Prevalence of transfusion-transmissible viral infections in first-time US blood donors by donation site

BACKGROUND: Understanding the donor base, infectious disease prevalence, and donation loss at various blood donation sites will help maximize blood collection efforts and blood availability. STUDY DESIGN AND METHODS: Using donation data collected at five US blood centers, the prevalence of HIV, HTLV, HBsAg, and HCV in first-time whole-blood donations at 10 donation sites was evaluated: military, education, religious, professional, industry, services, community, health care, government, and fixed sites. Donation loss from screening test reactivity at each donation site was also evaluated. RESULTS: During the study, 1.2 million first-time whole-blood donations were collected. Military and education sites had a low prevalence of all viral markers, except for HBsAg, which was highest at education sites. Variations in viral marker prevalence among donation sites were partially explained by donor demographic differences. Donation loss varied by donation site, ranging from 3.3 percent at education sites to 6.4 percent at industry sites, indicating differential efficiency of blood collection efforts. CONCLUSION: Different rates of positive viral test results and donation loss in first-time whole-blood donors were observed at various types of donation sites. This information may be useful in estimating the yield of usable units from specific blood drives and in allocating resources to meet blood center collection goals.     

Surveillance of risk profiles among new and repeat blood donors with transfusion-transmissible infections from 1995 through 2003 in the Netherlands

BACKGROUND: To evaluate the effectiveness of blood donor selection, this study reports risk profiles of donors with transfusion-transmissible infections as obtained by ongoing surveillance, 1995 through 2003, in the Netherlands. STUDY DESIGN AND METHODS: A surveillance program was installed to monitor risk profiles among new and repeat donors infected with human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), or human T-lymphotropic virus (HTLV), or positive for the presence of syphilis antibodies. At posttest counseling, a physician interviewed donors to clarify possible sources of infection. RESULTS: A total of 167 repeat donors and 404 new donors were interviewed: 33 with HIV, 123 with HCV, 279 with HBV, 21 with HTLV, and 112 with syphilis antibodies. Most HBV, HCV, and HTLV infections were among new donors (80, 85, and 67%), whereas most HIV infections were among repeat donors (79%). Nearly 25 percent of the donors did not report factors at screening that would have deferred them from donating blood. At posttest interviews, new donors with HCV often reported injecting drug use (19%). Repeat donors with HIV often reported male-to-male sex (8/26, 31%). CONCLUSION: A significant level of deferrable behavioral risks was found among donors with confirmed transfusion-transmissible infections that persist despite current donor selection. Reporting such behavior at initial donor selection would have eliminated a substantial part of the infections found. This study argues against relaxing the existing donor deferral of persons practicing male-to-male sex, given their significant proportion of HIV infections among repeat donors. Systematic surveillance of risk factors among infected blood donors provides ongoing information about the effectivity of donor selection and is recommended to evaluate and optimize blood policies.     

献血45d后献血者部分生化和免疫指标变化的研究

目的分析无偿献血者献血后部分生化免疫参数的变化及其对机体功能恢复能力的影响。方法选择生活、工作环境相同,饮食种类和运动量基本一致的献血者250名,年龄18—26岁,按血液采集标准步骤采集外周静脉血,分别测定其总蛋白、白蛋白、总淋巴细胞(CD3)、T辅助细胞(CD4)和T抑制细胞(CD8)浓度(数),45d后再次采集血液测定相同参数并进行比较。结果与献血前比较,所测定的献血后外周血中的生化指标变化无统计学意义(P>0.05);血液中总蛋白和白蛋白浓度均在正常范围内,与献血前比较其浓度明显增加(P<0.05);四色流式细胞仪检测显示,献血后CD3、CD4和CD8均显著增高(P<0.01),CD4/CD8比值变化无统计学意义(P>0.05);此外,还显示献400ml者的总蛋白、白蛋白和总淋巴细胞数有高于献200ml者的趋势。结论献血能启动献血者机体应激反应系统,蛋白合成增加,T细胞亚群比例升高,使机体进入新的平衡状态。     

