Donor recruitment programs differ in countries depending on local conditions and causes. Regularly voluntary blood donation rate should be 5% of the population but it is extremely low in Turkey. In 1998, “Thalassemia flowers don’t fade” campaigning was started to get regular voluntary blood for patients with thalassemia. We would like to present results of our campaigning.
Materials and Methods:
The Thalassemia center was established in Antalya on the 1st June 1994 by Ministry of Health, Turkey, because the incidence of thalassemia is very high in the Antalya region. A total of 388 patients with thalassemia were followed up regularly in the center. The annually blood requirement was approximately 5000 units per year. In 1998, a new program of blood donation for patients with thalassemia called “BLOOD MOTHER and BLOOD FATHER” was started with the support of Governor of Antalya and health management system in Antalya.
Between year 1998 and 2006, a total 3000 voluntary blood donors between age 18 and 65 years, of which 2160 males (72%) and 840 were females (28%), had participated in this program.
“Blood Mother and Blood Father” campaign was successful donor recruitment program for thalassemic care. After 2006, this program is now adopted and run by Turkish Red Crescent and Thalassemia Federation of Turkey for all thalassemics in Turkey.
Plasma derived medicines (PDM) including immunoglobulins, clotting factors and albumin are life saving medicines which due to their high costs are inaccessible for many patients living in developing countries. By contrary substantial volume of plasma as raw materials for production of these medicines are discarded worldwide. Good quality recovered plasma, as a result of separation of donated blood into its components, could be used for production of PDM. In 2011 Iranian donors donated about 2 million units of blood. A shift from administration of whole blood to components therapy has resulted in the generation of over 250,000 liters of surplus of recovered plasma. This created a good opportunity for Iran’s health care system to use this plasma for production of PDM. Therefore Iran national transfusion service has started a contract fractionation program for converting recovered plasma into PDM. This program not only provided essential PDM for Iran pharmaceutical market but also has created a direct saving of about 8.5 million Euros in 2011 for national health sector. In addition this program has drastically contributed to improvement of overall quality of working procedures and services provided by Iran national blood transfusion organization.
Iran; Cost effectiveness; Plasma contract fractionation; Blood transfusion service
Though health benefits to households in developing countries from antiretroviral treatment (ART) programs are widely reported in the literature, specific estimates regarding impacts of treatments on household incomes are rare. This type of information is important to governments and donors, as it is an indication of returns to their ART investments, and to better understand the role of HIV/AIDS in development. The objective of this study is to estimate the impact of a community-based ART program on household incomes in a previously underserved rural region of Uganda. A community-based ART program, based largely on labor contributions from community volunteers, was implemented and evaluated. All households with HIV/AIDS patients enrolled in the treatment programme (n = 134 households) were surveyed five times; once at the beginning of the treatment and every three months thereafter for a period of one year. Data were collected on household income from cash earnings and value of own production. The analysis, using ordinary least squares and quantile regressions, identifies the impact of the ART program on household incomes over the first year of the treatment, while controlling for heterogeneity in household characteristics and temporal changes. As a result of the treatment, health conditions of virtually all patients improved, and household incomes increased by approximately 30% to 40%, regardless of household income quantile. These increases in income, however, varied significantly depending on socio-demographic and socio-economic control variables. Overall, results show large and significant impacts of the ART program on household incomes, suggesting large returns to public investments in ART, and that treating HIV/AIDS is an important precondition for development. Moreover, development programs that invest in human capital and build wealth are important complements that can increase the returns to ART programs.
In 2009 the Canadian Blood services launched the Living Donor Paired Exchange Registry. This program circumvents the obstacle presented by blood-group or immunologic incompatibility between a living potential donor and his or her intended recipient. At the beginning, only 3 provinces joined the program, but as of October 2010 all Canadian provinces are participants. Up to now, participating donors have travelled to recipients’ transplant centres. We might question whether, in a country such as Canada, the donor or the organ should travel. In this article, we review the arguments for donor travel and the arguments for shipping the kidney.
We aimed to prove the safety and feasibility of right-sided hand-assisted laparoscopic donor nephrectomy (HALDN).
