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Padalko E, Colenbie L, Delforge A, Ectors N, Guns J, Imbert R, Jansens H, Pirnay JP, Rodenbach MP, Van Riet I, Vansteenbrugge A, Verbeken G, Baltes M, Beele H. Preanalytical variables influencing the interpretation and reporting of biological tests on blood samples of living and deceased donors for human body materials. Cell Tissue Bank 2024; 25:509-520. [PMID: 37624485 PMCID: PMC11143040 DOI: 10.1007/s10561-023-10106-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023]
Abstract
With the present paper, the Working Group on Cells, Tissues and Organs and other experts of the Superior Health Council of Belgium aimed to provide stakeholders in material of human origin with advice on critical aspects of serological and nucleic acid test (NAT) testing, to improve virological safety of cell- and tissue and organ donation. The current paper focusses on a number of preanalytical variables which can be critical for any medical biology examination: (1) sampling related variables (type of samples, collection of the samples, volume of the sample, choice of specific tubes, identification of tubes), (2) variables related to transport, storage and processing of blood samples (transport, centrifugation and haemolysis, storage before and after centrifugation, use of serum versus plasma), (3) variables related to dilution (haemodilution, pooling of samples), and (4) test dependent variables (available tests and validation). Depending on the type of donor (deceased donor (heart-beating or non-heart beating) versus living donor (allogeneic, related, autologous), and the type of donated human material (cells, tissue or organs) additional factors can play a role: pre- and post-mortem sampling, conditions of sampling (e.g. morgue), haemodilution, possibility of retesting.
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Affiliation(s)
- Elizaveta Padalko
- Department of Medical Microbiology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
- Department of Diagnostic Sciences, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium.
| | - Luc Colenbie
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Department of Transplant Center, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Alain Delforge
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Laboratory of Clinical Cellular Therapy, Institute J. Bordet, Rue Meylemeersch 90, 1070, Brussels, Belgium
| | - Nadine Ectors
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Faculty of Medicine, KU Leuven (Catholic University of Leuven), Oude Markt 13, 3000, Leuven, Belgium
| | - Johan Guns
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Department of Laboratory Quality, Free University of Brussels VUB/University Hospital, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Romain Imbert
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Department of Medically Assisted Reproduction, CHIREC, Boulevard du Triomphe 201, 1160, Brussels, Belgium
| | - Hilde Jansens
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Department of Medical Microbiology, Antwerp University/University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Jean-Paul Pirnay
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Bruynstraat 1, B-1120, Brussels, Belgium
| | - Marie-Pierre Rodenbach
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Service du Sang, Croix-Rouge de Belgique, Rue du Fond du Maréchal 8, 5021, Suarlée, Belgium
| | - Ivan Van Riet
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Department of Hematology, University Hospital Brussels (UZ Brussel), Jette, Belgium
| | - Anne Vansteenbrugge
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Department of Medically Assisted Reproduction, CHIREC, Boulevard du Triomphe 201, 1160, Brussels, Belgium
| | - Gilbert Verbeken
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Bruynstraat 1, B-1120, Brussels, Belgium
| | - Muriel Baltes
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
| | - Hilde Beele
- Working Group on Cells, Tissues and Organs of the Superior Health Council, Brussels, Belgium
