Occurrence of non-A, non-B post-transfusion hepatitis in heart surgery. Prospective study on the value of the determination of serum alanine aminotransferase and detection of anti-HBc antibodies in blood donors

We studied a group of 64 patients undergoing cardiac surgery for the occurrence of post-transfusion hepatitis during a follow-up period of 5 months. They received blood units (packed red cells in saline-adenine-glucose medium and/or fresh frozen plasma exclusively) from 447 volunteer donors. Post-transfusion hepatitis was identified in 5 patients: 1 patient had cytomegalovirus hepatitis and the remaining 4 cases were defined, by exclusion, as non-A, non-B hepatitis (with prevalence and incidence rates of 80% and 6.25% respectively). We found no statistically significant differences between the numbers of transfused blood product units in patients who developed non-A, non-B hepatitis as compared to those who did not. Our analysis of the predictive effectiveness of alanine aminotransferase and anti-HBc antibodies screening in blood donors to prevent non-A, non-B post-transfusion hepatitis led to the following conclusions: we failed to confirm the association between anti-HBc in blood donors and enhanced risk of non-A, non-B hepatitis in recipients since no case developed among patients receiving blood products from anti-HBc positive donors. So, 20 donors (4.5%) would have been discarded without any reduction of the incidence of non-A, non-B hepatitis. we could not confirm nor exclude the possibility that screening donor blood for elevated alanine aminotransferase levels would have reduced the number of non-A, non-B hepatitis in recipients.     

Qualification of serological infectious disease assays for the screening of samples from deceased tissue donors

Whilst some of the assays used for serological screening of post-mortem blood samples from deceased tissue donors in some countries have been specifically validated by the manufacturer for this purpose, a significant number of those currently in use globally have not. Although specificity has previously been considered a problem in the screening of such samples, we believe that ensuring sensitivity is more important. The aim of this study was to validate a broader range of assays for the screening of post-mortem blood samples from deceased tissue donors. Six microplate immunoassays currently in use within National Health Service Blood and Transplant (NHSBT) for the screening of blood, tissue and stem cell donations were included. Representative samples from confirmed positive donors were titrated in screen negative post-mortem samples in parallel with normal pooled negative serum to determine if there was any inhibition with the post-mortem samples. There were no significant differences seen (P < 0.005) between the dilution curves obtained for the positive samples diluted in post-mortem samples and normal pooled sera. Although small numbers of samples were studied, it can be surmised that the post-mortem blood samples from deceased tissue donors, collected according to United Kingdom guidelines, are a suitable substrate for the assays evaluated. No diminution of reactivity was seen when dilution with sera from deceased donors was compared to dilution using pooled serum from live donors. In the absence of genuine low titre positive post-mortem samples, the use of samples spiked with various levels of target material provides a means of qualifying serological screening assays used by NHSBT for the screening of post-mortem blood samples from deceased tissue donors.     

Should we neglect or nurture replacement blood donors in sub-Saharan Africa?

Lack of blood is common in SSA but quantification of the overall shortfall is hampered by a lack of evidence-based targets for blood collection. Despite recommendations that all blood donors should be voluntary and non-remunerated, replacement donors are common throughout sub-Saharan Africa (SSA). Voluntary donors are generally recruited through centralised systems whereas replacement donors are recruited by families and donate through hospitals. Blood from a centralised service is more expensive than from a hospital-based service due to the higher costs of donor recruitment, quality assurance processes and the maintenance of distribution networks.Information about the contribution of replacement donors to the blood supply is scanty and inconsistent but it is likely that they currently provide over half of the blood in SSA. WHO's guidelines for transfusion services deal exclusively with voluntary donors and neglect the substantial contribution made by replacement donors. Examples of how the supply and quality of blood from the replacement donors can be improved have been published but need to be evaluated and disseminated. Political will and open-mindedness to innovative ways to improve supply and safety of blood from all types of donors are essential to promote more evidence-based approaches to blood transfusion practice in low-income countries.     

