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El Ekiaby M, Diop S, Gouider E, Moftah F. Challenges associated with access to plasma-derived medicinal products in low middle-income and low-income countries. Vox Sang 2024; 119:166-170. [PMID: 38050721 DOI: 10.1111/vox.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Plasma-derived medicinal products (PDMPs) are essential to treat many chronic conditions such as haemophilia and primary immunodeficiency. Patients living in low middle-income and low-income countries (LMICs and LICs, respectively) have limited access to PDMPs. The aim of this article is to explore the challenges of accessing PDMPs in LMICs and LICs. MATERIALS AND METHODS A review of the literature and reports on blood safety, plasma production and its utilization to produce PDMPs in LMICs and LICs was carried out. RESULTS There is huge wastage of recovered plasma in LMICs and LICs as a result of a lack of good manufacturing practice (GMP) in the production of plasma for fractionation. Together with the high cost of imported PDMP procurement, patients have limited access to such products. CONCLUSION There is a need to improve the situation by using domestically sourced plasma through the initiation of local plasma programmes through a stepwise approach to improve access to PDMPs in LMICs and LICs.
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Affiliation(s)
| | - Saliou Diop
- Dakar National Blood Transfusion Center, Dakar, Senegal
| | - Emna Gouider
- Hematology Department, Aziza Othmana Hospital, Tunis, Tunisia
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2
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Smid WM, Thijssen-Timmer DC. Safeguarding plasma for fractionation: How can we deal with operational challenges in European Union countries. Vox Sang 2024; 119:128-130. [PMID: 37986695 DOI: 10.1111/vox.13566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Willem Martin Smid
- Sanquin Blood Supply, Amsterdam, The Netherlands
- Academic Institute for International Development of Transfusion Medicine, Groningen, The Netherlands
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3
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Hartnett KP, Powell KM, Rankin D, Gable P, Kim JJ, Spoto S, Breaker E, Hunter R, Dotson N, McAllister G, Stevens V, Halpin AL, Houston H, Epson E, Malarkey M, Mendoza M, McNeill L, Perkins KM. Investigation of Bacterial Infections Among Patients Treated With Umbilical Cord Blood-Derived Products Marketed as Stem Cell Therapies. JAMA Netw Open 2021; 4:e2128615. [PMID: 34618037 PMCID: PMC8498849 DOI: 10.1001/jamanetworkopen.2021.28615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE The number of clinics marketing stem cell products for joint diseases, chronic pain, and most recently, COVID-19, has increased despite warnings from the US Food and Drug Administration that stem cell products for these and other indications have not been proven safe or effective. OBJECTIVE To examine bacterial infections in 20 patients who received umbilical cord blood-derived products marketed as stem cell treatment. DESIGN, SETTING, AND PARTICIPANTS This case series is a national public health investigation including case-finding, medical record review and abstraction, and laboratory investigation, including sterility testing of products and whole-genome sequencing of patient and product isolates. Participants included patients who developed bacterial infections following administration of umbilical cord blood-derived products marketed as stem cell treatment during August 2017 to September 2018. Data analysis was performed from March 2019 to September 2021. EXPOSURES Umbilical cord blood-derived products marketed as stem cell treatment. MAIN OUTCOMES AND MEASURES Data were collected on patient infections and exposures. The Centers for Disease Control and Prevention performed sterility testing on undistributed and distributed vials of product marketed as stem cell treatment and performed whole-genome sequencing to compare patient and product bacterial isolates. RESULTS Culture-confirmed bacterial infections were identified in 20 patients (median [range] age, 63 [2-89] years; 13 male patients [65%]) from 8 US states who sought stem cell treatment for conditions including pain, osteoarthritis, rheumatoid arthritis, and injury; all but 1 required hospitalization. The most frequently isolated bacteria from patients with infections were common enteric species, including Escherichia coli (14 patients) and Enterobacter cloacae (7 patients). Of unopened, undistributed products sampled for testing, 65% (22 of 34 vials) were contaminated with at least 1 of 16 bacterial species, mostly enteric. A patient isolate from Arizona matched isolates obtained from products administered to patients in Florida, and patient isolates from Texas matched undistributed product sent from the company in California. CONCLUSIONS AND RELEVANCE Unapproved stem cell products can expose patients to serious risks without proven benefit. Sequencing results suggest a common source of extensive contamination, likely occurring during the processing of cord blood into product. Patients and health care practitioners who are considering the use of unapproved products marketed as stem cell treatment should be aware of their unproven benefits and potential risks, including serious infections.
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Affiliation(s)
- Kathleen P. Hartnett
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krista M. Powell
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Erin Breaker
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valerie Stevens
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hollis Houston
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Epson
- California Department of Public Health, Sacramento
| | - Mary Malarkey
- US Food and Drug Administration, Silver Spring, Maryland
| | | | - Lorrie McNeill
- US Food and Drug Administration, Silver Spring, Maryland
| | - Kiran M. Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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4
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Makoni M. Africa's coalition for adequate blood established. Lancet Haematol 2021; 8:e106. [PMID: 33513369 DOI: 10.1016/s2352-3026(21)00007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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5
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Viennet E, Frentiu FD, Williams CR, Mincham G, Jansen CC, Montgomery BL, Flower RLP, Faddy HM. Estimation of mosquito-borne and sexual transmission of Zika virus in Australia: Risks to blood transfusion safety. PLoS Negl Trop Dis 2020; 14:e0008438. [PMID: 32663213 PMCID: PMC7380650 DOI: 10.1371/journal.pntd.0008438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 07/24/2020] [Accepted: 06/01/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Since 2015, Zika virus (ZIKV) outbreaks have occurred in the Americas and the Pacific involving mosquito-borne and sexual transmission. ZIKV has also emerged as a risk to global blood transfusion safety. Aedes aegypti, a mosquito well established in north and some parts of central and southern Queensland, Australia, transmits ZIKV. Aedes albopictus, another potential ZIKV vector, is a threat to mainland Australia. Since these conditions create the potential for local transmission in Australia and a possible uncertainty in the effectiveness of blood donor risk-mitigation programs, we investigated the possible impact of mosquito-borne and sexual transmission of ZIKV in Australia on local blood transfusion safety. METHODOLOGY/PRINCIPAL FINDINGS We estimated 'best-' and 'worst-' case scenarios of monthly reproduction number (R0) for both transmission pathways of ZIKV from 1996-2015 in 11 urban or regional population centres, by varying epidemiological and entomological estimates. We then estimated the attack rate and subsequent number of infectious people to quantify the ZIKV transfusion-transmission risk using the European Up-Front Risk Assessment Tool. For all scenarios and with both vector species R0 was lower than one for ZIKV transmission. However, a higher risk of a sustained outbreak was estimated for Cairns, Rockhampton, Thursday Island, and theoretically in Darwin during the warmest months of the year. The yearly estimation of the risk of transmitting ZIKV infection by blood transfusion remained low through the study period for all locations, with the highest potential risk estimated in Darwin. CONCLUSIONS/SIGNIFICANCE Given the increasing demand for plasma products in Australia, the current strategy of restricting donors returning from infectious disease outbreak regions to source plasma collection provides a simple and effective risk management approach. However, if local transmission was suspected in the main urban centres of Australia, potentially facilitated by the geographic range expansion of Ae. aegypti or Ae. albopictus, this mitigation strategy would need urgent review.
