates than the Brazilian ones for the diseases studied in patients undergoing IVF. Only a few patients were immunized against hepatitis B.

Prevalence and trends in transfusion-transmissible infections among blood donors in Brazil from 2010 to 2016

Background

Assessing trends in the rate of transfusion-transmissible infections (TTIs) in blood donors is critical to the monitoring of the blood supply safety and the donor screening effectiveness. The objective of this study was to conduct a trend analysis of TTIs and associated demographic factors of donors at a public blood bank in the central Brazil.

Methods

A retrospective analysis (2010–2016) of blood donation data was performed to determine the prevalence of markers for TTIs. Multinomial and multivariate logistic regression were used to verify the association between the explanatory variables and TTIs. The trend was evaluated with the Prais Winsten’s regression analysis.

Results

The prevalence of TTIs was 4.04% (5,553 donors) among 137,209 donors, with a steady trend in the analyzed period. The seroprevalence for the hepatitis B virus (HBV), syphilis, hepatitis C virus (HCV), human immunodeficiency virus (HIV), Chagas disease, and human T-lymphotropic virus (HTLV) were 1.63%, 0.87%, 0.46%, 0.21%, 0.21% and 0.09%, respectively. The prevalence of HBV decreased (b = −0.021, p <  0.001), while syphilis increased (b = 0.112; p =  0.001), during the period investigated. The probability for a positive test for TTI was higher among donors with a low level of education, aged ≥30 years old, without stable marital status, and first-time donors.

Conclusions

Even with the reduction in HBV, the increased rate of syphilis may have contributed to the fact that the overall rate of TTIs did not decrease in the evaluated period.