基于主动召回的全血献血者人口学特征建立东莞地区招募策略的探讨

目的通过对主动召回的全血献血者的人口学特征进行分析,为本地区制定高效的招募策略,解决季节性、结构性和紧急性供血紧张问题提供科学参考依据。方法分析2019年1月~2020年6月通过主动召回并成功献血的21 934名全血献血者在年龄、性别、户籍、职业、血型、文化程度、献血次数、献血地点和召回方式的特征规律,探讨建立本地区的招募策略。结果主动召回的献血者的年龄在36~45岁的占39.79%,男性占69.61%,外地户籍占70.49%,学历为初中至高中的献血者合计占62.96%,职业为普通员工的占36.57%,献血量400 mL的占56.87%,O型血的比例达42.18%,献血2~5次的献血者合计占70.27%,松山湖片区献血者人数最多(23.46%),水乡片区最少(3.26%),通过短信召回的献血者占76.42%。结论在制定本地区招募策略时,首选36~45岁,献血2~5次,曾献血400 mL,初中、中专或高中学历的外地户籍男性普通员工,重点招募区域为松山湖片区、主城区、滨海片区和东南临深片区,并根据不同的招募规模和紧急程度选择不同的召回方式。     

Infectious disease markers in blood donors in northern Thailand

BACKGROUND: A major epidemic of human immunodeficiency virus type 1 (HIV-1) infections that are primarily due to heterosexual transmission has developed in Thailand since 1988. The epidemic has been most severe in northern Thailand. The blood banks in Chiang Mai began screening donors for HIV-1 antibodies in February 1988 and for p24 antigen in April 1992. STUDY DESIGN AND METHODS: The trends of HIV-1 antibody prevalence were analyzed by type of donor (i.e., paid, replacement, and voluntary) for the period of 1988 through 1993. In addition, the prevalence of HIV-1 p24 antigen and of antibodies to syphilis, hepatitis B surface antigen, and hepatitis C virus was evaluated among blood donors at Chiang Mai University Hospital and the Thai Red Cross blood banks in Chiang Mai. RESULTS: The prevalence of HIV-1 antibodies increased from 0.84 percent in 1988 to 4.04 percent in 1991. Seropositivity was highest in paid professional donors. After discontinuation of the use of paid donors in 1993, HIV-1 antibody prevalence decreased to 3.34 percent. Antibody prevalence in replacement donors increased from 0.56 percent in 1988 to 5.82 percent in 1991. Among 44,446 donors tested, 7 (0.016%) were HIV-1 p24 antigen positive but antibody negative. CONCLUSION: The exclusion of paid donors and the use of p24 antigen testing are justified in northern Thailand. Additional strategies to exclude donors at very high risk and to attract those at low risk for infection should be developed and evaluated to increase blood transfusion safety in this and other, similar populations.     

赤道几内亚比奥科岛献血者的输血传播感染疾病血清流行学研究和风险因素评估

目的在比奥科岛上献血人群中开展一次输血传播感染疾病（transfusion—transmissibleinfections,TTIs）的血清流行病学调查。方法用金标法和ELISA对合格献血者血样进行4项输血传播感染疾病的检测,包括人类免疫缺陷病毒（HIV）、乙型肝型病毒（HBV）、丙型肝型病毒（HCV）、梅毒螺旋体（LUES）,同时用多元回归分析方法评估TTIs疾病的相关危险因素。结果在2937名献血者中HIV、HBV、HCV和梅毒螺旋体的感染率分别为7．83％（95％CI：6．85～8．80）、10．01％（95％CI：8．92～11．10）、3．71％（95％CI：3．03～4．39）和21．52％（95％CI：20．02～23．00）。多重混合感染的阳性率是6．30％（95％CI：5．42～7．18）。同时发现女性献血者的HIV和梅毒感染阳性率明显高于男性献血者（HIV：AOR=I．50,95％CI：1．10-2．04,P=0．010;梅毒：AOR=1．27,95％CI：1．02～1．58,P=0．034）。岛上的未规划居住区是艾滋病、乙肝和梅毒感染的显著危险因素（HIV：AOR=I．66,95％CI：1．04～2．66,P=-0．033;HBV：AOR=I．78,95％CI：1．11～2．83,P=-0．016;梅毒：AOR=I．73,95％CI：1．26-2．37,P=-0．001）。结论比奥科岛的献血人群中输血传播感染的阳性率极高,当地政府和卫生部门应采取更有效的干预措施来提高血液安全。     