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Affiliation(s)
- Elvina Viennet
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
- Institute for Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
- * E-mail:
| | - Francesca D. Frentiu
- Institute for Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
| | - Craig R. Williams
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Gina Mincham
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Cassie C. Jansen
- Communicable Diseases Branch, Queensland Department of Health, Herston, Queensland, Australia
| | - Brian L. Montgomery
- Metro South Public Health Unit, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Robert L. P. Flower
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
- Institute for Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
| | - Helen M. Faddy
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
- Institute for Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia
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6
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Doughty H, Chowdhury F. Emergency preparedness, resilience and response guidance for UK hospital transfusion teams. Transfus Med 2020; 30:177-185. [PMID: 32020684 PMCID: PMC7317494 DOI: 10.1111/tme.12665] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To present Emergency Preparedness, Resilience and Response (EPRR) guidance for Hospital Transfusion Teams on behalf of the National Blood Transfusion Committee emergency planning working group. BACKGROUND The Civil Contingencies Act 2004 requires healthcare organisations to demonstrate that they can deal with major incidents while maintaining critical services. Recent mass casualty events and the use of transfusion-based resuscitation have highlighted the evolving role of the Hospital Transfusion Team. METHODS This multi-disciplinary advice is informed by recent global and national experience, the 2018 NHS England clinical guidelines for Major Incidents, and stakeholder workshops. GUIDANCE Transfusion staff should be familiar with local EPRR plans including casualty type and numbers. Staff should be exercised as part of wider Trust preparation, with documented roles and responsibilities. Transfusion support should be proactive and include blood issue, regulatory compliance and sample handling. Robust LIMS-compatible emergency identification systems are essential to minimise errors. Emergency stock management requires rapid assessment of existing stock and estimated demand before re-ordering. Initial demand should be based on 2 to 4 red blood cells (RBC) per patient admitted. Patients with significant haemorrhage may require further red cells and early haemostatic support. Where "universal" components are demanded, they should be gender appropriate. Senior staff should lead the response, log and communicate key decisions, and prepare for post-incident recovery. CONCLUSIONS Transfusion teams have an important role in ensuring continuity of transfusion support. Teams should develop their EPRR plans based on local plans and national guidance. Emergency preparedness should include post-incident debriefing for ongoing staff support and future service improvement.
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Affiliation(s)
- Heidi Doughty
- NHS Blood and TransplantClinical Services, BirminghamUnited Kingdom
| | - Fateha Chowdhury
- NHS Blood and TransplantClinical Services, BirminghamUnited Kingdom
- Imperial College Healthcare NHS TrustLondonUnited Kingdom
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7
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Goldman M, Butler-Foster T, Lapierre D, O'Brien SF, Devor A. Trans people and blood donation. Transfusion 2020; 60:1084-1092. [PMID: 32343438 DOI: 10.1111/trf.15777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - Don Lapierre
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sheila F O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Aaron Devor
- Sociology Department, University of Victoria, Victoria, British Columbia, Canada
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8
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Fredrick J, Berger JJ, Menitove JE. Strategic issues currently facing the US blood system. Transfusion 2020; 60:1093-1096. [PMID: 32339298 DOI: 10.1111/trf.15769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jacquelyn Fredrick
- Former CEO Versiti, Milwaukee, WI and Chair, HHS Advisory Committee on Blood and Tissue Safety and Availability, USA
| | - James J Berger
- Senior Advisor for Blood and Tissue Policy, Washington DC, USA
| | - Jay E Menitove
- Former CEO and Medical Director, Community Blood Center of Greater Kansas City, Kansas City, MO and Clinical Professor, Pathology and Laboratory Medicine, Kansas University Medical Center, Kansas City, KS, USA
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9
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Danovic F, Lieshout-Krikke RW, Koopman RWW, van Kraaij MGJ. [Blood safety in the Netherlands: prevention of blood-transmitted infections]. Ned Tijdschr Geneeskd 2020; 164:D4060. [PMID: 32186817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Amongst the various blood-safety measures to prevent blood-transmitted infections in transfusion recipients, the most important are the selection of blood donors and the testing for infections of the donations. A look-back procedure aims to inform hospitals about potentially infected blood products and to trace the relevant recipients. The opposite, reverse look-back, can also occur: following a report that a patient has an infection of which blood transfusion may be the possible source, all possibly implicated donors will be screened for the particular agent. Over the period 2007-2017, 84 look-backs were carried out by the Dutch blood product organisation Sanquin. Transmission via blood products of the human immunodeficiency virus, hepatitis C virus, human T-cell Lymphotropic virus or Treponema pallidum were not found. Look-back identified four recipients with hepatitis-B virus infection. These recipients had received a blood product from donors with an occult chronic hepatitis-B virus infection. In the Netherlands, the risks associated with transmission of infection through blood products are minimal; however, transmission may still occur, despite extensive blood-safety measures.
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Affiliation(s)
- Fikreta Danovic
- Sanquin Bloedbank, Unit Transfusiegeneeskunde,Amsterdam
- Contact: Fikreta Danovic
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10
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Levy I, Olmer L, Livnat Y, Shalhavi R, Hizki O, Shinar E. Attitudes and perceptions among men having sex with men towards a new non-deferral blood donation policy in Israel. Vox Sang 2019; 114:310-316. [PMID: 30854673 DOI: 10.1111/vox.12766] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/19/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND In June 2017, Israel lifted the ban on blood donations from men who have sex with men (MSM) and accepts donations if 12 months have passed since the last sexual contact. Recently, the National Blood Services suggested a novel approach that involves acceptance of MSM blood donations without deferral, keeping solely the frozen plasma in quarantine and releasing it for transfusion if a subsequent donation, at least 4 months later, is found negative for transfusion-transmitted agents. In this study, we examined the attitudes and perceptions of MSM to the new Frozen Plasma Quarantine Policy (FPQP). METHOD A survey was published on gay-oriented websites, collecting anonymous demographic data, history of blood donations and attitudes towards the new policy. RESULTS We analysed responses from 1233 MSM. Of these, 13·4% had donated blood at least once during the previous year, almost all of them (89·7%) not complying with the current 12-month deferral. Most respondents (64·5%) supported the suggested new approach and would consider donating blood if it were introduced. Of MSM who had donated blood in the previous year, 85% stated they would agree to reveal their sexual practice in the donor health questionnaire (DHQ) in order to be included in the programme, compared with 8·5% under the current 12-month deferral policy. CONCLUSION The suggested Plasma Quarantine Policy may be more acceptable to MSM than a 12-month deferral and increase their compliance with the blood services policy. This and retesting of donors may increase blood safety.
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Affiliation(s)
- Itzchak Levy
- Unit of Infectious Diseases, Sheba Medical Center, Ramat Gan, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Liraz Olmer
- The Department of Statistics, The Gertner Institute for Epidemiology and Health Policy Research, Tel HaShomer, Israel
| | | | | | - Ohad Hizki
- Israel's LGBT Task Force, Tel Aviv, Israel
| | - Eilat Shinar
- Magen David Adom National Blood Services, Ramat Gan, Israel
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11
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Takci S, Asci A, Erkekoglu P, Yiğit S, Kocer-Gumusel B, Yurdakök M. Lead and Mercury Levels in Preterm Infants Before and After Blood Transfusions. Biol Trace Elem Res 2019; 188:344-352. [PMID: 30066064 DOI: 10.1007/s12011-018-1436-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/05/2018] [Indexed: 11/28/2022]
Abstract
Very low birth weight (VLBW) infants usually receive packed red blood cell unit (pRBC) transfusions. Heavy metal transfer via pRBCs is not widely discussed before. This study aimed to determine pre-/post-transfusion erythrocyte lead and mercury levels in infants and to correlate these levels to heavy metal concentrations in pRBCs. VLBW infants (n = 80), needing pRBC transfusion for the first time, were enrolled. Erythrocyte heavy metal levels were determined in pre-/post-transfusion blood samples and also in pRBC units. Mean lead and mercury levels in the pRBCs were found to be 16.3 ± 10.8 and 3.75 ± 3.23 μg/L, respectively. Of the infants, 69.7% received lead above reference dose. Erythrocyte lead levels increased significantly after transfusions (10.6 ± 10.3 vs. 13 ± 8.5, p < 0.05) with significant correlated to amount of lead within pRBCs (r = 0.28). Mean pre-/post-transfusion erythrocyte mercury levels were 3.28 ± 3.08 and 3.5 ± 2.83 μg/L, respectively (p > 0.05). There was a significant correlation between mean difference of mercury levels after transfusion and amount of mercury delivered by pRBCs (r = 0.28). Infants can be subject to high levels of lead and mercury through pRBC transfusions.