Hepatitis C virus infection from blood and blood products

Abstract: The addition of second-generation HCV epitopes in antibody detection assays has increased the sensitivity and specificity of blood donor testing, to prevent post-transfusion hepatitis non-A, non-B (PTH-NANB), later characterized as Hepatitis C. However, it is not clear whether all HCV infectious donors are detected by second generation anti-HCV testing. Prospective studies on PTH-NANB were left with some unresolved cases. The use of second-generation anti-HCV assays in blood banks presented a problem with a relatively large number of indeterminate reactivities in supplemental assays such as RIBA-2. These indeterminate reactivities may be solved by the use of polymerase chain reaction (PCR). PCR is more and more used as an extra confirmatory assay to resolve RIBA indeterminate results on blood donors. However, a European study on the proficiency of HCV PCR in different countries revealed that only a minority of the reference laboratories perform this test faultness. Lately, third generation RIBA was developed, which was originally designed to resolve RIBA-2 indeterminate cases. RIBA-3 was shown to be more sensitive and specific in early HCV infection and blood donors than RIBA-2. Third generation anti-HCV testing will become standard practice. Some questions, however, remain unanswered. Do we miss any rare HCV infectious donors, of other genotypes, with third-generation assays, based only on the type 1 sequence of HCV? Can we improve HCV detection in the early phase of infection? What is the role of sporadic HCV transmission? How can we standardize HCV nucleic acid detection methods?     

Social structure of the donor sample of a district blood donation and transfusion institute

The change from paid blood donation to that made within the Red Cross Organization at the Erfurt District Institute for Blood Donation and Transfusion Service is reflected in the altered composition of the donor population. Team A (n = 4903) consists of "traditional" paid blood donors and Red Cross blood donors. It is characterized as follows: - approximately equal percentage of men and women, - high percentage of working class people with skilled worker's certificate. Women are relatively less frequent among blood donors than men, they are more frequently represented, however, as Red Cross blood donors. Team B (n = 759) covers all new blood donors since 1986, exclusively Red Cross blood donors. It is characterized as follows: - women are represented by 69% (predominantly female students), - the highest percentage (42%) of the team is made up of students. The percentage of blood donors from working class people with a skilled worker's certificate correspond to GDR average. Among the donors graduates from technical colleges and universities are overrepresented, whereas trained working class people with a skilled worker's certificate and those without it are underrepresented. Members of the staff of the municipal health service and Medical Academy as well as students of medicine and education made up the highest percentage of blood donors. About 17% of all members of the medical health service are blood donors, far more than in other branches of Erfurt.     

北京血站献血员戊型肝炎流行病学调查

为了解献血员戊型肝炎感染情况,对2002年7～8月向北京市血液中心义务献血的所有人员进行整群抽样并抽血,应用ELISA检测戊型肝炎病毒(HEV)IgG的感染率.结果发现:北京献血员HEV IgG总感染率为26.59%,性别、年龄、省份分布存在着差别,男性比女性感染率高,年龄越大感染率越高,来自高感染省份者感染率也高,但ALT与HEV IgG感染无关.因此,男性、年龄大、来自高感染省份具有较高的HEV感染风险,进一步研究献血员的亚临床感染对HEV的输血安全性具有重要意义.     

Seroprevalence and Incidence of hepatitis E in Blood Donors in Upper Austria

Background

In recent years various studies showed, that hepatitis E virus (HEV) is a growing public health problem in many developed countries. Therefore, HEV infections might bear a transmission risk by blood transfusions. The clinical relevance still requires further investigations. The aim of this study was to provide an overview of acute HEV infections in Upper Austrian blood donors as well as a risk estimation of this transfusion-related infection.

Methods and Findings

A total of 58,915 blood donors were tested for HEV RNA using a commercial HEV RT-PCR Kit. 7 of these donors (0.01%) were PCR-positive with normal laboratory parameters in absence of clinical signs of hepatitis. Viral load determined by quantitative real-time PCR showed a HEV nucleic acid concentration of 2,217 293,635 IU/ml. At follow-up testing (2–11 weeks after donation) all blood donors had negative HEV RNA results. Additionally, genotyping was performed by amplification and sequencing of the ORF1 or ORF2 region of the HEV genome. All HEV RNA positive donor samples revealed a genotype 3 isolate. For the antibody screening, anti-HEV IgM and IgG were detected by ELISA. Follow up serological testing revealed that no donor was seropositive for HEV IgM or IgG antibodies at time of donation. Moreover, we verified the prevalence of anti-HEV IgG in 1,203 of the HEV RNA negative tested blood donors. Overall 13.55% showed positive results for anti-HEV IgG.

