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Saba N, Nasir JA, Waheed U, Aslam S, Mohammad I, Wazeer A, Ahmed S, Nisar M. Seroprevalence of Transfusion-Transmitted Infections among Voluntary and Replacement Blood Donors at the Peshawar Regional Blood Centre, Khyber Pakhtunkhwa, Pakistan. J Lab Physicians 2021; 13:162-168. [PMID: 34483564 PMCID: PMC8409124 DOI: 10.1055/s-0041-1729485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Introduction
Blood transfusion is linked to several risks, most notably the transmission of transfusion-transmitted infections (TTIs), including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), syphilis, and malaria. The risk posed by these blood-borne infectious agents is high in developing countries, including Pakistan. This fact stresses the need for regular surveillance of TTIs. Therefore, the present study was undertaken to assess the seroprevalence of TTIs at a regional blood center.
Material and Methods
This was a retrospective 4-year descriptive study undertaken at the Regional Blood Centre in Peshawar, Khyber Pakhtunkhwa Province of Pakistan, on the blood donor data from June 2016 to May 2020. A total of 41,817 donors donated blood during the study period and were screened for HBV, HCV, HIV, syphilis, and malaria. To ensure donor privacy, donors were identified via codes and no personal information was available. The data were extracted from the ZAAVIA blood transfusion information system database.
Results
The study included a total of 41,817 donors—41,493 (99.22%) males and 324 (0.78%) females. Of them, 22,343 (53.43%) were voluntary donors while 19,474 (46.57%) were replacement donors. An overall TTI prevalence rate of 4.61% was found. The TTI prevalence rate in voluntary donors was 3.90% while 5.42% in replacement donors. The overall prevalence of HBV, HCV, HIV, syphilis, and malaria was 1.95, 1.38, 0.23, 0.91, and 0.14%, respectively.
Conclusion
The current study documented a high prevalence (1,929 out of 41,817, 4.61%) of TTIs, especially in replacement donors (1,057 out of 19,474, 5.42%), and low participation of female donors. The recommendations include the promotion of voluntary blood donors, enrolment of female blood donors, and screening of donated blood through highly sensitive screening assay (i.e., nucleic acid testing).
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Affiliation(s)
- Noore Saba
- Department of Health, Peshawar Regional Blood Centre, Khyber Pakhtunkhwa, Pakistan
| | - Jamal Abdul Nasir
- Department of Health, Peshawar Regional Blood Centre, Khyber Pakhtunkhwa, Pakistan
| | - Usman Waheed
- Islamabad Blood Transfusion Authority, Ministry of National Health Services, Government of Pakistan, Pakistan
| | - Sidra Aslam
- Department of Pathology, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, Azad Jammu and Kashmir, Pakistan
| | - Iqbal Mohammad
- Department of Health, Peshawar Regional Blood Centre, Khyber Pakhtunkhwa, Pakistan
| | - Akhlaaq Wazeer
- Department of Biotechnology, Mirpur University of Science and Technology, Mirpur, Azad Jammu and Kashmir, Pakistan
| | - Saeed Ahmed
- Department of Blood Bank, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Muhammad Nisar
- Department of Health, Peshawar Regional Blood Centre, Khyber Pakhtunkhwa, Pakistan
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2
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Cutts JC, Quinn B, Seed CR, Kotsiou G, Pearson R, Scott N, Wilson DP, Harrod ME, Maher L, Caris S, Thompson AJ, Farrell M, Pink J, Hellard ME. A Systematic Review of Interventions Used to Increase Blood Donor Compliance with Deferral Criteria. Transfus Med Hemother 2020; 48:118-129. [PMID: 33976612 DOI: 10.1159/000509027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/28/2020] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives Pre-donation screening of potential blood donors is critical for ensuring the safety of the donor blood supply, and donor deferral as a result of risk factors is practised worldwide. This systematic review was conducted in the context of an expert review convened by the Australian Red Cross Lifeblood in 2013 to consider Lifeblood's injecting drug use (IDU)-related policies and aimed to identify studies assessing interventions to improve compliance with deferral criteria in blood donation settings. Materials and Methods MEDLINE/PubMed, OVID Medline, OVID Embase, LILACS, and the Cochrane Library (CENTRAL and DARE) databases were searched for studies conducted within blood donation settings that examined interventions to increase blood donor compliance with deferral criteria. Observational and experimental studies from all geographical areas were considered. Results Ten studies were identified that tested at least one intervention to improve blood donor compliance with deferral criteria, including computerized interviews or questionnaires, direct and indirect oral questioning, educational materials, and a combination of a tickbox questionnaire and a personal donor interview. High-quality evidence from a single study was provided for the effectiveness of a computerized interview in improving detection of HIV risk behaviour. Low-quality evidence for the effectiveness of computerized interviews was provided by 3 additional studies. Two studies reported a moderate effect of direct questioning in increasing donor deferral, but the quality of the evidence was low. Conclusion This review identified several interventions to improve donor compliance that have been tested in blood donation settings and provided evidence for the effectiveness of computerized interviews in improving detection of risk factors.
