Description and evaluation of a canine volunteer blood donor program

Human volunteer blood donor programs are commonplace, but the concept of nonhuman animal blood banking is relatively new. Few studies exist regarding efficacy, donor screening, and safety for volunteer companion animals. This retrospective study evaluated a nonprofit, community-based canine volunteer donor program using community blood drives. Of 98 potential donors, 14 were ineligible to donate, including 4 who tested seropositive for blood-borne pathogens. Of 84 donors, 45 were Dog Erythrocyte Antigen (DEA) 1.1 positive and 39 were DEA1.1 negative. Donations totaling 143 included 29 repeat donors (35%). No serious adverse events occurred. Minor adverse events included acute donor reaction (2.8%), hematoma (4.2%), rebleeding (2.1%), and skin irritation (0.7%). Adverse event rates were comparable to data for human blood donations. A substantial fraction of donors donated multiple times, suggesting that volunteer donors and their guardians perceived the donation process to be safe and effective. This article discusses the issue of donor consent and use of the term volunteer. This study indicates that nonprofit, community-based canine volunteer donor programs for animal blood banks can be successful while maintaining high safety standards and ethical treatment of volunteers.     

Donor vigilance: What are we doing about it?

Donor vigilance is the systematic monitoring of adverse reactions and incidents in blood donor care with a view to improving quality and safety for blood donors. Standard international definitions are available for surveillance purposes. In recent years advances have been made in determining risk factors for vasovagal and other adverse reactions to blood donation as well as in evaluating preventive measures. Blood establishments should record all adverse reactions in blood donors. Besides its use for individual donor care, this information can be reviewed within and between organisations to guide policy decisions and research for improving donor care.     

Evaluation of the autopsy report before releasing musculoskeletal tissue donors; what is the benefit?

EU directive 2006/17/EC requires that all available medical information, including the autopsy report, is evaluated before releasing tissues for transplantation. The study objective was to investigate whether evaluation of autopsy results of musculoskeletal tissue donors contributes to safety and availability of transplantable tissues. The files of all donors of whom musculoskeletal tissues were retrieved by BIS in 2006 were reviewed for death cause and autopsy results. Of 84 donors musculoskeletal tissues were retrieved. In 47 donors autopsy was performed (56.0%). The groups with and without autopsy were similar in sex, age, length, and weight. In one donor no autopsy results were evaluated, since the donor was already rejected because of positive blood tests. In 13 donors (28.1%) death causes before autopsy were unknown. In 12 of these donors a death cause could be established after autopsy. In nine of the donors with a clear suspected death cause (27.3%), the death cause after autopsy differed from the suspected death cause. Four donors with autopsy (8.7%) had a general contraindication for donation, a (possible) sepsis in three and a persisting unknown death cause in one. Eight donors (17.4%) had musculoskeletal-specific contraindications, i.e. local infections. In conclusion, in 26.1% of the donors with autopsy, general or musculoskeletal-specific contraindications for donation were found. Furthermore, performance of autopsies enlarges the potential donor pool, since death causes can be established in almost all autopsies done in case of an unknown death cause. Therefore, evaluation of autopsy results improves the safety and quantity of tissues for transplantation.     

Establishment of a Canine Rabies Burden in Haiti through the Implementation of a Novel Surveillance Program

The Republic of Haiti is one of only several countries in the Western Hemisphere in which canine rabies is still endemic. Estimation methods have predicted that 130 human deaths occur per year, yet existing surveillance mechanisms have detected few of these rabies cases. Likewise, canine rabies surveillance capacity has had only limited capacity, detecting only two rabid dogs per year, on average. In 2013, Haiti initiated a community-based animal rabies surveillance program comprised of two components: active community bite investigation and passive animal rabies investigation. From January 2013 –December 2014, 778 rabies suspect animals were reported for investigation. Rabies was laboratory-confirmed in 70 animals (9%) and an additional 36 cases were identified based on clinical diagnosis (5%), representing an 18-fold increase in reporting of rabid animals compared to the three years before the program was implemented. Dogs were the most frequent rabid animal (90%). Testing and observation ruled out rabies in 61% of animals investigated. A total of 639 bite victims were reported to the program and an additional 364 bite victims who had not sought medical care were identified during the course of investigations. Only 31% of people with likely rabies exposures had initiated rabies post-exposure prophylaxis prior to the investigation. Rabies is a neglected disease in-part due to a lack of surveillance and understanding about the burden. The surveillance methods employed by this program established a much higher burden of canine rabies in Haiti than previously recognized. The active, community-based bite investigations identified numerous additional rabies exposures and bite victims were referred for appropriate medical care, averting potential human rabies deaths. The use of community-based rabies surveillance programs such as HARSP should be considered in canine rabies endemic countries.     