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Affiliation(s)
- Sahin Takci
- School of Medicine, Department of Pediatrics, Gaziosmanpasa University, Tokat, Turkey
| | - Ali Asci
- Faculty of Pharmacy, Department of Toxicology, Hacettepe University, Ankara, Turkey
- Faculty of Pharmacy, Department of Toxicology, Atatürk University, Erzurum, Turkey
| | - Pinar Erkekoglu
- Faculty of Pharmacy, Department of Toxicology, Hacettepe University, Ankara, Turkey
| | - Sule Yiğit
- Faculty of Medicine, İhsan Dogramaci Children's Hospital, Neonatology Unit, Hacettepe University, Ankara, Turkey
| | - Belma Kocer-Gumusel
- Faculty of Pharmacy, Department of Toxicology, Hacettepe University, Ankara, Turkey.
- Faculty of Pharmacy, Department of Toxicology, Lokman Hekim University, Ankara, Turkey.
| | - Murat Yurdakök
- Faculty of Medicine, İhsan Dogramaci Children's Hospital, Neonatology Unit, Hacettepe University, Ankara, Turkey
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Peoc'h K. [Saving patient blood: a new rule of life? Focus on pre-operative anemia]. Ann Biol Clin (Paris) 2019; 77:7-9. [PMID: 30799302 DOI: 10.1684/abc.2019.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Katell Peoc'h
- UF de biochimie clinique, Hôpital Beaujon, AP-HP, HUPNVS, UFR de médecine Xavier Bichat, Université Paris-Diderot, Paris, France, Comité scientifique de la Société française de biologie clinique, France
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13
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Anand A, Mace KE, Townsend RL, Madison-Antenucci S, Grimm KE, Espina N, Losco P, Lucchi NW, Rivera H, Breen K, Tan KR, Arguin PM, White JL, Stramer SL. Investigation of a case of suspected transfusion-transmitted malaria. Transfusion 2018; 58:2115-2121. [PMID: 30178476 PMCID: PMC6334839 DOI: 10.1111/trf.14778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/13/2018] [Accepted: 05/04/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transfusion-transmitted malaria (TTM) is a rare occurrence with serious consequences for the recipient. A case study is presented as an example of best practices for conducting a TTM investigation. CASE REPORT A 15-year-old male with a history of sickle cell disease developed fever after a blood transfusion. He was diagnosed with Plasmodium falciparum malaria and was successfully treated. The American Red Cross, New York State Department of Health, and the Centers for Disease Control and Prevention investigated the eight donors who provided components to the transfusion. The investigation to identify a malaria-positive donor included trace back of donors, serologic methods to identify donor(s) with a history of malaria exposure, polymerase chain reaction (PCR) testing, microsatellite analysis to identify the parasite in a donor and match its genotype to the parasite in the recipient, and reinterview of all donors to clarify malaria risk factors. RESULTS One donor had evidence of infection with P. falciparum by PCR, elevated antibody titers, and previously undisclosed malaria risk factors. Reinterview revealed that the donor immigrated to the United States from Togo just short of 3 years before the blood donation. The donor was treated for asymptomatic low parasitemia infection. CONCLUSION This investigation used standard procedures for investigating TTM but also demonstrated the importance of applying sensitive laboratory techniques to identify the infected donor, especially a donor with asymptomatic infection with low parasitemia. Repeat interview of all donors identified as having contributed to the transfused component provides complementary epidemiologic information to confirm the infected donor.
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Affiliation(s)
- Anjoli Anand
- Epidemic Intelligence Service, CDC
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| | - Kimberly E. Mace
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| | | | | | | | - Noel Espina
- Parasitology Laboratory, Wadsworth Center, New York State Department of Health
| | - Paul Losco
- Donor Client and Support Center, American Red Cross
| | - Naomi W. Lucchi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| | - Hilda Rivera
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| | - Kathleen Breen
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| | - Kathrine R. Tan
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| | - Paul M. Arguin
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, CDC
| | - Jennifer L. White
- Bureau of Communicable Disease Control, New York State Department of Health
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14
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DeSimone RA, Nowak MD, Lo DT, Crowley KM, Parra P, Cushing MM, Hsu YMS. Logistical and safety implications of temperature-based acceptance of returned red blood cell units. Transfusion 2018; 58:1500-1505. [PMID: 29624677 DOI: 10.1111/trf.14615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/02/2018] [Accepted: 02/01/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AABB requires that red blood cells (RBCs) are maintained at 1 to 10°C during transport. Historically, blood banks used the 30-minute rule for returned RBCs transported outside of validated containers. The implications of this policy have not been previously reported in a real-life hospital setting. STUDY DESIGN AND METHODS A 2-year, retrospective review of RBC units returned outside of qualified containers was conducted. During the first year, the 30-minute rule was used to accept RBCs back into inventory. Sequentially, the following year, a temperature-based approach was implemented using a thermometer with an accuracy of ±1°C. Time out of the blood bank, temperature upon return, wastage, and transfusion reactions associated with the reissued RBCs were analyzed. RESULTS In our practice, the 30-minute rule would have accepted 15.2% of RBC units outside of the allowed temperature. Compared to the 30-minute rule, temperature-based acceptance was associated with a 13% increase in wastage (p < 0.001). During the 30-minute rule period, transfusion of returned and subsequently reissued RBCs was associated with a nonsignificant trend toward a higher transfusion reaction rate compared to the overall RBC transfusion reaction rate (1.4% vs. 0.6%, p = 0.084). During the temperature period, transfusion of returned and subsequently reissued RBCs had the same transfusion reaction rate compared to the overall RBC transfusion reaction rate (0.5% vs. 0.5%, p = 1.0). CONCLUSION Temperature-based acceptance of returned RBCs is associated with significantly higher wastage compared to the 30-minute rule. A temperature-based acceptance practice mitigates the risk of accepting RBCs with unacceptable temperatures returned within 30 minutes of issue.
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Affiliation(s)
- Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Michael D Nowak
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Dian T Lo
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Kathleen M Crowley
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Priscilla Parra
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Yen-Michael S Hsu
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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Marano G, Franchini M, Farina B, Piccinini V, Pupella S, Vaglio S, Grazzini G, Liumbruno GM. The human pegivirus: A new name for an "ancient" virus. Can transfusion medicine come up with something new? Acta Virol 2018; 61:401-412. [PMID: 29186957 DOI: 10.4149/av_2017_402] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Human pegivirus (HPgV, formerly called GB virus C/hepatitis G virus) is a poorly understood RNA virus of the Flaviviridae family. The HPgV infection is common worldwide and the virus is likely transmitted by blood products. At this time, no causal association between HPgV and human diseases has been identified. While waiting for new findings to better understand the Pegivirus genus, the aim of our narrative review is to discuss the currently available information on HPgV focusing on its prevalence in blood donors and its potential threat to transfusion safety.
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16
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Seed CR, Hewitt PE, Dodd RY, Houston F, Cervenakova L. Creutzfeldt-Jakob disease and blood transfusion safety. Vox Sang 2018; 113:220-231. [PMID: 29359329 DOI: 10.1111/vox.12631] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 01/09/2023]
Abstract
Transmissible spongiform encephalopathies (TSEs) are untreatable, fatal neurologic diseases affecting mammals. Human disease forms include sporadic, familial and acquired Creutzfeldt-Jakob disease (CJD). While sporadic CJD (sCJD) has been recognized for near on 100 years, variant CJD (vCJD) was first reported in 1996 and is the result of food-borne transmission of the prion of bovine spongiform encephalopathy (BSE, 'mad cow disease'). Currently, 230 vCJD cases have been reported in 12 countries, the majority in the UK (178) and France (27). Animal studies demonstrated highly efficient transmission of natural scrapie and experimental BSE by blood transfusion and fuelled concern that sCJD was potentially transfusion transmissible. No such case has been recorded and case-control evaluations and lookback studies indicate that, if transfusion transmission occurs at all, it is very rare. In contrast, four cases of apparent transfusion transmission of vCJD infectivity have been identified in the UK. Risk minimization strategies in response to the threat of vCJD include leucodepletion, geographically based donor deferrals and deferral of transfusion recipients. A sensitive and specific, high-throughput screening test would provide a potential path to mitigation but despite substantial effort no such test has yet appeared. The initial outbreak of vCJD appears to be over, but concern remains about subsequent waves of disease among those already infected. There is considerable uncertainty about the size of the infected population, and there will be at least a perception of some continuing risk to blood safety. Accordingly, at least some precautionary measures will remain in place and continued surveillance is necessary.