Materials and Methods
Between May 2006 and May 2009, 16 patients underwent right-sided HALDN at our institution. Of these patients, 15 showed significantly lower renal function in the right kidney than in the left one and 1 had a stone in the right kidney. When the right renal vein was divided, an EndoGIA stapling device was placed on the wall of the inferior vena cava to gain a maximal length of the vein. We evaluated intraoperative and postoperative parameters such as operative time, delivery time, warm ischemic time, estimated blood loss, intraoperative and postoperative complication rates, length of hospital stay, and serum creatinine levels of donors (at the time of discharge) and recipients (4 weeks postoperatively), comparing the right-sided HALDN group (our study) with a left-sided HALDN group (from a previously reported study).
A total of 16 right-sided HALDNs were successfully performed without any complications or open conversion. All of the intraoperative and postoperative parameters were similar between the right-sided HALDN and left-sided HALDN groups. There were no technical problems in the recipients in the anastomosis of the renal vein, and the ureteral anastomoses were also successful.
Right-sided HALDN is safe and technically feasible in a donor, showing favorable graft outcomes. The results of our study suggest that right-sided HALDN may be preferable in patients with significantly lower renal function in the right kidney than in the left one.
Laparoscopy; Living donors; Nephrectomy; Hand
The effect of reducing vCJD transmission by excluding potential blood donors who have received a blood transfusion can be quantified and depends on the absolute number of cases observed or expected.
Variant Creutzfeldt-Jakob disease (vCJD) may be transmissible by blood. To prevent secondary transmission through blood components, several countries have started to exclude as donors persons who have received a blood transfusion. We investigated the effectiveness of this measure by using a dynamic age-structured model. It is the first such model based on epidemiologic data: 1) blood donor activities, 2) a case-control study on CJD, 3) age distribution of recipients, and 4) death of recipients of blood transfusions. The model predicts that an infection like vCJD, which has been introduced into the population by the alimentary route, could not become endemic by transfusion alone and that <1% of cases would be avoided by excluding from blood donation those persons who have received a transfusion.
blood transfusion; blood donors; variant Creutzfeldt-Jakob disease; models; theoretical; biometry; infection; endemic diseases; epidemiology; communicable diseases; emerging; risk assessment; research
Haemovigilance is defined as the surveillance of adverse reactions occurring in donors and in recipients of blood components and as epidemiological surveillance of donors. The ultimate purpose of haemovigilance is to prevent the repetition of adverse events and reactions.
Since the 2002/98/EC Directive came into force, the introduction of haemovigilance systems has become a priority for all countries in the European Community. The Italian haemovigilance system is essentially in line with the Directive, although it does not include surveillance of adverse events in donors and does not have a national level of registration of severe incidents connected with the collection, processing and storage of blood and blood components. Epidemiological surveillance of donors has been performed nationally since 1989 for HIV and since 1999 for HBV, HCV and Treponema pallidum. Surveillance of adverse events in recipients was started at the end of 2004.
Materials and methods
The national form proposed for notifying adverse reactions (PETRA) was prepared by the National Institute of Health and distributed to all Transfusion Structures.
The data collected (adverse reactions, errors, and near miss errors) came from 21.0% of the Transfusion Structures in 2004 and 38.4% in 2005. The system monitored 49.6 % of all the units distributed in Italy. Overall 1,495 adverse reactions were reported, which is equivalent to 0.8 reactions/1,000 units of blood components distributed. There were 16 reports of errors involving transfusions to the wrong patient. Not all the Transfusion Structures sent their data using the PETRA form. From the 986 PETRA forms received, it was possible to analyse the relevance of the transfusion, the outcome of the patient, the type of blood component involved, the type of error and the type of near miss error.
This study is the first Italian report on transfusion errors and adverse reactions.
haemovigilance; transfusion; PETRA; adverse reactions; errors; near miss errors
Robotic-assistance did not improve outcomes associated with laparoscopic donor nephrectomy in this study.
To examine donor and recipient outcomes after right-sided robotic-assisted laparoscopic donor nephrectomy (RALDN) compared with standard laparoscopic donor nephrectomy (LDN) and to determine whether robotic-assistance enhances LDN.
