Serological ineptitude in blood banks: is there an association with sexually transmitted infections? / Inaptidão sorológica em bancos de sangue: existe associação com infecções sexualmente transmissíveis?

Introduction: Sexually transmitted infections (STIs) are a serious public health problem, and some of these infections are also transmitted through blood transfusions. Objective: To identify publications in scientific journals in Brazil and in the world showing if there is an important association between serological inadequacy due to sexually transmitted infections traced in blood and blood products used for medical use. Methods: Systematic review of articles published from 2018 to 2023, using the LILACS, SciELO and PubMed databases, with a concomitant approach to the issues of serological disability and STI. Original studies or review articles in Portuguese, English and Spanish with Brazilian and international data were included. Editorial publications, letter to the editor, letter from the editor or comments on the subject were excluded. Results: The search found 571 articles, of which 106 (18.40%) met the inclusion criteria, that is, Serological disability and STI. In studies with international data, the prevalence of donors with hepatitis C ranged from 0.12 to 4.8%; with hepatitis B, from 1.3 to 8.2%; with HIV, from 0.0021 to 2.5%; with syphilis, from 1.73 to 2.4%; with HTLV, 0.66%; and with Chagas disease, from 0.017 to 2.76%. Among articles with Brazilian data, the prevalence of donors with seroreactive tests for hepatitis C ranged from 0.18 to 1.76%; with hepatitis B, from 0.05 to 7.9%; with HIV, from 0.03 to 0.82%; with syphilis, from 0.37 to 3.51%; with HTLV, from 0.02 to 0.3%, and with Chagas disease, from 0.8 to 0.5%. Conclusion: STIs are rarely discussed in the scientific literature in studies on serological inadequacy. In addition, a minority of articles were with Brazilian data. However, results show that STIs, despite being little discussed in the scientific literature in studies on the subject of serological inadequacy, have statistically significant percentages of seropositivity for STIs. Moreover, hepatitis C and B have a relevant seroprevalence, reaching 8.2% and 4.8%, respectively, in the international scenario. In Brazil, hepatitis B continues to occupy a prominent place with a seroprevalence of up to 7.9%. However, syphilis now holds a very important role, with a maximum percentage of 3.51%. More studies are needed for further reflection: although STIs are little addressed in studies about serological inadequacy in human blood banks, would they contribute to the maintenance and non-reduction of the general frequency of infections transmitted by blood transfusion

Introdução: As infecções sexualmente transmissíveis (IST) são um grave problema de saúde pública e algumas dessas infecções, também, transmitidas por intermédio de transfusões de sangue. Objetivo: Identificar publicações em periódicos científicos no Brasil e no mundo sobre se existe importante associação entre inaptidão sorológica por infecções sexualmente transmissíveis rastreadas em sangue e hemoderivados usados para uso médico. Métodos:Revisão sistemática de artigos publicados no período de 2018 a 2023, usando as bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Scientific Electronic Library Online (SciELO) e United States National Library of Medicine (PubMed) com abordagem concomitante para os assuntos de inaptidão sorológica e IST. Incluíram-se estudos originais ou artigos de revisão nos idiomas português, inglês e espanhol com dados brasileiros e internacionais. Foram excluídas publicações do tipo editorial, carta ao editor, carta do editor ou comentários sobre o tema. Resultados:A busca localizou 571 artigos dos quais 106 (18,40%) se encaixavam nos critérios de inclusão, ou seja, inaptidão sorológica e IST. Em estudos com dados internacionais, a prevalência de doadores com hepatite C variou de 0,12 a 4,8%; com hepatite B de 1,3 a 8,2%; com HIV de 0,0021 a 2,5%; com sífilis de 1,73 a 2,4%; com HTLV 0,66%; e com doença de Chagas de 0,017 a 2,76 %. Já entre os artigos com dados brasileiros, a prevalência de doadores com exames soro-reatores para hepatite C variou de 0,18 a 1,76%; com hepatite B de 0,05 a 7,9%; com HIV de 0,03 a 0,82%; com sífilis de 0,37 a 3,51%; com HTLV 0,02 a 0,3%, e com doença de Chagas de 0,8 a 0,5%. Conclusão: As IST são pouco abordadas na literatura científica em estudos com o tema inaptidão sorológica. Além disso, uma minoria de artigos era com dados brasileiros. Entretanto, resultados demonstram que, apesar de pouco abordadas na literatura científica em estudos com o tema inaptidão sorológica, as IST possuem percentuais de soropositividade estatisticamente significativos. Além disso, as hepatites C e B possuem soroprevalência relevante, podendo chegar a 8,2 e 4,8%, respectivamente, no cenário internacional. Já no cenário nacional, brasileiro, a hepatite B continua ocupando um lugar de destaque, com soroprevalência de até 7,9%. Todavia, a sífilis passa a ocupar um papel de altíssima relevância, com percentual máximo de 3,51%. São necessários mais estudos para mais reflexão: apesar de as IST serem pouco abordadas em estudos acerca da inaptidão sorológica em bancos de sangue humano, seriam elas contribuintes para a manutenção e a não redução da frequência geral de infecções transmitidas por transfusão sanguínea?