Canadians for Health Research conference

Dentists were surveyed regarding a history of hepatitis and the presence in the blood of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) to determine whether they were at high risk of exposure to hepatitis B virus. Of 288 Canadian dentists 5.2% gave a history of hepatitis after graduation. This proportion is similar to that for 1462 Ontario dentists (6.3%) and that for 3162 accountants (5.1%) who had previously completed a mailed questionnaire. One dentist (0.3%) was HBsAg-positive and 42 (14.6%) were anti-HBs-positive. Of 210 healthy volunteer blood donors matched for age, sex and ethnic origin with the group of dentists none was HBsAg-positive and 2.9% significantly fewer (P less than 0.005), were anti-HBs-positive. Among Ontario blood donors 0.3% were HBsAg-positive and 3% were anti-HBs-positive. Thus, in Canada, dentists are not at increased risk of acquiring clinical hepatitis or becoming carriers, but they are more likely than other groups to have anti-HBs in the blood. Among dentists from outside Canada a higher proportion had a history of hepatitis (10.3%) and were HBsAg-positive (1.6%), but approximately the same proportion were anti-HBs-positive (15.9%).     

Post-Transfusion Hepatitis—A Serious Clinical Problem

Serum hepatitis and infectious hepatitis may have a common pathogen and their few clinical differences the result only of a difference in portal of entry.The risk of serum hepatitis from transfusions derived from prison and Skid Row populations is at least 10 times that from the use of volunteer donors. For every 100 patients receiving a single transfusion, the attack rate is 0.3 per cent when the donor is of the family or volunteer type and 3.2 per cent when the donor is from a prison or Skid Row population.The most practical methods of reducing the hazard of serum hepatitis from blood are to limit the use of blood by giving one transfusion instead of two, two instead of three, etc., and especially by excluding, if possible, all prison and Skid Row donors.It is urged that state and federal control of the quality of blood used for blood transfusions be studied with the possibility that measures may be taken to increase its safety. If it is necessary that blood from prison and Skid Row donors be used to meet the demands, such blood should be labeled as carrying a significantly increased hazard of transmitting serum hepatitis in order that the physician prescribing blood may take the necessary precautions.     

Intracoronary allogeneic cardiosphere‐derived stem cells are safe for use in dogs with dilated cardiomyopathy

Cardiosphere‐derived cells (CDCs) have been shown to reduce scar size and increase viable myocardium in human patients with mild/moderate myocardial infarction. Studies in rodent models suggest that CDC therapy may confer therapeutic benefits in patients with non‐ischaemic dilated cardiomyopathy (DCM). We sought to determine the safety and efficacy of allogeneic CDC in a large animal (canine) model of spontaneous DCM. Canine CDCs (cCDCs) were grown from a donor dog heart. Similar to human CDCs, cCDCs express CD105 and are slightly positive for c‐kit and CD90. Thirty million of allogeneic cCDCs was infused into the coronary vessels of Doberman pinscher dogs with spontaneous DCM. Adverse events were closely monitored, and cardiac functions were measured by echocardiography. No adverse events occurred during and after cell infusion. Histology on dog hearts (after natural death) revealed no sign of immune rejection from the transplanted cells.     

Recruitment of blood donors in Burkina Faso: how to avoid donations from family members?

Burkina Faso is a continental West African country of approximately 16 M people whose transfusion needs were covered by 66,210 blood units collected mostly in 4 regional transfusion centers part of a national network but also from hospital-based smaller blood centers. The first group of blood centers relies almost exclusively on volunteer, non-remunerated, blood donors and only approximately 32.7% of them are repeating donation. In contrast, hospital-based blood centers rely nearly exclusively on family/replacement donors. The general strategy of the national blood transfusion network was to base the system exclusively on volunteer donors, which was nearly accomplished overall and completely at Bobo-Dioulasso, the largest center. However, despite considerable increase in blood collection, the overall blood supply remains low (4.7 units/1000 inhabitants) and worsens during the secondary school recesses since young student blood constitutes the most part of volunteer donors. To overcome such shortages, mobile blood collection sessions are organized in alternate sites such as military barracks or places of worship but with limited success. Another critical issue is that despite considerable efforts and help from community advocates, only 32.7% of volunteers repeat donation limiting the considerably safety advantage of a pool of regular donors.     

