ABSTRACT
Background: In modern transfusion therapy, whole blood is used only in certain limited circumstances and trust is placed in the use of specific blood components (BCs). BC must be processed using appropriate validated procedures, including measures to avoid contamination and microbial growth in the initial and final prepared BCs (Directive 2005/62/EC, Annex 6.42). Consequently, methods of centrifugation of whole blood, filtration of leukocytes, washing and irradiation must be specified. Aim(s): We analyse national data on non-haemolytic pyrexial and allergic reactions related to blood transfusion reported to the Coordinating Haemovigilance Centre and Surveillance of Transfusion (SKAEM) of the Hellenic National Public Health Organization (EODY) by hospital Transfusion Departments in 2010-2020, in relation to the processing procedures applied using conventional blood bank methodologies. The results of an automated blood processing system employed in two hospital blood banks are also discussed in view of the national policy for stepwise implementation of a centralized automated processing procedure aiming to improve the quality and safety of blood transfusion. Method/Study: Annual haemovigilance data for all adverse reactions associated with BCs transfusion are reported to SKAEM using standardized questionnaires. Protocols are in line with International Haemovigilance Network guidelines and ISBT definitions of the types of adverse reactions associated with blood transfusion. The processing procedures used are: buffy coat removal, leukocyte depletion after storage, pre-storage leukodepletion, red cell washing in additive solution, and irradiation. The Reveos Automated Blood System (Terumo BCT) was also used, processing 4 units of whole blood to two components (plasma and red cells) or three main components (plasma, concentrated red cells and interim platelet unit) according to the manufacturer's instructions. Both protocols collect a Leukopak unit containing the main leukocyte fraction which is discarded. The resulting RCC is further leukoreduced by gravity using the Reveos in-line filter. Consistent leukoreduction of plasma is done through the simultaneous centrifugation/ extraction step of this method. Result(s): 13005 adverse reactions (AR) associated with the transfusion of 7 894 054 blood components were reported. Febrile nonhaemolytic transfusion reactions were 43.7% and allergic 37%. The distribution of febrile reactions in relation to processing procedure was: in RBCs with buffy coat 61.7%, without buffy coat 10.9%, leukodepletion after storage 16.5%, leukodepletion pre-storage 6.7%, washing 4.1% and irradiation 0.1%. Results from the use of the Reveos Automated Processing System (Terumo BCT) by the National Blood Centre for processing the blood collected and used by two large HBBs over a two-year period showed a statistically significant reduction of pyrexial reactions (p = 0.044 in one hospital and 0.002 in the other) in comparison with the relevant data before the use of this system. The corresponding difference in the allergic reactions was not statistically significant. Conclusion(s): This study demonstrates high incidence of pyrexial nonhaemolytic and allergic reactions associated with the use of blood components processed without leukodepletion, particularly during the COVID-19 pandemic when blood transfusion services were shortstaffed owing to re-assignment to other duties. Compliance with Good Practice Guidelines and improvement of blood processing and safety by automation should be a national priority.
ABSTRACT
Background: The speed of development of COVID-19 vaccines, and the need to balance their effectiveness versus possible complications, raised doubts over vaccine acceptance in the first period of the national vaccination campaign aiming at herd immunity against SARSCoV- 2. In the field of transfusion medicine, timely vaccination of the blood donor population represents a powerful measure in the general strategy to sustain blood collection and optimize the blood supply. Aims: To explore perceptions and attitudes of blood donors towards SARS-CoV-2 vaccination, in comparison to the general population. Methods: Donors in 20 blood collection services throughout Greece in May-October 2021 answered voluntarily and confidentially a structured questionnaire, covering: donor demographics;date and type of blood donation;frequency of donation;history of COVID-19;SARSCoV- 2 vaccination including type and doses;reasons for getting vaccinated or not;satisfaction with the vaccination procedure;side effects;feelings after vaccination;certainty about return to normality;and recommending vaccination to others. Hesitancy and beliefs leading to not getting vaccinated, worries over future side effects, and not recommending vaccination to others were also investigated. Results: Completed questionnaires were received from 3361 blood donors (61% response rate) aged 18-65 years during blood sessions at mobile sites and within hospitals. Respondents were mainly males (72%). A very high proportion (92%) of responders had completed high school of higher education and the majority resided in large cities. Almost half were regular donors. A small proportion (5.4%) had undergone a mild COVID19 infection and 17.3% mentioned COVID-19 in a relative. 52% had already been vaccinated. The proportion vaccinated increased steadily throughout the study. Vaccine acceptance was highest in males 45-54 years old and in females 18-24 and 50-59 years old. All four EMA approved vaccines (Pfizer, Moderna, Astra Zeneca and Johnson) were used. Mild complications were reported by 21% of vaccinated donors after the first dose and 19% after the second. Thirty-five donors reported fever and local pain at the vaccination site after both doses. The vast majority (79%) of vaccinated donors were very satisfied with the vaccination procedure and only 10 complained. After vaccination, 20% of donors felt safe and protected against COVID-19 and 55% intended to continue all recommended personal protective measures in their families and felt satisfaction for doing the right thing. Among unvaccinated respondents, 48% were awaiting their appointment, 19% were undecided, 16% were afraid of complications, a few said that they were waiting for more information about the beneficial effect of the vaccines, or that COVID-19 is not a severe disease, and 10% did not specify their reasons. In the general population of Greece surveyed in May 2021 in the Flash Eurobarometer study, COVID-19 vaccination acceptance was 59%. The proportion of those with negative perception and attitude towards vaccination was 12%. Key reasons for getting vaccinated or not were similar to those found in blood donors. Summary/Conclusions: The benefits of vaccination and the need to continue all personal protection measures were highly recognized by blood donors, whether already vaccinated or awaiting vaccination. The perceptions and attitudes towards vaccination against COVID-19, especially of regular donors, are compatible with their high social, altruistic and humanitarian behaviour.
ABSTRACT
BACKGROUND: Although the SARS-CoV-2 virus is transmitted mainly through the respiratory tract, possible transmission by transfusion from asymptomatic carriers should be explored. As yet there are no reports of transfusion transmission of COVID-19. Haemovigilance findings within a three-month surveillance period during the new coronavirus pandemic are presented. MATERIALS AND METHODS: Due to great demand and shortage, blood sessions in outpatient facilities were organized during the high prevalence period of COVID-19, alongside a national plan to monitor the evolving public health situation by random molecular screening of high-risk groups of the population. Haemovigilance protocols were implemented as well as surveillance for any COVID-19 case reported post-transfusion. A 14-day quarantine and follow-up molecular and antibody testing of any COVID-19 positive case was obligatory. RESULTS: Post-donation, post-transfusion information and molecular testing of swab samples collected from three asymptomatic donors at risk for COVID-19, revealed the case of an immunosupressed patient who had been transfused with whole blood derived platelets from a donor subsequently diagnosed with COVID-19. The recipient exhibited no symptoms of the disease. Molecular and antibody testing results were negative. CONCLUSION: Haemovigilance provided information supporting the absence of transfusion transmission of COVID-19, thus strengthening the hypothesis that, even if it cannot yet be definitively ruled out, COVID-19 is not transmitted through blood transfusion. As of early June 2020, a perfect test does not exist, therefore haemovigilance along with the implementation of strict proactive measures is crucial to identify eluding asymptomatic individuals and ensure blood safety during the pandemic.