Serorreacción y prevalencia de sífilis en donantes de un banco de sangre de Barranquilla, Colombia / Seroreactivity and prevalence of syphilis in donors at a blood bank in Barranquilla, Colombia

Resumen Introducción. La sífilis es una enfermedad de interés en salud pública por sus elevadas tasas de morbilidad y mortalidad. Objetivo. Determinar la serorreacción y la seroprevalencia de sífilis según las variables sociodemográficas de los donantes de un banco de sangre del distrito de Barranquilla, Colombia, durante 2015 y 2016. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal basado en los resultados de las pruebas treponémicas y no treponémicas. Se analizaron las variables sociodemográficas de la población estudiada y se hizo un análisis univariado en el que se determinaron las frecuencias absoluta y relativa de cada una de las variables categóricas. Se determinó la serorreacción a Treponema pallidum y la prevalencia de la infección activa. Se utilizó la prueba de ji al cuadrado de Pearson para evaluar las diferencias entre las proporciones. Resultados. Se encontró una serorreacción de 1,86 % para la infección previa con T. pallidum y una prevalencia de 0,93 % para la infección activa, las cuales fueron más altas en hombres adultos y en adultos mayores, viudos, desempleados y personas residentes en otros municipios del departamento de Atlántico diferentes de Barranquilla y su área metropolitana. Se encontró una asociación significativa entre la sífilis y las variables de sexo y ocupación. Conclusión. Se registró una serorreacción elevada a T. pallidum en donantes de sangre, comparada con el promedio nacional. Se encontró asociación entre la sífilis, y las variables sociodemográficas de sexo y ocupación, principalmente.

Abstract Introduction: Syphilis is a public health concern given its high impact on morbidity and mortality. Objective: We aimed to determine the association of syphilis seroreactivity and seroprevalence with sociodemographic variables of donors at a blood bank in the district of Barranquilla, Colombia, during 2015 and 2016. Materials and methods: We conducted a descriptive cross-sectional study based on the results of the treponemal and nontreponemal tests and the sociodemographic variables of the study population. We performed a univariate analysis to determine the absolute and relative frequencies for each categorical variable. We determined the seroreactivity against Treponema pallidum and the prevalence of active syphilis infection, and we used Pearson's chi-square test to evaluate the differences between the proportions. Results: We found a seroreactivity of 1.86% in individuals with previous T. pallidum infection, and a prevalence of 0.93% in those with active T. pallidum infection. These values were higher in adult men and older adults, widowers, the unemployed, and people living in municipalities of the Department of Atlántico other than Barranquilla and its metropolitan area. The incidence of syphilis infection showed a significant association with sex and occupation. Conclusion: In comparison to the national average, syphilis seroreactivity was high among blood donors. There was an association between syphilis infection incidence and sociodemographic variables such as sex and occupation.