Conclusions

In the presented study, we investigated HEV infections in blood donations of Upper Austria over 1 year. We concluded that 1 out of 8,416 blood donations is HEV RNA positive. Seroprevalence of anti HEV IgG results in an age-related increase of 13.55%. Therefore, based on this data, we recommend HEV-PCR screening to prevent transmission of hepatitis E virus by transfusion.     

Antibodies against the common polysaccharide and protein protective antigens of Pseudomonas aeruginosa in normal blood donors.

Screening of normal plasma obtained from 172 blood donors from the Helsinki area and from 46 blood donors from the Moscow area was performed in order to reveal 'natural' antibodies to the common polysaccharide (rhamnan) and protein antigens of P. aeruginosa. Antibodies were detected by ELISA. Among blood donors from the Helsinki area high titres of antibodies to the protein antigens were detected in 42 active blood donors (24.4%) and very high titres in nine (5.3%) highly-active blood donors, whereas in the Moscow area in 15 (34.9%) and in one case (2.3%), respectively. Antibodies to the common polysaccharide antigen were determined in the Helsinki area in 23 active blood donors (13.4%) and in one (0.5%) highly active blood donor, whereas in the Moscow area in four active blood donors (8.6%). The plasma contained both polysaccharide and anti-protein antibodies. The level of antibodies to the polysaccharide antigen was lower than the level of antibodies to the protein antigens. There was no statistically significant difference between the corresponding values of blood donor groups from the Helsinki and Moscow areas.     

HIV-specific antibody among voluntary blood donors in Lower Saxony (FRG)

Anti-HIV test results of the Red Cross Blood Transfusion Service of Lower Saxony from 1 June 1985 to 31 July 1986 inclusive were analysed retrospectively. Nine out of 70,936 donors who had not donated blood before 1 June 1985 (first-time donors) and 9 out of 261,231 donors who had donated blood before this date (repeating donors) were found anti-HIV confirmed positive at the time of the first blood donation during the study period. The prevalence of HIV antibody in first-time donors was significantly higher than in repeating donors (p less than 0.01). It was concluded that some members of risk groups used blood donation to obtain an anti-HIV test result. One out of 30,300 blood donations was confirmed anti-HIV positive. The results of this study justify the transfusion of blood donations that are reactive only in the initial ELISA test.     

Analysis of factors related to ELISA-HBsAg negative and HBV DNA positive blood donors

This report analyzed factors relating to ELISA-HBsAg and Hepatitis B virus (HBV) DNA in blood donors. To provide a reference for an accurate screening model for HBV infection in donated blood, we collected rel-evant information from 124 blood donors testing ELISA-HBsAg negative and HBV DNA positive in 2017, including ELISA-HBsAg Max s/co, gender, age, residence, education level, blood donation record and alanine aminotransferase(ALT) value. Meanwhile, 99 blood donors with the results ELISA-HBsAg negative and HBV DNA negative were randomly selected as control. Univariate logistic analysis was conducted for possible correlation factors, then multivariate logistic regression analysis was performed for statistically significant observation indicators. The results showed that the Ct value of HBV DNA mixed test in the observation group donor was higher than that of HBV DNA single test (P<0.05). If one of the two ELISA-HBsAg s/co values was within the range of 0.259 to 0.304, the chance of HBV DNA positive was increased. Univariate logistic regression analysis showed that ELISA-HBsAg Max s/co, gender, age, blood donation history and ALT value were all risk factors in the observation group. Multivariate logistic regression analysis showed that ELISA-HBsAg Max s/co, (OR=5352.448, P<0.05), age (OR= 4.527, P<0.05) and blood donation history (OR=0.441) were risk factors. The study concluded that ELISA-HBsAg Max s/co, age and number of blood donations are risk factors for ELISA-HBsAg negative and HBV DNA positive blood donors, women or donors under 26 years of age had the lowest risk.     

