Reduced risk of transfusion‐transmitted HIV in Kenya through centrally co‐ordinated blood centres,stringent donor selection and effective p24 antigen‐HIV antibody screening

Background Following a 1994 study showing a high rate of transfusion‐associated HIV, Kenya implemented WHO blood safety recommendations including: organizing the Kenya National Blood Transfusion Service (NBTS), stringent blood donor selection, and universal screening with fourth‐generation p24 antigen and HIV antibody assays. Here, we estimate the risk of transfusion‐associated HIV transmission in Kenya resulting from NBTS laboratory error and consider the potential safety benefit of instituting pooled nucleic acid testing (NAT) to reduce window period transmission. Methods From November to December 2008 in one NBTS regional centre, and from March to June 2009 in all six NBTS regional centres, every third unit of blood screened negative for HIV by the national algorithm was selected. Dried blood spots were prepared and sent to a reference laboratory for further testing, including NAT. Test results from the reference laboratory and NBTS were compared. Risk of transfusion‐associated HIV transmission owing to laboratory error and the estimated yield of implementing NAT were calculated. Findings No cases of laboratory error were detected in 12 435 units tested. We estimate that during the study period, the percentage of units reactive for HIV by NAT but non‐reactive by the national algorithm was 0·0% (95% exact binomial confidence interval, 0·00–0·024%). Interpretation By adopting WHO blood safety strategies for resource‐limited settings, Kenya has substantially reduced the risk of transfusion‐associated HIV infection. As the national testing and donor selection algorithm is effective, implementing NAT is unlikely to add a significant safety benefit. These findings should encourage other countries in the region to fully adopt the WHO strategies.     

Blood donors in Kenya: a comparison of voluntary and family replacement donors based on a population‐based survey

Background and Objectives Blood safety and sufficiency are major challenges in Kenya and other sub‐Saharan African countries forcing many countries to rely on family replacement donors (FRD). We analysed data from a national AIDS indicator survey to describe blood donors in Kenya and potential risks of transfusion transmissible infections (TTI) comparing voluntary donors and FRD. Materials and Methods A population‐based, cross‐sectional survey was conducted in 2007 among 15‐ to 64‐ year‐olds. Consenting participants were interviewed about blood donation history and were tested for HIV, HSV‐2 and syphilis. Results Of the 17 940 people surveyed, 445 (2·3%) reported donating blood in the prior 12 months. Sixty‐four per cent were voluntary donors, and the rest were FRD. Compared to FRD, the majority of voluntary donors were < 25 years old (59% versus 18%), from the highest wealth quintile (57% versus 42%) and single (64% versus 23%). In addition, voluntary donors were less likely to have been sexually active than replacement donors (43% versus 13%). HIV prevalence was lower among voluntary donors than among FRD (2·6% versus 7·4%, P‐value = 0·07). Conclusions The majority of blood donors in Kenya are voluntary with lower potential risk of TTI.     

Allergic transfusion reactions from blood components donated by IgA‐deficient donors with and without anti‐IgA: a comparative retrospective study

Background and Objectives IgA deficiency is common (1/500) and up to 40% of affected individuals will develop anti‐IgA. A few studies suggested that passive transfusion of anti‐IgA was not associated with an increased risk of allergic reactions. This study was designed to assess the safety of transfusing blood components containing anti‐IgA. Materials and Methods IgA‐deficient blood donors with and without anti‐IgA were identified from Héma‐Québec’s (HQ) computerized database. IgA deficiency was confirmed by an ELISA method and the presence of anti‐IgA by a passive hemagglutination assay. Blood donations from IgA‐deficient donors issued to hospitals between March 1999 and December 2004 were retrieved. Medical charts of recipients were reviewed for the occurrence of a suspected transfusion reaction. Presence and nature of transfusion reactions were assessed blindly by an adjudicating committee. Results A total of 323 IgA‐deficient blood products were issued by HQ to 55 hospitals. Of these, 48 agreed to participate [315 blood products (97·5%)]. A total of 272 products were transfused: 174 contained anti‐IgA, and 98 did not. Only two minor allergic reactions occurred in each group. Incidence of allergic reactions was 1·15% in the anti‐IgA group and 2·04% in the group without anti‐IgA (P = 0·91). There was no anaphylactic reaction in either group. Conclusions This study indicates that the proportion of allergic reactions does not appear to be greater in recipients of blood components containing anti‐IgA compared to recipients of non‐anti‐IgA‐containing components. Allowing donations from IgA‐deficient donors with anti‐IgA may therefore be contemplated.     