Prevalencia del virus linfotrópico de células T humanas (HTLV) I/II en donantes de sangre / Prevalence of Human T-Lymphotropic Virus HTLV I/II among Blood Donors

La transmisión de infecciones por vía transfusional (sangre y derivados plasmáticos) es una complicación de gran importancia en relación con la morbimortalidad en receptores de sangre, lo que ha creado la necesidad de establecer estrategias de prevención que reduzcan o eliminen este riesgo. Como enfoque principal este estudio pretendió determinar la prevalencia del virus linfotrópico de células T humanas (HTLV) I/II en donantes que acuden a un banco de sangre hospitalario, además de abordar de manera documental y experimental la importancia de la implementación de dicha prueba, durante el tamizaje rutinario para unidades de sangre. Se utilizó el inmunoanálisis quimioluminiscente de micropartículas (CMIA) que detecta la presencia de anticuerpos contra antígenos del HTLV-I/II en el suero del donante y que se basa en la emisión de quimioluminiscencia. En el periodo de estudio se realizaron 650 pruebas que representan el 6.5% del total anual de donantes atendidos en un banco de sangre hospitalario. Los resultados indicaron que la prevalencia del HTLV I/II en esta muestra de donantes fue de 0.15%, con un intervalo de confianza del 95-99.5% [0.14, 0.29], sugiriendo que la inclusión de la determinación de HTLV I/II en las pruebas obligadas por la Ley de Servicios de Medicina Transfusional y Bancos de Sangre, Decreto 87-97 de Guatemala es de importancia considerando los datos obtenidos y analizados.

The infections transmitted via blood transfusion (blood and plasma derivatives) are a complication of great importance in relation to morbidity and mortality in blood recipients, what has created the need to establish prevention strategies that reduce or eliminate this risk. The main focus of this study was to determine the prevalence of Human T-Lymphotropic Virus HTLV I/II among blood donors who attend a Hospital Blood Bank, in addition to addressing in a documental and experimental way, the importance of the implementation of this test during the routine screening of blood units. To this end, a chemiluminescent microparticle immunoassay (CMIA) was used to detect the presence of antibodies to HTLV-I/II in plasma from donors. In the study period, 650 samples were tested, representing 6.5% of total annual donors attending the Hospital Blood Bank. Results indicated that the prevalence of the Human T-Lymphotropic Virus HTLV I/II in this population was 0.15%, with the confidenceinterval of 95-99.5% [0.14, 0.29], suggesting that the inclusion of the determination of HTLV I/II in tests required by the Law of Services of Transfusion Medicine and Blood Banks, Decree 87-97 of Guatemala is of importance considering the data obtained and analyzed.

Control de calidad del volumen de hemocomponentes obtenidos mediante equipo fraccionador automatizado COMPOMAT en el Servicio de Hemoterapia y Banco de Sangre del HNDAC - 2011 / Quality control of the volume of blood components obtained by automated fractionator equipment Compomat in Service of Hemotherapy and Blood Bank at the HNDAC - 2011