Materials & Methods:
From December 2005 to January 2011, 25 patients underwent right-sided LDN or RALDN. An IRB-approved retrospective review was performed of both donor and recipient medical charts. Primary endpoints included both intraoperative and postoperative outcomes.
Twenty right-sided LDNs and 5 RALDNs were performed during the study period. Neither estimated blood loss (76.4mL vs. 30mL, P=.07) nor operative time (231 min vs. 218 min, P=.61) were significantly different between either group (LDN vs. RALDN). Warm ischemia time for LDN was 2.6 min vs. 3.8 min for RALDN (P=.44). Donor postoperative serum estimated glomerular filtration rates (eGFR) were similar (53 vs. 59.6mL/min/1.73m2, LDN vs. RALDN, P=.26). For the recipient patients, posttransplant eGFR were similar at 6 months (53.4 vs. 59.8mL/min/1.73m2, LDN vs. RALDN, P=.53).
In this study, robotic-assistance did not improve outcomes associated with LDN. Larger prospective studies are needed to confirm any perceived benefit of RALDN.
Robotic donor nephrectomy; Laparoscopic donor nephrectomy; Kidney transplant
The transmission of parasitic organisms through transfusion is relatively rare. Of the major transfusion-transmitted diseases, malaria is a major cause of TTIP in tropical countries whereas babesiosis and Chagas’ disease pose the greatest threat to donors in the USA In both cases, this is due to the increased number of potentially infected donors. There are no reliable serologic tests available to screen donors for any of these organisms and the focus for prevention remains on adherence to donor screening guidelines that address travel history and previous infection with the etiologic agent. One goal is the development of tests that are able to screen for and identify donors potentially infectious for parasitic infections without causing the deferral of a large number of non-infectious donors or significantly increasing costs. Ideally, methods to inactivate the infectious organism will provide an element of added safety to the blood supply.
Parasites; transfusion; transmitted
In most sub-Saharan countries screening of blood-transmitted infections includes mainly HIV, HBV, HCV and syphilis. Many viruses such as Hepatitis G (HGV) and Epstein-Barr virus (EBV) which also carry a risk of transmission by blood transfusion raise the question of the extent of screening for these pathogens. This work aims to evaluate the prevalence of HGV and EBV in first-time blood donors in Ouagadougou.
The prevalence of HGV and EBV in 551 blood donors was 7.4% and 5.4% respectively. HGV prevalence was significantly higher in blood donors with hepatitis B antigens and positive for HCV compared to donors negative for HCV and no hepatitis B antigens (respectively p<0.001 and p=0.004). EBV prevalence was higher among blood donors of < 20 years age group. HBV and HCV positive individuals are not eligible for blood donation.
This study shows significant results with regard to the prevalence of HGV and EBV prevalence in blood donors in Burkina Faso and emphasizes the need for a general screening.
Transplantable organs are scarce everywhere. Therefore, countries have developed policies to support the efficient use of potential donors. Nevertheless, the shortage of organs remains. Were these policies in vain? The aim of this study is to assess the impact of donor policies on donor procurement in 10 Western European countries from 1995 to 2005.
To assess the impact of the donor policies we studied the conversion of potential donors into effectuated donors. 80% of the donors died from CVAs or a (traffic) accident. We considered these mortality rates to be a good proxy for potential donors. Here we call the conversion of potential donors into actual donors 'the donor efficiency rate by proxy'.
The mortality rates for CVA and (traffic) accidents have decreased in the countries under study. At the same time, in most countries the donor efficiency rates have steadily increased. The variance in donor efficiency rates between countries has also increased from 1995 to 2005. Four countries introduced a new consent system or changed their existing system, without (visible) long-term effects.
The overall increase in donor efficiency means that the efforts to improve donor policies have paid off. However, substantial differences between countries were found. The success of donor policies in terms of the number of absolute donors is blurred by the success of policies on traffic safety and CVA treatment. It remains unclear which specific policy measures are responsible for the increase in donor efficiency rates. This increase is not related to having a presumed consent system. Furthermore, an analysis of countries that introduced a new consent system or changed their system showed no effect on donor efficiency.
