Predonation screening of blood donors with rapid tests: implementation and efficacy of a novel approach to blood safety in resource-poor settings

Authors

  • Shirley Owusu-Ofori,

    1. From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Haematology, Division of Transfusion Medicine, University of Cambridge, Cambridge, UK; and the National Blood Service, Cambridge Blood Center, Cambridge, UK.
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  • Jillian Temple,

    1. From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Haematology, Division of Transfusion Medicine, University of Cambridge, Cambridge, UK; and the National Blood Service, Cambridge Blood Center, Cambridge, UK.
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  • Francis Sarkodie,

    1. From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Haematology, Division of Transfusion Medicine, University of Cambridge, Cambridge, UK; and the National Blood Service, Cambridge Blood Center, Cambridge, UK.
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  • Margaret Anokwa,

    1. From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Haematology, Division of Transfusion Medicine, University of Cambridge, Cambridge, UK; and the National Blood Service, Cambridge Blood Center, Cambridge, UK.
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  • Daniel Candotti,

    1. From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Haematology, Division of Transfusion Medicine, University of Cambridge, Cambridge, UK; and the National Blood Service, Cambridge Blood Center, Cambridge, UK.
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  • Jean-Pierre Allain

    Corresponding author
    1. From the Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Haematology, Division of Transfusion Medicine, University of Cambridge, Cambridge, UK; and the National Blood Service, Cambridge Blood Center, Cambridge, UK.
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  • This project was supported in part by Grant BS01/03 from the National Blood Service, England.

Address reprint requests to: Jean-Pierre Allain, MD, PhD, Division of Transfusion Medicine, Department of Haematology, Cambridge Blood Center, Long Road, Cambridge CB2 2PT, UK; e-mail: jpa1000@cam.ac.uk.

Abstract

BACKGROUND:  In sub-Saharan Africa, the percentage of screened blood is limited to approximately 75 percent for human immunodeficiency virus antibodies (anti-HIV), 50 percent for hepatitis B surface antigen, and 19 percent for hepatitis C virus antibodies (anti-HCV), mainly because of costs.

STUDY DESIGN AND METHODS:  In 2002 to 2003, candidate blood donors were screened before donation for HIV, HCV, and hepatitis B virus (HBV) serologic markers with rapid tests. The efficacy of this screening was assessed by nucleic acid testing (NAT) applied to pools of 10 plasma samples from donated units with a virus specific triplex assay. NAT-reactive pools were resolved by viral genome identification in individual plasma sample. Deferred candidate donors were referred to a donor-care program.

RESULTS:  A total of 9372 people were screened and 1534 (16.4%) were deferred. No HIV or HCV RNA–containing samples remained undetected by rapid tests unless a human testing error was involved. In contrast, 1.3 and 3.0 percent of HBV DNA–containing blood units were negative with rapid tests but were detected in individual donations with enzyme immunoassay and genomic amplification, respectively. Only half of these units were detectable in pools of 10 samples. One-third of deferred candidate donors attended the donor-care program and were informed and counseled.

CONCLUSIONS:  Predonation viral screening of blood donors is effective in high endemic areas, and the savings it generates may improve the safety and limit the cost of blood. Communication with deferred donors may contribute to public health. A new screening strategy associating serologic rapid test before donation and NAT on pools of 10 plasma samples after donation is proposed.

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