Towards total voluntary non-remunerated blood donation in Trinidad and Tobago

Objective: Investigate the historical origins of voluntary nonremunerated blood donation (VNRD) and describe a UWI-led initiative. Design and Methodology: Historical review was performed using internet searches, documents, books, journals, interviews. Data from blood donor cards and Microsoft Excel spreadsheets was collected prospectively and analysed retrospectively. Donors were classified by age, gender, donation status (first-time or repeat) and donation outcome (accepted or deferred). The prevalence of transfusion transmissible infections and deferrals in donors was compared to the national donor pool using Chi square analysis to compare proportions and a p value < 0.05 to assign statistical significance. Results: Human to human blood transfusion and voluntary non-remunerated blood donation were first practised in metropolitan countries and amplified in large scale community blood donation programmes during World War II. Blood donation systems based on individual, transactional donations emerged in most developing countries, including Trinidad and Tobago, causing low donation rates, chronic blood shortage, unequal access, high donor infections and high donor deferrals. A voluntary non-remunerated blood donation programme started by the UWI Blood Donor Foundation and the North Central Health Authority has collected 660 units of blood in its first three years, the majority from persons aged 16 -25 age (52%), females (52%) and repeat donors (51%). Deferrals were < 10% and total transfusion transmissible infections in donors 0.9% compared with 43.6% and 2.4 % respectively (p < 0.05 for both) for the involuntary national donor pool. Conclusion: This model could be extended to all blood donation centres and the community to achieve 100% VNRD.

Local public knowledge of blood donation systems in Trinidad and Tobago and in other places

OBJECTIVE: To investigate the Trinidad and Tobago (TRT) public’s knowledge of donation procedures locally and in the United States (USA) and United Kingdom (UK) and its effect on willingness to donate blood locally. DESIGN AND METHODS: A cross sectional study was conducted on a convenience sample from adults in TRT concerning knowledge and attitudes towards blood donation. Data was collected using an interviewer-administered questionnaire. 529 responses were received. Analysis was performed using SPSS Statistics 21. Chi-squared testing was done to determine statistical significance. RESULTS: Of 529 respondents, 141 (26.7%) had donated previously, 34 (6.4%) had been excluded and 354 (66.9%) had never donated. 76.8% of those who had donated did so for a friend or family member. 53.6% of respondents rated their knowledge of TRT’s system, and 86.2% rated that of the US and UK, as ‘poor’ or ‘very poor’. Knowledge of the local system was directly correlated to willingness to donate blood in TRT (p<0.001). No relation was found concerning knowledge of the foreign systems and local willingness to donate (p=0.423). Factors deemed most ‘likely’ or ‘very likely’ to influence people to donate included: if donation was for an ill family member (87.7%) or friend (77.9%); if the blood donation system in place was a replacement system (70.9%) and if more information was given to the public about blood donation (67.3%). CONCLUSION: Public knowledge of the blood donation system of TRT affected willingness to donate while knowledge of the US and UK systems had no effect.

Predictors of thalassaemia carriers in Trinidad and Tobago

OBJECTIVE: To determine possible predictors of thalassaemia carriers among prospective blood donors in Trinidad and Tobago. DESIGN AND METHODS: 460 prospective blood donors were screened for microcytosis (MCV<83fL) by performing a complete blood count (CBC) using a Sysmex XE-2100. The 86 samples with microcytosis further had a blood film analysis, iron studies, haemoglobin electrophoresis, haemoglonin F and A2 quantification, and DNA analysis for thalassaemia mutations. Statistical analysis was done using SPSS to determine predictors of thalassaemia trait. The variables tested were ethnicity, haemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin volume (MCHC), red blood cell (RBC), RBC distribution width (RDW-SD and RDW-CV). We looked at different mathematical formulae to predict thalassaemia trait ie the Mentzer Index, Shine and Lal Index, Green and King Index, Srivastava Index, RDW Index and the red cell indices tested were RDW-CV, RDW-SD and RCC. RESULTS: 86 (18.7%) subjects had microcytosis. 44(51.2%) of these had DNA results. 31(70.5%) had thalassaemia trait: 25(80.6%) with genotype –α/αα, 4(12.9%) α-/α-(all α3.7), one IVS I-5 G/C and one IVSII-666 T/C. The MCV, RDW-SD and RDW-CV were useful in predicting thalassaemia trait. RDW-SD identified 30 (96.8%) of the 31 carriers, the Green and King formula identified 27 (87.1%), and Ricerca index identified all 31 (100%). CONCLUSION: MCV, RDW-SD, Green and King formula and Ricerca index may be useful predictors of thalassaemia trait in Trinidad and Tobago.