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Affiliation(s)
| | - Brendan Quinn
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Clive R Seed
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - George Kotsiou
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Ruth Pearson
- Burnet Institute, Melbourne, Victoria, Australia
| | - Nick Scott
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Mary Ellen Harrod
- NSW Users and AIDS Association, Surry Hills, New South Wales, Australia
| | - Lisa Maher
- Burnet Institute, Melbourne, Victoria, Australia.,Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sharon Caris
- Haemophilia Foundation Australia, Malvern East, Victoria, Australia
| | - Alex J Thompson
- Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanne Pink
- Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.,Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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3
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Niazkar HR, Dorgalaleh A, Rad F. First-time Blood Donors Are Double-edged Swords for Blood Transfusion Centers: A Retrospective Study in Southwest Iran. Turk J Haematol 2020; 37:30-35. [PMID: 31475800 PMCID: PMC7057759 DOI: 10.4274/tjh.galenos.2019.2019.0166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: First-time blood donors are the most common group of blood donors. They usually have different motivations for blood donation, some of which provoke the donors to hide risk factors of transfusion-transmissible infections (TTIs). Therefore, detection of TTIs among first-time donors is crucial and can decrease the rate of TTIs among blood recipients. This study aimed to evaluate the prevalence of TTIs among first-time donors in the transfusion center of Kohgiluyeh and Boyer-Ahmad Province (KBTC), Iran. Materials and Methods: This retrospective study was conducted with volunteer blood donors in 2004-2014 in the KBTC. Various data, including sex, confidential unit exclusion (CUE), previous donation history, and the laboratory findings of confirmatory tests, were extracted from blood donor software. Data were analyzed by SPSS using the chi-square test. Results: Among 198,501 blood donors, 52,527 (26.46%) were first-time donors, while 145,974 donors (73.54%) were repeat and regular donors. Most of the donors (94.5%) were male, while a minority (5.5%) were female. The CUE option was chosen by 2,237 (1.13%) donors. The incidence of hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) was 247 (0.13%) and 134 (0.07%) among the entire study population, respectively. Three donors (0.002%) had confirmed human immunodeficiency virus (HIV), while none of the blood donors were positive for syphilis. Most of the donors with positive HBsAg (95.8%), HCV (86.6%), and HIV (100%) infection were first-time donors. Conclusion: Since TTIs are more common among first-time blood donors than regular and repeat donors, special considerations should be taken into account for this common group of blood donors.
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Affiliation(s)
- Hamid Reza Niazkar
- Gonabad University of Medical Sciences, Student Research Committee, Gonabad, Iran
| | - Akbar Dorgalaleh
- School of Allied Medical Science, Department of Hematology and Blood Transfusion, Tehran, Iran
| | - Fariba Rad
- Yasuj University of Medical Sciences, Cellular and Molecular Research Center, Yasuj, Iran,Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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4
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Pandey S, Shan H. Do high-risk behavior deferrals work? How to make it better? Transfusion 2019; 59:2180-2183. [PMID: 31268590 DOI: 10.1111/trf.15409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Suchitra Pandey
- Department of Pathology, Stanford University, Palo Alto, California.,Stanford Blood Center and Transfusion Service, Stanford Health Care, Palo Alto, California
| | - Hua Shan
- Department of Pathology, Stanford University, Palo Alto, California.,Stanford Blood Center and Transfusion Service, Stanford Health Care, Palo Alto, California
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5
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Mitchel J, Custer B, Kaidarova Z, Murphy EL, van den Berg K. Implementation of a script for predonation interviews: impact on human immunodeficiency virus risk in South African blood donors. Transfusion 2019; 59:2344-2351. [PMID: 30946490 PMCID: PMC6610781 DOI: 10.1111/trf.15288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The way in which the donor history questionnaire is conducted plays a crucial role in the self-disclosure of behavioral risk factors for human immunodeficiency virus (HIV) infection by prospective donors. The South African National Blood Service changed its policy on the process of donor assessment in May 2015 by implementing a compulsory interviewer script used to assess donor eligibility. STUDY DESIGN AND METHODS A pre- and postevaluation study to determine the impact of scripted interviews on high-risk deferrals and recently acquired HIV infections. We used historical data to compare 18 months before and after the implementation of the script. RESULTS We recorded a total of 3,169,656 donor presentations during the two 18-months periods, of which 52.2% (1,655,352) were made during the scripted period. A multivariable logistic regression analysis adjusting for donor and demographic characteristics found the odds of high-risk deferral to be slightly greater (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.05-1.07) during the scripted period. A separate multivariate logistic regression model, also adjusting for donor and demographic characteristics, showed that the odds of recently acquired HIV infection were significantly lower (OR, 0.88; 95% CI, 0.79-0.97) during the scripted period. CONCLUSION This study showed that implementation of a scripted interview was associated with increased HIV risk deferral and decreased recent HIV infection. This study indicates potential improvement in blood safety with the implementation of a scripted donor interview and has relevance to blood safety in other sub-Saharan African countries.