Evaluation of two,commercial, multi‐dye,nucleic acid amplification technology tests,for HBV/HCV/HIV‐1/HIV‐2 and B19V/HAV,for screening blood and plasma for further manufacture

Background The cobas^® TaqScreen MPX Test, version 2.0, a multiplex, multi‐dye nucleic acid amplification technology (NAT) test from Roche was evaluated by two European Blood Banks, the German Red Cross Blood Donor Service, Frankfurt, Germany and Centro de Hemoterapia y Hemodonación de Castilla y León, Valladolid, Spain. In addition, the cobas^® TaqScreen DPX Test was evaluated for the simultaneous detection and quantitation of parvovirus B19 and the detection of hepatitis A virus (HAV). Study Design and Methods The performances of the two tests were evaluated regarding the analytical sensitivity, the reproducibility of the tests using samples containing low concentrations of each virus and cross‐contamination using samples containing high titres of virus. Results The analytical sensitivity of the MPX Test, version 2.0, obtained by the German Red Cross Blood Donor Service was 1·1, 3·9 and 43·3 IU/ml for HBV, HCV and HIV‐1, respectively. The comparable analytical sensitivity at Centro de Hemoterapia y Hemodonación de Castilla y León was 3·5, 17·6 and 50·6 IU/ml for HBV, HCV and HIV‐1, respectively. The analytical sensitivity of the DPX test determined by the German Red Cross Blood Donor Service was 0·6 and 3·8 IU/ml for HAV and B19. Conclusion These multiplex and multi‐dye blood screening assays represent a flexible NAT screening system for mini‐pools between 6 and 96 samples per pool and fulfil all requirements of the European Pharmacopoeia for HCV and B19V testing of plasma for fractionation. The inclusion of a new multi‐dye technology means discriminatory assays are no longer required for either test thus improving workflow, turn‐around time and minimize the risk of obtaining a reactive result for which the virus cannot be identified.     

The blood donation experience: self-reported motives and obstacles for donating blood

Background and Objectives The aim of the study was to investigate motives for donating blood as well as difficulties and obstacles associated with blood donation as perceived by the donors themselves. Materials and Methods Six hundred consecutive blood donors (i.e. all blood donors with a history of at least one previous whole blood donation attending, during nine working days, the Blood Centre of Umeå University Hospital) received a self‐administered questionnaire that contained questions aimed at elucidating motives for donating blood (general motives for donating blood, specific motives for the first donation and motives for continuing to be an active blood donor). Questions concerning difficulties and obstacles that had to be overcome in order to continue being a blood donor were also included in the questionnaire. Results Altogether 531 whole blood donors filled in the questionnaire (88·5%; 322 men and 209 women). No statistically significant differences were found between male and female blood donors concerning general reasons and motives related to donating blood. The most frequently reported reasons for giving blood the first time were ‘influence from a friend’ (47·2% of donors) and ‘request via media’ (23·5% of donors). Among general reasons/motives with highest ranking of importance, the most commonly reported motive for donating blood were ‘general altruism’ (40·3%), ‘social responsibility/obligation’ (19·7%) and ‘influence from friends’ (17·9%). General altruism’ and ‘social responsibility/obligation’ were also the most frequent reasons for continuing to donate blood (68·4 and 16·0%, respectively). The most commonly reported obstacle to becoming a regular blood donor was ‘laziness’ (19·1%) followed by ‘fear of needles’ (10·5%). Conclusions Altruism was the most common general motive for donating blood and also for continuing to be an active blood donor. Yet, for the first blood donation, direct ‘influence from friends/relatives’, ‘media appeal’ and other types of recruitment were more commonly reported as reasons or motives for donating blood than altruism. The findings support the notion that different strategies should be used/adopted to get people to donate blood the first time (e.g. recruitment through other blood donors using, for example, the ‘bring a friend along’ method) and to retain these subjects as active blood donors (e.g. by information and by strengthening their sense of being a blood donor or their self‐efficacy etc.).     

Moving on from voluntary non‐remunerated donors: who is the best blood donor?