Confidence intervals for biomarker-based human immunodeficiency virus incidence estimates and differences using prevalent data

Prevalent biologic specimens can be used to estimate human immunodeficiency virus (HIV) incidence using a two-stage immunologic testing algorithm that hinges on the average time, T, between testing HIV-positive on highly sensitive enzyme immunoassays and testing HIV-positive on less sensitive enzyme immunoassays. Common approaches to confidence interval (CI) estimation for this incidence measure have included 1) ignoring the random error in T or 2) employing a Bonferroni adjustment of the box method. The authors present alternative Monte Carlo-based CIs for this incidence measure, as well as CIs for the biomarker-based incidence difference; standard approaches to CIs are typically appropriate for the incidence ratio. Using American Red Cross blood donor data as an example, the authors found that ignoring the random error in T provides a 95% CI for incidence as much as 0.26 times the width of the Monte Carlo CI, while the Bonferroni-box method provides a 95% CI as much as 1.57 times the width of the Monte Carlo CI. Further research is needed to understand under what circumstances the proposed Monte Carlo methods fail to provide valid CIs. The Monte Carlo-based CI may be preferable to competing methods because of the ease of extension to the incidence difference or to exploration of departures from assumptions.

HTLV in the Americas: challenges and perspectives

The first description of the human T-lymphotropic virus type 1 (HTLV-1) was made in 1980 followed closely by the discovery of HTLV-2, in 1982. Since then, the main characteristics of these viruses, commonly referred to as HTLV-1/2, have been thoroughly studied. Central and South America and the Caribbean are areas of high prevalence of HTLV-1 and HTLV-2 and have clusters of infected people. The major modes of transmission have been through sexual contact, blood, and mother to child via breast-feeding. HTLV-1 is associated with adult T-cell leukemia/lymphoma (ATL), HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and HTLV-associated uveitis as well as infectious dermatitis of children. More clarification is needed in the possible role of HTLV in rheumatological, psychiatric and infectious diseases. Since cures for ATL and HAM/TSP are lacking and no vaccine is available to prevent HTLV-1 and HTLV-2 transmission, these illnesses impose enormous social and financial cost on infected individuals, their families, and health care systems. For this reason, public health interventions aimed at counseling and educating high-risk individuals and populations are of vital importance. In the Americas this is especially important in the areas of high prevalence(AU)

Promoting quality blood services in the Region of the Americas

Over the past several years, great progress has been made in the safety of blood transfusion available in the Region of the Americas. The screening of blood units for infectious markers has increased. Of the 5.9 million units of blood collected in Latin America and the Caribbean in 1997, 68 1666 (1.1 percent) were not screened for human immunodeficiency virus (HIV); 77 095 (1.3 percent) for hepatitis B, and 343 858 (5.8 percent) for hepatitis C. The corresponding figures for 2001 are 6338 (0.09 percent) for HIV, 8797 (0.13 percent) for hepatitis B, and 60 112 (0.88 percent) for hepatitis C, despite the fact that the number of units collected that year had increased to 6.8 million. The units not screened for HIV came from five countries, two of which test over 99 percent of the blood collected and another two at least 85 percent. Sixteen countries do not have universal screening for hepatitis C. Of these, five do not test for hepatitis C at all. The quality of screening also appears to have improved in the Region. Training activities, development of standard operating procedures, implementation of quality standards, and the use of appropriate testing kits contribute to better laboratory performance. Nevertheless, there are still many challenges ahead in terms of achieving desired levels of safety and availability of blood (AU)

Estudio de factores socioculturales relacionados con la donacion voluntaria de sangre en las Americas / A study of sociocultural factors related to voluntary blood donation in the Americas