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Affiliation(s)
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, United States.,University of California San Francisco, San Francisco, California, United States
| | - Zhanna Kaidarova
- Vitalant Research Institute, San Francisco, California, United States
| | - Edward L. Murphy
- Vitalant Research Institute, San Francisco, California, United States.,University of California San Francisco, San Francisco, California, United States
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6
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Sombra Neto LL, Baracho MG, Farias GMN, Lima DM, Colares JKB, Távora LGF. Is early HIV infection diagnosis at a reference center a reality in the state of Ceara? Rev Soc Bras Med Trop 2018; 51:518-522. [PMID: 30133637 DOI: 10.1590/0037-8682-0393-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/28/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Early diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) can decrease transmission and significantly affect morbidity and mortality; however, Brazil still confronts the reality of late HIV diagnosis. METHODS Medical records of 284 HIV-positive patients were reviewed in this cross-sectional study. RESULTS Of all patients, 28% were diagnosed in the context of health assessments, whereas 27% were symptomatic at diagnosis. Early HIV infection (Group 1) was diagnosed in 60.2% of participants. They were younger than those with late diagnosis (Group 2) (p = 0.002). CONCLUSIONS These findings highlight the need for strategies to increase HIV testing in asymptomatic individuals and older patients.
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Affiliation(s)
| | - Monya Garcia Baracho
- Centro de Pesquisa, Universidade de Fortaleza, Fortaleza, CE, Brasil.,Departamento de Pesquisa, Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil
| | | | - Danielle Malta Lima
- Centro de Pesquisa, Universidade de Fortaleza, Fortaleza, CE, Brasil.,Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, CE, Brasil.,Programa de Pós-Graduação em Ciências Médicas, Universidade de Fortaleza, Fortaleza, CE, Brasil
| | - Jeová Keny Baima Colares
- Centro de Pesquisa, Universidade de Fortaleza, Fortaleza, CE, Brasil.,Departamento de Pesquisa, Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil.,Programa de Pós-Graduação em Ciências Médicas, Universidade de Fortaleza, Fortaleza, CE, Brasil
| | - Lara Gurgel Fernandes Távora
- Centro de Pesquisa, Universidade de Fortaleza, Fortaleza, CE, Brasil.,Departamento de Pesquisa, Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil
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7
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Kasraian L, Karimi MH. A study on confidential unit exclusion at Shiraz Blood Transfusion Center, Iran. Asian J Transfus Sci 2016; 10:132-5. [PMID: 27605850 PMCID: PMC4993082 DOI: 10.4103/0973-6247.187939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Confidential unit exclusion (CUE) system has been designed to enhance transfusion safety as an extra additive approach. Aims: This study was designed to survey demographic characteristics, prevalence of serologic markers, and reasons of opting CUE. Materials and Methods: The cross-sectional study was performed at Shiraz Blood Transfusion Center (Southern Iran). CUE is used for all individuals who refer for blood donation, and donors can choose their blood not to be used if they have any doubt about their blood suitability for transfusion. The prevalence rate of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) was compared between the blood donors who opted into and out of CUE. Then, the donors were contacted to give another blood sample and the reasons of deferral. Researchers also determined whether their reasons were logical or not. Data were analyzed using comparison of proportions in MedCalc software 7. Results: Out of all the donors, 2365 ones (2.3%) opted for CUE. CUE was more frequent among men, singles, donors with low education levels, between 18 and 25 years old, and with history of previous donation (P < 0.05). The prevalence rate of HCV was higher among the donors who opted for CUE (P < 0.05), but it was not the case regarding HBV and HIV (P>0.05). Furthermore, 91.5% of the donors had opted for CUE by mistake and only 8% had chosen CUE logically. Conclusion: It is necessary to review the process of CUE, make some changes both in procedure and design, and then survey its effectiveness in blood safety.
