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Arslanoglu S, Moro GE, Tonetto P, De Nisi G, Ambruzzi AM, Biasini A, Profeti C, Gagliardi L, Salvatori G, Bertino E. Recommendations for the establishment and operation of a donor human milk bank. Nutr Rev 2023; 81:1-28. [PMID: 36892193 PMCID: PMC9997086 DOI: 10.1093/nutrit/nuad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
In Europe, an increasing number of human milk banks (HMBs) collect donor human milk to feed preterm infants when their mother's milk is not available or not enough. Moreover, donor milk is a bridge to breastfeeding, with positive clinical and psychological advantages for both mother and infant. Italy, with 41 HMBs actively operating in 2022, has the highest number of HMBs in Europe. The process of human milk donation is complex, so activity of HMBs must be regulated according to well-established rules. The present recommendations have been prepared as a tool to standardize the organization, management, and procedures of HMBs operating in Italy and to determine the minimal essential requirements to establish new HMBs. This article covers all the aspects of human milk donation and human milk banking, including general recommendations, donor recruitment and screening, expression, handling and storage of donor human milk, milk screening, and milk treatment (pasteurization). A pragmatic approach was taken to drafting the recommendations. Items for which there was consensus or robust published evidence on which to base recommendations were included. When there were differences that could not be resolved by reference to published research, a statement of explanation based on the expert opinion of the authors (all members of the Italian Association of Human Milk Banks) was included. Implementation of these recommendations can contribute to promotion of breastfeeding.
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Affiliation(s)
- Sertac Arslanoglu
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,is with the Division of Neonatology, Department of Pediatrics, İstanbul Medeniyet University, School of Medicine, İstanbul, Turkey
| | - Guido E Moro
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Paola Tonetto
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,are with the Neonatal Care Unit of the University, City of Health and Science Hospital, Turin, Italy
| | - Giuseppe De Nisi
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Amalia Maria Ambruzzi
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Augusto Biasini
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Claudio Profeti
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Luigi Gagliardi
- is with the Woman and Child Health Department, Azienda USL Toscana Nord-Ovest, Lucca, Italy
| | - Guglielmo Salvatori
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,is with the Donor Human Milk Bank, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Enrico Bertino
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,are with the Neonatal Care Unit of the University, City of Health and Science Hospital, Turin, Italy
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Grujić J, Bujandrić N, Banović P. Personal Freedom and Public Responsibility: Remaining Questions after First Case of HIV Transmission via Blood Transfusion in North Serbia. Healthcare (Basel) 2022; 10:healthcare10081397. [PMID: 35893219 PMCID: PMC9332804 DOI: 10.3390/healthcare10081397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/28/2022] Open
Abstract
The reduction in the risk of transfusion-transmissible infections (including HIV infection) is an essential part of transfusion patient care. Here, we report the first incident of HIV transmission via transfusion in north Serbia due to blood donor dishonesty, and the failure of the laboratory screen tests to detect the presence of HIV particles in his blood. Infected blood products were distributed to two recipients, and HIV infection was confirmed in one. This incident finally led to the implementation of Nucleic Acid Amplification Technology as mandatory testing of blood donors for HIV infection in Serbia and raised many questions related to the responsibility and ethics of all the participants in the blood transfusion supply chain. There is a need for the implementation of modern and non-discriminative laws in Serbia in order to reduce transfusion-transmissible infections. In addition, transfusion institutes in Serbia need to be obliged to pursue the constant upgrade of their diagnostic capacities in order to prevent similar incidents and to provide the best possible care for blood donation recipients.
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Affiliation(s)
- Jasmina Grujić
- Blood Transfusion Institute of Vojvodina, 21000 Novi Sad, Serbia;
- Department of Internal Medicine, Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia
- Correspondence: (J.G.); (P.B.)
| | - Nevenka Bujandrić
- Blood Transfusion Institute of Vojvodina, 21000 Novi Sad, Serbia;
- Department of Internal Medicine, Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Pavle Banović
- Department of Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia
- Correspondence: (J.G.); (P.B.)