Objective. To obtain baseline data for countries of the Americas on knowledge, attitudes, and practices related to voluntary blood donation as well as on the current level and quality of services that blood banks provide to donors. Methods. The study was conducted in 15 countries in the Americas: Argentina, Bolivia, Colombia, Costa Rica, Cuba, the Dominican Republic, Ecuador, El Salvador, Guatemala, Jamaica, Nicaragua, Panama, Paraguy, Peru, and Venezuela. Technical cooperation for the study came from the Pan American Health Organization. A qualitative formative methodology was applied, utilizing interviews with donors, health workers, and members of the general public; direct observation; focus groups; knowledge tests; and a review of documents. Results. Information was generated on people's knowledge of donation; their beliefs, perceptions, attitudes, and motivations; and their barriers to donating. Knowledge was also gained as to the best means for disseminating messages supporting voluntary donation. Conclusions. This information will serve as a foundation for designing a strategy in the countries of the Americas that is aimed at establishing and building the loyalty of voluntary blood donors. This strategy can support the implementation of changes needed in the care of donors, and it can also help in motivating donors to regularly return to donate blood (AU)

Availability, safety, and quality of blood for transfusion in the Americas

Objectives. This article has two objectives: (1) to present for countries and territories of the Region of the Americas data on the number of blood donations, proportion of voluntary blood donors versus remunerated blood donors, coverage of screening for infectious agents, and separation of donated blood into its components and (2) to explore the relationships of those characteristics with economic and organizational factors in the countries and territories. Methods. We carried out comparative analyses using population and health information gathered annually by the Pan American Health Organization (PAHO) from national health officials from the countries in the Americas, as well as economic information (gross national product (GNP) per capita) obtained from publications of the World Bank. Results. There is a direct correlation between the availability of blood for transfusion and GNP per capita. Seven countries with a GNP per capita above US$ 10 000 per year account for 38 percent of the Regional population but 68 percent of the Regional blood donations. Voluntary blood donation is more common in the countries with better blood availability. There is no association between GNP per capita and coverage of screening for infectious agents. Nevertheless, of the six countries with a GNP per capita below US$ 1 000, only one of the six screens all units for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B surface antigen (HBsAg). Countries with a higher proportion of voluntary blood donors tend to have lower prevalence rates of infectious markers. Separation of blood into its components is also more common in countries with higher blood donation rates. Conclusions. The availability, safety, and quality of blood for transfusion in the Americas needs to be improved. As part of that effort, national policies and strategies must be put into place so that the resources already allocated for blood services are better utilized (AU)

Retrospective audit of blood donation at a Hospital-based blood centre: Implications for blood product supply and safety

An audit of blood donation at the University Hospital of the West Indies (UHWI) was performed between January 1995 and December 1998. During these four years, 21,733 persons attended the blood collection centre and 6,711 (30.8 percent) were rejected as donors. Females accounted for 3, 054 (45.6 percent) of rejected donors while 3,647 (54.4 percent) were males. Females were rejected primarily because of low haemoglobin levels, while rejection was most frequently attributed to symptoms of the common cold and recent drug use. One hunderd and two rejected donors (1.5 percent) admitted to recent treatment of a sexually transmitted disease, and 138 (2.0 percent) presented within 16 weeks of a prior donation. Of 15,022 units donated, altruistic voluntary donations accounted for 307 (2 percent) and 53 (0.3 percent) were autologous donations. Seven hundred and four units (4.6 percent) were discarded because of positivity on initial testing for a marker of transmissible infection. Overall prevalence for markers of infection was 2.5 eprcent for HTLV-1, 0.9 percent for Hepatitis B and 0.4 percent for HIV I/II. Donations at the University Hospital of the West Indies (UHWI) collection centre contributed 15.8 percent of the national blood supply for the period under study.(Au)

HDV 16 antibody prevalence in Jamaica and the United States reflects differences in cervical cancer rates