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Affiliation(s)
- Leila Kasraian
- Blood Transfusion Research Center, Higher Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Mohammad Hossein Karimi
- Blood Transfusion Research Center, Higher Institute for Research and Education in Transfusion Medicine, Tehran, Iran; Transplant Research Center, Shiraz University of Medical Science, Shiraz, Iran
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8
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Goncalez TT, Blatyta PF, Santos FM, Montebello S, Esposti SPD, Hangai FN, Salles NA, Mendrone A, Truong HHM, Sabino EC, McFarland W. Does offering human immunodeficiency virus testing at the time of blood donation reduce transfusion transmission risk and increase disclosure counseling? Results of a randomized controlled trial, São Paulo, Brazil. Transfusion 2015; 55:1214-22. [PMID: 25646883 DOI: 10.1111/trf.13009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND In a randomized controlled trial (RCT) in a blood bank in São Paulo, we tested the hypotheses that offering client-centered human immunodeficiency virus (HIV) counseling and testing to blood donors would: 1) reduce the risk of HIV contamination in the blood supply by diverting higher-risk, test-seeking donors away from donation and 2) increase return for results and referrals to care. STUDY DESIGN AND METHODS We randomly selected weeks between August 2012 and May 2013 when donors were offered HIV counseling and testing (n = 6298), leaving usual procedure weeks as control (n = 5569). RESULTS Few candidate donors chose HIV testing (n = 81, 1.3%). There was no significant difference in herpes simplex virus Type 2 (HSV-2) prevalence (a marker of sexual risk) among donors during intervention weeks compared to control (10.4% vs. 11.1%, p = 0.245). No donor choosing testing was HIV infected, and there was no difference in HSV-2 prevalence between testers and donors (9.9% vs. 10.4%, p = 0.887). Returning for positive results did not differ between testers and donors (three of three vs. 58 of 80, p = 0.386). A higher proportion of donors acknowledged that HIV testing was a strong motivation to donate during intervention weeks compared to control (2.6% vs. 2.0%, p = 0.032). CONCLUSION The evidence of our RCT is that offering HIV counseling and testing at the time of donation would not change the risk of contamination in the blood supply, nor improve results disclosure and referral to care.
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Affiliation(s)
| | - Paula F Blatyta
- Fundação Pró-Sangue/Hemocentro De São Paulo, São Paulo, Brazil
| | | | | | | | - Fatima N Hangai
- Fundação Pró-Sangue/Hemocentro De São Paulo, São Paulo, Brazil
| | - Nanci A Salles
- Fundação Pró-Sangue/Hemocentro De São Paulo, São Paulo, Brazil
| | | | - Hong-Ha M Truong
- University of California at San Francisco, San Francisco, California
| | | | - Willi McFarland
- University of California at San Francisco, San Francisco, California.,San Francisco Department of Public Health, San Francisco, California
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9
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Freitas DRC, Duarte EC. Normative evaluation of blood banks in the Brazilian Amazon region in respect to the prevention of transfusion-transmitted malaria. Rev Bras Hematol Hemoter 2014; 36:394-402. [PMID: 25453648 PMCID: PMC4318476 DOI: 10.1016/j.bjhh.2014.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 06/25/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate blood banks in the Brazilian Amazon region with regard to structure and procedures directed toward the prevention of transfusion-transmitted malaria (TTM). METHODS This was a normative evaluation based on the Brazilian National Health Surveillance Agency (ANVISA) Resolution RDC No. 153/2004. Ten blood banks were included in the study and classified as 'adequate' (≥80 points), 'partially adequate' (from 50 to 80 points), or 'inadequate' (<50 points). The following components were evaluated: 'donor education' (5 points), 'clinical screening' (40 points), 'laboratory screening' (40 points) and 'hemovigilance' (15 points). RESULTS The overall median score was 49.8 (minimum=16; maximum=78). Five blood banks were classified as 'inadequate' and five as 'partially adequate'. The median clinical screening score was 26 (minimum=16; maximum=32). The median laboratory screening score was 20 (minimum=0; maximum=32). Eight blood banks performed laboratory tests for malaria; six tested all donations. Seven used thick smears, but only one performed this procedure in accordance with Ministry of Health requirements. One service had a Program of External Quality Evaluation for malaria testing. With regard to hemovigilance, two institutions reported having procedures to detect cases of transfusion-transmitted malaria. CONCLUSION Malaria is neglected as a blood-borne disease in the blood banks of the Brazilian Amazon region. None of the institutions were classified as 'adequate' in the overall classification or with regard to clinical screening and laboratory screening. Blood bank professionals, the Ministry of Health and Health Surveillance service managers need to pay more attention to this matter so that the safety procedures required by law are complied with.