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Pati I, Masiello F, Pupella S, Cruciani M, De Angelis V. Efficacy and Safety of Pathogen-Reduced Platelets Compared with Standard Apheresis Platelets: A Systematic Review of RCTs. Pathogens 2022; 11:pathogens11060639. [PMID: 35745493 PMCID: PMC9231062 DOI: 10.3390/pathogens11060639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
In this systematic review, we evaluate the efficacy and safety of blood components treated with pathogen reduction technologies (PRTs). We searched the Medline, Embase, Scopus, Ovid, and Cochrane Library to identify RCTs evaluating PRTs. Risk of bias assessment and the Mantel–Haenszel method for data synthesis were used. We included in this review 19 RCTs evaluating 4332 patients (mostly oncohematological patients) receiving blood components treated with three different PRTs. Compared with standard platelets (St-PLTs), the treatment with pathogen-reduced platelets (PR-PLTs) does not increase the occurrence of bleeding events, although a slight increase in the occurrence of severe bleeding events was observed in the overall comparison. No between-groups difference in the occurrence of serious adverse events was observed. PR-PLT recipients had a lower 1 and 24 h CI and CCI. The number of patients with platelet refractoriness and alloimmunization was significantly higher in PR-PLT recipients compared with St-PLT recipients. PR-PLT recipients had a higher number of platelet and RBC transfusions compared with St-PLT recipients, with a shorter transfusion time interval. The quality of evidence for these outcomes was from moderate to high. Blood components treated with PRTs are not implicated in serious adverse events, and PR-PLTs do not have a major effect on the increase in bleeding events. However, treatment with PRTs may require a greater number of transfusions in shorter time intervals and may be implicated in an increase in platelet refractoriness and alloimmunization.
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Peliganga LB, Mello VM, de Sousa PSF, Horta MAP, Soares ÁD, Nunes JPDS, Nobrega M, Lewis-Ximenez LL. Transfusion Transmissible Infections in Blood Donors in the Province of Bié, Angola, during a 15-Year Follow-Up, Imply the Need for Pathogen Reduction Technologies. Pathogens 2021; 10:pathogens10121633. [PMID: 34959588 PMCID: PMC8705259 DOI: 10.3390/pathogens10121633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 12/18/2022] Open
Abstract
Transfusion transmissible infections (TTIs), caused by hepatitis B virus (HBV), human immunode-ficiency virus (HIV), hepatitis C virus (HCV), and syphilis, have a high global impact, especially in sub-Saharan Africa. We evaluated the trend of these infections over time in blood donors in Angola. A retrospective cross-sectional study was conducted among blood donors in Angola from 2005 to 2020. Additionally, frozen samples obtained from blood donors in 2007 were investigated to identify chronic HCV carriers and possible occult HBV infection (OBI). The overall prevalence of HBV, HCV, HIV, and syphilis was 8.5, 3, 2.1, and 4.4%, respectively, among 57,979 blood donors. HBV was predominant among male donors, while the remaining TTIs were predominant among women. Donors >50 years had a significantly high prevalence for all TTIs. Chronic HCV infection was ab-sent in 500 samples tested and OBI was present in 3%. Our results show the continued high prev-alence of TTIs among blood donors in Angola. Most infections showed a significantly low preva-lence in years with campaigns seeking voluntary blood donors, thus, reinforcing the importance of this type of donor to ensure safe blood. Africa, with a high prevalence of diverse pathogens, should consider cost-effective pathogen reduction technologies, once they are commercially accessible, to increase the availability of safe blood.
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Affiliation(s)
- Luis Baião Peliganga
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (L.B.P.); (V.M.M.); (P.S.F.d.S.)
- Disease Control Department, National Directorate of Public Health, Ministry of Health, Luanda, Angola
- Internal Medicine Investigation Department, Faculdade de Medicina da Universidade Agostinho Neto, Luanda, Angola
| | - Vinicius Motta Mello
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (L.B.P.); (V.M.M.); (P.S.F.d.S.)
| | - Paulo Sergio Fonseca de Sousa
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (L.B.P.); (V.M.M.); (P.S.F.d.S.)
| | | | | | - João Pedro da Silva Nunes
- Laboratory of Experimental Vaccines, Paulista School of Medicine, Federal University of São Paulo, São Paulo 04039-032, Brazil;
| | | | - Lia Laura Lewis-Ximenez
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (L.B.P.); (V.M.M.); (P.S.F.d.S.)