Human papillomavirus (HPV) is widely accepted as the primary etiologic agent in the development of cervical cancer. DNA of a particular HPV type, HPV 16, is found in about half of tumors tested. Inconsistent with this causal relationship, however, population-based studies of HPV DNA prevalence have often failed to find high rates of anogenital HPV infection in countries with high cervical cancer rates. To examine this issue, we used serology to compare HPV 16 exposure in healthy volunteer blood donors in the United States (n = 278) and similar subjects from a country with 3-fold higher cervical cancer rates, Jamaica (n = 257). Jamaican sexually transmitted disease (STD) patients (n = 831) were also studied to examine in detail the relation of HPV 16 antibodies with sexual history. Serology was conducted using an ELISA employing HPV 16 virus-like particles (VLPs). Age-adjusted seroprevalence rates were greatest among male (29 percent) and female (42 percent) STD patients, intermediate in male (19 percent) and female (24 percent) Jamaican blood donors and lowest among male (3 percent) and female (12 percent) U.S. blood donors. The higher seroprevalence in women was significant, and prevalence tended to increase with age. In multivariate logistic regression, controlling for age and gender, Jamaican blood donors were 4.2-fold (95 percent CI 2.4 - 7.2) and STD patients 8.1-fold (95 percent CI 5.0 - 13.2) more likely to have HPV 16 VLP antibodies than U.S. blood donors. Among STD patients, HPV 16 antibodies were associated with lifetime number of sex partners and years of sexual activity, as well as other factors. Our data suggest that HPV 16 VLP antibodies are strongly associated with sexual behavior. Moreover, exposure to HPV 16 appears to be much greater in Jamaica than in the United States, consistent with the high rate of cervical cancer in Jamaica (Au)

De prevalentie van humaan T-Lymfotroop virus type 1 en 2 bij bloeddonors en patienten met seksueel overdraagbare aandoeningen in Suriname / The prevalence of human T-Lymphotropic virus types 1 and 2 in blood donors and patients with sexually transmitted diseases in Suriname

OBJECTIVE; To determine the prevalence of HTLV-1 and HTLV-2 infection in the population of Suriname in order to enhance the safety of blood transfusion in Suriname. DESIGN; Descriptive. SETTING; Academic Hospital, Paramaribo, Suriname. METHOD: Blood was examined of the 777 regular donors(constituting 97 procent of the total pool) who donated blood between 1 February and 1 June 1995 at the Blood Transfusion Centre of the Suriname Red Cross in Paramaribo, and also of the 140 patients with a sexually transmitted disease (STD) seen during the same period at the Dermatological centre of the Ministry of Health. All sera were sreened with particle agglutination. Sera which were not negative were subsequently tested with a western blot method which distinguishes between HTLV-1 and HTLV-2. RESUTLS. Three sera (0.4 percent) of the blood donors and 2(1.4 procent) of the STD patents were positive for HTLV-1(difference not significant). Nobody was found to be HTLV-2 positive. CONCLUSION; The HTLV-1 prevalence in the Suriname blood donors is similar to that of blood donors and general population of many regions in Brazil, but substantially lower than in several other regions in the Caribbean. Since examination of all donated blood is not a realistic option in Suriname it is recommended that all new regular blood donors should be tested for HTLV antibodies(AU)

Pre-operative autologous blood donations: a five year experience in Trinidad and Tobago

A pre-operative autologous blood donation programme was started in 1988 and made available to all doctors offering elective surgical procedures. Two hundred and seventy-seven (277) patients presented for autologous donation over a five-year period. Nine point four per cent were rejected because of low haemoglobin (<10.5 g/dl). The single biggest user of the programme was the Princess Elizabeth Hospital for handicapped persons. Patients undergoing orthopaedic procedures gave 50 per cent of the donations, and ranged in age from 10 to 73 years. The oldest donor was a 73-year-old man who had an abdominal aortic aneurysm replaced. Gynaecological surgeons in the public and private sectors together provided 43.9 percent of donors, 3.6 percent of these underwent elective Caesarean Section, each donating one unit of blood at 36 weeks. Patients undergoing general surgical procedures comprised 10.4 percent of donors. Autologous donors contributed 1.3 percent of the total number of donations over this period (AU)