Blood transfusion safety in sub‐Saharan Africa (SSA) is marred by the high prevalence of infectious agents, chronic blood shortage and lack of resources. However, considerable pressure is applied by richer countries and international transfusion bodies to establish voluntary, non‐remunerated blood donors (VNRD) as the only source of blood, excluding the traditional family/replacement donors on the grounds of a higher level of safety. Such a policy increases the cost of a unit of blood by two to fivefold and exacerbates the pre‐existing blood shortage. This review provides compelling evidence that first‐time VNRD are no safer than family/replacement donors and that only repeat donation provides improved blood safety. In order to limit blood shortage and maintain affordability of the blood supply in SSA, both types of donors should be accepted and both should be encouraged to donate regularly.     

Peripheral blood cells chimerism after unrelated cord blood transplantation in children: kinetics,predictive factors and impact on post‐transplant outcome

This study aimed to describe kinetics of complete donor chimerism occurrence (cDC, >99·9% donor) after unrelated cord blood transplantation (UCBT), to identify its predictive factors and its impact on post‐transplant outcome. Ninety‐four children who received single UCBT after a myeloablative conditioning regimen had blood chimerism evaluation at predefined post‐transplant dates, using a real‐time polymerase chain reaction method with 0·1% sensitivity. Cumulative incidence of cDC at 1 year post‐transplantation was 61·8%. Three predictive factors were identified in multivariate analysis: history of malignant disease (P = 0·03), older age (above 2·16 years, the first quartile of age, P = 0·0055) and higher level of cord/recipient human leucocyte antigen mismatch (4/6 vs. 5‐6/6, P < 0·001) increased the probability of post‐transplant cDC. Although graft cell dose had a strong impact on haematological recovery, it did not apparently influence cDC occurrence. Early cDC (i.e. more than 99·9% donor chimerism on days 15–30 post‐transplant) appeared useful to predict engraftment (P = 0·003) as well as acute and chronic graft‐versus‐host disease (GvHD). Severe acute or chronic GvHD never occurred in patients with DC ≤99·9%, suggesting than even minimal residual host haematopoiesis is associated with a very low risk of GvHD after UCBT.     

Seroprevalence and risk factors of Toxoplasma gondii infection among healthy blood donors in south‐east of Iran

This prospective cross‐sectional study was aimed to evaluate the prevalence of IgM and IgG anti‐T. gondii antibodies and the associated risk factors among healthy blood donors in Kerman province, south‐eastern Iran. Structured questionnaires (before the donors gave blood) were used to obtain information on risk factors for infection. Totally, 500 serum samples from healthy blood donors of Kerman Blood Transfusion Organization (KBTO) at Kerman, Iran, were screened for IgG and IgM anti‐T. gondii antibodies by enzyme‐linked immunosorbent assay (ELISA) and Roche Elecsys Toxo IgM assay. Real‐time PCR was used to detect DNA of T. gondii in the IgM‐positive samples. Seroprevalence of IgG and IgM anti‐T. gondii antibodies was 28·8% and 3·2%, respectively. In the multiple logistic regression, it could be observed that living in rural regions, having B blood type, being in contact with cats, consuming raw vegetables and raw milk/egg and doing agricultural activities were independent risk factors for Toxoplasma seropositivity. T. gondii DNA was also found in one (9·0%) of IgM‐positive samples. In this study, it was found that T. gondii infection was present among healthy blood donors in south‐east of Iran. Therefore, it is suggested to design screening programmes for preventing transfusion‐transmitted toxoplasmosis.     

The safety of blood donation by elderly blood donors

Background Due to the ageing population, blood donation by the elderly is necessary to maintain blood supply. We initiated a prospective study, to assess whether there is an increased risk of donor reactions in elderly donors. Study Design and Methods In this prospective study, regular donors aged from 66 to 68 and 69 to 71 years were invited to continue blood donation on mobile collection sites of the German Red Cross Blood Service West. A control group (50–52 years) was established. Admission of donors in all groups followed the German national guidelines for blood donation. Donor deferrals and all kinds of donor reactions during donation (on‐site) and in the 48 h following donation (off‐site) were monitored. Results A total of 64 260 valid cases were entered in the study. Donor deferrals increased with age from 1·12% in the control group up to 8·74 in female donors aged 69–71 years. Adverse reactions to blood donation were rare with an overall reaction rate of 0·63% (0·05% on‐site; 0·58% off‐site). Off‐site reactions significantly decreased with increasing age. The relative risk (RR) for adverse reactions in elderly donors compared to the control group (50–52 years) was slightly increased for on‐site reactions in the 69‐ to 71‐year‐old donors (RR 1·0309; 95% CI 1·0292–1·0325). In all other comparisons, the RR for adverse reactions was distinctively lower in elderly donors (RR 0·3785 – 0·7778). Conclusions Our data confirm that elderly regular blood donors may safely continue blood donation at least to the age of 71. Based on these data, we increased the upper age limit.     