Antibody to hepatitis E virus (anti-HEV) is prevalent in Western countries, where clinical hepatitis E is rarely reported. The aim of this study was to determine the prevalence of anti-HEV among Danish blood donors and Danish farmers. In addition, we compared the prevalence among 2 sets of serum samples obtained from blood donors 20 years apart.
Samples from 291 Danish farmers and 169 blood donors that were collected in 1983 and samples from 461 blood donors that were collected in 2003 were tested for anti-HEV. Relevant information on HEV exposure was collected by self-administered questionnaire.
Anti-HEV testing was performed on samples after 20 years of storage at −20°C. The prevalence of anti-HEV was 50.4% among farmers and 32.9% among donors in 1983 and 20.6% among donors in 2003 (P < .05). Presence of anti-HEV was significantly correlated with increasing age in all 3 groups (P < .05). Among donors who had serum samples obtained in 2003, age, contact with horses, and the presence of antibody to hepatitis A virus were associated with the presence of anti-HEV in multivariate analysis. Among farmers, only age was independently associated with the presence of anti-HEV.
Anti-HEV was highly prevalent among Danes but has decreased in prevalence over the past 50 years. Our study supports the hypothesis that HEV infection in Denmark may be an asymptomatic zoonotic infection.
Sultanate of Oman is geographically situated in south-west of Asia, having common borders on western side by the land with United Arab Emirates, Saudi Arabia and Yemen and with the Arabian Sea and the Gulf of Oman in the east and the north respectively. The country enjoys one of the best health care facilities including blood transfusion services in the region.
Information was collected through informal personal interviews, digging out the past records, and the report presentations at various forums.
A modest start by providing blood units through import, the country is now self-reliant on procuring blood units from voluntary non-remunerate blood donors within the sultanate. A steady growth of blood banks is witnessed in every aspect of blood banking including blood collection, blood processing and supply. Various modalities are adapted in promoting voluntary blood donation programme.
Sultanate of Oman has created one of the best blood transfusion services in the region in providing safe blood for transfusion through voluntary donation, a use of blood components and irradiating blood products.
Blood transfusion services; voluntary blood donation; national blood transfusion services; Sultanate of Oman
Thalassemia is a hereditary blood disorder that results from genetic defects causing deficient synthesis of hemoglobin polypeptide chains. Although thalassemia mostly affects developing countries, there is limited knowledge of its accurate frequency and distribution in these regions. Knowing the prevalence of thalassemia and the frequency of responsible mutations is therefore an important step in the prevention and control program as well as treatment strategies. This study was performed to determine the prevalence and to study the spectrum of gene deletions that are responsible in α-thalassemia in Kelantan, located in northeastern Malaysia. A total 400 first-time blood donors from multiple areas of donation centre were chosen randomly. The presence of three types of α-thalassemia gene deletion in southeast Asian population which were -SEAdeletion, -α3.7 rightward deletion, and -α4.2 leftward deletion was detected by using multiplex PCR method. 37 (9.25%) of blood donors were confirmed to have α-thalassemia deletion types. 34 (8%) were heterozygous for α3.7 deletion, 1 (0.25%) was heterozygous for α4.2 deletion, and 2 (0.5%) were heterozygous for SEA type deletion. Alpha-thalassemia-2 with 3.7 deletion was the most common determinant detected in Kelantan Malay compared to other ethnic groups. It has been noted that alpha-thalassemia-2 with 3.7 deletion is the most common type of α-thalassemia throughout the world.
Chagas disease is a parasitic disease due to Trypanosoma cruzi, endemic in Central and Southern America, where the protozoon infects about 8–10 million people. In rural areas the infection is acquired mostly through reduviidae insect vectors, whereas in urban ones it is acquired mainly through the transfusion of blood products, vertical transmission and organ transplantation. The important migratory flows of the last decades have focused attention on possible T. cruzi transmission by transfusion also in non-endemic countries, and platelets have been recognised as the main origin of infection for recipients from serologically-positive Latino-American donors.
