TESTING OF VOLUNTARY BLOOD DONORS: HISTORICAL OVERVIEW AND CURRENT STATUS
Keywords:
blood transfusion, blood donors, serological testing, transfusion medicineAbstract
Blood transfusion remains an indispensable component of health care, contributing to saving millions of lives each year. Donating blood is an exceptionally special way to help another human being and save their life. Blood is an invaluable medicine that humans produce themselves, being the only source of this medicine. Blood transfusion is categorized as a form of transplantation, offering vital assistance to individuals in need while ensuring that it does not harm them in any way. Blood products must meet numerous national requirements to ensure their safety for use.
Transfusion of incompatible blood or blood infected with bloodborne diseases can worsen the patient's condition, and in some cases, even lead to death. Ensuring a safe transfusion requires careful donor selection, comprehensive blood screening, and rigorous testing of blood products.
Due to the emergence of new pathogens posing public health concerns, over time, mandatory testing of blood donors has included tests to detect these pathogens, aiming to reduce the risk of bloodbourne diseases. The detection and appropriate handling of reactive blood donations directly mitigate the risk of harm and the development of infections or diseases that the pathogen might induce in the recipient of the blood transfusion.
Testing blood donors for HIV, hepatitis B and C, and Syphilis has become a foundation that persists to this day, significantly improving the safety of blood products. However, there was a challenge with the speed of infection detection, as many infected individuals could still be donors before the virus became detectable in the blood. The main goal was to produce higher quality and more reliable tests. After the successful implementation of serological testing for all voluntary blood donors worldwide, the safety of blood products has finally reached a high level.
To provide an additional layer of blood safety, in the late 90s and early 2000s, the world gradually began to introduce molecular screening techniques for donors, known as Nucleic Acid Testing (NAT). The implementation of NAT testing has been a significant step in ensuring the safety of blood products. One of great advantages of NAT is its ability to detect and amplify very small amounts of viruses that are not detectable by serological test (18)
In order to ensure the highest quality and safety of blood products, it is not sufficient to solely rely on laboratory tests and interpret their results. It is necessary to have a comprehensive strategy, standards, systems, and infrastructure prescribed by national health authorities and transfusion centers, and implemented into the laws and regulations of each individual country.
Ongoing advancements in serological testing technologies contribute to improved sensitivity and specificity. The implementation of a comprehensive quality system in transfusion medicine and laboratory testing is of utmost importance, and continuous improvement should be the goal. It is crucial to continue monitoring all emerging threats to the safety of blood products and provide an adequate response.
References
Bloch, E. M. (2022). Transfusion-transmitted infections. Annals of Blood, 7, 20. https://doi.org/10.21037/aob-21-60
Busch, M. P., Young, M. J., Samson, S. M., Mosley, J. W., Ward, J. W., & Perkins, H. A. (1991). Risk of human immunodeficiency virus (HIV) transmission by blood transfusions before the implementation of HIV-1 antibody screening. The Transfusion Safety Study Group. Transfusion, 31(1), 4–11. https://doi.org/10.1046/j.1537-2995.1991.31191096183.x
Busch, M. P., Bloch, E. M., & Kleinman, S. (2019). Prevention of transfusion-transmitted infections. Blood, 133(17), 1854–1864. https://doi.org/10.1182/blood-2018-11-833996
Centers for Disease Control and Prevention. (1982). Possible transfusion-associated acquired immune deficiency syndrome (AIDS) – California. MMWR. Morbidity and Mortality Weekly Report, 31(48), 652-654.
Curran, J. W., Lawrence, D. N., Jaffe, H., Kaplan, J. E., Zyla, L. D., Chamberland, M., Weinstein, R., Lui, K. J., Schonberger, L. B., & Spira, T. J. (1984). Acquired immunodeficiency syndrome (AIDS) associated with transfusions. The New England Journal of Medicine, 310(2), 69–75. https://doi.org/10.1056/NEJM198401123100201
Drlje, I. T., & Arapovic, J. (2022). Prevalence of hepatitis B surface antigen (HBsAg) in the blood donor population in Bosnia and Herzegovina: Impact of the pre-donation questionnaire implementation and mandatory hepatitis B virus (HBV) vaccination schedule – 20 years of experience at the University Hospital Mostar. Transfusion Clinique et Biologique, 29(3), 231-235.
Fearon M. (2005). The laboratory diagnosis of HIV infections. The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien Des Maladies Infectieuses et De La Microbiologie Medicale, 16(1), 26–30. https://doi.org/10.1155/2005/515063
Gardella, C., Marfin, A. A., Kahn, R. H., Swint, E., & Markowitz, L. E. (2002). Persons with early syphilis identified through blood or plasma donation screening in the United States. The Journal of Infectious Diseases, 185(4), 545–549. https://doi.org/10.1086/338829
Hans, R., & Marwaha, N. (2014). Nucleic acid testing-benefits and constraints. Asian Journal of Transfusion Science, 8(1), 2–3. https://doi.org/10.4103/0973-6247.126679
Hutchinson, C. M., Hook, E. W., 3rd, Shepherd, M., Verley, J., & Rompalo, A. M. (1994). Altered clinical presentation of early syphilis in patients with human immunodeficiency virus infection. Annals of Internal Medicine, 121(2), 94–100. https://doi.org/10.7326/0003-4819-121-2-199407150-00003
Jones, A., & Heyes, J. (2014). Processing, testing and selecting blood components. Nursing Times, 110(37), 20–22.
Orton S. (2001). Syphilis and blood donors: What we know, what we do not know, and what we need to know. Transfusion Medicine Reviews, 15(4), 282–291. https://doi.org/10.1053/tmrv.2001.26956
Perkins, H. A., & Busch, M. P. (2010). Transfusion-associated infections: 50 years of relentless challenges and remarkable progress. Transfusion, 50(10), 2080–2099. https://doi.org/10.1111/j.1537-2995.2010.02851.x
Stolz, M., Gowland, P., Tinguely, C., & Niederhauser, C. (2019). Safe-Testing Algorithm for Individual-Donation Nucleic Acid Testing: 10 Years of Experience in a Low-Prevalence Country. Transfusion Medicine and Hemotherapy: Offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie, 46(2), 104–110. https://doi.org/10.1159/000499166
Tan, P. P., Mohamed Fauzi, H., Bahar, R., Chang, C. T., & Abdul Rahim, N. A. (2019). Knowledge and perceptions of blood safety among blood donors in Kelantan, Malaysia. Malaysian Journal of Medical Sciences, 26(6), 127–136. https://doi.org/10.21315/mjms2019.26.6.13
World Health Organization. (1975). World Health Assembly resolution WHA28.72: Utilization and supply of human blood and blood products. Geneva. Available from: https://www.who.int/publications/i/item/WHA28.72
World Health Organization. (2009). Screening donated blood for transfusion-transmissible infections: Recommendations (2nd ed., National blood screening programme for transfusion-transmissible infections). Geneva. Available from: https://www.ncbi.nlm.nih.gov/books/NBK142995/
Yasmeen, H., & Hasnain, S. (2019). Epidemiology and risk factors of transfusion-transmitted infections in thalassemia major: A multicenter study in Pakistan. Hematology, Transfusion and Cell Therapy, 41(4), 316–323. https://doi.org/10.1016/j.htct.2019.03.008
Zorob, T., Farooqi, M. A., Ahsan, A., Zaki, A., Rathore, M. A., & Farooqi, H. M. U. (2023). Prevalence and trends in Hepatitis B & C Virus among blood donors in Pakistan: A regional transfusion center study. Livers, 3(2), 271-281. https://doi.org/10.3390/livers3020018