- Correspondence: or ; Tel.: +55-(21)-991-921-519
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Grubyte S, Urboniene J, Nedzinskiene L, Jelinskaite A, Zagminas K, Ambrozaitis A, Jancoriene L. Prevalence, incidence and residual risk of transfusion transmitted viruses (HBV, HCV and HIV infections) in Lithuanian blood donors from 2004 to 2018: The incidence/window-period model study. PLoS One 2021; 16:e0246704. [PMID: 33606700 PMCID: PMC7894937 DOI: 10.1371/journal.pone.0246704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/25/2021] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Estimation of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transfusion risk in blood donors is essential for monitoring the safety of the blood supply and the impact of new screening tests. Due to improvements in donor selection and continuing progress in screening assays, residual risk of virus transmission has significantly decreased over the past years. It is not practical and sometimes even not possible to measure residual risk in blood donors directly and mathematical models are used. The aim of this study was to calculate the prevalence, incidence rates of HBV, HCV and HIV infections and analyse evolution of their transmission residual risk from 2004 to 2018 at the National Blood Center of Lithuania. MATERIALS AND METHODS Data from the archives of the National Blood Center of Lithuania from 2004 to 2018 was retrospectively analysed. The residual risk was calculated for each virus and year by applying the incidence/window-period model suggested by World Health Organization. For the analysis of the residual risk yearly trends a linear regression was used. RESULTS A total of 754,755 blood donors and 1,245,568 donations were included in the analysis and represented a 2.06 donations per donor over 15 years. Average residual risk for HBV, HCV and HIV respectively was 570.04, 807.14 and 35.72 per 1,00,000 donations. During the study period, there was statistically significant downward trend in the residual risk for every analysed virus. DISCUSSION Residual risk of virus transmission has been steadily decreasing over past 15 years in Lithuanian donors, but the current risk remains quite high. It is difficult to establish how much the risk is affected by statistical assumptions or virus prevalence in general population. However, results of this study indicate the need of the population screening program of transfusion transmitted viruses.
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Affiliation(s)
- Samanta Grubyte
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jurgita Urboniene
- Center of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Laura Nedzinskiene
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Auguste Jelinskaite
- Center of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kestutis Zagminas
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arvydas Ambrozaitis
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ligita Jancoriene
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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de Oliveira Garcia Mateos S, Preiss L, Gonçalez TT, Di Lorenzo Oliveira C, Grebe E, Di Germanio C, Stone M, Amorim Filho L, Carneiro Proietti AB, Belisario AR, de Almeida-Neto C, Mendrone-Junior A, Loureiro P, Busch MP, Custer B, Cerdeira Sabino E. 10-year analysis of human immunodeficiency virus incidence in first-time and repeat donors in Brazil. Vox Sang 2020; 116:207-216. [PMID: 32996602 DOI: 10.1111/vox.13002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Incidence in first-time and repeat blood donors is an important measure of transfusion-transmitted HIV infection (TT-HIV) risk. This study assessed HIV incidence over time at four large blood centres in Brazil. MATERIALS AND METHODS Donations were screened and confirmed using serological assays for HIV from 2007 to 2016, and additionally screened by nucleic acid testing from 2011 forward. Limiting antigen (LAg) avidity testing was conducted on HIV seroreactive samples from first-time donors to classify whether an infection was recently acquired. We calculated incidence in first-time donors using the mean duration of recent infection and in repeat donors using classical methods. Time and demographic trends were assessed using Poisson regression. RESULTS Over the 10-year period, HIV incidence in first-time donors was highest in Recife (45·1/100 000 person-years (105 py)) followed by São Paulo (32·2/105 py) and then Belo Horizonte (23·3/105 py), and in repeat donors was highest in Recife (33·2/105 py), Belo Horizonte (27·5/105 py) and São Paulo (17·0/105 py). Results from Rio de Janeiro were available from 2013 to 2016 with incidence in first-time donors of 35·9/105 py and repeat donors from 2011 to 2016 of 29·2/105 py. Incidence varied by other donor demographics. When incidence was considered in 2-year intervals, no significant trend was evident. Overall residual risk of TT-HIV was 5·46 and 7·41 per million units of pRBC and FFP transfused, respectively. CONCLUSION HIV incidence in both first-time and repeat donors varied by region in Brazil. Clear secular trends were not evident.