OBJETIVO: El objetivo del presente Trabajo de Investigación ha sido realizar el Control de Calidad del Volumen de los diferentes hemocomponentes obtenidos mediante el Equipo Fraccionador Automatizado COMPOMAT en el Servicio de Hemoterapia y Banco de Sangre del Hospital Nacional Daniel A. Carrión durante el año 2011, el mismo que se ha desarrollado en forma individualizada, considerando exclusivamente el volumen y en el 100 por ciento de hemocomponentes producidos. MATERIALES Y METODOS: Para la realización del presente Trabajo de Investigación se ha utilizado el Equipo Automatizado COMPOMAT con el programa de fraccionamiento para Bolsas colectoras de sangre cuádruples con anticoagulante SAG Manitol y sistema de tubuladura superior e inferior (TOP and BOTTOM). Al realizar el procedimiento se registró todos los volúmenes de los hemocomponentes fraccionados como son 2140 unidades de paquete globular, 2093 unidades de plasma fresco congelado y 1851 concentrados de plaquetas. El trabajo se desarrolló en el área de fraccionamiento sanguíneo del Servicio de Hemoterapia y Banco de Sangre del Hospital Nacional Daniel A. Carrión de la Región Callao, durante el periodo comprendido desde el mes de Octubre del año 2010 al mes de Marzo del año 2011 en que los datos obtenidos fueron registrados manualmente en un programa Microsoft Excel 2007 para el procesamiento de los mismos y para la realización de Curvas de Control de Calidad de Levey Jennings. RESULTADOS: De los 2140 paquetes globulares procesados, un 77 por ciento cumple con los parámetros de calidad establecidos para volumen. De los 2092 plasmas frescos congelados, el 98 por ciento cumple con los parámetros de calidad establecidos para volumen. De los 1851 concentrados de plaquetas procesadas, el 95 por ciento cumple con los parámetros de calidad establecidos para volumen. CONCLUSIONES: Se concluye que el volumen de los hemocomponentes obtenidos, tanto Paquete Globular, como Plasma Fresco Congelado y Plaquetas, cumple...

Individual donor nucleic acid testing for blood safety against HIV-1 and hepatitis B and C viruses in a tertiary care hospital.

Background. In July 2010, we started universal individual donor nucleic acid testing (ID-NAT) at our blood bank. This test simultaneously detects human immunodeficiency virus-1 (HIV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) in samples of donor blood. We continued to do the enzymelinked immunosorbent assay (ELISA) test for these agents, as per the guidelines of the Drug Controller General of India. We assessed the impact of ID-NAT in preventing transfusionassociated transmission of viruses. Methods. We used fourth generation ELISA to screen blood samples of all voluntary and replacement blood donors. ID-NAT was done by transcription-mediated amplification (TMA). Results. Of the 18 356 donors, ID-NAT could not be performed on 2 samples which were inadequate. Of the 18 354 donors tested by both ID-NAT and fourth generation ELISA, 7 were found to be NAT-positive but ELISA-negative (NAT yield) for HBV and HCV. The prevalence of NAT yield cases among routine donors was 1 in 2622 donations tested (0.038%). Since we supply blood as components (packed red cells, fresh frozen plasma and platelet concentrate), these 7 units of blood would have yielded 21 components and hence 21 patients could have been infected with HBV and HCV viruses. Conclusion. In the vast majority of blood units tested, the results of ELISA and ID-NAT for HIV-1, HBV and HCV were concordant. ID-NAT did detect the presence of viruses missed by ELISA in some blood units. It widespread use in blood banks would ensure safer blood transfusion.

Assessment of performance of professionals in immunohematology proficiency tests of the public blood bank network of the state of Minas Gerais

BACKGROUND: Despite significant advances, the practice of blood transfusion is still a complex process and subject to risks. Factors that influence the safety of blood transfusion include technical skill and knowledge in hemotherapy mainly obtained by the qualification and training of teams. OBJECTIVE: This study aimed to investigate the relationship between professional categories working in transfusion services of the public blood bank network in the State of Minas Gerais and their performance in proficiency tests. METHODS: This was an observational cross-sectional study (2007-2008) performed using a specific instrument, based on evidence and the results of immunohematology proficiency tests as mandated by law. RESULTS: The error rates in ABO and RhD phenotyping, irregular antibody screening and cross-matching were 12.5%, 9.6%, 43.8% and 20.1%, respectively. When considering the number of tests performed, the error rates were 4.6%, 4.2%, 26.7% and 11.0%, respectively. The error rates varied for different professional categories: biochemists, biologists and biomedical scientists (65.0%), clinical pathology technicians (44.1%) and laboratory assistants, nursing technicians and assistant nurses (74.6%). A statistically significant difference was observed when the accuracy of clinical pathology technicians was compared with those of other professionals with only high school education (p-value < 0.001). This was not seen for professionals with university degrees (p-value = 0.293). CONCLUSION: These results reinforce the need to invest in training, improvement of educational programs, new teaching methods and tools for periodic evaluations, contributing to increase transfusion safety and improve hemotherapy in Brazil.