Donor issues in Indonesia: A developing country in South East Asia

In most developing countries in South East Asia blood services have not been treated properly as an important service to support health program. Indonesia as a large archipelago country in South East Asia has specific obstacles in managing a blood service. To position the country blood service profile especially in term of donor issues, we compared our blood service with that in other South East Asia countries.Indonesia has 17 thousand islands with 220 million inhabitants. Blood services have been mostly run by the Indonesian Red Cross as a government assignment since 1950. Donor recruitment programs have been directed toward 100% of Voluntary Non Remunerated Blood Donor (VNRD), which now have reached 81.3%. Dissemination of information on VNRD, donor recruiter's training and VNRD appreciation programs are strategies to increase and maintain the VNRD.Limited female donors and insufficient blood supply during the fasting month and holidays constitute major challenges. Low hemoglobin level, low body weight and fear are reasons for low number of female donors. Poor management of blood stock during fasting month, long holidays and also poor networking of blood supply are reasons for insufficient blood supply during the year.Considering the great size of Indonesia with different ethnic groups and cultures, worsened by lack of infrastructure, decisive and effective strategies in donor recruitment and retention programs are needed.     

Exclusion of deceased donors post-procurement of tissues

The EU Tissues and Cells Directive (2004/23/EC, 2006/17/EC, 2006/86/EC) (EUTCD) provides standards for quality and safety for all aspects of banking of tissues and cells for clinical applications. Commission Directive 2006/17/EC stipulates that the complete donor record with all the medical information is assessed for suitability before releasing tissues for clinical use. The aim of this study was to investigate the medical reasons for post-procurement donor exclusion, to identify the various potential sources for gathering information about donors’ medical and behavioural history and to evaluate their contribution to maximising the safety of donations. Information was collected from the Tissue Services (TS) records of 1000 consecutive deceased donors submitted to National Health Service Blood and Transplant (NHSBT) medical officers for authorisation for release for subsequent tissue processing and then for transplantation. Of the 1000 donors 60 (6%) were excluded because they did not fulfil the donor selection requirements of the EUTCD and NHSBT donor selection guidelines. The main reasons for medical exclusion were the presence of significant local or systemic infection in 32 donors (53% of those excluded for medical reasons) and a history of past or occult malignancy in 9 donors (15% of those excluded for medical reasons) which was not identified prior to procurement. The information leading to post-procurement exclusion was obtained from autopsy reports in 35 of the 60 excluded donors for medical reasons (58%) and from the general practitioner for 10 donors (17% of those excluded for medical reasons). In summary, careful evaluation of complete donor records reduces the potential risk of disease transmission by tissue allografts and ensures compliance with regulations and guidelines. The findings may lead to changes in donor selection policies with the aim of improving efficiency without compromising safety.     

Implementing community-based cervical cancer screening programs using visual inspection with acetic acid in India: A systematic review

The objective of this review was to systematically appraise the existing published literature about community-based cervical cancer screening programs that have used visual inspection methods using acetic acid (VIA) in India. All peer reviewed journal articles till December 2015 were searched per PRISMA guidelines. Articles reporting results from cervical cancer screening programs in community-based settings, conducted in India, and using VIA were included in this review. The search resulted in 20 articles to be included in the review with a total of 313,553 women at 12 unique urban and rural sites across India. Seventeen (85%) studies were cross-sectional and three studies were randomized controlled trials; most studies compared accuracy of VIA with other screening tests such as visual inspection using Lugol’s Iodine (VILI), HPV DNA, and cytology. Of studies that reported test accuracy for CIN Grade 2+, the VIA sensitivity values ranged from 16.6–82.6% and specificity ranged from 82.1–96.8%. Women between age groups of 30–59 years were recruited using motivational one-on-one counseling and local support staff. All studies conducted diagnostic follow-up using colposcopy and guided biopsies, when necessary. Three major themes were identified that facilitated implementation of screening programs in a community-based setting: standardized training that maintained competency of test providers; collaborations with community-based organizations that used health education for recruitment of participants; and employing the screen-and-treat method to reduce loss to follow-up. Summarized evidence presented in this review could substantially influence future implementation and sustainment of cervical cancer screening programs at a national level.     

A seroepidemiologic survey of human T-cell lymphotropic virus type I in two Hawaiian hematologic-oncologic practices.