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Affiliation(s)
- Daniel Roberto Coradi Freitas
- Universidade de Brasília (UnB), Brasília, DF, Brazil; Agência Nacional de Vigilância Sanitária (ANVISA), Brasília, DF, Brazil.
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10
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Loureiro P, de Almeida-Neto C, Proietti ABC, Capuani L, Gonçalez TT, de Oliveira CDL, Leão SC, Lopes MI, Sampaio D, Patavino GM, Ferreira JE, Blatyta PF, Duarte Lopes ME, Mendrone-Junior A, Salles NA, King M, Murphy E, Busch M, Custer B, Sabino EC. [Not Available]. Rev Bras Hematol Hemoter 2014; 36:152-8. [PMID: 24790542 PMCID: PMC4005515 DOI: 10.5581/1516-8484.20140033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/26/2013] [Indexed: 11/27/2022] Open
Abstract
The Retrovirus Epidemiology Donor Study (REDS) program was established in the United States in 1989 with the purpose of increasing blood transfusion safety in the context of the HIV/AIDS and human T-lymphotropic virus epidemics. REDS and its successor, REDS-II were at first conducted in the US, then expanded in 2006 to include international partnerships with Brazil and China. In 2011, a third wave of REDS renamed the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) was launched. This seven-year research program focuses on both blood banking and transfusion medicine research in the United States of America, Brazil, China, and South Africa. The main goal of the international programs is to reduce and prevent the transmission of HIV/AIDS and other known and emerging infectious agents through transfusion, and to address research questions aimed at understanding global issues related to the availability of safe blood. This article describes the contribution of REDS-II to transfusion safety in Brazil. Articles published from 2010 to 2013 are summarized, including database analyses to characterize blood donors, deferral rates, and prevalence, incidence and residual risk of the main blood-borne infections. Specific studies were developed to understand donor motivation, the impact of the deferral questions, risk factors and molecular surveillance among HIV-positive donors, and the natural history of Chagas disease. The purpose of this review is to disseminate the acquired knowledge and briefly summarize the findings of the REDS-II studies conducted in Brazil as well as to introduce the scope of the REDS-III program that is now in progress and will continue through 2018. © 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. All rights reserved.
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Affiliation(s)
- Paula Loureiro
- Faculdade de Ciências Médicas, Universidade de Pernambuco (UPE), Recife, PE, Brazil; Fundação Hemope, Recife, PE, Brazil
| | | | | | - Ligia Capuani
- Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | | | | | | | - Divaldo Sampaio
- Faculdade de Ciências Médicas, Universidade de Pernambuco (UPE), Recife, PE, Brazil; Fundação Hemope, Recife, PE, Brazil
| | | | - João Eduardo Ferreira
- Instituto de Matemática e Estatística, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | | | | | | | | | - Edward Murphy
- University of California San Francisco, California, USA
| | - Michael Busch
- Blood System Research Institute, San Francisco, California, USA
| | - Brian Custer
- Blood System Research Institute, San Francisco, California, USA
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11
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Miranda C, Moreno E, Bruhn R, Larsen NM, Wright DJ, Oliveira CDL, Carneiro-Proietti ABF, Loureiro P, de Almeida-Neto C, Custer B, Sabino EC, Gonçalez TT. Knowledge of HIV testing and attitudes towards blood donation at three blood centres in Brazil. Vox Sang 2013; 106:344-53. [PMID: 24313562 DOI: 10.1111/vox.12114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 10/08/2013] [Accepted: 10/17/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reducing risk of HIV window period transmission requires understanding of donor knowledge and attitudes related to HIV and risk factors. STUDY DESIGN AND METHODS We conducted a survey of 7635 presenting blood donors at three Brazilian blood centres from 15 October through 20 November 2009. Participants completed a questionnaire on HIV knowledge and attitudes about blood donation. Six questions about blood testing and HIV were evaluated using maximum likelihood chi-square and logistic regression. Test seeking was classified in non-overlapping categories according to answers to one direct and two indirect questions. RESULTS Overall, respondents were male (64%) repeat donors (67%) between 18 and 49 years old (91%). Nearly 60% believed blood centres use better HIV tests than other places; however, 42% were unaware of the HIV window period. Approximately 50% believed it was appropriate to donate to be tested for HIV, but 67% said it was not acceptable to donate with risk factors even if blood is tested. Logistic regression found that less education, Hemope-Recife blood centre, replacement, potential and self-disclosed test-seeking were associated with less HIV knowledge. CONCLUSION HIV knowledge related to blood safety remains low among Brazilian blood donors. A subset finds it appropriate to be tested at blood centres and may be unaware of the HIV window period. These donations may impose a significant risk to the safety of the blood supply. Decreasing test-seeking and changing beliefs about the appropriateness of individuals with behavioural risk factors donating blood could reduce the risk of transfusing an infectious unit.