[Haemovigilance]

Haemovigilance is defined as a set of surveillance procedures from the collection of blood and its components to the follow-up of recipients, denoted to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence or recurrence. In this system the complications of blood transfusion are systematically collected and reported and data of adverse effects of blood transfusion are analyzed and a series of corrective measures are performed to prevent the recurrence of them. Another goal of haemovigilance is documentary collections of blood transfusion cases which eventually leads to conducting and promoting blood transfusion in hospitals. Haemovigilance only works if complications of blood transfusion are early detected and reported

Umbilical cord blood: Current status & promise for the future.

Umbilical cord blood (UCB) has been shown to be a suitable source of haematopoietic stem cells (HSCs) for haematopoietic reconstitution. An increase in the number of UCB transplants indicates an expansion of utility in a broad spectrum of disease conditions. Along with the advantages, UCB also has limitations, and hence several investigators are working to further optimize UCB for this use. Beyond haematopoietic transplantation, additional potential applications of UCB include immunotherapy, tissue engineering and regenerative medicine. UCB banking has improved with time largely due to involvement of professional organizations and their published standards. However, accreditation of these organizations remains voluntary, and in India three of ten banks are public with the remaining being private. Only one public and one private bank are American Association of Blood Banks (AABB) accredited in India. Government agencies need to provide regulatory and safety oversight, which is lacking in serveral countries. Public policy regarding UCB is in its infancy throughout most of the world. Ethical issues, including access to UCB banking and use as therapy for diseases other than haematological and metabolic disorders are in the early phase of trials and remain speculative.

Creación de la red de servicios de medicina transfusional y bancos de sangre del Ministerio de Salud Pública y Asistencia Social, para su regionalización y categorización: acuerdo ministerial No. 529-2011 / Creation of the network of transfusion medicine services and blood banks of the Ministry of Public Health and Social Assistance, for its regionalization and categorization: ministerial agreement No. 529-2011

El objetivo de crear esta red, es la de integrar todos los servicios de la medicina transfusional y los bancos de sangre. En el documento se establecen las funciones de la mencionada red. Incluye las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada centro, incluidos el equipo y recurso humano y técnico. Enumera la ubicación de los distintos centros de medicina transfusional y los bancos de sangre, destacando como de "referencia" los de los hospitales San Juan de Dios y Roosevelt, los mismos cuentan con los dos bancos principales de sangre del país. Hace la diferencia entre un banco de sangre regional y un centro de trasfusión, detallando igualmente la infraestructura, características, servicios y personal de estos últimos.

Evaluación de un Inmunoensayo de partículas en gel para la determinación de anticuerpos contra Treponema pallidum en donantes de sangre / Evaluation of a particle gel immunoassay for determination of antibodies against Trepanoma pallidum in blood donors

El tamizaje de laboratorio para sífilis está usualmente llevado a cabo por serología. No se observó resultados falsos positivos cuando se utilizó ID-PaGIA y se observó una excelente sensibilidad y especificidad de esta prueba treponérnica. Las ventajas del método son el tiempo de reacción de tan solo 20 minutos, la simplicidad del procedimiento con poco equipo de laboratorio, la posibilidad de realizar lecturas automatizadas y la posibilidad de mantener un record de los resultados y con ello la trazabilidad.

Laboratory diagnosis of syphilis is usually accomplished by serology. No false-positive results were found with ID-PaGIA and compared with other treponemal tests ID-PaGIA has excellent sensitivity and specificity. Advantages of the PaGIA are the fast reaction time of only 20 minutes and the simplicity of the procedure with minimal technical equipment.