Current concepts for quality assured long‐distance transport of temperature‐sensitive red blood cell concentrates

Background and Objectives The German Armed Forces Blood Service in Koblenz supplies red blood cell concentrates (RBCs) to military and civilian institutions at home and to field hospitals during peacekeeping operations abroad. During long‐distance transport, blood products can be exposed to extreme environmental conditions or inappropriate handling, which may compromise product quality. Materials and Methods Different active and passive cooling systems, cooling elements, packaging material and data loggers were examined in a climate chamber. A number of techniques for measuring temperature were investigated in order to preserve the blood products’ quality during transport, including some field tests with multiparametric data recording. Results Any kind of active cooling systems, conventional cooling elements and customary packaging material, as well as temperature‐sensitive labels, minimum–maximum thermometers and intra‐product measurement were found to be unsuitable for military requirement. The best results were obtained when the passively cooling RCB 25 transport box (Dometic) was used together with latent heat/cold storage elements (deltaT) and Junior data loggers (Escort). Conclusion The elaborated protocol allows temperatures to be maintained between 2 and 6°C as required by European guidelines for at least 36 h each and between 1 and 10°C as required by German guidelines for at least 48 or 64 h at ambient temperatures between ?10 and 40°C. Preliminary results indicate that care must be taken concerning additional factors such as air pressure variation or vibration.     

Payment for whole blood donations in Lithuania: the risk for infectious disease markers

Background and Objectives In Lithuania, remuneration for whole blood donations still prevails, with the government covering payment for the donors. The payment per donation in cash is equal to 40 litas (€11·6); it is offered to all blood donors and accepted by the majority of them. Donors who gave blood and received the payment are treated as remunerated donors; those who gave blood and did not take the payment are treated as non‐remunerated ones. The purpose of this study was to assess the risk of payment for whole blood donations and to analyse the prevalence of infectious diseases markers per 100 remunerated and non‐remunerated, first‐time and regular whole blood donations, and to compare the risk ratios of infectious disease markers of remunerated and non‐remunerated whole blood donations in 2005 and 2006 at the National Blood Center in Lithuania. Materials and Methods Whole blood donors were categorized as follows: (i) first‐time donor, remunerated; (ii) first‐time donor, non‐remunerated; (iii) regular donor, remunerated; and (iv) regular donor, non‐remunerated. The blood donations were analysed for the presence or absence of the following infectious disease markers: anti‐hepatitis C virus (anti‐HCV), hepatitis B surface antigen (HBsAg), anti‐human immunodeficiency virus (anti‐HIV ¹/₂) and syphilis. Only confirmed infectious disease markers were classified. To assess the risk of payment for whole blood donations, the prevalence of infectious disease markers per 100 donations in the different donor groups and the risk ratios between the remunerated and non‐remunerated donations were determined. Results The prevalence per 100 first‐time remunerated donations was: for anti‐HCV 1·84 (2005) and 2·98 (2006); for HBsAg 1·73 (2005) and 2·03 (2006); for syphilis 0·67 (2005) and 1·03 (2006). The prevalence per 100 first‐time non‐remunerated donations was: for anti‐HCV 0·93 (2005) and 0·98 (2006); for HBsAg 1·57 (2005) and 1·33 (2006); for syphilis 0·29 (2005) and 0·47 (2006). The first‐time donors who were remunerated for whole blood donations had a significantly higher prevalence of infectious disease markers per 100 donations and a higher risk ratio for at least three infectious disease markers (HBsAg, anti‐HCV and syphilis) as compared to first‐time donors who were non‐remunerated. The regular donors who were non‐remunerated for whole blood donations had the lowest prevalence of all infectious disease markers: anti‐HCV –0·03 (2005) and 0·04 (2005); syphilis –0·06 (2005) and 0·02 (2006); and any positive cases of HBsAg and anti‐HIV ¹/₂ were found both in 2005 and 2006. No statistically significance differences in incidence and risk ratio existed when comparing the regular donations who were remunerated and non‐remunerated. Conclusion The payment for whole blood donors provides a higher risk for infectious disease markers of first‐time donations at the National Blood Center in Lithuania.     