Prevalence of antibodies to hepatitis C virus and other markers in Jamaica

Three population groups, 1500 blood donors, 513 antenatal women representing a normal population group and 250 sicklers representing a multiply transfused group were studied to determine the prevalence of hepatitis C viral (HCV) infection in Jamaica. The relationship to liver enzyme levels, hepatitis B infection, syphilis and HIV infection was also investigated. Sera were screened by enzyme-linked immunoassay (EIA) for anti-HCV C100-3 and subsequently tested by a supplementary second generation recombinant immunoblot assay (RIBA). In the blood donors, the prevalence of anti-HCV was low, 0.3 per cent - 0.4 per cent, the same level as that reported by several European countries. In the multiply transfused sicklers, the prevalence was more than seven times higher. No HCV infection was detected in the antenatal group. There was little correlation between HCV infection and surrogate markers alanine aminotransferase (ALT) and antibody to hepatitis B core antigen (anti-HBc) and no correlation with sexually transmitted diseases. (AU)

The HIV/AIDS epidemic in Jamaica

OBJECTIVE:To describe the HIV/AIDS epidemic in Jamaica. METHODS: Data from the national surveillance system for HIV infection and AIDS based in the Epidemiology Unit, Ministry of Health, were reviewed. These include case reports; HIV screening of blood donors, migrant farmworkers and US visa applicants; sentinel surveillance among antenatal clinic (ANC) attenders and sexually transmitted disease (STD) clinic attenders; and various serosurveys. RESULTS: A total of 669 AIDS cases were reported in Jamaica from December 1993 representing a cumulative AIDS case rate of 28 per 100 000 population. Since 1987 the annual AIDS case rate doubled every 2 years with 69 percent of individuals having died with AIDS. Heterosexual transmission predominates with the cumulative adults AIDS male-to-female case ratio declining from 2:8:1 in 1988 to 1:9:1 in 1993. A total of 55 children with AIDS account for 8.2 percent of all cases. The HIV infection rate per 1000 in 1993 was 3.8 among blood donors, 1.4 among ANC attenders and significantly higher among STD clinic attenders (men 6 percent, women 2.7 percent) homosexuals (9.6 percent), female prostitutes (12 percent) and individuals with repeat STD infectious (10 percent). Consistent condom use increased from 27 percent in 1989 to 47 percent in 1993. CONCLUSIONS: HIV infection was introduced into Jamaica from abroad through several different routes including the Jamaican homosexual community, migrant farmworkers, female prostitutes, and informal commercial importers. HIV transmission is well established locally and is spreading more rapidly in Western Jamaica and along the North Coast, which may reflect increase sexual activity associated with tourism. Although awareness of AIDS and HIV is high and condom use has increased considerably, there are no grounds for complacency concerning the HIV/AIDS epidemic in Jamaica.(AU)

An unique seroepidemiological situation for hepatitis B markers in Guadeloupe: results of a prospective study in blood donors - abstract

Screening for HBsAG, anti-HBc, anti-HCV and ALAT levels is now performed on donor blood to prevent post-transfusion hepatitis. A prospective study of 2368 blood donors was performed in Guadeloupe (French West Indies) to determine risk factors associated with serologic abnormalities: 571 blood donations (24 percent) were positive for at least 1 of the 4 markers with 3.2 percent positive for HBsAG, 22 percent for anti-HBc, 0.8 percent for anti-HCV and 1.4 percent for ALAT (<45 IU/L). The anti-HCV prevalence was significantly different according to ALAT levels (P<10). Transfusion histosry and employment status (worker or serviceman) were found to be risk factors, with an odds ratio (OR) of 1.94 for serviceman population. Other unexpected risk factors were: number of years' residency in Guadeloupe (progressively increased risk with increasing number of years); birthplace and residence in the southern part of the island as well as the existence of gastrointestinal discomfort unrelated to viral hepatitis (OR=2.91). The results of this study show a unique epidemiological situation for hepatitis B virus in Guadeloupe necessitating careful selection of blood donors (AU)

Risk of transfusion-related hepatitis and HTLV-1 in Barbados - abstract

The study was designed to determine the prevalence of hepatitis B, hepatitis C, and human T-cell lymphotropic virus type 1 (HTLV-1) among blood donors in Barbados, with a view to reviewing the blood bank screening practices currently in place. Blood samples from 1,022 consecutive blood donors were collected and stored. Samples were then tested for hepatitis B surface antigen (HBsAg), antibodies to surface and core antigens of hepatitis B (anti-HBs) and anti-HBc, respectively, hepatitis C (HCV), and HTLV-1. HBsAg was found in 0.98 per cent, anti-HBs in 7.24 per cent, anti-HBc in 8.4 per cent (n=619), anti-HCV in 2.57 per cent (n=894) and anti-HTLV-1 in 1.4 per cent (n=708). It is recommended that while screening of blood donors is adequate for hepatitis B infection, urgent consideration should be given to additional screening for hepatitis C and HTLV-1 (AU)