Aplicación del análisis modal de fallos y efectos en el proceso de donación de sangre total / Application of modal analysis of failures and effects in the process of total blood donation

La búsqueda constante de medidas para garantizar la calidad y seguridad de la sangre y hemocomponentes constituye una necesidad para el logro de la seguridad transfusional. Aunque las buenas prácticas de producción tienen el objetivo de disminuir los riesgos para obtener productos puros, seguros y eficaces, es necesario complementarlas con herramientas que permitan prevenir los posibles fallos y detectar dichos riesgos. Tal es el caso de la aplicación del Análisis Modal de Fallos y Efectos en el Banco de Sangre Provincial de Villa Clara, donde se identificaron y evaluaron las posibles fallas del proceso de donación de sangre total, lo que permitió caracterizar este proceso, identificar sus variables críticas, proporcionar las bases para proponer nuevos puntos críticos de control y establecer las acciones necesarias para la reducción o eliminación de las fallas detectadas. Esto contribuyó al aumento de la satisfacción de los servicios de transfusión hospitalarios y de los pacientes

The constant search of measures to guarantee the quality and the safe of blood and hemocomponents is a need to achieve the transfusion safe. Although the aim of the good practices of production was to decrease the risks to obtain pure, safe and effective products, it is necessary its fulfillment with tools allowing to prevent the potential failures and to detect such risks. That is the case of the application of the Modal Analysis of Failures and Effects in the Provincial Blood Bank of Villa Clara where the potential failures in the process of total blood donation were identified and assessed, allowing to characterize it, to identify its critical variables, to lay the foundations to propose new critical points of control and to establish the actions necessary to reduce or to eliminate the failures detected. All this contributed to the satisfaction of hospital transfusion services and of patients

Pérdida de donaciones sanguíneas por positividad de virus de inmunodeficiencia humana en la provincia de Santiago de Cuba 2001- 2005 / Loss of blood donations due to HIV positive testing in Santiago de Cuba province 2001 - 2005

Se efectuó un estudio descriptivo y retrospectivo de las 197 723 donaciones de sangre efectuadas entre 2001 y 2005 en la provincia de Santiago de Cuba, con vista a mejorar la calidad del tamizaje de ese líquido y determinar la frecuencia del síndrome de inmunodeficiencia adquirida en la población donante, procedente de los diferentes centros de extracciones ubicados en los diferentes municipios y recogidas en el Banco de Sangre Provincial Renato Guitart Rosell. Se detectó la presencia del virus en 1 865 casos (0,95 por ciento), equivalente a 932 litros de sangre perdidos.

A descriptive and retrospective study of the 197 723 blood donations between 2001 and 2005 in Santiago de Cuba province was made, with the aim of improving the quality of the screening of that liquid and of determining the frequency of the acquired immunodeficiency syndrome in the donating population, from the different donation institutions located in the different municipalities and from collections in Renato Guitart Rosell Provincial Blood Bank. The presence of the virus was detected in 1 865 cases (0,95 per cent), equivalent to 932 liters of blood lost.

Análisis del producto no conforme en el Banco de Sangre del Hospital Dr. Max Peralta, enero-abril, 2009: importancia en la toma de decisiones / Nonconforming product analysis at the Dr. Max Peralta Hospital Blood Bank, January-April 2009

El análisis de productos no conformes es un aspecto clave en la seguridad de la sangre. La producción de hemocomponentes ha avanzado pero muchos son los aspectos que deben ser valorados en relación a la aceptación de productos con el fin de evitar los efectos adversos que se pueden suscitar. Se realizó un análisis de todos los productos obtenidos entre Enero-Abril de 2009 y se obtuvo los productos que fueron descartados y las razones por las cuales se tomó la decisión de descarte, así como el análisis del error y las acciones preventivas y correctivas empleadas. El producto no conforme representó un 7% del total de unidades obtenidas entre Enero y Abril del 2009.

The Nonconforming product analysis is a key in the blood safety. The hemocomponents production has been advanced but there are many aspects to consider and thus. to avoid adverse effects. The analysis included the unsatisfied products and the reasons why they are nonconforming. The analysis searched the preventive and corrective actions. The nonconforming product was 7% of the product obtained since January - April 2009 at the Dr. Max Peralta Hospital.