- Department of Dermatology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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Lu J, Xu J, Reilly KH, Li Y, Zhang CM, Jiang Y, Geng W, Wang L, Shang H. The proportion and trend of human immunodeficiency virus infections associated with men who have sex with men from Chinese voluntary blood donors: a systematic review and meta-analysis. Transfusion 2014; 55:576-85. [PMID: 25331965 DOI: 10.1111/trf.12871] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 08/06/2014] [Accepted: 08/06/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-positive cases associated with men who have sex with men (MSM) have rapidly increased over the past years. The objective of this study is to comprehensively evaluate the proportions, changing trends, and geographical distribution of MSM-associated HIV cases from Chinese voluntary blood donors by systematically reviewing the available literature. STUDY DESIGN AND METHODS Major English and Chinese research databases were searched for studies reporting study locations, study years, the number of HIV infections among blood donors, and the number of HIV-positive donations associated with MSM in China. The proportion estimates were calculated; subgroup analyses and test for time trend were performed using software of comprehensive meta-analysis. RESULTS Thirty-four studies met eligibility criteria. The pooled proportion of HIV-positive donations associated with MSM from 2001 to 2012 was 36.5% (95% confidence interval, 29.6%-44.1%). The epidemic was found to be more severe in northeast and north China compared to south China (59.6%; 55.0% vs. 3.8%, respectively). The proportion showed a significantly increasing trend over the study period (10.3% in 2001-2005; 38.6% in 2006-2009; and 47.6% in 2010-2012; trend test chi-square = 16.42, p < 0.001). CONCLUSION The relatively high proportion of MSM- associated HIV-positive donors is of concern. Efficient and effective measures focused on public education and improving knowledge of blood safety are needed to prevent this at-risk population from seeking HIV testing through blood donation. It is also imperative to expand the scope of postdonation nucleic acid testing to shorten the window period to improve blood supply safety in China.
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Affiliation(s)
- Jinxin Lu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, P.R. China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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Jarvis LM, Mulligan K, Dunsford TH, McGowan K, Petrik J. Suitability of an automated nucleic acid extractor (easyMAG) for use with hepatitis C virus and human immunodeficiency virus type 1 nucleic acid amplification testing. J Virol Methods 2010; 171:364-8. [PMID: 21126541 DOI: 10.1016/j.jviromet.2010.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 11/16/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022]
Abstract
Serological screening assays have greatly reduced, but not eliminated, the risk of transmission of viral infections by transfusion of blood and blood products. In addition, the 1999 regulation of the European Agency for the Evaluation of Medicinal Products requiring all plasma for fractionation to have tested negative for hepatitis C virus (HCV) RNA (CPMP/BWP/390/97, 1998) led many blood transfusion services to introduce nucleic acid amplification technology (NAT) to screen blood donations for HCV, and in some services for human immunodeficiency virus (HIV) and hepatitis B virus (HBV). BioMérieux's second-generation system, the NucliSENS easyMAG, was evaluated as a suitable platform for the automated extraction of nucleic acids for use with the existing SNBTS NAT assays. Two nucleic acid extraction protocols were examined, either lysis on the easyMAG (on board) or a 30-min pre-incubation of the sample with lysis buffer at 37 °C (off board). Off board lysis was found to extract nucleic acid more efficiently for both HCV and HIV NAT assays although the improvement was more marked with HIV. The 95% limit of detections (LODs) were 10.11 IU/ml (on board) and 7.21 IU/ml (off board) for HCV and 55.11 IU/ml (on board) and 34.13 (off board) for HIV. Using the more sensitive off board lysis, nucleic acid extraction specificity, robustness and reliability of the easyMAG were examined and over 10,000 Scottish blood donations (in 107 pools of 95 donations) were tested for HCV and HIV in parallel with the existing assay. The results indicate that the easyMAG is a suitable and flexible nucleic acid extraction system, providing high quality nucleic acids and a rapid response alternative to commercial, fully automated, approved blood screening platforms.
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Affiliation(s)
- L M Jarvis
- Scottish National Blood Transfusion Service Transfusion Transmissible Infections Group, Scottish National Blood Transfusion Service, 21 Ellen's Glen Road, Edinburgh EH177QT, United Kingdom.