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Affiliation(s)
- C R Seed
- Australian Red Cross Blood Service, Perth, WA, Australia
| | | | - R Y Dodd
- American Red Cross Scientific Affairs, Gaithersburg, MD, USA
| | - F Houston
- The Roslin Institute, University of Edinburgh, Midlothian, Scotland
| | - L Cervenakova
- The Plasma Protein Therapeutics Association (PPTA), Annapolis, MD, USA
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Bello-López JM, Castañeda-García C, Muñoz-Estrada C, Machorro-Peréz AJ. External quality control program in screening for infectious diseases at blood banks in Mexico. Transfus Apher Sci 2018; 57:97-101. [PMID: 29452838 DOI: 10.1016/j.transci.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Quality control for the detection of infectious markers in blood banks is a necessary activity to ensure the accuracy of donor screening results. Considering that in Mexico blood safety is one of the goals of the National Action Programs, it is essential to evaluate banks through an External Quality Control Program. OBJECTIVE To analyze one of the evaluations that showed the greatest participation (2014-2/lot46) of banks in the Mexican Republic in the detection of transfusion-transmitted diseases. MATERIALS AND METHODS A randomized panel of infectious markers of HIV, HCV, HBV, Treponema pallidum and Trypanosoma cruzi was manufactured under high quality standards. The evaluation criteria for each infectious marker were the identification of false positives and false negative results. Additionally, technologies used to detect infectious markers were requested for each bank. RESULTS Of the 503 banks, only 374 participated in the evaluation. Technologies based on chemiluminescence, immunofluorescence and immunocolorimetry were used to detect viral markers. Even rapid tests for T. pallidum continue to be the methods of choice with 42%. Trypanosoma cruzi was 20% with fast techniques versus 80% with automated tests. Highest incidence of false positives was identified for T. pallidum and HBV, followed by T. cruzi, HIV and HCV. Fourteen (3.74%) false negatives results were identified for T. cruzi, followed by T. pallidum (n = 5/1.33%), HCV (n = 4/1.06) and HVB/HIV (n = 2/0.53%). CONCLUSION False positive results identified for each infectious marker was considered high. This evidence will allow us to focus on areas of opportunity during serologic screening with greater emphasis on good laboratory practices.
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Affiliation(s)
- J Manuel Bello-López
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico; Research Unit in Microbiology and Toxicology, Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico.
| | - Cristina Castañeda-García
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico
| | - Celerino Muñoz-Estrada
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico
| | - Antonio José Machorro-Peréz
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico
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18
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Di Minno G, Navarro D, Perno CF, Canaro M, Gürtler L, Ironside JW, Eichler H, Tiede A. Pathogen reduction/inactivation of products for the treatment of bleeding disorders: what are the processes and what should we say to patients? Ann Hematol 2017; 96:1253-1270. [PMID: 28624906 PMCID: PMC5486800 DOI: 10.1007/s00277-017-3028-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/22/2017] [Indexed: 12/11/2022]
Abstract
Patients with blood disorders (including leukaemia, platelet function disorders and coagulation factor deficiencies) or acute bleeding receive blood-derived products, such as red blood cells, platelet concentrates and plasma-derived products. Although the risk of pathogen contamination of blood products has fallen considerably over the past three decades, contamination is still a topic of concern. In order to counsel patients and obtain informed consent before transfusion, physicians are required to keep up to date with current knowledge on residual risk of pathogen transmission and methods of pathogen removal/inactivation. Here, we describe pathogens relevant to transfusion of blood products and discuss contemporary pathogen removal/inactivation procedures, as well as the potential risks associated with these products: the risk of contamination by infectious agents varies according to blood product/region, and there is a fine line between adequate inactivation and functional impairment of the product. The cost implications of implementing pathogen inactivation technology are also considered.
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Affiliation(s)
- Giovanni Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Regional Reference Centre for Coagulation Disorders, Federico II University, Via S. Pansini 5, 80131, Naples, Italy.
| | - David Navarro
- Department of Microbiology, Microbiology Service, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Mariana Canaro
- Department of Hemostasis and Thrombosis, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Lutz Gürtler
- Max von Pettenkofer Institute for Hygiene and Medical Microbiology, University of München, Munich, Germany
| | - James W Ironside
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, School of Clinical Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Hermann Eichler
- Institute of Clinical Hemostaseology and Transfusion Medicine, Saarland University Hospital, Homburg, Germany
| | - Andreas Tiede
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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Abstract
Although considerable progress has been made in improving the blood service system in China over the last 2 decades, many challenges remain. A number of issues have received public attentions; however, others continue to be underacknowledged and controversial. This article describes 3 of these important and less emphasized issues: first, the ambiguity of the definition of voluntary nonremunerated blood donation and its relationship to an adequate blood supply; second, the current inadequacies of cost recovery from the blood service system; and third, the lack of a universally implemented program of hemovigilance. Currently, there is controversy regarding these challenges. Open recognition and discussion offers the prospect of bringing solutions closer to reality.
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Affiliation(s)
- Yongming Zhu
- Shanghai Blood Center, WHO Collaborating Center for Blood Transfusion Services, Shanghai, China.
| | - Dongfu Xie
- Shanghai Blood Center, WHO Collaborating Center for Blood Transfusion Services, Shanghai, China
| | - Xun Wang
- Shanghai Blood Center, WHO Collaborating Center for Blood Transfusion Services, Shanghai, China
| | - Kaicheng Qian
- Shanghai Blood Center, WHO Collaborating Center for Blood Transfusion Services, Shanghai, China
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He M, Wang J, Chen L, Liu J, Zeng P. The Impact of Emerging Infectious Diseases on Chinese Blood Safety. Transfus Med Rev 2017; 31:94-101. [PMID: 27923518 PMCID: PMC7126663 DOI: 10.1016/j.tmrv.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/19/2016] [Accepted: 10/24/2016] [Indexed: 12/16/2022]
Abstract
Emerging infectious diseases (EIDs) have always been one of the major threats to public health. Although the implementation of mandatory testing for 4 classical transfusion-transmitted infectious-human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis-has reduced the transfusion risk of these pathogens, the potential threat of various EID agents and their constantly evolving variants to blood safety in China is not fully understood. This review presents 9 representative EID agents that are autochthonous and epidemic nationally or regionally in China. The epidemiologic status and distribution of these EID agents among donors and/or healthy populations are summarized. The potential risks of these EID agents to blood safety are discussed. The review also explores strategies to strengthen hemovigilance systems and studies to further evaluate the impact of EID agents on blood safety.
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Affiliation(s)
- Miao He
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Jingxing Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Limin Chen
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Jing Liu
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Peibin Zeng
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.
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21
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Abstract
Tolerance for blood transfusion risks is very low, as evidenced by the implementation of expensive blood tests and the rejection of gay men as blood donors. Is this low risk tolerance supported by the precautionary principle, as defenders of such policies claim? We discuss three constraints on applying (any version of) the precautionary principle and show that respecting these implies tolerating certain risks. Consistency means that the precautionary principle cannot prescribe precautions that it must simultaneously forbid taking, considering the harms they might cause. Avoiding counterproductivity requires rejecting precautions that cause more harm than they prevent. Proportionality forbids taking precautions that are more harmful than adequate alternatives. When applying these constraints, we argue, attention should not be restricted to harms that are human caused or that affect human health or the environment. Tolerating transfusion risks can be justified if available precautions have serious side effects, such as high social or economic costs.