Materials and methods
In order to avoid the occurrence of transfusion-related cases, in 2010 systematic screening for anti-T. cruzi antibodies was started at the Umberto I Polyclinic in Rome, controlling blood donors born and/or coming from Latin-American countries in which the disease is endemic. The aim of this paper is to report the preliminary results achieved since the introduction of this screening.
Anti-T. cruzi antibodies have been detected to date in 3.9% out of the 128 people examined. A seropositive subject also proved positive by polymerase chain reaction analysis and showed very light parasitaemia.
The preliminary results are quite alarming. Indeed, serological findings exceed those reported in other non-endemic countries, and Italian travellers proved to be an insidious possible source of direct transmission. The need for systematic screening of at-risk blood donors also in non-endemic countries is emphasised.
Trypanosoma cruzi; Chagas disease; screening; transfusion
A 35-year-old mother was scheduled to be the living donor for liver transplantation to her second son, who suffered from biliary atresia complicated with biliary cirrhosis at the age of 2 years. The operative plan was to recover the left lateral segment of the mother’s liver for living donor transplantation. With the use of cholangiography at the time of surgery, we found the right anterior segmental duct (RASD) emptying directly into the cystic duct, and the catheter passed into the RASD. After repairing the incision in the cystic duct, transplantation was successfully performed. Her postoperative course was uneventful. Biliary anatomical variations were frequently encountered, however, this variation has very rarely been reported. If the RASD was divided, the repair would be very difficult because the duct will not dilate sufficiently in an otherwise healthy donor. Meticulous preoperative evaluation of the living donor’s biliary anatomy, especially using magnetic resonance cholangiography and careful intraoperative techniques, is important to prevent bile duct injury and avoid the risk to the healthy donor.
Bile duct injury; Cystohepatic duct; Intraoperative cholangiography; Living liver transplantation; Bile duct injury; Magnetic resonance cholangiography
Blood donors make up the largest group in the United States that is tested for human immunodeficiency virus, type 1 (HIV) antibody. The blood donor population is ideal for detecting and quantifying uncommon or unrecognized modes of HIV transmission in the general population because persons at known risk for HIV infection are excluded from donating blood. The national HIV surveillance program consists of a centralized computer database of information on all donations at selected American Red Cross blood centers, which together account for about a quarter of the blood supply, and all donations at 20 regional blood centers where seropositive blood donors are interviewed to evaluate their risk factors for HIV infection and to determine their epidemiologic characteristics and motives for donation. Trends in HIV prevalence and incidence within specific demographic subgroups are determined for first-time and repeat donors. Combining the trends with HIV-risk profile data from seropositive donors provides a rate for HIV seropositive donors with no identified risk. Epidemiologic and behavioral data from seropositive donors will help in the development and evaluation of future donor deferral strategies.
Loa loa is unique among the human filariae in that adult worms are occasionally visible during subconjuntival migration. A 29-yr-old African female student, living in Korea for the past 5 yr without ever visiting her home country, presented with acute eyelid swelling and a sensation of motion on the left eyeball. Her symptoms started one day earlier and became worse over time. Examination revealed a threadlike worm beneath the left upper bulbar conjunctiva with mild eyelid swelling as well as painless swelling of the right forearm. Upon exposure to slit-lamp illumination, a sudden movement of the worm toward the fornix was noted. After surgical extraction, parasitologic analysis confirmed the worm to be a female adult Loa loa with the vulva at the extreme anterior end. On blood smear, the microfilariae had characteristic features of Loa loa, including sheath and body nuclei up to the tip of the tail. The patient also showed eosinophilia (37%) measuring 4,100/µL. She took ivermectin (200 µg/kg) as a single dose and suffered from a mild fever and chills for one day. This patient, to the best of our knowledge, is the first case of subconjunctival loiasis with Calabar swelling in Korea.
Loa; African Eye Worm; Calabar Swelling; Microfilaremia; Ivermectin
Thalassaemia is a genetic disease that requires a hypertransfusion regimen to treat the anaemia caused by enhanced red blood cell destruction. The only radical cure for thalassaemia is to correct the genetic defect by bone marrow transplantation from an HLA-identical donor capable of producing and maintaining a normal haemoglobin level in the recipient. Complete donor haematopoiesis is not essential for sustained engraftment and the simultaneous presence of haematopoietic cells of both donor and recipient origin is not a rare event after a transplant.