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Davidson F, Yirrell DL, Lycett C, Petrik J, Dow BC. Human immunodeficiency virus 1 subtypes detected in Scottish blood donors. Vox Sang 2009; 96:160-2. [PMID: 19152609 DOI: 10.1111/j.1423-0410.2008.01123.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of our study was to determine human immunodeficiency virus 1 subtypes in Scottish blood donors. We were able to document virus subtypes present in this population over a period of 19 years and examine associated risk factors where available. Subtype B was found to be the predominant cause of human immunodeficiency virus 1 infection in Scottish blood donors with subtype C increasing in this population after 2002. Non-B subtypes were found mainly in heterosexuals but also in all other risk categories with the exception of men having sex with men (MSM). Within Scotland there is an increase in transmission via heterosexual contact and the consequential introduction of non-B subtypes.
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Affiliation(s)
- F Davidson
- Transfusion Transmitted Infection Group, Scottish National Blood Transfusion Service, Royal Dick Veterinary School, Summerhall, Edinburgh, UK.
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Jarvis LM, Dow BC, Cleland A, Davidson F, Lycett C, Morris K, Webb B, Jordan A, Petrik J. Detection of HCV and HIV-1 antibody negative infections in Scottish and Northern Ireland blood donations by nucleic acid amplification testing. Vox Sang 2005; 89:128-34. [PMID: 16146504 DOI: 10.1111/j.1423-0410.2005.00686.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES To reduce the risk of transfusion-transmissible viruses entering the blood supply, the nucleic acid amplification testing (NAT) was implemented to screen Scottish and Northern Irish blood donations in minipools. After 5 years of NAT for hepatitis C virus (HCV) and 2 years for human immunodeficiency virus-1 (HIV-1), the yield of serologically negative, nucleic acid positive 'window donations' and cost-benefit of NAT is under review. MATERIALS AND METHODS When the Scottish National Blood Transfusion Service (SNBTS) implemented NAT in 1999, a fully automated 'black box' system was not available. Therefore, an 'in-house' assimilated NAT assay was developed, validated and implemented. The system is flexible and allows testing for additional viral markers to be introduced with relative ease. RESULTS The HCV and HIV NAT assays have 95% detection levels of 7.25 IU/ml and 39.8 IU/ml, respectively, as determined by probit analysis. One HCV (1 in 1.9 million) and one HIV (1 in 0.77 million) window donation have been detected in 5 and 2 years, respectively, of NAT. CONCLUSION The SNBTS NAT assays are robust and have performed consistently over the last 5 years. The design of the in-house system allowed HIV NAT to be added in 2003 at a relatively small additional cost per sample, although for both assays, the royalty fee far exceeds the cost of the test itself. Clearly NAT has a benefit in improving the safety of the blood supply although the risks of transfusion-transmitted viral infections, as reported in the Serious Hazards of Transfusion (SHOT) report, are extremely low. Also, in UK the yield of HCV antibody negative, NAT positive donations is far lower than predicted although the early detection of an HIV window period donation and the increase of HIV in the blood donor and general populations may provide a stronger case for HIV NAT. SUMMARY SENTENCE: The yield of HCV and HIV NAT in UK is significantly less than that anticipated from statistical models.
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Affiliation(s)
- L M Jarvis
- Scottish National Blood Transfusion Service, Transfusion Transmissible Infections Group, University of Edinburgh, Edinburgh, Scotland, UK.