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Affiliation(s)
- Koen Kramer
- a Sanquin Blood Supply Foundation and Wageningen University and Research Center
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Cumming M, Osinski A, O'Hearn L, Waksmonski P, Herman M, Gordon D, Griffiths E, Knox K, McHale E, Quillen K, Rios J, Pisciotto P, Uhl L, DeMaria A, Andrzejewski C. Hemovigilance in Massachusetts and the adoption of statewide hospital blood bank reporting using the National Healthcare Safety Network. Transfusion 2017; 57:478-483. [PMID: 27774608 DOI: 10.1111/trf.13872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/26/2016] [Indexed: 11/29/2022]
Abstract
A collaboration that grew over time between local hemovigilance stakeholders and the Massachusetts Department of Public Health (MDPH) resulted in the change from a paper-based method of reporting adverse reactions and monthly transfusion activity for regulatory compliance purposes to statewide adoption of electronic reporting via the National Healthcare Safety Network (NHSN). The NHSN is a web-based surveillance system that offers the capacity to capture transfusion-related adverse events, incidents, and monthly transfusion statistics from participating facilities. Massachusetts' hospital blood banks share the data they enter into NHSN with the MDPH to satisfy reporting requirements. Users of the NHSN Hemovigilance Module adhere to specified data entry guidelines, resulting in data that are comparable and standardized. Keys to successful statewide adoption of this reporting method include the fostering of strong partnerships with local hemovigilance champions and experts, engagement of regulatory and epidemiology divisions at the state health department, the leveraging of existing relationships with hospital NHSN administrators, and the existence of a regulatory deadline for implementation. Although limitations exist, successful implementation of statewide use of the NHSN Hemovigilance Module for hospital blood bank reporting is possible. The result is standardized, actionable data at both the hospital and state level that can facilitate interfacility comparisons, benchmarking, and opportunities for practice improvement.
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Affiliation(s)
- Melissa Cumming
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Anthony Osinski
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Lynne O'Hearn
- Department of Transfusion Medicine and Pathology, Baystate Medical Center
| | - Pamela Waksmonski
- Division of Health Care Facility Licensure and Certification, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Michele Herman
- Department of Pathology, Division of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Deborah Gordon
- Department of Pathology, Heywood Hospital, Gardner, Massachusetts
- Department of Pathology, Athol Memorial Hospital, Athol, Massachusetts
| | - Elzbieta Griffiths
- Department of Pathology, Mount Auburn Hospital, Cambridge, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Kim Knox
- Infection Prevention and Control Department, Milford Regional Medical Center, Milford, Massachusetts
| | - Eileen McHale
- Bureau of Healthcare Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Karen Quillen
- Department of Pathology & Laboratory Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Jorge Rios
- New England Region American Red Cross Blood Services, Dedham, Massachusetts
| | - Patricia Pisciotto
- New England Region American Red Cross Blood Services, Dedham, Massachusetts
| | - Lynne Uhl
- Department of Pathology, Division of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Alfred DeMaria
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Chester Andrzejewski
- Department of Transfusion Medicine and Pathology, Baystate Medical Center
- Tufts University School of Medicine, Boston, Massachusetts
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Li L, Li KY, Yan K, Ou G, Li W, Wang J, Song N, Tian L, Ji X, Chen Y, Liang X, Liu Z, Wu Y. The History and Challenges of Blood Donor Screening in China. Transfus Med Rev 2016; 31:89-93. [PMID: 28012709 DOI: 10.1016/j.tmrv.2016.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022]
Abstract
Since the establishment of People's Republic of China in 1949, the Chinese government has encountered several catastrophes related to transfusion transmitted diseases. The government's increasing attention to blood safety has prompted the initiation of a series of policies and measures that have enhanced the level of safety for the blood supply and met the basic clinical demands of blood for 1.3 billion people in the country. Blood donation screening strategies in China predominantly comprise donor screening and donor testing. Donor screening includes selection of low-risk blood donors by the use of a donor history questionnaire, predonation physical examination, and initial rapid donor testing. Donor testing includes direct pathogen detection and serology tests. The year 1998 marked the most transformative change in blood donor selection and screening policies in China. Before 1998, paid donation was the predominant mode of blood donation. Donor screening and donor testing were conducted before donation, and only those who were eligible were allowed to donate. To ensure the safety of blood, donor testing was performed again after donation. After the implementation of the Blood Donation Law in 1998, to promote voluntary and unpaid donation, predonation donor testing was eliminated to reduce the amount of waiting time and to provide a more convenient donation experience for blood donors. However, it is the national requirement that donated blood should undergo 2 rounds of testing using different equipment or reagents, conducted by different personnel. Donor selection has transitioned from paid donation and obligatory donation to voluntary donation with fixed volunteer groups, as the latter mode of donation provides the lowest risks. Donations are currently screened for syphilis, hepatitis C virus, HIV, and hepatitis B virus (HBV). Units, previously typed only for ABO, are now routinely tested for both ABO and Rh(D). Innovations in testing technologies and methods have also brought changes to screening parameters. For instance, screening for HBV pathogens evolved from the early use of hemagglutination method to the later use of radioimmunoassay, independent enzyme-linked immunosorbent assay, and now the widespread application of nucleic acid test (NAT). Since 2010, the Chinese government has established NAT capacity in several blood centers; and in 2015, the government invested 900 million RMB on the nationwide expansion of NAT. Although the Chinese government has worked to enhance blood safety, many challenges remain. Concern exists for rising rates of HIV infection. The existence of occult HBV infection and the transmission of emerging blood-borne diseases continue to challenge the safety of the blood supply.
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Affiliation(s)
- Ling Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Ka Yi Li
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Ke Yan
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Guojin Ou
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Wenhui Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Jue Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Ning Song
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Li Tian
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Xin Ji
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Yongjun Chen
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | | | - Zhong Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China.
| | - Yanyun Wu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China; Bloodworks, Seattle, WA, United States
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25
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Semenza JC, Tran A, Espinosa L, Sudre B, Domanovic D, Paz S. Climate change projections of West Nile virus infections in Europe: implications for blood safety practices. Environ Health 2016; 15 Suppl 1:28. [PMID: 26961903 PMCID: PMC4895699 DOI: 10.1186/s12940-016-0105-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND West Nile virus (WNV) is transmitted by mosquitoes in both urban as well as in rural environments and can be pathogenic in birds, horses and humans. Extrinsic factors such as temperature and land use are determinants of WNV outbreaks in Europe, along with intrinsic factors of the vector and virus. METHODS With a multivariate model for WNV transmission we computed the probability of WNV infection in 2014, with July 2014 temperature anomalies. We applied the July temperature anomalies under the balanced A1B climate change scenario (mix of all energy sources, fossil and non-fossil) for 2025 and 2050 to model and project the risk of WNV infection in the future. Since asymptomatic infections are common in humans (which can result in the contamination of the donated blood) we estimated the predictive prevalence of WNV infections in the blood donor population. RESULTS External validation of the probability model with 2014 cases indicated good prediction, based on an Area Under Curve (AUC) of 0.871 (SD = 0.032), on the Receiver Operating Characteristic Curve (ROC). The climate change projections for 2025 reveal a higher probability of WNV infection particularly at the edges of the current transmission areas (for example in Eastern Croatia, Northeastern and Northwestern Turkey) and an even further expansion in 2050. The prevalence of infection in (blood donor) populations in the outbreak-affected districts is expected to expand in the future. CONCLUSIONS Predictive modelling of environmental and climatic drivers of WNV can be a valuable tool for public health practice. It can help delineate districts at risk for future transmission. These areas can be subjected to integrated disease and vector surveillance, outreach to the public and health care providers, implementation of personal protective measures, screening of blood donors, and vector abatement activities.