Patients and methods
The evolution of marrow engraftment of 93 transplanted thalassaemic patients, all from Middle East or Asian countries, was monitored by analysis of short tandem repeats.
Forty-three of 93 (46%) patients experienced a status of mixed chimerism early after bone marrow transplantation. Results of further engraftment analysis in these patients showed in 27 complete donor engraftment; rejection occurred in seven, while eight maintained the presence of both host and donor-derived cells. Interestingly, five out of the seven patients who rejected their transplant showed more than 25% residual host cells early after transplantation.
Discussion and conclusion
Our study confirmed that the presence of large amounts of residual host cells within the first 2 months after a transplant is a risk factor for graft rejection also in a group of patients with wide ethnic heterogeneity, irregular transfusion regimens and/or poor chelation treatment. Ten percent of the transplanted thalassaemic patients maintained coexistence of donor and recipient cells, showing a stable functional graft, characterized by normal production of beta globin chains and high levels of haemoglobin. A mechanism responsible for peripheral tolerance induction, such as the production of specific regulatory T-cell clones, seems to play a key role in the induction of long-term tolerance after the transplant.
bone marrow transplantation; mixed chimerism; rejection; thalassaemia
The aim of this paper is to focus on the ethical issues raised by the removal of anonymity from sperm donors. The increasing currency of a 'right to genetic truth' is clearly visible in the drive to revise the legislation on donor anonymity in Western and European countries. The ethical debate is polarized between the 'right to privacy' of the donor or parent and the 'right to know' of the prospective child. However, it is evident that religious, social and cultural attitudes have an overarching impact on attitudes towards sperm donation generally and anonymity specifically. In Asian countries, the social and cultural heritage is hugely diverse and different from those of the West. This review considers the research exploring the complexity of ethical issues informing this debate, and argues that parent's decisions to reveal donor insemination origins to their children are highly complex and relate to a range of social and cultural attitudes that have not been addressed within the policy to remove anonymity from sperm donors.
anonymity; ethics; disclosure; genetic origins; secrecy; sperm donation
An overview of European blood donors shows that the distribution of men and women donors is similar in many countries, with Italy being an exception in that women account for only 30% of donors. Gender medicine is a key issue in this context, even though gender studies are very limited in the transfusion field, whether considered broadly or with specific regards to the selection, management and retention of donors. It, therefore, seemed important to compare the presence of women among blood donors in different European countries and examine the roles that gender is reported to play in the donation of blood in order to identify possible implications for communication with and management of the donor.
To determine the proportion of women among donors in European countries, data were collected from annual reports or documents available on the websites of national associations; furthermore, all papers related to giving blood published in the five main journals in the sector (Transfusion, Vox Sanguinis, Transfusion and Apheresis Science, Transfusion Medicine, Blood Transfusion) were considered; about 80 publications were selected and the gender variable was examined.
The published studies showed that gender plays key roles in the motivation to give blood (women being more altruistic, men being more individualistic) and in adverse reactions, which was a particularly critical problem leading to fewer women become regular donors. A few aspects specific to the management of donors in Italy also emerged.
Gender seems to play an important role in the aspects studied and does, therefore, merit further consideration in relation to strategies to recruit donors and the management of critical events during donation.
donation; blood; gender differences
Reports of successful transplantation of bone marrow obtained from unrelated donors who were histocompatibility leukocyte antigen (HLA) identical prompted the Canadian Red Cross Blood Transfusion Service in Ottawa to assess the possibility of developing a bone marrow donor registry in Canada. We sent a pamphlet that explained the program to 1568 people who had undergone apheresis and asked them to reply, stating their interest. At the same time the pamphlets and a poster were placed in the blood donor clinic. We received 1232 replies (78.6%) from the apheresis donors, 838 (68.0%) of which indicated a willingness to attend information sessions. Of the 7158 people who gave blood during the 3-month study period, 225 (3.1%) were interested. At the time this paper was written 47 information sessions had been held, and 721 people had attended, 624 (86.5%) of whom had signed a consent form. This indicates a clear interest in a bone marrow donation program. We believe that the ethical issues are overcome by requesting the donation before identification of any patient. From our experience a national registry of unrelated donors seems feasible, and steps are being taken to implement such a program.