HTLV-1 seroprevalence among blood donors and food handlers in Guyana - a preliminary report - abstract

The aim of this study was to determine the prevalence of HTLV-1 seropositivity in those blood donors, food handlers and patients with symptoms suggestive of HTLV-1 infection who were seen at the Georgetown Hospital from July 15 to September 30, 1992. Sera were tested for HTLV-1 antibodies at the Caribbean Epidemiology Centre. Three hundred and fifty-four subjects were studied of whom 279 (79 per cent) were blood donors and 75 (21 per cent) food handlers; 3.9 per cent of the former (11/279) and 12.0 per cent of the latter (9/75) were seropositive with an overall seropositivity of 5.6 per cent. Although Indo-Guyanese accounted for about 40 per cent of the total sample there was only one Indo-Guyanese who was seropositive for HTLV-1. The presence of signs and symptoms associated with HTLV-1 infection was not a useful predictor of the disease (AU)

Factor VIII:C activity in cryoprecipitate prepared at the Blood Bank, University Hospital of the West Indies, Jamaica - abstract

Cryoprecipitate is the blood product rich in factor VIII: C activity used in the treatment of haemophhlia A. The University Hospital Blood Bank makes most of this product used in Jamaica. Commercially prepared factor VIII concentrates are expensive. We examined the effect of donor variables and techniques of preparation on the potency of cryoprecipitates in order to determine the most efficient production method. Factor VIII: C activity of cryoprecipitate was measured using the activated partial thromboplastin time with a normal plasma pool being used as reference plasma. Donor age and method of freezing the plasma had no effect on potency. Blood group B had a higher yield of factor VIII: C than groups A and O. Potency was decreased by prolonged storage of blood prior to processing (p = 0.015) but was increased by increasing volumes of cryprecipitate (p<0.01). The mean potency of the factor VIII: C was 184 i.u., surprisingly higher than the usually assumed 70 i.u. used for calculating the requirements of our haemophiliacs. We recommend that plasma from fresh tested blood, frozen in - 40§C be used for preparing cryoprecipitate and that a higher value than 70 i.u. of factor VIII: C be used for each bag of cryoprecipitate (AU)

A prospective study of transmission by transfusion of HTLV-I and risk factors associated with seroconversion

To evaluate the risk of transfusion-related transmisssion of HTLV-I in Jamaica, a prospective study was initiated, prior to availability of a licensed HTLV-I serological screening assay. This information would prove useful in formulating strategies for blood-donor screening. We followed 118 pre-transfusion HTLV-I-negative transfusion recipients at monthly intervals post-transfusion for 1 year. Laboratory and questionnaire data were obtained at each visit to evaluate the clinical and immunological status of recipients. Cumulative incidence of HTLV-I seroconversion was estimated and risk-factor data associated with seroconversion among 66 HTLV-I-exposed transfusion recipients were analyzed. Seroconversion occurred in 24/54 (44 percent) of recipients of HTLV-I-positive cellular blood components, 0/12 recipients of positive non-cellular donor units and 0/52 recipients of HTLV-I-negative donor units. Significant risk factors associated with recipient seroconversion were receipt of a seropositive cellular blood component stored for less than one week odds ratio (OR) = 6.34, 95 percent confidence interval (CI) = 1.83 to 21.92], male sex (OR = 4.79, 95 percent CI = 1.15 to 20.0) or use of immunosuppressive therapy at time of transfusion (OR = 12.20, 95 percent CI = 0.95 to 156). Risk of blood-borne infection per person per year in Jamaica was estimated to be 0.009 percent. Our results confirm that blood transfusion carries a significant risk of HTLV-I transmission and that screening of donor blood effectively prevents HTLV-I seroconversion. Recipients at greatest risk for seroconversion were those who required multiple transfusions or who were receiving immunosuppressive therapy at the time of transfusion. These patients should be given priority in receiving selectively screened blood components, if universal blood-donor screening for HTLV-I is not possible (AU)