A seroepidemiologic survey for antibodies to the human T-cell lymphotropic virus type I (HTLV-I) was carried out in two Hawaiian hematologic-oncologic practices. Specimens of serum or plasma from 215 donors were assayed using the ELISA technique, followed by the Western blot technique to confirm antibody specificity to HTLV-I. Of 214 seropositive donors, 16 (7.5%) were positive. Of 172 donors of Japanese ancestry, 16 (9.3%) were seropositive; none were white, Chinese, Filipino, or Pacific Islander. One donor contracted the virus through blood transfusions. The results suggest that HTLV-I was introduced to Hawaii with the Japanese immigration.     

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.     

Humoral and cellular CMV responses in healthy donors; identification of a frequent population of CMV-specific, CD4+ T cells in seronegative donors

CMV status is an important risk factor in immune compromised patients. In hematopoeitic cell transplantations (HCT), both donor and recipient are tested routinely for CMV status by serological assays; however, one might argue that it might also be of relevance to examine CMV status by cellular (i.e., T lymphocyte) assays. Here, we have analyzed the CMV status of 100 healthy blood bank donors using both serology and cellular assays. About half (56%) were found to be CMV seropositive, and they all mounted strong CD8+ and/or moderate CD4+ T cell responses ex vivo against the immunodominant CMV protein, pp65. Of the 44 seronegative donors, only five (11%) mounted ex vivo T cell responses; surprisingly, 33 (75%) mounted strong CD4+ T cell responses after a brief in vitro peptide stimulation culture. This may have significant implications for the analysis and selection of HCT donors.     

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.     

Safety and Effectiveness of Mycophenolate in Systemic Sclerosis. A Systematic Review

BackgroundMycophenolate is increasingly being used in the rheumatic diseases. Its main adverse effects are gastrointestinal, myelosuppression, and infection. These may limit use in systemic sclerosis (SSc) since gastrointestinal involvement is common. The objective of this study is to evaluate gastrointestinal adverse events of mycophenolate in SSc. Secondarily we evaluated other adverse events, and the effectiveness of mycophenolate in skin and lung disease.MethodsA literature search of Medline, Embase, Cochrane Central Register of Controlled Trials, and CINAHL (inception-2013) was performed. Studies reporting use of mycophenolate in SSc patients, adverse events, modified Rodnan skin score (MRSS), forced vital capacity (FVC), or diffusing capacity of carbon monoxide (DLCO) were included. The primary outcome was gastrointestinal events occurring after the initiation of mycophenolate. Secondary safety outcomes included myelosuppression, infection, malignancy, and death after the initiation of mycophenolate.Results617 citations were identified and 21 studies were included. 487 patients were exposed to mycophenolate. The mean disease duration ranged between 0.8-14.1 years. There were 18 deaths and 90 non-lethal adverse events. The non-lethal adverse events included 43 (47.7%) gastrointestinal events, 34 (26%) infections, 6 (5%) cytopenias and 2 (2%) malignancies. The most common gastrointestinal events included diarrhea (n=18 (14%)), nausea (n=12 (9%)), and abdominal pain (n=3 (2%)). The rate of discontinuation ranged between 8%-40%. Seven observational studies reported improvement or stabilization in FVC, and 5 studies report stabilization or improvement in MRSS.ConclusionMycophenolate-associated gastrointestinal adverse events are common in SSc, but not severe enough to preclude its use. Observational data suggests mycophenolate may be effective in improving or stabilizing interstitial lung disease, and skin involvement.     

Analysis of potential factors affecting allografts contamination at retrieval

The microbiological contamination of retrieved tissues has become a very important topic and it is a critical aspect in the safety of allografts, especially from multi-tissue donors whose tissues are frequently contaminated as a consequence of retrieval. We analysed a total of 10,107 tissues, 8178 musculoskeletal and 1929 cardiovascular tissues, retrieved from 978 multi-tissue donors. Of these, 159 heart-beating donors (HBD) were also organ donors, while the remaining 819 non-heart-beating donors (NHBD) were tissue donors only. A multivariate logistic model was used to determine the factors affecting contamination risk during retrieval. In the model, the dependent variable was the presence/absence of contamination while the covariates included were: gender, type of donor, age of donor, cause of death, previous skin donation, cadaver time, number of people attending the retrieval, number of tissues retrieved. Moreover, a second log-linear model was used to determine the number of strains isolated per tissue. Tissue contamination was statistically correlated with gender, type of donor, cadaver time, number of people attending the retrieval and season. In conclusion, to minimize the risk of bacterial contamination, aseptic techniques should be used at retrieval, with the number of retrieval team members kept to a minimum. In addition, cadaver time should be as short as possible and the donor should be refrigerated within a few hours after death.     