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Affiliation(s)
- Sheila de Oliveira Garcia Mateos
- Departamento de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Hemotherapy, Hemorio, Rio de Janeiro, Brazil
| | - Liliana Preiss
- Division of Biostatistics and Epidemiology, RTI International, Rockville, MD, USA
| | | | | | - Eduard Grebe
- Vitalant Research Institute, San Francisco, CA, USA.,University of California San Francisco, San Francisco, CA, USA
| | | | - Mars Stone
- Vitalant Research Institute, San Francisco, CA, USA
| | | | | | - Andre Rolim Belisario
- Department GDTC (Technical-Scientific Development Management), Hemominas, Minas Gerais, Brazil
| | - Cesar de Almeida-Neto
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Disciplina de Ciências Médicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Paula Loureiro
- Pernambuco University, Recife, Brazil.,Fundação Hemope/Hemocentro de Pernambuco, Recife, Brazil
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, CA, USA.,University of California San Francisco, San Francisco, CA, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, CA, USA.,University of California San Francisco, San Francisco, CA, USA
| | - Ester Cerdeira Sabino
- Departamento de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto de Medicina Tropical da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Prevalence, incidence and residual risk of transfusion-transmitted hepatitis B virus infection in Italy from 2009 to 2018. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:409-417. [PMID: 31846606 DOI: 10.2450/2019.0245-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND In Italy, the use of nucleic acid testing for hepatitis B virus (HBV) in donor screening has allowed the detection of infections in the window phase, as well as the presence of occult infections which could potentially be transmitted. The aim of this study was to analyse the trends of epidemiological data focused on HBV infection in blood donors and to estimate the residual risk of transmitting HBV from both the window phase and occult infection over a 10-year period in Italy. MATERIALS AND METHODS Data were obtained from the Italian Haemovigilance System which includes the results of screening tests for transfusion transmissible infections. During the period of this survey (2009-2018), the molecular methods used for HBV screening were transcription-mediated amplification and polymerase chain reaction tests. Prevalence and incidence were calculated. The residual risk was estimated by applying the incidence-window period model for acute cases and a more recently reported model for estimating the risk due to occult infections. RESULTS A total of 17,424,535 blood donors and 30,842,794 donations were tested for HBV. Altogether, 6,250 donors tested positive for HBV markers: 4,782 (175.6×105) were first time donors and 1,468 (10.0×105) were repeat donors. The prevalence of HBV markers in first time donors was 275.9×105 in 2009, declining to 143.6×105 in 2018. The incidence of new infections was 3.37×105 in 2009 and 2.17×105 in 2018. The overall residual risk for HBV amounted to 1 in 2,566,854 donations calculated as the sum of risks of both acute infections in the window period (1 in 5,835,306 donations) and occult infections (1 in 4,582,270 blood units). DISCUSSION In Italy, the residual risk of transfusing a blood unit infected with HBV, both from window phase and occult infections, is currently very low, amounting to levels that can be considered tolerable.