Self‐monitoring of blood glucose changed non‐insulin‐treated Type 2 diabetes patients’ beliefs about diabetes and self‐monitoring in a randomized trial

Aims To determine whether differences in beliefs about diabetes and its treatment resulted from different intensities of self‐monitoring of blood glucose (SMBG) in non‐insulin treated patients with Type 2 diabetes in the Diabetes Glycaemic Education and Monitoring (DiGEM) trial. Methods Patients (n = 453) were randomized to usual care, less‐intensive SMBG and more intensive SMBG. Beliefs about diabetes were measured with a standard questionnaire (the revised Illness Perceptions Questionnaire; IPQ‐R). Changes in beliefs were analysed using analysis of covariance (ancova) with adjustment for baseline values. Mediation analyses assessed whether differences in behavioural outcomes between groups could be attributed to differences in beliefs. Results Completed questionnaires were returned by 339 patients (74.8%). Respondents were mean (± sd ) age 65.9 ± 10 years and with diabetes duration of 4.8 ± 4.7 years (median 36, range 1–384 months). Concerns about the consequences of diabetes increased in both self‐monitoring groups, relative to control subjects [P = 0.004; Cohen's d standardized effect size = 0.19 less intensive and d = 0.36 more intensive monitoring]. No other beliefs about diabetes differed between groups. Beliefs about the importance of self‐testing increased in both self‐monitoring groups relative to the usual‐care group (P < 0.001; d = 0.57 less intensive and d = 0.63 more intensive monitoring). Changes in psychological well‐being did not differ between groups, but control patients reported greater increases in general (P = 0.014) and specific (P < 0.001) dietary adherence than did patients in the self‐monitoring groups. These outcomes were not mediated by intervention‐related changes in beliefs. Conclusions Despite changes in some beliefs about diabetes differing between groups there were no corresponding changes in self‐reported health behaviours. This suggests that changes in illness beliefs resulting from SMBG do not cause changes in diabetes‐related health behaviours.     

Detection of HHV‐8 (human herpesvirus‐8) genomes in induced peripheral blood mononuclear cells (PBMCs) from US blood donors

Background Human herpesvirus‐8 (HHV‐8) causes Kaposi’s sarcoma and can be detected and induced in peripheral blood mononuclear cells (PBMCs) from infected individuals. The prevalence of viral genomes in induced/cultured PBMCs from healthy blood donors has not been systematically studied. Materials and Methods PBMCs from 164 donors were purified and stored as two equal aliquots in liquid nitrogen. One aliquot was used for CD19⁺ B‐cell purification with a fraction reserved for DNA extraction. The second aliquot was cultured for 2 or 4 days in culture media containing n‐butyrate and tetradecanoyl phorbol acetate. DNA was extracted from all four cell sources: PBMCs, purified B cells, induced PBMCs harvested at days 2 and 4 of culture. A sensitive real‐time PCR with a DNA equivalent of 3 × 10⁵ cells per reaction was run in duplicate for all samples along with a quantitative HHV‐8 DNA standard ranging from 1·6 to 200 copies. Results For all 164 donors, HHV‐8 genomes were not detected in the DNA equivalent of 3–6 × 10⁵ of PBMCs and induced/cultured PBMCs with a real‐time PCR assay (95% CI: 0–3·5/164). HHV‐8 DNA was not detected from DNA equivalent of 1·5 (0·5–5·6) × 10⁵ CD19⁺ B cells from 139/164 donors. HHV‐8 antibodies were detected in 7 of the 164 donors (4·3%). Conclusions HHV‐8 genomes were not detected from PBMCs, induced/cultured PBMCs and CD19⁺ B cells from 164 blood donors. The level of detectable HHV‐8 genomes in blood donors seems to be extremely low, if they exist.     