Cardiovascular disease risk assessment and prevention in blood donors

BACKGROUND: Blood centers have implemented public health initiatives, including cardiovascular disease (CVD) screening, to improve donor and community health and serve as an incentive to donate. STUDY DESIGN AND METHODS: CVD risk screening and counseling were performed at mobile blood drives in diverse neighborhoods. Risk factors were determined by point‐of‐care testing (total cholesterol, high‐density lipoprotein, and hemoglobin A1c levels), interviews, and physical examinations (body mass index, waist circumference, and blood pressure). Results were confidentially relayed to participant by health counselors. A 60‐day follow‐up survey was sent to some participants. RESULTS: Over 11 months, 2406 participants (44% male; mean age 28 ± 16; 67% minority racial/ethnic group) were screened at 290 mobile drives. A total of 92% of participants had medical insurance. A total of 14% had none, 26% one, 33% two, and 27% three or more risk factors. A total of 72% of teenage participants had at least one risk factor. A total of 18% of participants who were taking medications for risks were poorly controlled. A total of 15% had newly identified risks. A total of 711 participants completed follow‐up survey: 21% sought medical care, 51% were motivated to change their lifestyle, 81% were pleased with screening, 48% were more likely to donate, and 62% recommended donation to friends and family because of the screening. CONCLUSION: CVD risk screening and counseling can occur during a mobile blood drive. A majority of participants screened had risk factors. Follow‐up surveys showed that the program was well received. Further studies are planned to evaluate long‐term effects of the program on donor health and donor return rates.     

Human T-lymphotropic virus type I among blood donors from Guadeloupe: donation, demographic, and biologic characteristics

BACKGROUND: Epidemiologic data on human T-lymphotropic virus type I (HTLV-I) in Guadeloupe (French West Indies) are scant. STUDY DESIGN AND METHODS: From January 1989 to December 1996, 59,426 blood donors were screened by enzyme immunoassay for antibodies to HTLV-I. All repeatedly reactive samples were confirmed by Western blot. Temporal trends in HTLV-I seropositivity rates were examined during the study period. A multivariate analysis of donation, demographic, and biologic characteristics was performed. RESULTS: Of the screened blood donors, 195 were confirmed as seropositive, for an overall prevalence of 0.33 percent (95% CI 0.28-0.38). A marked decrease in overall HTLV-I prevalence with time (from 0.47% in 1989 to 0.13% in 1996) was observed, which can be explained mainly by the decreasing percentage of recruited new donors during the study period. Four independent risk factors for HTLV-I were identified: new donor status (odds ratio [OR] 12.5), female sex (OR 1.7), increasing age (30-39 years: OR, 2.4; 40-49 years: OR, 3.7; >50 years: OR 6.6), and positive antibodies to hepatitis B virus core antigen (OR, 1.7). Selection of specific locations for blood collection was inversely associated with HTLV-I (OR 0.5). CONCLUSION: New donor status, advancing age, female sex, and positivity for hepatitis B virus core antibodies were the major factors associated with HTLV-I infection in Guadeloupe.     

Bruising following blood donation, its management and the response and subsequent return rates of affected donors

A study was undertaken to determine the incidence of bruising among blood donors and to analyse their response to the management of this complication. A total of 52 510 donors were bled at 476 consecutive donor sessions held by the Brentwood Centre during a 4-month period. Of these, 344 donors (0.66%) were found to have developed bruises following venepuncture. The incidence of bruising among males was 0. 35% and that among females was 0.98%. All bruised donors were managed by the Centre nursing and medical staff. One hundred and sixty-one donors informed the Centre that they were fully satisfied with the way their bruising was managed. Of 329 bruised donors who remained in the panel, 249 (75.7%) attended subsequent blood donor sessions in response to routine invitations, showing that the majority of bruised donors continued to donate blood. This response was compared with that of a control group of donors who did not develop any complications and there was no significant difference in the return rates between the two groups.     

Adverse effects in blood donors after whole-blood donation: a study of 1000 blood donors interviewed 3 weeks after whole-blood donation

BACKGROUND: There are no reports in the transfusion medicine literature that describe adverse reactions and donor arm injuries after whole-blood donation based on solicited information. STUDY DESIGN AND METHODS: The present study solicited adverse reaction and donor arm injury information from 1000 randomly selected whole-blood donors approximately 3 weeks after the whole-blood donation. Two 16-gauge phlebotomy needles in use were also compared. RESULTS: Thirty-six percent of the donors had one or more adverse effects (AEs). The most common systemic AEs were fatigue (7.8%), vasovagal symptoms (5.3%), and nausea and vomiting (1.1%). The most common arm findings were bruise (22.7%), arm soreness (10.0%), and hematoma (1.7%). Men were half as likely as women to have an AE (23% AE vs. 48% AE, p < 0.0001). Repeat blood donors had fewer AEs than first-time blood donors (36% AE vs. 47% AE, p < 0.007), and African-American donors had numbers of AEs similar to those of Caucasian donors (31% AE vs. 38% AE, p = 0.30). The two phlebotomy needles did not differ in causing blood donor AEs. CONCLUSION: AEs after donation and complaints may be more common than previously thought. The postdonation interview is a good tool for defining the blood donor's experience. It can also be used to evaluate and potentially improve blood donor safety and comfort.     