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Affiliation(s)
- Jan C Semenza
- European Centre for Disease Prevention and Control, Stockholm,, SE-171 83, Sweden.
| | - Annelise Tran
- CIRAD, UPR Animal et Gestion Intégrée des Risques, Montpellier,, F-34093, France.
| | - Laura Espinosa
- European Centre for Disease Prevention and Control, Stockholm,, SE-171 83, Sweden.
| | - Bertrand Sudre
- European Centre for Disease Prevention and Control, Stockholm,, SE-171 83, Sweden.
| | - Dragoslav Domanovic
- European Centre for Disease Prevention and Control, Stockholm,, SE-171 83, Sweden.
| | - Shlomit Paz
- Department of Geography and Environmental Studies, University of Haifa, Mt. Carmel, Haifa,, 31905, Israel.
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Johns DM, Bayer R, Fairchild AL. Evidence and the Politics of Deimplementation: The Rise and Decline of the "Counseling and Testing" Paradigm for HIV Prevention at the US Centers for Disease Control and Prevention. Milbank Q 2016; 94:126-62. [PMID: 26994712 PMCID: PMC4941977 DOI: 10.1111/1468-0009.12183] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
POLICY POINTS In situations of scientific uncertainty, public health interventions, such as counseling for HIV infection, sometimes must be implemented before obtaining evidence of efficacy. The history of HIV counseling and testing, which served as the cornerstone of HIV prevention efforts at the US Centers for Disease Control and Prevention (CDC) for a quarter of a century, illustrates the influence of institutional resistance on public health decision making and the challenge of de-implementing well-established programs. CONTEXT In 1985, amid uncertainty about the accuracy of the new test for HIV, public health officials at the Centers for Disease Control and Prevention (CDC) and AIDS activists agreed that counseling should always be provided both before and after testing to ensure that patients were tested voluntarily and understood the meaning of their results. As the "exceptionalist" perspective that framed HIV in the early years began to recede, the purpose of HIV test counseling shifted over the next 30 years from emphasizing consent, to providing information, to encouraging behavioral change. With this increasing emphasis on prevention, HIV test counseling faced mounting doubts about whether it "worked." The CDC finally discontinued its preferred test counseling approach in October 2014. METHODS Drawing on key informant interviews with current and former CDC officials, behavioral scientists, AIDS activists, and others, along with archival material, news reports, and scientific and governmental publications, we examined the origins, development, and decline of the CDC's "counseling and testing" paradigm for HIV prevention. FINDINGS Disagreements within the CDC emerged by the 1990s over whether test counseling could be justified on the basis of efficacy and cost. Resistance to the prospect of policy change by supporters of test counseling in the CDC, gay activists for whom counseling carried important ethical and symbolic meanings, and community organizations dependent on federal funding made it difficult for the CDC to de-implement the practice. CONCLUSIONS Analyses of changes in public health policy that emphasize the impact of research evidence produced in experimental or epidemiological inquiries may overlook key social and political factors involving resistance to deimplementation that powerfully shape the relationship between science and policy.
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Affiliation(s)
- David Merritt Johns
- Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University
| | - Ronald Bayer
- Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University
| | - Amy L Fairchild
- Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University
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Holmberg JA. Blood you can trust: global trends in transfusion safety. MLO Med Lab Obs 2015; 47:20-22. [PMID: 26591254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Bayer R. Science, politics, and the end of the lifelong gay blood donor ban. Milbank Q 2015; 93:230-3. [PMID: 26044622 DOI: 10.1111/1468-0009.12114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Stramer SL. The potential threat to blood transfusion safety of emerging infectious disease agents. Clin Adv Hematol Oncol 2015; 13:420-422. [PMID: 26353036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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30
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Dolange H, Philibert M, Savy C, Veto D. [Continuing education, a tool to enhance blood safety in the hospital]. Soins 2015; Spec No:2S14-2S15. [PMID: 26506721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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31
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Kasraian L, Negarestani N. Rates and reasons for blood donor deferral, Shiraz, Iran. A retrospective study. SAO PAULO MED J 2015; 133:36-42. [PMID: 25166463 PMCID: PMC10496620 DOI: 10.1590/1516-3180-2013-7110002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 05/07/2013] [Accepted: 06/06/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Knowledge of the reasons for donor deferral can help in planning more efficient recruitment strategies and evaluating donor selection criteria. This study aimed to investigate the rates and reasons for donor deferral. DESIGN AND SETTING Retrospective study at Shiraz Blood Transfusion Center, Shiraz, Iran. METHODS 141,820 volunteers were interviewed confidentially by physicians before blood donation. The rate of and reasons for donor deferral were investigated according to demographic characteristics. The data were analyzed using the comparison-of-proportions test of the MedCalc statistical software. RESULTS 43,839 people (30.9%) who had come for blood donation were deferred, 1,973 (4.5%) of them permanently. The deferral rate was significantly higher among women, single individuals and first-time donors, compared with men, married individuals and those with a history of previous donation (P < 0.0001). The deferral rate was significantly higher in the 17 to 30-year-old group (P < 0.05). The reasons for deferral were divided into five categories: risk factors possibly related to HIV or hepatitis (43.6%), underlying diseases (31.9%), non-eligible conditions (13.5%), medications that interfere with blood donation (7.8%) and risk factors that may relate to bacterial or viral infections except HIV and hepatitis infections (3.2%). CONCLUSION Effective measures are required for documenting the impact of deferral on blood availability, monitoring the effectiveness of and need for deferral, and determining the reasons and rates of deferral.
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Affiliation(s)
- Leila Kasraian
- Blood Transfusion Research Center, High Institute for Transfusion Research and Education, Shiraz, Iran
| | - Neda Negarestani
- Shiraz Consultation Center, Iranian Blood Transfusion Research Center, Shiraz, Iran
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Abstract
Guidelines and evidence from randomised controlled trials and meta-analyses increasingly support restrictive blood transfusion, but it is being implemented only slowly, explain Lawrence Tim Goodnough: and Michael Murphy: . They argue that electronic systems for clinical decision support could improve blood use.
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Affiliation(s)
- Lawrence Tim Goodnough
- Transfusion Service, Stanford University Medical Center, Stanford University, Stanford, CA, USA
| | - Michael F Murphy
- NHS Blood and Transplant, Oxford, UK Oxford University Hospitals, University of Oxford, Oxford, UK
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Piercecchi-Marti MD, Tuchtan-Torrents L, Lassale B, Leonetti G, Bartoli C. [Responsibility for prescribing and monitoring an act transfusion and safety blood transfusion]. Transfus Clin Biol 2014; 21:158-61. [PMID: 25282487 DOI: 10.1016/j.tracli.2014.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/04/2014] [Indexed: 11/18/2022]
Abstract
The act to transfuse is a prescription following basic rules similar to drug prescriptions. If harm happens, potentially linked with this prescription, the harm's responsibility is borne by the physician, the paramedics, the care organization but by the supplier laboratory too. The setting of good practice rules consistent with science data at the time when the act is performed, the respect of the patient's rights and the quality of supplied products will be assessed during the expertise. Under restorative responsibility, it is necessary to previously establish a direct and certain causation between the litigious act and the harm to enforce the vicarious liability. Nowadays, legal precedents grant a larger protection to more and more numerous victims, enhancing the field of the fault with the appeal to assumption of fault. At the same time, the lawmaker himself promulgated objective conditions of compensation for many categories of victims of medical risk from which transfused people are part. The law of March the 4th of 2002 went one step closer devoting a new foundation of compensation: national solidarity.