Prospective quality control study of a novel gravity‐driven whole blood separation system suitable for humanitarian crises

Centrifugation‐based whole blood (WB) separation represents the worldwide standard but it depends on electricity and infrastructure. We have prospectively evaluated a novel hollow‐fibre WB separation system that does not require manual priming or blood flow regulation (n = 29). RBC units contained sufficient Hb (50·4 g ± 4·3), low leucocytes (90 000 ± 0·008), exhibited low haemolysis (0·57% ± 0·49) and robust ATP content (51·47% ± 8·2) after 43 days storage. Plasma units contained low leucocytes and mean coagulation factor activities for FV, FVIII and FXI were 47%, 90% and 68%, respectively. RBC met quality specifications but plasma units exhibited reduced FV and FXI activity.     

Impact of ELN recommendations in the management of first‐line treated chronic myeloid leukaemia patients: a French cross‐sectional study

The availability of tyrosine kinase inhibitors has extended therapeutic options for chronic myeloid leukaemia (CML) patients. Monitoring recommendations and clinical response goals have recently been updated. The objective of this study was to describe the profile of CML patients in chronic phase currently receiving first‐line therapy, including treatment, monitoring and response kinetics. A multicentre, cross‐sectional, epidemiological survey in unselected chronic phase CML patients in France attending consultations during a one‐month period was performed. 438 of 697 (62·8%) reported patients were currently receiving first‐line treatment and were analysed. Imatinib was the most frequently received treatment (72·4% of patients). Retrospective cytogenetic and molecular assessments at 3, 6, 12 or 18 months were available in 88·4% of patients. At the 12‐month assessment, 32·2% were not in major molecular response (MMR). At last assessment, among 355 patients with duration of treatment ≥ 12 months, 91·5% had achieved MMR and 66·5% were in deep molecular response. This study, performed in everyday practice population of CML patients, suggests that monitoring of molecular responses in real‐life practice is aligned with European LeukaemiaNet recommendations. The majority of patients still receiving first‐line treatment are in optimal response, with a few being classified as in the warning area or responding to failure.     

Prevalence of leucocyte antibodies in the Dutch donor population

Introduction Donor leucocyte antibodies have been associated with transfusion‐related acute lung injury (TRALI) and can be present in allo‐exposed donors. Donor deferral policies aiming at excluding allo‐exposed donors are increasingly implemented worldwide. We aimed at assessing the prevalence of leucocyte antibodies in different subgroups of allo‐exposed donors in the Dutch donor population. Methods Consecutive donors were enrolled during routine whole blood donation. Donors filled out a questionnaire on allo‐exposure history. Blood samples were tested for human leucocyte antigens (HLA) (LifeScreen Deluxe and the Lifecodes LSA I/II assays) and granulocyte‐reactive (GIFT, GAT, and MAIGA) antibodies. Results Six thousand and thirty‐four consecutive donors (60% men) were included. A total of 2·5% reported a history of blood transfusions, and 51% (of female donors) reported a history of pregnancy. In never allo‐exposed donors, the prevalence of granulocyte‐reactive antibodies was 2·0% (95% CI: 1·6–2·4), and for HLA antibodies, it was 7·0% (95% CI: 6·3–7·8). In previously pregnant donors, the prevalence of granulocyte‐reactive antibodies was increased to 3·0% (95% CI: 2·0–4·0), and for HLA antibodies, it was increased to 33% (95% CI: 30–36). Prevalence of leucocyte antibodies of all types depended on transfusion history, number of pregnancies, time since last pregnancy, and pregnancy outcome. Conclusions Fourteen percent of Dutch blood donors are allo‐immunized against HLA or granulocyte antigens. Deferral of all self‐reported allo‐exposed donors will decrease this prevalence to 9%. Deferral of all female donors and transfused male donors will result in a similar prevalence among remaining donors but approximately twice as many deferrals.     

Next‐generation sequencing is a credible strategy for blood group genotyping

Although several medium/high‐throughput tools have been engineered for molecular analysis of blood group genes, they usually rely on the targeting of single nucleotide polymorphisms, while other variants remain unidentified. To circumvent this limitation a strategy for genotyping blood group genes by next‐generation sequencing (NGS) was set up. Libraries consisting of exons, flanking introns and untranslated regions of 18 genes involved in 15 blood systems were generated by the Ion AmpliSeq^? Library Kit 2.0 and by fragmenting polymerase chain reaction products, normalized by two different approaches, mixed and sequenced by the Ion Torrent Personal Genome Machine (PGM^?) Sequencer. In our conditions, defined to limit both intra‐ and inter‐sample variability, sequences from mixed libraries were read in a single run for a total coverage of 86·03% of the coding DNA sequences, including all loci defining the most clinically relevant antigens in all genes, except ABO. Importantly, the challenging attempt to generate gene‐specific data for the homologous genes was successful. This work, which combines two complementary approaches to generate libraries, defines technical conditions for genotyping blood group genes, illustrates that NGS is suitable for such an application and suggests that, after automation, this novel tool could be used for molecular typing at the laboratory level.     