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Affiliation(s)
- C Miranda
- Fundação Hemominas Hemocentro de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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12
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Blatyta PF, Custer B, Gonçalez TT, Birch R, Lopes ME, Lopes Ferreira MI, Carneiro Proietti AB, Sabino EC, Page K, de Almeida-Neto C. Undisclosed human immunodeficiency virus risk factors identified through a computer-based questionnaire program among blood donors in Brazil. Transfusion 2013; 53:2734-43. [PMID: 23521083 DOI: 10.1111/trf.12166] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/10/2012] [Accepted: 12/10/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) risk factor screening among blood donors remains a cornerstone for the safety of blood supply and is dependent on prospective donor self-disclosure and an attentive predonation interview. Audio computer-assisted structured interview (ACASI) has been shown to increase self-reporting of risk behaviors. STUDY DESIGN AND METHODS This cross-sectional study was conducted between January 2009 and March 2011 at four Brazilian blood centers to identify the population of HIV-negative eligible blood donors that answered face-to-face interviews without disclosing risks, but subsequently disclosed deferrable risk factors by ACASI. Compared to the donor interview, the ACASI contained expanded content on demographics, sexual behavior, and other HIV risk factors questions. RESULTS A total of 901 HIV-negative blood donors were interviewed. On the ACASI, 13% of donors (n = 120) declared a risk factor that would have resulted in deferral that was not disclosed during the face-to-face assessment. The main risk factors identified were recent unprotected sex with an unknown or irregular partner (49 donors), sex with a person with exposure to blood or fluids (26 donors), multiple sexual partners (19 donors), and male-male sexual behavior (10 donors). Independent factors associated with the disclosure of any risk factor for HIV were age (≥40 years vs. 18-25 years; adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.23-0.88) and blood center (Hemope vs. Hemominas; AOR, 2.51; 95% CI, 1.42-4.44). CONCLUSION ACASI elicited increased disclosure of HIV risk factors among blood donors. ACASI may be a valuable modality of interview to be introduced in Brazilian blood banks.
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Affiliation(s)
- Paula Fraiman Blatyta
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, SP, Brazil; Blood Systems Research Institute, San Francisco, California; Westat, Rockville, Maryland; Fundação Hemorio, Rio de Janeiro, RJ, Brazil; Fundação Hemope, Recife, PE, Brazil; Fundação Hemominas, Belo Horizonte, MG, Brazil; Department of Infectious Diseases, Medical School, University of São Paulo, São Paulo, SP, Brazil; University of California at San Francisco, San Francisco, California
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Kleinman S, King MR, Busch MP, Murphy EL, Glynn SA. The National Heart, Lung, and Blood Institute retrovirus epidemiology donor studies (Retrovirus Epidemiology Donor Study and Retrovirus Epidemiology Donor Study-II): twenty years of research to advance blood product safety and availability. Transfus Med Rev 2012; 26:281-304, 304.e1-2. [PMID: 22633182 PMCID: PMC3448800 DOI: 10.1016/j.tmrv.2012.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The Retrovirus Epidemiology Donor Study (REDS), conducted from 1989 to 2001, and the REDS-II, conducted from 2004 to 2012, were National Heart, Lung, and Blood Institute-funded, multicenter programs focused on improving blood safety and availability in the United States. The REDS-II also included international study sites in Brazil and China. The 3 major research domains of REDS/REDS-II have been infectious disease risk evaluation, blood donation availability, and blood donor characterization. Both programs have made significant contributions to transfusion medicine research methodology by the use of mathematical modeling, large-scale donor surveys, innovative methods of repository sample storage, and establishing an infrastructure that responded to potential emerging blood safety threats such as xenotropic murine leukemia virus-related virus. Blood safety studies have included protocols evaluating epidemiologic and/or laboratory aspects of human immunodeficiency virus, human T-lymphotropic virus 1/2, hepatitis C virus, hepatitis B virus, West Nile virus, cytomegalovirus, human herpesvirus 8, parvovirus B19, malaria, Creutzfeldt-Jakob disease, influenza, and Trypanosoma cruzi infections. Other analyses have characterized blood donor demographics, motivations to donate, factors influencing donor return, behavioral risk factors, donors' perception of the blood donation screening process, and aspects of donor deferral. In REDS-II, 2 large-scale blood donor protocols examined iron deficiency in donors and the prevalence of leukocyte antibodies. This review describes the major study results from over 150 peer-reviewed articles published by these 2 REDS programs. In 2011, a new 7-year program, the Recipient Epidemiology and Donor Evaluation Study-III, was launched. The Recipient Epidemiology and Donor Evaluation Study-III expands beyond donor-based research to include studies of blood transfusion recipients in the hospital setting and adds a third country, South Africa, to the international program.