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Platelet-rich plasma for sports-related muscle, tendon and ligament injuries: an umbrella review. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:465-478. [PMID: 31846610 DOI: 10.2450/2019.0274-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Platelet-rich plasma (PRP) has been used in different non-transfusion indications due to its role in tissue regeneration and healing. The aim of this overview of systematic reviews (umbrella review) is to provide a summary of the existing research syntheses related to PRP use for sports-related muscle, tendon and ligament injuries. MATERIALS AND METHODS Literature searches were performed in MEDLINE, Embase, and Cochrane Library to identify systematic reviews focusing on PRP use for sports-related muscle, tendon and ligament injuries. The methodological quality of included studies was assessed using the checklist for systematic reviews and research syntheses developed by the Joanna Briggs Institute and the GRADE assessment. RESULTS Twenty-two studies met the inclusion criteria. Five studies evaluated PRP use for acute muscle injury, and 17 evaluated PRP use for tendon and ligament injury. Studies were heterogeneous in terms of the dose and number of PRP injections, and the control groups. Three of the 5 reviews evaluating acute muscle injury concluded that PRP had no effect on the outcomes considered. One review shows superior efficacy of rehabilitation exercise compared to PRP. One review shows that PRP may result in an earlier return to sport for acute grade I-II injury. Eight out of the 17 reviews evaluating PRP for tendon and ligament injuries show a statistically significant (p<0.05) difference in pain and/or function outcome measures favouring PRP compared to controls, although most of the observed differences were small. Adverse events data and quality of life outcomes were rarely analysed or reported in the included studies and were considered clinically insignificant. DISCUSSION In most of the included reviews, the available evidence was judged to be of low/very low quality due to risk of bias, inconsistency and imprecision, thus making the level of certainty of these findings low and not adequate to support the general use of PRP in this setting.
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López-Menchero C, Alvarez M, Fernández P, Guzmán M, Ortiz-de-Salazar MI, Arbona C. Evolution of the residual risk of HBV, HCV and HIV transmission through blood transfusion in the Region of Valencia, Spain, during a 15-year period (2003-2017). BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:418-427. [PMID: 31403928 PMCID: PMC6917534 DOI: 10.2450/2019.0058-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/09/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Towards the end of the 20th century, transfusion-transmitted viral infections (TTVI) represented a huge problem for public health. From the beginning of the screening of blood donations, this risk has decreased to the point that it is no longer possible to measure it directly and it is necessary to use mathematical models. Using one of these models, the aim of this study was to analyse the evolution of the residual risk of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) transmission through blood transfusion from 2003 to 2017 in the Region of Valencia, Spain. MATERIALS AND METHODS Using data from the Blood Transfusion Centre of the Valencian Community, the incidence rate in donors and the residual risk were calculated for each agent and year by applying the most updated version of the incidence/window period model. For the set of the three viruses, these magnitudes were calculated as the algebraic sum of the specifics ones for each of them. The evolution of both magnitudes was analysed by the Mann-Kendall trend test and the Sen estimation of trend slope. RESULTS The residual risks obtained vary depending on the agent and the year. Considering the three viruses jointly, they range from 1 per 360,380 to 1 per 44,715 donations. During the study period, there was a statistically significant downward trend in the incidence rate of HBV (p<0.05, trend slope -0.88), the residual risk of HBV (p<0.0005, slope -0.98), and the joint residual risk for the three viruses (p<0.0001, slope -0.99). DISCUSSION The current risk of TTVI is very low in the Region of Valencia. In the last 15 years, there has been a reduction in the donor incidence rate and in the residual risk for the case of HBV; such a reduction cannot be confirmed for HCV and HIV. Consideration of the three viruses jointly confirms a reduction in the residual risk; we are unable to establish whether the evolution of the joint incidence rate has contributed to this reduction or whether it is due only to the shortening of window periods.