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Affiliation(s)
- M D Piercecchi-Marti
- Service de médecine légale droit de la Santé-Aix-Marseille université UMR 7268 ADES, 13344 Marseille cedex 15, France.
| | - L Tuchtan-Torrents
- Service de médecine légale droit de la Santé-Aix-Marseille université UMR 7268 ADES, 13344 Marseille cedex 15, France
| | - B Lassale
- Unité d'hémovigilance APHM, hôpital Sainte-Marguerite, 274, boulevard Sainte-Marguerite, 13009, France.
| | - G Leonetti
- Service de médecine légale droit de la Santé-Aix-Marseille université UMR 7268 ADES, 13344 Marseille cedex 15, France
| | - C Bartoli
- Service de médecine légale droit de la Santé-Aix-Marseille université UMR 7268 ADES, 13344 Marseille cedex 15, France
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Boulahdid S, Benahadi A, Adouani B, Laouina A, Mehdaoui FE, Mokhtari A, Soulaymani A, Hajjout K, Alami R. Improvement of national blood safety profile: effect of contract fractionation of plasma in resource limited countries, the Moroccan experience. Haemophilia 2014; 20:e359-62. [PMID: 25039933 DOI: 10.1111/hae.12482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- S Boulahdid
- Centre National de Transfusion Sanguine/Centre Régional de Transfusion Sanguine, Rabat, Morocco; Laboratoire de Génétique et de Biométrie, Faculté des Sciences, University Ibn Tofaïl, Kenitra, Morocco
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36
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O'Dowd A. MPs call for risk assessment review of safety of UK blood supply. BMJ 2014; 349:g4772. [PMID: 25059409 DOI: 10.1136/bmj.g4772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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37
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Pouget T, Garcia-Hejl C, Bouzard S, Roche C, Sailliol A, Martinaud C. [Assessment of malaria screening management in blood donation control in the French Military Blood Institute]. Transfus Clin Biol 2014; 21:103-6. [PMID: 24948206 DOI: 10.1016/j.tracli.2014.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/14/2014] [Indexed: 11/16/2022]
Abstract
The French Military Blood Institute is responsible for the entire blood supply chain in the French Armed Forces. Considering, the high exposition rate of military to malaria risk, blood donation screening of plasmodium infection must be as efficient as possible. The main aim of our study was to assess our malaria testing strategy based on a single Elisa test compared with a two-step strategy implying immunofluorescence testing as confirmation test. The second goal was to describe characteristic of malaria Elisa positive donors. We conducted a prospective study: every malaria Elisa positive test was implemented by immunofluorescence testing and demographical data were recorded as usual by our medical software. We showed a significant risk of malaria ELISA positive tests among donor born in endemic area and we estimate the number of abusively 3-year rejected donors. However, based on our estimations, the two-step strategy is not relevant since the number of additionally collected blood products will be low.
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Affiliation(s)
- T Pouget
- Centre de transfusion sanguine des armées, 1, rue du Lieutenant-Batany, 92140 Clamart, France
| | - C Garcia-Hejl
- Fédération de biologie médicale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - S Bouzard
- Centre de transfusion sanguine des armées, 1, rue du Lieutenant-Batany, 92140 Clamart, France
| | - C Roche
- Centre de transfusion sanguine des armées, 1, rue du Lieutenant-Batany, 92140 Clamart, France
| | - A Sailliol
- Centre de transfusion sanguine des armées, 1, rue du Lieutenant-Batany, 92140 Clamart, France
| | - C Martinaud
- Fédération de biologie médicale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
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38
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Smith B, Smith J. Indefinitely deferred: a look at blood donation policies for gay men. N J Nurse 2014; 44:4. [PMID: 24809166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Busby H, Kent J, Farrell AM. Revaluing donor and recipient bodies in the globalised blood economy: transitions in public policy on blood safety in the United Kingdom. Health (London) 2014; 18:79-94. [PMID: 23467898 PMCID: PMC3930469 DOI: 10.1177/1363459313476966] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The clinical use of blood has a long history, but its apparent stability belies the complexity of contemporary practices in this field. In this article, we explore how the production, supply and deployment of blood products are socially mediated, drawing on theoretical perspectives from recent work on 'tissue economies'. We highlight the ways in which safety threats in the form of infections that might be transmitted through blood and plasma impact on this tissue economy and how these have led to a revaluation of donor bodies and restructuring of blood economies. Specifically, we consider these themes in relation to the management of recent threats to blood safety in the United Kingdom. We show that the tension between securing the supply of blood and its products and ensuring its safety may give rise to ethical concerns and reshape relations between donor and recipient bodies.
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Balint B, Vucetic D, Todorovic-Balint M, Borovcanin N, Jovanovic-Cupic S, Mandusic V. Safety improving by complementary serological and molecular testing combined with pathogen reduction of the donated blood in window period. Transfus Apher Sci 2013; 49:103-4. [PMID: 23820432 DOI: 10.1016/j.transci.2012.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 09/18/2012] [Indexed: 12/11/2022]
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41
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Mant S, Smith MP. Blood safety. N Z Med J 2013; 126:10-11. [PMID: 23799377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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42
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Brecher ME, Jacobs MR, Katz LM, Jacobson J, Riposo J, Carr-Greer A, Kleinman S. Survey of methods used to detect bacterial contamination of platelet products in the United States in 2011. Transfusion 2013; 53:911-8. [PMID: 23461271 DOI: 10.1111/trf.12148] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/19/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Testing of platelets (PLTs) for bacterial contamination is required by the AABB Standards but is not fully standardized. On January 31, 2011, a new AABB Standard, 5.1.5.1.1, specified that bacterial detection methods for PLT components shall use assays either approved by the Food and Drug Administration (FDA) or validated to provide sensitivity equivalent to these FDA-approved methods. METHODS An Internet-based survey of AABB member institutions was conducted from May to June 2012, to document current practices used in 2011 for bacterial detection in different PLT products and to assess the impact of the new standard. RESULTS Of 1053 AABB member institutions surveyed, 40 of 99 blood centers (40.4%) and 184 of 954 hospital blood banks or transfusion services (19.3%) responded. Sixty-four respondents manufactured PLTs. Apheresis PLTs (APs) were predominantly screened with the BacT/ALERT system (89.5%); the majority (95.2%) were cultured with at least 8 mL of product. There was substantial variation in the minimum incubation time of cultures before release of PLTs (range, 0 to >24 hr). Recalls of released AP for possible bacterial contamination were largely successful (67.3%); successful interdiction before transfusion was associated with incubation for more than 12 hours before release (p < 0.01). After Standard 5.1.5.1.1 took effect, there was a decrease in production of whole blood-derived PLT concentrates (WBPCs). Point-of-issue ("rapid") immunoassays were used to screen a substantial proportion of WBPC PLTs, but were rarely used as secondary tests for previously cultured APs. CONCLUSION The survey identified variability in culture methods and release times with AP, while use of WBPC decreased after AABB Standard 5.1.5.1.1 became effective.
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Affiliation(s)
- Mark E Brecher
- Laboratory Corporation of America, Burlington, North Carolina; Case Western Reserve University, Cleveland, Ohio, USA.
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43
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Abstract
BACKGROUND In spite of interventions, approximately 1000 per 1,000,000 platelet (PLT) collections are contaminated with bacteria at collection. The current prestorage culture procedure at some blood centers is to inoculate a fixed volume from the collection bag (4-8 mL) regardless of collection volume. The sensitivity of early testing varies with the percent of collection volume sampled. We applied the Poisson model to determine whether sampling larger volumes might increase detection at pertinent contamination levels. STUDY DESIGN AND METHODS The intervention was testing a fixed proportion of the collection volume from single, double, and triple collections. The Poisson model was applied to blood center data to calculate weighted average detection. Model 1 consisted of inoculating 3.2% of the collection volume from single, 1.6% from double, and 1.2% from triple PLT procedures (8 mL in each case). Model 2 consisted of inoculating 3.8% of the collection volume from all PLT procedures. Volume-related and non-volume-related contamination mechanisms were evaluated. RESULTS Testing constant proportions of the collection volume (Model 2) increases percent detection over testing constant volumes (Model 1) (68% vs. 41% detection if contamination is 30 colony-forming units (CFUs)/collection bag and 17% vs. 9% detection if contamination is 5 CFUs/collection bag). At low levels of contamination (approx. 5 CFUs/bag), the intervention might double the number of contaminated units detected. CONCLUSION Based on the application of the Poisson model to detection of bacteria in PLT concentrates, inoculating cultures with slightly consistent proportions of the collection volume should lead to a reduction in false negative tests and in the number of contaminated units transfused.