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Affiliation(s)
- Steven Kleinman
- Department of Pathology, University of British Columbia, Victoria, British Columbia, Canada.
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Sabino EC, Gonçalez TT, Carneiro-Proietti AB, Sarr M, Ferreira JE, Sampaio DA, Salles NA, Wright DJ, Custer B, Busch M. Human immunodeficiency virus prevalence, incidence, and residual risk of transmission by transfusions at Retrovirus Epidemiology Donor Study-II blood centers in Brazil. Transfusion 2012; 52:870-9. [PMID: 21981109 PMCID: PMC3257370 DOI: 10.1111/j.1537-2995.2011.03344.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Brazil nationally representative donor data are limited on human immunodeficiency virus (HIV) prevalence, incidence, and residual transfusion risk. The objective of this study was to analyze HIV data obtained over 24 months by the Retrovirus Epidemiology Donor Study-II program in Brazil. STUDY DESIGN AND METHODS Donations reactive to third- and fourth-generation immunoassays (IAs) were further confirmed by a less-sensitive (LS) IA algorithm and Western blot (WB). Incidence was calculated for first-time (FT) donors using the LS-EIA results and for repeat donors with a model developed to include all donors with a previous negative donation. Residual risk was projected by multiplying composite FT and repeat donor incidence rates by HIV marker-negative infectious window periods. RESULTS HIV prevalence among FT donors was 92.2/10(5) donations. FT and repeat donor and composite incidences were 38.5 (95% confidence interval [CI], 25.6-51.4), 22.5 (95% CI, 17.6-28.0), and 27.5 (95% CI, 22.0-33.0) per 100,000 person-years, respectively. Male and community donors had higher prevalence and incidence rates than female and replacement donors. The estimated residual risk of HIV transfusion transmission was 11.3 per 10(6) donations (95% CI, 8.4-14.2), which could be reduced to 4.2 per 10(6) donations (95% CI, 3.2-5.2) by use of individual-donation nucleic acid testing (NAT). CONCLUSION The incidence and residual transfusion risk of HIV infection are relatively high in Brazil. Implementation of NAT will not be sufficient to decrease transmission rates to levels seen in the United States or Europe; therefore, other measures focused on decreasing donations by at-risk individuals are also necessary.
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Questionnaire-related deferrals in regular blood donors in norway. JOURNAL OF BLOOD TRANSFUSION 2012; 2012:813231. [PMID: 24089651 PMCID: PMC3779598 DOI: 10.1155/2012/813231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 10/06/2011] [Accepted: 10/23/2011] [Indexed: 11/17/2022]
Abstract
Voluntary donation is a key issue in transfusion medicine. To ensure the safety of blood transfusions, careful donor selection is important. Although new approaches to blood safety have dramatically reduced the risks for infectious contamination of blood components, the quality and the availability of blood components depend on the willingness to donate and the reliability of the information given by the donors about their own health, including risk behavior. As donors who are deferred by the blood bank will be less motivated to return for donation, it is important to reduce the number of deferrals. The aims of the present study were to investigate the reasons for deferral of registered donors coming to the blood bank for donation, in order to identify areas of importance for donor education-as these deferrals potentially could be avoided by better donor comprehension. Deferral related to testing of donors is not included in this study as these deferrals are dependent on laboratory results and cannot be indentified by questionnaire or interview. Data were collected from all blood donors in a period for 18 months who came for blood donation at a large university hospital in Norway. 1 163 of the 29 787 regular donors, who showed up for donation, were deferred (3.9%). The main reasons were intercurrent illness (n = 182) (15.6%), skin ulcers (n = 170) (14.6%), and risk behaviour (n = 127) (10.9%). In a community, intercurrent illnesses, skin ulcers, and potential risk behavior are the most frequent reasons for deferral of regular donors. Strategized effort on donor education is needed, as "failure to donate" reduces donor motivation.