Blood Lead Levels in a Welsh Rural Community

In a study of the blood lead levels of 626 healthy blood donors no differences were found between men and women, but there was a significant increase with age. Resident donors had a higher blood lead than students, and the level in residents increased with living in the Aberystwyth area up to about 20 years. The levels in the students did not increase with residence in Aberystwyth. No differences were found in the blood lead of donors living in different wards of Aberystwyth and none between the blood lead of donors living in the rural area and those in the town. Almost half of the local resident donors had a level above the “normal” range.     

Absence of detectable XMRV and other MLV-related viruses in healthy blood donors in the United States

Background

Preliminary studies in chronic fatigue syndrome (CFS) patients and XMRV infected animals demonstrated plasma viremia and infection of blood cells with XMRV, indicating the potential risk for transfusion transmission. XMRV and MLV-related virus gene sequences have also been detected in 4–6% of healthy individuals including blood donors in the U.S. These results imply that millions of persons in the U.S. may be carrying the nucleic acid sequences of XMRV and/or MLV-related viruses, which is a serious public health and blood safety concern.

Methodology/Principal Findings

To gain evidence of XMRV or MLV-related virus infection in the U.S. blood donors, 110 plasma samples and 71 PBMC samples from blood donors at the NIH blood bank were screened for XMRV and MLV-related virus infection. We employed highly sensitive assays, including nested PCR and real-time PCR, as well as co-culture of plasma with highly sensitive indicator DERSE cells. Using these assays, none of the samples were positive for XMRV or MLV-related virus.

Conclusions/Significance

Our results are consistent with those from several other studies, and demonstrate the absence of XMRV or MLV-related viruses in the U.S. blood donors that we studied.     

Update on a titration method for measuring the interferon-producing capacity in humans

To make it possible to measure the interferon-alpha (IFN-alpha) producing capacity in a great number of healthy donors and patients, we developed the simple method (the whole blood method). For the measurement of the IFN-producing capacity, the heparinized blood was incubated with Sendai virus at 37 degrees C for 20 hours. The IFN activity of the culture supernatants was determined by the cytopathic effect inhibition assay. We measured the IFN-producing capacity in 531 healthy donors and 130 cancer patients. The results showed that the IFN-producing capacity in cancer patients was significantly lower than that in healthy donors. Although there were individual variations in the IFN-producing capacity, no age and sex differences were observed. These results indicate that this method is useful for the measurement of IFN-producing capacity in human.     

Hepatitis B antigen in screened blood units for transfusion in renal dialysis patients

Blood units for transfusion are screened routinely in Ontario for the presence of hepatitis B antigen (HB-Ag) by counter-immunoelectrophoresis (CIEP). Since the radioimmunoassay (RIA) method is more sensitive for this purpose we used it to test blood units delivered to the hospital''s Renal Dialysis Unit in order to determine if HB-Ag-carrying blood donors were being missed by the less sensitive CIEP method.Out of the 606 blood units tested, eight were found to contain HB-Ag, an incidence of 13 out of 1000 donors. This finding indicates that the counter-immunoelectrophoresis method is insufficiently sensitive as a safe screening method for detection of hepatitis antigen.     

Blood coagulation and fibrinolysis in blood donors after plasmapheresis]

Authors were interested in blood coagulation proteins and fibrinolysis in blood donors following several plasmaphereses. This interest was related to the occurrence of thrombo-embolic and hemorrhagic complications in these subjects. Blood morphology, serum protein, blood coagulation and fibrinolysis have been examined in 40 healthy blood donors, aged between 19 and 46 years, who gave blood plasma by plasmapheresis technique for 1-59 times. Results did not show any significant changes in blood morphology and serum protein levels prior to and after consecutive plasmaphereses. No significant decrease in blood coagulation proteins and fibrinolysis has been noted. However, a significant increase in factors VIII and IX activities was noted in several blood donors, who underwent the largest number of plasmaphereses. It may predispose these donors to thrombo-embolic complications.     