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Affiliation(s)
| | - Manuel Alvarez
- Blood Transfusion Centre of the Valencian Community, Valencia, Spain
| | - Pascual Fernández
- Department of Clinical Medicine, School of Medicine, Miguel Hernández University, Sant Joan d'Alacant, Spain
| | - María Guzmán
- Blood Transfusion Centre of the Valencian Community, Valencia, Spain
| | | | - Cristina Arbona
- Blood Transfusion Centre of the Valencian Community, Valencia, Spain
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Han R, Zhou J, François C, Toumi M. Prevalence of hepatitis C infection among the general population and high-risk groups in the EU/EEA: a systematic review update. BMC Infect Dis 2019; 19:655. [PMID: 31337339 PMCID: PMC6647266 DOI: 10.1186/s12879-019-4284-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/12/2019] [Indexed: 12/22/2022] Open
Abstract
Background Although significant improvement in efficacy measured by a sustained virological response, the high acquisition costs of direct-acting antivirals limit the access for patients and influence the costs of healthcare resource utilisation in hepatitis C. It is important to have the latest estimates of prevalence, especially in high-risk groups, for cost of illness, cost-effectiveness and budget impact studies. Methods Original studies on the estimates of the prevalence among general and high-risk groups in the European Union/European Economic Area (EU/EEA) were retrieved from Medline and Embase for the period from 2015 to 2018. All included studies were evaluated for risk of selection bias and summarised together in a narrative form. Results from previous reviews and updated searches were compared per country among different populations, respectively. Results Among the 3871 studies identified, 46 studies were included: 20 studies were used for the estimate of the general population; 3 for men who have sex with men (MSM); 6 for prisoners; and 17 for people who inject drugs (PWID). Compared with the results reported in previous systematic reviews, the updated estimates were lower than previously in most available countries. Anti-HCV general population prevalence estimates ranged from 0.54 to 1.50% by country. The highest prevalence of anti-HCV was found among PWID (range of 7.90–82.00%), followed by prisoners (7.00–41.00%), HIV-positive MSM (1.80–7.10%), HIV-negative MSM (0.20–1.80%), pregnant women (0.10–1.32%) and first-time blood donors (0.03–0.09%). Conclusions Our study highlights the heterogeneity in anti-HCV prevalence across different population groups in EU/EEA. The prevalence also varies widely between European countries. There are many countries that are not represented in our results, highlighting the need for the development of robust epidemiological studies. Electronic supplementary material The online version of this article (10.1186/s12879-019-4284-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ru Han
- University of Aix-Marseille, Marseille, France. .,Creativ-Ceutical, 215, rue de Faubourg St-Honoré, 75008, Paris, France.
| | - Junwen Zhou
- University of Aix-Marseille, Marseille, France.,Creativ-Ceutical, 215, rue de Faubourg St-Honoré, 75008, Paris, France
| | - Clément François
- University of Aix-Marseille, Marseille, France.,Creativ-Ceutical, 215, rue de Faubourg St-Honoré, 75008, Paris, France
| | - Mondher Toumi
- University of Aix-Marseille, Marseille, France.,Creativ-Ceutical, 215, rue de Faubourg St-Honoré, 75008, Paris, France
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11
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Franchini M, Marano G, Veropalumbo E, Masiello F, Pati I, Candura F, Profili S, Catalano L, Piccinini V, Pupella S, Vaglio S, Liumbruno GM. Patient Blood Management: a revolutionary approach to transfusion medicine. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:191-195. [PMID: 31246561 PMCID: PMC6596379 DOI: 10.2450/2019.0109-19] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 04/12/2023]
Abstract
Patient Blood Management (PBM) is a multimodal, multidisciplinary approach adopted to limit the use and the need for allogeneic blood transfusion in all at-risk patients with the aim of improving their clinical outcomes. Although PBM usually refers to surgical patients, its clinical use has gradually evolved over the last few years and it now also refers to medical conditions. This review will critically analyse the current knowledge on the use of PBM programmes in surgical and non-surgical patients.
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Affiliation(s)
- Massimo Franchini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
- Department of Haematology and Transfusion Medicine, “Carlo Poma” Hospital, Mantua, Italy
| | - Giuseppe Marano
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Eva Veropalumbo
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Francesca Masiello
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Ilaria Pati
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Fabio Candura
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Samantha Profili
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Liviana Catalano
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Vanessa Piccinini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Simonetta Pupella
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health, Rome, Italy
- Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
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Red blood cell alloimmunisation in transfusion-dependent thalassaemia: a systematic review. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:4-15. [PMID: 30653458 DOI: 10.2450/2019.0229-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic red blood cell transfusion is the first-line treatment for severe forms of thalassaemia. This therapy is, however, hampered by a number of adverse effects, including red blood cell alloimmunisation. The aim of this systematic review was to collect the current literature data on erythrocyte alloimmunisation. MATERIALS AND METHODS We performed a systematic search of the literature which identified 41 cohort studies involving 9,256 patients. RESULTS The prevalence of erythrocyte alloimmunisation was 11.4% (95% CI: 9.3-13.9%) with a higher rate of alloimmunisation against antigens of the Rh (52.4%) and Kell (25.6%) systems. Overall, alloantibodies against antigens belonging to the Rh and Kell systems accounted for 78% of the cases. A higher prevalence of red blood cell alloimmunisation was found in patients with thalassaemia intermedia compared to that among patients with thalassaemia major (15.5 vs 12.8%). DISCUSSION Matching transfusion-dependent thalassaemia patients and red blood cell units for Rh and Kell antigens should be able to reduce the risk of red blood cell alloimmunisation by about 80%.