Psychological and behavioural impacts of the 2008 China earthquake on blood donors

Background and Objectives On May 12, 2008, a severe earthquake hit Sichuan province in China. A post‐earthquake survey was conducted to study the earthquake’s effect on blood donor behaviour and stress at three blood centres at varying distances from the epicentre. Materials and Methods A questionnaire was developed to assess donor post‐traumatic stress disorders (PTSD) and attitudes toward giving blood. Responses were compared by centre and donor characteristics using multivariate logistic regression techniques. Results Of all 17 456 donors, the overall prevalence of PTSD was 13·2%. Donors who knew someone killed or injured by the earthquake were 2·1 times more likely to have PTSD than others (95% CI: 1·8–2·4). 85·2% of donors cited the earthquake as their reason for donating. 16·1% of donors felt it acceptable to be less honest about one’s health history in an emergency. After adjusting for PTSD, geographic and demographic characteristics, the donors knowing someone killed or injured by the earthquake were 1·4 times (95% CI: 1·2–1·7) more likely to cite the earthquake as reason for donating, and 1·8 times (95% CI: 1·5–2·1) more likely to accept being less honest about one’s health history in case of national emergency. Conclusions The psychological and behavioural impacts of the earthquake on blood donors extended far from the epicentre. After a disaster, it is important to emphasize that donors must be truthful on the donor questionnaire as some donors appear willing to be less than honest when they perceive an increased need for blood products.     

Effects of tannic acid on Haemonchus contortus larvae viability and immune responses of sheep white blood cells in vitro

Direct inhibitory effects of tannic acid on Haemonchus contortus viability were studied in vitro using the larval migration inhibition (LMI) assay. Sheep white blood cells (WBC) were preincubated with 5 and 50 μg/mL tannic acid or not followed by whole H. contortus antigen (WHA). Cells were harvested at 24 h post‐incubation to test host immune responses. Concentrations of 50, 100, 500, 1000, 3000 and 5000 μg/mL tannic acid inhibited larvae migration by 19·8, 42·4, 46·3, 92·0, 93·7 and 100%, respectively, within 96 h post‐incubation (P < 0·001). The relative mRNA levels of interferon (IFN)‐γ, interleukin (IL)‐2, IL‐4 and IL‐10 were increased by WHA stimulation without tannic acid. However, the increased effects on IFN‐γ and IL‐2 were inhibited by tannic acid preincubation (P < 0·001), while the increases in IL‐4 and IL‐10 were greatly enhanced by tannic acid preincubation (P < 0·001). Changes in protein levels of all cytokines essentially paralleled the changes in their corresponding mRNA levels. In conclusion, tannic acid is directly harmful to larvae in a dose‐ and time‐dependent manner and modulates immune responses of sheep WBC stimulated by H. contortus antigen by inhibiting Th1 cytokines and increasing Th2 cytokine expression in vitro.     

Two‐drug fixed‐dose combinations of blood pressure‐lowering drugs as WHO essential medicines: An overview of efficacy,safety, and cost

Cardiovascular diseases (CVD) are the world''s leading cause of death. High blood pressure (BP) is the leading global risk factor for all‐cause preventable morbidity and mortality. Globally, only about 14% of patients achieve BP control to systolic BP <140 mm Hg and diastolic BP <90 mm Hg. Most patients (>60%) require two or more drugs to achieve BP control, yet poor adherence to therapy is a major barrier to achieving this control. Fixed‐dose combinations (FDCs) of BP‐lowering drugs are one means to improve BP control through greater adherence and efficacy, with favorable safety and cost profiles. The authors present a review of the supporting data from a successful application to the World Health Organization (WHO) for the inclusion of FDCs of two BP‐lowering drugs on the 21st WHO Essential Medicines List. The authors discuss the efficacy and safety of FDCs of two BP‐lowering drugs for the management of hypertension in adults, relevant hypertension guideline recommendations, and the estimated cost of such therapies.