The impact of male-to-male sexual experience on risk profiles of blood donors

BACKGROUND: Men who have had sex with men (MSM) since 1977 are permanently deferred from donating blood. Excluding only men who engaged in male-to-male sex within either the prior 12 months or 5 years has been proposed. Little is known about infectious disease risks of MSM who donate blood. STUDY DESIGN AND METHODS: Weighted analyses of data from an anonymous mail survey of blood donors were conducted to examine the characteristics of men reporting male-to-male sex during specified time periods. RESULTS: Of the 25,168 male respondents, 569 (2.4%) reported male-to-male sex, 280 (1.2%) since 1977. Compared to donors who did not report male-to-male sex, the prevalence of reactive screening test results was higher among donors who reported the practice within the past 5 years (< or =12 months odds ratio [OR] 5.3, 95% confidence interval [CI] 2.6-10.4; >12 months to 5 years, OR 7.1, 95% CI 1.2-41.7); however, no significant difference was found for donors who last practiced male-to-male sex more than 5 years ago (>5 years-after 1977, OR 1.4, 95% CI 0.7-2.6; 1977 or earlier, OR 1.6, 95% CI 0.7-3.7). The prevalence of unreported deferrable risks (UDRs) other than male-to-male sex was significantly higher for all donors who reported male-to-male sex with ORs ranging from 3.1 to 18.9 (p < or = 0.01). CONCLUSIONS: No evidence was found to support changing current policy to permit donations from men who practiced male-to-male sex within the past 5 years. For donors with a more remote history of male-to-male sex, the findings were equivocal. A better understanding of the association between male-to-male sex and other UDRs appears needed.     

Number of recent sexual partners among blood donors in Brazil: associations with donor demographics, donation characteristics, and infectious disease markers

BACKGROUND: Brazilian blood centers ask candidate blood donors about the number of sexual partners in the past 12 months. Candidates who report a number over the limit are deferred. We studied the implications of this practice on blood safety. STUDY DESIGN AND METHODS: We analyzed demographic characteristics, number of heterosexual partners, and disease marker rates among 689,868 donations from three Brazilian centers between July 2007 and December 2009. Donors were grouped based on maximum number of partners allowed in the past 12 months for each center. Chi‐square and logistic regression analysis were conducted to examine associations between demographic characteristics, number of sex partners, and individual and overall positive markers rates for human immunodeficiency virus (HIV), human T‐lymphotropic virus Types 1 and 2, hepatitis B virus, hepatitis C virus, and syphilis. RESULTS: First‐time, younger, and more educated donors were associated with a higher number of recent sexual partners, as was male sex in São Paulo and Recife (p < 0.001). Serologic markers for HIV and syphilis and overall were associated with multiple partners in São Paulo and Recife (p < 0.001), but not in Belo Horizonte (p = 0.05, p = 0.94, and p = 0.75, respectively). In logistic regression analysis, number of recent sexual partners was associated with positive serologic markers (adjusted odds ratio [AOR], 1.2‐1.5), especially HIV (AOR, 1.9‐4.4). CONCLUSIONS: Number of recent heterosexual partners was associated with HIV positivity and overall rates of serologic markers of sexually transmitted infections. The association was not consistent across centers, making it difficult to define the best cutoff value. These findings suggest the use of recent heterosexual contacts as a potentially important deferral criterion to improve blood safety in Brazil.     

Determinants of repeated blood donation among new and experienced blood donors

BACKGROUND: The maintenance of a safe level of blood supply is provided by a small number of volunteers, and their retention is difficult. The aim of this study was to identify factors predicting repeated blood donation among experienced and new donors. STUDY DESIGN AND METHODS: A random sample of 2,231 donors (2,070 experienced and 161 new) completed a questionnaire assessing psychosocial factors as defined by the most prominent social cognitive theories. Six months later, an objective measure of frequency of registrations to give blood was obtained from the database of the local official agency for blood donation. RESULTS: Logistic regression analysis indicated that for experienced donors, the predictors were intention, perceived control, anticipated regret, moral norm, age, and frequency of blood donation in the past. For new donors, intention and age were the only determinants of behavior. Important differences in the determinants of intention were also noted between experienced and new donors. CONCLUSION: In summary, the results of this study support the idea that distinct promotion strategies should be adopted to increase repeated blood donation among experienced versus new donors.     