Hepatitis B (HBV) and C (HCV) infections are a serious global and national public health problem. Earlier studies have reported increasing rates of hepatitis infection in Pakistan, particularly in rural areas. Pakistan has no active surveillance program to monitor trends of these infections. The objective of this study was to verify this trend in blood donors from the rural Sindh area of the country.
The study analysed the data of blood donors of interior Sindh who donated blood at JPMC blood bank from January 1, 2004 to September 15, 2007. HBsAg status was determined by using HBsAg Serodia kit and antibodies to HCV using the Detect HCV ™ V.3 Kit. Samples repeatedly reactive for HBsAg or anti-HCV were considered positive for HBV or HCV infection respectively.
The overall seroprevalence of HBV infection among donors was 6.2 % (95% CI 5.5%–6.9%) and did not change significantly over the study period. Overall seroprevalence of HBV infection in literate blood donors was 5.7 %(95% CI 4.7%–6.8%). Prevalence decreased significantly in this group over the study period (p = 0.05). No other significant trends in seroprevalence of HBV infection were seen in the stratified analyses.
The overall seroprevalence of HCV among donors was 7.5% (95% CI 6.8%–8.3%) and increased significantly over the study period from 7.2% (95% CI 5.8%–8.7%) in 2004 to 8.9% (95% CI 7.4%–10.6%) in 2007 (p = 0.02). Significant increase in seroprevalence was particularly seen in literate (p = 0.03), non–first time (p = 0.01) and Sindhi speaking (p = 0.01) donors.
Our study finds a steady increase in the prevalence of HCV infection in blood donors from interior Sindh between 2004 and 2007. On the contrary, decreasing prevalence of HBV was found, particularly in literate blood donors. There may be a need to have rural community-based epidemiological studies to identify the determinants of the spread of HCV infection and also those that are limiting the spread of HBV infection particularly in the literate blood donor population.
The goal of selecting a healthy blood donor is to safeguard donors and reduce the risks of infections and immunologic complications for recipients.
STUDY DESIGN AND METHODS
To evaluate the blood donor selection process, a survey was conducted in 28 blood transfusion centers located in 15 francophone African countries. Data collected included availability of blood products, risk factors for infection identified among blood donor candidates, the processing of the information collected before blood collection, the review process for the medical history of blood donor candidates, and deferral criteria for donor candidates.
During the year 2009, participating transfusion centers identified 366,924 blood donor candidates. A mean of 13% (range, 0%–36%) of the donor candidates were excluded based solely on their medical status. The main risk factors for blood-borne infections were having multiple sex partners, sexual intercourse with occasional partners, and religious scarification. Most transfusion centers collected this information verbally instead of having a written questionnaire. The topics least addressed were the possible complications relating to the donation, religious scarifications, and history of sickle cell anemia and hemorrhage. Only three centers recorded the temperature of the blood donors. The deferral criteria least reported were sickle cell anemia, piercing, scarification, and tattoo.
The medical selection process was not performed systemically and thoroughly enough, given the regional epidemiologic risks. It is essential to identify the risk factors specific to francophone African countries and modify the current medical history questionnaires to develop a more effective and relevant selection process.
Rare cases of stable allograft acceptance after discontinuation of immunosuppression are often accompanied by macrochimerism (> 1% donor cells in blood) or microchimerism (< 1% donor cells in blood). Here, we have investigated whether persistence of donor cells is the cause or the consequence of long-lasting CTL unresponsiveness. We found that engraftment of splenocytes bearing a single foreign MHC class I–restricted epitope resulted in lifelong donor cell microchimerism and specific CTL unresponsiveness. This status was reversed in a strictly time- and thymus-dependent fashion when the engrafted cells were experimentally removed. The results presented herein show that microchimerism actively maintains CTL unresponsiveness toward a minor histocompatibility antigen by deleting the specific repertoire and thus excluding dominant, T cell extrinsic mechanisms of CTL unresponsiveness independent of systemically persisting donor cell antigen.