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Ali SM, Raza N, Irfan M, Mohammad MF, Kazmi FH, Fatima Z. Effectiveness of Using Nucleic Acid Amplification Test to Screen Blood Donors for Hepatitis B, Hepatitis C, and HIV: A Tertiary Care Hospital Experience From Pakistan. Cureus 2023; 15:e34216. [PMID: 36852365 PMCID: PMC9958204 DOI: 10.7759/cureus.34216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 01/27/2023] Open
Abstract
Background Ensuring blood safety is the primary goal of transfusion medicine. Despite extensive serological tests and strict safety measures, the risk of transfusion-transmitted infections (TTIs) still exists. As applied to blood screening, Nucleic Acid Amplification Test (NAT) offers much higher sensitivity for detecting viral infections. It is, however, currently available to a handful of centers due to the high cost. This study aims to establish the Effectiveness of NAT by assessing the NAT yield and residual risk of transmission of Hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV with and without NAT testing. Material and method This prospective cross-sectional study recruited blood donors from January 2020 to November 2022. All donors underwent routine serologic screening. Only serologically negative donors were tested for HBV, HCV, and HIV by NAT. The NAT yield and residual risk (RR) per million donors were computed for viral infections in seronegative blood donors and calculated using the incidence/window period model. Result A total of 59708 donors were included during the study period. The overall prevalence of TTI's were: For HCV 1.7% (n = 1018), HBV 1.5% (n = 918), HIV 0.07% (n = 47), Syphilis 1.2% (n = 758) and malaria 0.3% (n = 218). Out of 57759 seronegative donors, thirty-four NAT-reactive samples were identified, with 3 cases of HCV, 31 cases of HBV, and Nil HIV cases. NAT yield of HBV was 1 in 1863 with an RR of 8.6 per million, followed by HCV with a NAT yield of 1 in 19253 and RR of 0.8 per million donations. NAT testing reduced RR for HBV by 48.9% and HCV by 94.5%. Conclusion Our study showed that NAT detected 34 out of 57759 cases initially missed by serological tests. The study suggests that the parallel use of serology and NAT screening of donated blood would be beneficial.
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Affiliation(s)
- Syeda M Ali
- Hematology and Oncology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Naila Raza
- Hematology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Muhammad Irfan
- Hematology, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | - Fatima H Kazmi
- Hematology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Zainab Fatima
- Hematology, Liaquat National Hospital and Medical College, Karachi, PAK
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Kiely P, Hoad VC, Wood EM. False positive viral marker results in blood donors and their unintended consequences. Vox Sang 2018; 113:530-539. [PMID: 29974475 DOI: 10.1111/vox.12675] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/29/2018] [Accepted: 06/06/2018] [Indexed: 12/15/2022]
Abstract
False positive (FP) viral marker results in blood donors continue to pose many challenges. Informing donors of FP results and subsequent deferral can result in stress and anxiety for donors and additional complexity and workload for blood services. Donor management strategies need to balance the requirement to minimise donor anxiety and inconvenience while maintaining sufficiency of supply. Decisions about how and when to inform donors of FP results and determine deferral periods can be difficult as FP results, while often transitory, can take up to several years to resolve. Additional complexities include the interpretation of indeterminate serological confirmatory testing without detectable viral RNA or non-discriminated NAT results with concomitant anti-HBc reactivity - both may be due to FP results, but the former may also represent past infection and the later may represent occult hepatitis B infection. In this review we discuss strategies to minimise indeterminate serological confirmatory results, possible donor deferral policies and the impact on donors when notified of FP results. We also provide some new data from Australia that address the challenge of interpreting non-discriminated NAT results with concomitant anti-HBc reactivity. Ultimately, the challenge is for each blood service to develop appropriate strategies for donor management, taking into account local information and requirements.
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Affiliation(s)
- Philip Kiely
- Australian Red Cross Blood Service, Melbourne, Victoria, Australia
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Veronica C Hoad
- Australian Red Cross Blood Service, Perth, Western Australia, Australia
| | - Erica M Wood
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Kiely P, Gambhir M, Cheng AC, McQuilten ZK, Seed CR, Wood EM. Emerging Infectious Diseases and Blood Safety: Modeling the Transfusion-Transmission Risk. Transfus Med Rev 2017; 31:154-164. [PMID: 28545882 PMCID: PMC7126009 DOI: 10.1016/j.tmrv.2017.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 12/28/2022]
Abstract
While the transfusion-transmission (TT) risk associated with the major transfusion-relevant viruses such as HIV is now very low, during the last 20 years there has been a growing awareness of the threat to blood safety from emerging infectious diseases, a number of which are known to be, or are potentially, transfusion transmissible. Two published models for estimating the transfusion-transmission risk from EIDs, referred to as the Biggerstaff-Petersen model and the European Upfront Risk Assessment Tool (EUFRAT), respectively, have been applied to several EIDs in outbreak situations. We describe and compare the methodological principles of both models, highlighting their similarities and differences. We also discuss the appropriateness of comparing results from the two models. Quantitating the TT risk of EIDs can inform decisions about risk mitigation strategies and their cost-effectiveness. Finally, we present a qualitative risk assessment for Zika virus (ZIKV), an EID agent that has caused several outbreaks since 2007. In the latest and largest ever outbreak, several probable cases of transfusion-transmission ZIKV have been reported, indicating that it is transfusion-transmissible and therefore a risk to blood safety. We discuss why quantitative modeling the TT risk of ZIKV is currently problematic. During the last 20 years there has been a growing awareness of the threat to blood safety from emerging infectious diseases (EIDs), a number of which are known to be, or are potentially, transfusion-transmissible. The transfusion-transmission risk of EID agents can be estimated by risk modeling which can form an important part of risk assessments and inform decisions regarding risk mitigation strategies. We describe and compare the methodological principles of two published risk models for estimating the transfusion transmission risk of EIDs. We use Zika virus as a case study to demonstrate that reliable risk modeling for EID agents can be problematic due to the uncertainty of the input parameters.