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Affiliation(s)
- Peter A Tomasulo
- Medical and Scientific Affairs, Blood Services, Inc., Scottsdale, AZ 85257, USA.
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44
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Abstract
In a previous article, we reviewed the management of blood component recalls and withdrawals (G. Ramsey. Transfusion Med Rev 2004;18:36-45). Since then, US rates of recall and biological product deviation for blood components have improved significantly, particularly with regard to reduced recalls for donor infectious disease risks or testing. However, analysis of the current data from the US Food and Drug Administration suggests that 1 (0.4%) in 250 blood components is involved in market withdrawals and quarantines, with 1 in 5800 components formally recalled. Most of these units, unfortunately, had already have been transfused. The U.S. Food and Drug Administration has issued several recent guidances that address transfusion service actions for dealing with specific infectious disease problems. This present article updates our 2004 recommendations as to when to notify physicians about transfused nonconforming blood components.
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Affiliation(s)
- Glenn Ramsey
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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45
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Sailliol A, Martinaud C, Cap AP, Civadier C, Clavier B, Deshayes AV, Mendes AC, Pouget T, Demazeau N, Chueca M, Martelet FR, Ausset S. The evolving role of lyophilized plasma in remote damage control resuscitation in the French Armed Forces Health Service. Transfusion 2013; 53 Suppl 1:65S-71S. [PMID: 23301975 DOI: 10.1111/trf.12038] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Freeze-dried plasma was developed by the US Army for the resuscitation of combat casualties during World War II. The French Military Blood Institute began producing French lyophilized plasma (FLYP) in 1949, in accordance with French blood product guidelines. Since 2010, a photochemical pathogen inactivation process has been implemented to reduce the remaining transfusion-related infectious risk. All quality controls for this procedure verify that the hemostatic properties of FLYP are conserved. FLYP is compatible with all blood types, can be stored at room temperature for 2 years, and its reconstitution requires less than 6 minutes. As a result, FLYP allows quick delivery of all the coagulation proteins and the application of a 1:1 ratio of FLYP and red blood cells in the context of a massive transfusion. Hemovigilance data collected in France since 1994 have included FLYP. Results indicate no reporting of infection related to the use of FLYP. Clinical monitoring with a focus on hemostasis was implemented in 2002 and expanded in 2010. The data, obtained from overseas operations, confirmed the indications, the safety and the clinical efficacy of FLYP. Further research is needed to determine specific indications for FLYP in the therapeutic management of civilian patients with severe hemorrhage.
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Affiliation(s)
- Anne Sailliol
- Centre de Transfusion Sanguine des Armées, Clamart, France.
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46
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Baptista González H. [Acute adverse effects in transfusion. Proposals for the hemosurveillance system]. GAC MED MEX 2013; 149:94-101. [PMID: 23435081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
The management model based on risk prevention has become a major influence in shaping policies for transfusion safety. There are approximately sixty interactions between the health worker and the patient during the transfusion process,representing the number of times where you have the opportunity to make a mistake.We present an analysis of the weaknesses of the National Blood System, with particular attention to the haemovigilance donor and patient. The proposals include the implementation of the National Blood containing the need to establish from the National Blood Safety, significant changes in the regulatory framework and the internal regulations of the Ministry of Health, the CNTS and COFEPRIS. Is required to promote and coordinate the collection of accurate information from the committees of transfusion medicine, which will be accompanied by an initial diagnosis from the National Survey of Blood. Requires notice to other forms of funding to ensure the viability of the projects operating blood bank. Finally, as a strategic resource, the blood is of public, so access should not be restricted.
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Affiliation(s)
- Héctor Baptista González
- Coordinación de Hematología Perinatal, Instituto Nacional de Perinatología, México, D.F.,Medicina Transfusional y Banco de Sangre, Fundación Clínica Médica Sur, México, D.F.
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Semple E, Bowes-Schmidt A, Yi QL, Shimla S, Devine DV. Transfusion reactions: a comparative observational study of blood components produced before and after implementation of semiautomated production from whole blood. Transfusion 2012; 52:2683-91. [PMID: 22738255 DOI: 10.1111/j.1537-2995.2012.03752.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A semiautomated method of component production from whole blood was implemented at Canadian Blood Services. To assess safety of the new components, the frequency of adverse transfusion events (ATEs) to platelet components (PCs) and red blood cell (RBCs) produced before and after implementation of the new method was surveyed and compared. STUDY DESIGN AND METHODS This retrospective, observational, noninferiority study was conducted in 12 sentinel hospitals across Canada. The control group received RBCs in additive solution-3 (AS-3) and platelet-rich plasma (PRP)-produced platelets (PLTs) for 3 to 11 months before implementation of semiautomated production, and the study group received RBCs in saline-adenine-glucose-mannitol (SAGM) and buffy coat (BC)-produced PLTs for 3 to 11 months after implementation. ATE definitions at each hospital and standard practice for reporting did not change between control and study periods. Data for analysis were obtained from databases and original report forms. RESULTS The pooled risk ratio of a reaction to SAGM versus AS-3 RBCs was 0.77 (95% confidence interval [CI], 0.66-0.90), suggesting that SAGM products had significantly lower reaction rates than AS-3 products (p < 0.01). Reported allergic reactions to RBCs decreased from 0.07% (AS-3) to 0.04% (SAGM). For PLTs, the difference in reaction rates between BC and PRP was not significant (p = 0.37), and the pooled risk ratio of BC versus PRP was 1.14 (95% CI, 0.86-1.50). CONCLUSION The change in manufacturing method was associated with lower reaction rates to SAGM RBCs than to AS-3 RBCs. Pooled BC PLTs were noninferior to random-donor PRP PLTs with respect to ATEs.
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WHO Expert Group. Expert Consensus Statement on achieving self-sufficiency in safe blood and blood products, based on voluntary non-remunerated blood donation (VNRBD). Vox Sang 2012; 103:337-42. [PMID: 22690746 DOI: 10.1111/j.1423-0410.2012.01630.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
All countries face challenges in making sufficient supplies of blood and blood products available and sustainable, while also ensuring the quality and safety of these products in the face of known and emerging threats to public health. Since 1975, the World Health Assembly (WHA) has highlighted the global need for blood safety and availability. WHA resolutions 63·12, 58·13 and 28·72, The Melbourne Declaration on 100% Voluntary Non-Remunerated Donation of Blood and Blood Components and WHO Global Blood Safety Network recommendations have reaffirmed the achievement of 'Self-sufficiency in blood and blood products based on voluntary non-remunerated blood donation (VNRBD)' as the important national policy direction for ensuring a safe, secure and sufficient supply of blood and blood products, including labile blood components and plasma-derived medicinal products. Despite some successes, self-sufficiency is not yet a reality in many countries. A consultation of experts, convened by the World Health Organization (WHO) in September 2011 in Geneva, Switzerland, addressed the urgent need to establish strategies and mechanisms for achieving self-sufficiency. Information on the current situation, and country perspectives and experiences were shared. Factors influencing the global implementation of self-sufficiency, including safety, ethics, security and sustainability of supply, trade and its potential impact on public health, availability and access for patients, were analysed to define strategies and mechanisms and provide practical guidance on achieving self-sufficiency. Experts developed a consensus statement outlining the rationale and definition of self-sufficiency in safe blood and blood products based on VNRBD and made recommendations to national health authorities and WHO.
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49
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Wautier MP, Wautier JL. [Respiratory and infectious complications of blood transfusion]. Rev Prat 2012; 62:699-700. [PMID: 22730808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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50
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Affiliation(s)
- Darrell J Triulzi
- University of Pittsburgh Medical Center and Institute for Transfusion Medicine, Pittsburgh, Pennsylvania 15213, USA.
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