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Shaz BH, Kessler D, Hillyer CD. Evaluating the role of blood collection centers in public health: a status report. Transfus Med Rev 2011; 26:58-67. [PMID: 21871778 DOI: 10.1016/j.tmrv.2011.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Blood centers have a central role in the community through recruitment and donation, and these community interactions enable blood centers to have a critical role in public health. Some public health initiatives are inherent in the blood center, such as providing human immunodeficiency virus educational material, whereas other initiatives have been actively created, such as cardiovascular screening, as a means to increase blood donor rates and increase the blood center's community interaction. These public health initiatives have been inconsistently practiced by blood collection centers over many years. An understanding of the current literature and exploring the potential role of blood centers in public health, while considering cost and value of these programs, are necessary for blood centers to evaluate the value of implementing these programs. The studies do not support a significant improvement in donor health or significant increase in donation rates through these public health initiatives. However, no study published thus far has been comprehensive enough or carried out long enough to adequately evaluate the value of providing health initiatives to donors.
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Affiliation(s)
- Beth H Shaz
- New York Blood Center, 310 E 67 St, New York, NY 10065, USA.
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Patavino GM, de Almeida-Neto C, Liu J, Wright DJ, Mendrone-Junior A, Ferreira MIL, Carneiro ABDF, Custer B, Ferreira JE, Busch MP, Sabino EC. Number of recent sexual partners among blood donors in Brazil: associations with donor demographics, donation characteristics, and infectious disease markers. Transfusion 2011; 52:151-9. [PMID: 21756264 DOI: 10.1111/j.1537-2995.2011.03248.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Brazilian blood centers ask candidate blood donors about the number of sexual partners in the past 12 months. Candidates who report a number over the limit are deferred. We studied the implications of this practice on blood safety. STUDY DESIGN AND METHODS We analyzed demographic characteristics, number of heterosexual partners, and disease marker rates among 689,868 donations from three Brazilian centers between July 2007 and December 2009. Donors were grouped based on maximum number of partners allowed in the past 12 months for each center. Chi-square and logistic regression analysis were conducted to examine associations between demographic characteristics, number of sex partners, and individual and overall positive markers rates for human immunodeficiency virus (HIV), human T-lymphotropic virus Types 1 and 2, hepatitis B virus, hepatitis C virus, and syphilis. RESULTS First-time, younger, and more educated donors were associated with a higher number of recent sexual partners, as was male sex in São Paulo and Recife (p<0.001). Serologic markers for HIV and syphilis and overall were associated with multiple partners in São Paulo and Recife (p<0.001), but not in Belo Horizonte (p=0.05, p=0.94, and p=0.75, respectively). In logistic regression analysis, number of recent sexual partners was associated with positive serologic markers (adjusted odds ratio [AOR], 1.2-1.5), especially HIV (AOR, 1.9-4.4). CONCLUSIONS Number of recent heterosexual partners was associated with HIV positivity and overall rates of serologic markers of sexually transmitted infections. The association was not consistent across centers, making it difficult to define the best cutoff value. These findings suggest the use of recent heterosexual contacts as a potentially important deferral criterion to improve blood safety in Brazil.
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Delaney M, Schellhase KG, Young S, Geiger S, Fink A, Mast AE. Blood center practice and education for blood donors with anemia. Transfusion 2011; 51:929-36. [PMID: 20977487 PMCID: PMC3608117 DOI: 10.1111/j.1537-2995.2010.02919.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anemia is an early indicator of many diseases, yet blood donors with low hematocrit (Hct) often receive inadequate information about its medical importance. We sought to understand the types of information that are and should be provided to these donors. STUDY DESIGN AND METHODS Two companion studies were performed. The first investigated blood center practices for care of donors with low Hct including deferral length, information provided, and cutoff values used when referring donors for medical attention. The second was a randomized prospective pilot study comparing behavior of deferred donors receiving an "older" pamphlet providing a list of iron-rich foods or a "newer" pamphlet providing descriptions of common causes of anemia and advice for seeking medical attention. RESULTS More than 70% of centers defer donors for 1 day. Only 6% defer donors for more than 2 weeks. Most centers provide written and/or verbal information about low Hct. Only 35% have a cutoff value defining significant anemia that requires additional medical attention. In the study of donors with low Hct, significant disease was identified within 3 months after deferral in 2 of 104 subjects: metastatic lung cancer and acute lymphocytic leukemia. Only donors receiving the newer pamphlet reported that it "definitely improved" their ability to speak with their doctor about anemia. CONCLUSIONS The diagnosis of anemia in blood donors may be an indicator of significant undiagnosed disease. There are wide variations in how centers care for and educate donors with anemia. Donors with anemia should be provided improved and consistent educational information.
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