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Affiliation(s)
- Philip Kiely
- Australian Red Cross Blood Service, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Manoj Gambhir
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Allen C Cheng
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Health, Australia
| | - Zoe K McQuilten
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Clive R Seed
- Australian Red Cross Blood Service, Melbourne, VIC, Australia
| | - Erica M Wood
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Mapako T, Janssen MP, Mvere DA, Emmanuel JC, Rusakaniko S, Postma MJ, van Hulst M. Impact of using different blood donor subpopulations and models on the estimation of transfusion transmission residual risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in Zimbabwe. Transfusion 2016; 56:1520-8. [PMID: 26801952 DOI: 10.1111/trf.13472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/26/2015] [Accepted: 12/05/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Various models for estimating the residual risk (RR) of transmission of infections by blood transfusion have been published mainly based on data from high-income countries. However, to obtain the data required for such an assessment remains challenging for most developing settings. The National Blood Service Zimbabwe (NBSZ) adapted a published incidence-window period (IWP) model, which has less demanding data requirements. In this study we assess the impact of various definitions of blood donor subpopulations and models on RR estimates. We compared the outcomes of two published models and an adapted NBSZ model. STUDY DESIGN AND METHODS The Schreiber IWP model (Model 1), an amended version (Model 2), and an adapted NBSZ model (Model 3) were applied. Variably the three models include prevalence, incidence, preseroconversion intervals, mean lifetime risk, and person-years at risk. Annual mean RR estimates and 95% confidence intervals for each of the three models for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) were determined using NBSZ blood donor data from 2002 through 2011. RESULTS The annual mean RR estimates for Models 1 through 3 were 1 in 6542, 5805, and 6418, respectively for HIV; 1 in 1978, 2027, and 1628 for HBV; and 1 in 9588, 15,126, and 7750, for HCV. CONCLUSIONS The adapted NBSZ model provided comparable results to the published methods and these highlight the high occurrence of HBV in Zimbabwe. The adapted NBSZ model could be used as an alternative to estimate RRs when in settings where two repeat donations are not available.
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Affiliation(s)
- Tonderai Mapako
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,National Blood Service Zimbabwe, Harare, Zimbabwe
| | - Mart P Janssen
- Julius Center for Health Science and Primary Health Care, University Medical Center Utrecht, the Netherlands
| | | | | | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Maarten J Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,Institute of Science in Healthy Aging & Health caRE (SHARE), University Medical Center Groningen (UMCG)
| | - Marinus van Hulst
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, the Netherlands
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Bowen JR, Patterson JA, Roberts CL, Isbister JP, Irving DO, Ford JB. Red cell and platelet transfusions in neonates: a population-based study. Arch Dis Child Fetal Neonatal Ed 2015; 100:F411-5. [PMID: 25977265 DOI: 10.1136/archdischild-2014-307716] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/23/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to describe the use of red cells, platelets and exchange transfusions among all neonates in a population cohort, to examine trends in transfusion over time and to determine transfusion rates in at-risk neonates. DESIGN Linked population-based birth and hospital data from New South Wales (NSW), Australia, were used to determine rates of blood product transfusion in the first 28 days of life. The study included all live births ≥23 weeks' gestation in NSW between 2001 and 2011. RESULTS Between 2001 and 2011, 5326 of 989 491 live born neonates received a red cell, platelet or exchange transfusion (5.4/1000 births). Transfusion rates were 4.8 per 1000 for red cells, 1.3 per 1000 for platelets and 0.3 per 1000 for exchange transfusion. Overall transfusion rate remained constant from 2001 to 2011 (p=0.27). Among transfused neonates, 60% were <32 weeks' gestation (n=3210, 331/1000 births), 40% were ≥32 weeks' gestation (n= 2116, 2/1000 births) and 7% received transfusions in a hospital without a neonatal intensive care unit (NICU). Factors other than prematurity associated with higher transfusion rates were prior in utero transfusion (631/1000), congenital anomaly requiring surgery (440/1000) and haemolytic disorder (106/1000). CONCLUSIONS In this population-based study, preterm neonates had a higher rate of transfusion than term neonates; however, 40% of those who received a transfusion were born ≥32 weeks' gestation and 7% were transfused in hospitals without an NICU. These findings need to be considered by transfusion services and personnel developing neonatal transfusion guidelines.
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Affiliation(s)
- Jennifer R Bowen
- Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia University of Sydney, Sydney, New South Wales, Australia
| | - Jillian A Patterson
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Christine L Roberts
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | | | - David O Irving
- Department of Research and Development, Australian Red Cross Blood Service, Sydney, New South Wales, Australia
| | - Jane B Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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