Skin donors and human skin allografts: evaluation of an 11-year practice and discard in a referral tissue bank

The Saint Louis hospital tissue bank provides skin allografts to pediatric and adult burn units in the Paris area. The aim of this study was to analyze our activity during the last 11 years focusing on the reasons for skin discard. Skin is procured solely from the back of the body, which is divided into 10 zones that are harvested and processed separately. This retrospective study included all skin donors harvested between June 2002 and June 2013, representing a total of 336 donors and 2770 zones. The donors were multiorgan heart-beating donors in 91 % of cases (n = 307). The main reason for discarding harvested skin was microbial contamination, detected in 99 donors (29 %). Most contaminants were of low pathogenicity. Other reasons for discard included positive serologic tests for 2 donors [17 zones (0.61 %)], unsuitable physical skin characteristics for 3 zones (0.11 %), the donor’s medical history for 53 zones (1.91 %), and technical issues with processing or distribution for 61 zones (2.2 %). In our experience, microbial contamination continues to be the main reason for discarding potential skin allografts. However, discards are limited by separate harvesting and processing of multiple zones in each donor.     

Donor Safety in Living Donor Liver Transplantation: A Single-Center Analysis of 300 Cases

Aim

To evaluate the safety to donors of living-donor liver transplantation.

Methods

This study included 300 consecutive living liver tissue donors who underwent operations at our center from July 2002 to December 2012. We evaluated the safety of donors with regard to three aspects complications were recorded prospectively and stratified by grade according to Clavien’s classification, and the data were compared in two stages (the first 5 years’ experience (pre-January 2008) and the latter 5 years’ experience (post-January 2008); laboratory tests such as liver function and blood biochemistry were performed; and the health-related quality of life was evaluated.

Results

There was no donor mortality at our center, and the overall morbidity rate was 25.3%. Most of the complications of living donors were either grade I or II. There were significantly fewer complications in the latter period of our study than in the initial period (19.9% vs 32.6%, P<0.001), and biliary complications were the most common complications, with an incidence of 9%. All of the liver dysfunction was temporary; however, the post-operative suppression of platelet count lasted for years. Although within the normal range, eight years after operation, 22 donors showed lower platelet levels (189×10⁹/L) compared with the pre-operative levels (267×10⁹/L) (P<0.05). A total of 98.4% of donors had returned to their previous levels of social activity and work, and 99.2% of donors would donate again if it was required and feasible. With the exception of two donors who experienced grade III complications (whose recipients died) and a few cases of abdominal discomfort, fatigue, chronic pain and scar itching, none of the living donors were affected by physical problems.

Conclusion

With careful donor selection and specialized patient care, low morbidity rates and satisfactory long-term recovery can be achieved after hepatectomy for living-donor liver transplantation.     

Severe papillomavirus infection progressing to metastatic squamous cell carcinoma in bone marrow-transplanted X-linked SCID dogs

Canine X-linked severe combined immunodeficiency (XSCID) is due to mutations in the common gamma chain (gammac) gene and is identical clinically and immunologically to human XSCID, making it a true homologue of the human disease. Bone marrow-transplanted (BMT) XSCID dogs not only engraft donor T cells and reconstitute normal T-cell function but, in contrast to the majority of transplanted human XSCID patients, also engraft donor B cells and reconstitute normal humoral immune function. Shortly after our initial report of successful BMT of XSCID dogs, it soon became evident that transplanted XSCID dogs developed late-onset severe chronic cutaneous infections containing a newly described canine papillomavirus. This is analogous to the late-onset cutaneous papillomavirus infection recently described for human XSCID patients following BMT. Of 24 transplanted XSCID dogs followed for at least 1 year post-BMT, 71% developed chronic canine papillomavirus infection. Six of the transplanted dogs that developed cutaneous papillomas were maintained for >3 1/2 years post-BMT for use as breeders. Four of these six dogs (67%) developed invasive squamous cell carcinoma (SCC), with three of the dogs (75%) eventually developing metastatic SCC, an extremely rare consequence of SCC in the dog. This finding raises the question of whether SCC will develop in transplanted human XSCID patients later in life. Canine XSCID therefore provides an ideal animal model with which to study the role of the gammac-dependent signaling pathway in the response to papillomavirus infections and the progression of these viral infections to metastatic SCC.