论献血者在献血过程中的心理问题

对献血者在献血过程中不同阶段出现的不同心理反应,有针对性地实施心理护理干预,可以有效减少或避免献血反应的发生,保证了献血过程的顺利进行,促进了无偿献血队伍的保留和发展.     

Prevalence of HLA antibodies in remotely transfused or alloexposed volunteer blood donors

BACKGROUND: HLA antibody testing of previously transfused or pregnant donors may help reduce the risk of transfusion‐related acute lung injury (TRALI). However, the prevalence of HLA antibodies in transfused donors has not been well characterized. STUDY DESIGN AND METHODS: Transfusion and pregnancy history was obtained from consenting donors. HLA Class I and II antibody testing was performed by multiantigen bead Luminex platform. Cutoff values for Class I and II antibodies used normalized background ratios of 10.8 and 6.9, respectively. Linear probability models were used to evaluate potential associations between HLA alloimmunization and donor characteristics. RESULTS: A total of 7920 donors (2086 males and 5834 females) were tested. HLA antibody prevalence did not significantly differ between 895 transfused (1.7%) and 1138 nontransfused males (1.0%; odds ratio [OR], 1.75; 95% confidence interval [CI], 0.80‐3.82]. Prevalence in 45 transfused nulliparous females (4.4%; 95% CI, 0.1%‐11.8%) was not different from the 1.6% prevalence in 1732 nontransfused nulliparous females (OR, 2.94; 95% CI, 0.68‐12.74). Transfused parous females had higher prevalence than nontransfused counterparts (p = 0.004; OR, 1.39; 95% CI, 1.07‐1.80). In a linear probability model, the estimated additive risk of transfusion‐induced alloimmunization was only 0.8% (95% CI, ?0.2% to 1.8%; p = 0.10). Donor transfusion history showed that 58% of transfusions occurred more than 10 years previously. CONCLUSION: Transfused volunteer blood donors do not appear to have a significantly higher prevalence of HLA antibodies than their nontransfused counterparts. Thus, in an effort to reduce TRALI risk, ascertaining past history of transfusion and testing these donors for HLA antibodies is not necessary.     

All adverse events in autologous blood donors with cardiac disease are not necessarily caused by blood donation

BACKGROUND: Autologous blood donation before elective cardiac surgery has become a standard of care at many institutions. However, the safety of autologous blood donations by patients with cardiac disease is subject to controversy. CASE REPORTS: Two life-threatening cardiac arrests and one fatal myocardial infarction that occurred in three patients who were scheduled to donate blood for autologous use in elective cardiac surgery are reported. All three patients met the institution's selection criteria for autologous blood donors, and all of them had given written informed consent for their participation in the autologous blood donation program. One of the two cardiac arrests and the myocardial infarction occurred in the patients prior to any blood donations, and the other cardiac arrest occurred 7 days after the patient donated blood uneventfully. CONCLUSION: Life-threatening and fatal adverse events may occur during the donation period in autologous blood donors with cardiac disease. Not all adverse events are necessarily caused by blood donation.     

Evaluation of blood supply operation and infectious disease markers in blood donors during the Egyptian revolution

BACKGROUND: The Egyptian revolution took place on January 25, 2011. Millions of protesters demanded the overthrow of the Egyptian president's regime. Many people suffered from life‐threatening injuries after violent clashes between police and protesters. STUDY DESIGN AND METHODS: The overall management of the blood bank operation at Cairo University Hospital was described, in an attempt to evaluate blood safety and establish a standard effective plan to manage blood supply during crisis. RESULTS: Three days after the uprising, thousands of Egyptians rushed to the hospital to alleviate the blood shortage. A total of 3425 units were collected in 3 days and thousands of donors were turned away. An error delayed processing of 1000 units and they were used as stored whole blood. Apheresis platelets were donated by protesters who were particularly motivated to donate for two victims with liver injury. The usual positive rate of hepatitis C virus (HCV) antibody in Egyptian donors is 3.8%. However, the positive rate of HCV markers in the collected units was only 1.6%. The mean age of donors during the revolution was 31.7 ± 10.4 years while the usual mean age of donors is 39.2 ± 8.5 years. Operating theaters were used only for emergencies. A blood surplus developed that met the hospital needs for 1 month. CONCLUSION: Revolution resulted in an influx of first‐time donors with a relatively low positive rate of HCV antibody. To be prepared for disasters, a systematic approach to spread donors evenly on a daily basis is needed.