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Brojer E, Gronowska A, Medyńska J, Grabarczyk P, Mikulska M, Letowska M, Kryczka W, Gietka A. The hepatitis C virus genotype and subtype frequency in hepatitis C virus RNA-positive, hepatitis C virus antibody-negative blood donors identified in the nucleic acid test screening program in Poland. Transfusion 2004; 44:1706-10. [PMID: 15584984 DOI: 10.1111/j.0041-1132.2004.04156.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Since 2002, blood donors in Poland have been tested not only for hepatitis C virus antibodies (anti-HCV) but also for HCV RNA or HCV core antigen. This screening program identifies asymptomatic, recently infected individuals with no anti-HCV (in the "window period"). The aim of this study was to compare HCV genotype and subtype distribution in window-period (wp) donors, anti-HCV-positive donors, and chronic hepatitis C (CHC) patients. STUDY DESIGN AND METHODS A total of 2.37 million donors were investigated for HCV RNA, and 340,000 for HCV core antigen. HCV genotypes and subtypes were investigated in 50 HCV RNA-positive, anti-HCV-negative donors; in 70 anti-HCV-positive donors; and in 170 CHC patients. Re-questioning of wp donors for probable risk factors was introduced. RESULTS HCV RNA was detected in 50 donors of 2.71 million (1:54,200) anti-HCV-negative blood donations. Of these 50 donors, 36 percent exhibited Subtype 1b, whereas Subtypes 3a and 4c/d were identified in 40 and 14 percent, respectively. In anti-HCV-positive donors and CHC patients, the frequency of Subtype 1b was significantly higher (75.7 and 85.3%, respectively); in both groups the lower frequency of Subtypes 3a (14.3 and 10.6%, respectively) and 4c/d (4.3 and 1.2%, respectively) was found. The probable source of infection was identified in 9 wp donors. CONCLUSIONS The frequency of wp donors is 18.5 per 1 million. The unexpected high frequency of Genotype 4 and Subtype 3a and the low frequency of Subtype 1b was observed in wp donors compared to anti-HCV-positive individuals. Additional epidemiologic questioning introduced after HCV RNA detection may help to identify infection source.
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Affiliation(s)
- E Brojer
- Institute of Haematology and Blood Transfusion,Warsaw, Poland.
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Dow BC, Munro H, Buchanan I, Ferguson K, Davidson F, Lycett C, Jarvis M, Cleland A, Petrik J, Lumley S, MacLean A. Acute hepatitis C virus seroconversion in a Scottish blood donor: HCV antigen is not comparable with HCV nucleic acid amplification technology screening. Vox Sang 2004; 86:15-20. [PMID: 14984555 DOI: 10.1111/j.0042-9007.2004.00387.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES This study was conducted to analyse the usefulness of hepatitis C virus (HCV) core antigen tests for the confirmation of HCV infection in a donor presenting as nucleic acid amplification technology (NAT) positive but negative for antibodies to HCV (anti-HCV). MATERIALS AND METHODS Blood donations were screened, in parallel, for anti-HCV using the Abbott PRISM HCV Chemiluminescent immunoassay (ChLIA) and an 'in-house' HCV NAT (pools of up to 95 donations). An HCV NAT-positive antibody-negative donor was identified. Twelve follow-up samples were obtained and tested with various HCV antigen (including the recently marketed Trak-C second-generation assay) and HCV antibody assays. RESULTS The single HCV NAT-positive, antibody-negative donation was identified from 1 117 681 donations screened in the 4-year period, July 1999 to June 2003. The index donation was positive by Ortho HCV core antigen enzyme immunoassay (EIA) and Ortho Trak-C (second-generation HCV core antigen EIA). An archive sample, taken 127 days prior to the index donation, was negative for all HCV markers. Subsequent samples demonstrated a loss of reactivity in the Ortho HCV core antigen EIA and reduced activity in the Ortho Trak-C until day 69. Immunoblot (Ortho RIBA-3) and HCV PRISM became positive on day 62, whilst Ortho HCV ELISA was not positive until day 132 or Biorad HCV ELISA until day 160. An alternative immunoblot (Innogenetics Innolia III) was positive from day 55. RNA levels fluctuated considerably during the follow-up period, being completely undetectable by routine screening methods at the time-point around seroconversion; subsequently, antibody was detected using all assays investigated. CONCLUSIONS This HCV-converting blood donor provided a unique panel of samples for using to assess current (and future) HCV assay systems. The overall test results led to the conclusion that individual HCV antigen testing should not be considered as equivalent to HCV NAT minipool screening. Trak-C antigen testing may be considered as a suitable confirmatory assay for isolated HCV NAT reactivity.
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Affiliation(s)
- B C Dow
- Scottish National Blood Transfusion Service Microbiology Reference Unit, West Scotland Blood Transfusion Centre, Glasgow, UK.
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