Antibodies to cytomegaloviruses in blood donors

The use of seronegative blood products is important to prevent transfusion-associated cytomegalovirus infection in immunocompromised patients. We have screened 3,458 normal blood donors for CMV-IgG-antibodies with an ELISA to receive a panel of seronegative donors and to determine the antibody prevalence. 1,948 donors were seropositive. Female donors had higher antibody prevalence than males in each age range tested.     

Immunization with antigen D. Results obtained with 118 volunteers

During the last four years, 118 blood donors have been immunized to obtain plasma with a high level anti-D in order to prepare anti-D immunoglobulins. The results of the immunizing schedule are very successful, as we have obtained anti-D of titer superior to 256 in 96,36% of the cases (Coombs technic). However, the development of unwanted antibodies outside the Rh system (anti-Jka: 6, anti-Fya: 5) has led us since November 1979 to use phenotyped blood without undesirable red blood cell antigens. No irregular antibody has developed since except for an anti-Yta. The anti-HLA have been observed with a frequency of 36%. The use of frozen/thawed and phenotyped blood without undesirable red blood cell antigens can allow to obtain a high level of anti-D without risk for the donors. Nevertheless, the exceptional immunization to a public antigen persists.     

Variation of sex ratio and ABO blood group composition by month of birth of blood donors in Tokyo

Sex ratio of 17,273 blood donors born during the period between 1925 and 1935 was examined according to their month of birth and ABO blood groups in comparison with 5,810 healthy non-blood donors born in the 1900s to 1930s. The sex ratio of the blood donors and the non-blood donors varied similarly according to their month of birth with a prominent peak in summer births and a trough in winter births. This birth season with a high sex ratio was different from that of the general births during the period between 1921 and 1935, in which a maximum sex ratio was found in November. A possible explanation for the difference is the different rate of male and female infant deaths according to birth month. Variation of the sex ratio according to season of birth was not similar among the four ABO blood groups. Sex ratio of the donors with blood group B showed no elevation among the summer births. Non-blood donors with blood group B, on the contrary, showed a higher sex ratio than the others in the summer births. This difference can not be explained by infant or juvenile deaths. A possibility is that a tendency to become a blood donor is modified by the season of one's birth differently according to gender and ABO blood groups.     

Automated data processing system at the National Center for Blood Transfusion

1) Data processing of blood unit test result on Groupamatic with manual labelling listings:--according to unit numbers;--according to blood results. 2) Blood donor file (updating):--114 473 donors;--150 characters/standard donors;--250 characters/precious donors. 3) Automatic print-out of:--call-ups;--donor data cards;--national blood donor cards:--diplomas;--red cards of badges;--particular listings of blood donors for medical checking, calling up, selecting units with special characteristics;--general listings. 4) Automatic labelling of blood units, by reading the unit identification number, and by printing out the corresponding labels.     

Heterozygous defect in HIV-1 coreceptor CCR5 and chemokine production

CC chemokine receptor 5 (CCR5) is a cell entry cofactor for macrophage-tropic isolates of human immunodeficiency virus 1 (HIV-1). An inactive CCR5 allele with a 32-nucleotide deletion (CCR5Delta32) has been described that confers resistance to HIV-1 infection in homozygotes and slows the rate of progression to AIDS in heterozygotes. We found the allele CCR5Delta32 to be not rare in 399 Swiss blood donors with a frequency of 0.080. To assess the influence of defective CCR5 on production of its ligands we determined the capacity to produce the chemokines macrophage inflammatory protein (MIP)-1alpha, MIP-1beta and RANTES in comparison with the production of the CXC chemokine IL-8 which does not bind to CCR5. Production of chemokines was determined during endotoxin stimulation of whole-blood samples ex vivo. Both, basal and LPS-induced chemokine production in 32 blood donors heterozygous for CCR5Delta32 were not significantly different when compared with 55 blood donors who were homozygous for the wild type CCR5 allele.