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Blood safety policy: should cautionary policies be adopted with caution? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 16:405-407. [PMID: 30183614 DOI: 10.2450/2018.0135-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Transfusion-transmissible infections among Serbian blood donors: declining trends over the period 2005-2017. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:336-346. [PMID: 30865580 DOI: 10.2450/2019.0185-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/06/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The mass migrations experienced by the Western Balkans in the past decades have significantly changed the demographic structures and have probably altered the prevalence of transfusion-transmitted infections (TTIs) among blood donors. However, data on the prevalence of TTIs in the Western Balkans countries remain incomplete. This study reports the prevalence of TTIs among blood donors in Serbia in the period 2005-2017. MATERIALS AND METHODS Between January 2005 and December 2017, in the four largest Serbian transfusion centres, mandatory serology tests for screening HBV, HCV, HIV and syphilis infection were used for all blood donations. RESULTS Of the total of 1,660,019 blood donations made, 3,377 (0.203%) were positive for one of the TTIs: 1,440 (0.087%), 1,055 (0.064%), 215 (0.013%), and 667 (0.040%) were positive for HBV, HCV, HIV and syphilis, respectively. Serbia showed a declining trend of prevalence of HBV and HCV infection, while prevalence of HIV and syphilis remained unchanged. Prevalence of TTIs varied between different transfusion centres and showed a north-to-south upward trend. DISCUSSION The reported prevalence of TTIs among blood donors in Serbia was low and continued to follow a declining trend over the period of study.
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Budget impact of implementing platelet pathogen reduction into the Italian blood transfusion system. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 16:483-489. [PMID: 30201081 DOI: 10.2450/2018.0115-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/26/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite improvements in blood donor selection and screening procedures, transfusion recipients can still develop complications related to infections by known and emerging pathogens. Pathogen reduction technologies (PRT) have been developed to reduce such risks. The present study, developed whithin a wider health technology assessment (HTA) process, was undertaken to estimate the costs of the continuing increase in the use of platelet PRT in Italy. MATERIALS AND METHODS A multidisciplinary team was established to perform the HTA and conduct a budget impact analysis. Quantitative data on platelet use were derived from the 2015 national blood transfusion report and from the Italian Platelets Transfusion Assessment Study (IPTAS). The current national fee of 60 Euro per platelet PRT procedure was used to quantify the costs to the Italian National Health Service (INHS). The analysis adopts a 3-year time-frame. In order to identify the impact on budget we compared a scenario representing an increased use of PRT platelets over time with a control scenario in which standard platelets are used. RESULTS Progressive implementation of PRT for 20%, 40% and 66% of annual adult platelet doses could generate an increase in annual costs for the INHS amounting to approximately 7, 14 and 23 million Euros, respectively. Use of kits and devices suitable for the treatment of multiple adult platelet doses in one PRT procedure could lower costs. DISCUSSION In order to fully evaluate the societal perspective of implementing platelet PRT, the increase in costs must be balanced against the expected benefits (prevention of transfusion-transmissible infections, white cell inactivation, extension of platelet storage, discontinuation of pathogen detection testing). Further studies based on actual numbers of platelet transfusion complications and their societal cost at a local level are needed to see the full cost to benefit ratio of platelet PRT implementation in Italy, and to promote equal treatment for all citizens.
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