Blood utilization in five Chinese hospitals shows low hemoglobin thresholds in medical patients.

BACKGROUND: The number of red blood cell units transfused per capita in China is lower than in western countries and the reason(s) for the difference is unknown. STUDY DESIGN AND METHODS: We randomly chose 5050 transfused patients from five Chinese hospitals. We compared transfused cases to nontransfused controls matched for the same underlying diagnosis. We assessed the pretransfusion hemoglobin (Hb) trigger and other clinical characteristics associated with transfusion. After stratifying by underlying disease, we compared pretransfusion Hb level in Chinese hospitals to 12 US hospitals. RESULTS: In 5050 patients who received transfusion, the pretransfusion Hb levels were lower in medical (6.3 g/dL) compared to surgical patients receiving transfusion postoperatively (8.1 g/dL). In patients with nonsurgical diagnoses, the pretransfusion Hb was much lower than that in the United States; the difference in mean Hb level varied by underlying diagnosis from 0.4 to 1.8 g/dL. In case-control analysis of cases (n = 1356) compared to controls (n = 1201), the pretransfusion Hb showed the strongest association with transfusion. Compared to 10 g/dL, the odds ratio (95% confidence interval) for pretransfusion Hb of 7 to 7.9 g/dL was 37.7 (24.8-57.4). CONCLUSION: Transfusion triggers in five Chinese hospitals appear comparable to those in the United States for surgical patients; however, medical patients have lower pretransfusion Hb levels (approx. 6 g/dL). Of the factors assessed, the pretransfusion Hb was most strongly associated with transfusion. The clinical impact of lower transfusion thresholds used in China is unknown.

The association of elevated alanine aminotransferase levels with hepatitis E virus infections among blood donors in China.

BACKGROUND: Transfusion transmission of hepatitis E virus (HEV) is an emerging health risk, yet blood donors are rarely screened for this pathogen. Many blood centers instituted screening of blood donors for elevated levels of alanine aminotransferase (ALT) levels to prevent hepatitis C virus, which has continued in China. We evaluated whether elevated ALT levels were associated with HEV among blood donors in China. STUDY DESIGN AND METHODS: Blood samples were collected from 9069 qualified volunteer blood donors from four blood centers in China. A total of 5023 had elevated ALT levels, that is, more than 40 IU/L, and 4046 samples had normal ALT. We tested all the 9069 samples for anti-HEV immunoglobulin (Ig)M, anti-HEV IgG, and HEV antigen. Those who were positive for anti-HEV IgM or HEV antigen were tested individually for HEV RNA by polymerase chain reaction. RESULTS: The prevalence of anti-HEV IgG in donors with elevated ALT levels (33.3%) was higher than those with normal ALT (24.9%; p < 0.01). The prevalence of anti-HEV IgM was similar in donations with increased ALT (1.41%) and normal ALT (1.46%). More ALT-elevated donations were HEV antigen positive, 62 of 5023 (1.23%), than were ALT-normal donations, seven of 4046 (0.17%; p < 0.01). Six donors with elevated ALT levels and acute HEV infection markers (anti-HEV IgM or HEV antigen) were HEV RNA positive. CONCLUSION: Markers of active infection including HEV antigen and HEV RNA are significantly more common among donors with elevated ALT levels in China. These data support the fact that ALT testing of donors to HEV antigen or HEV RNA would have greater specificity and exclude fewer acceptable donors.

Which is safer source plasma for manufacturing in China: apheresis plasma or recovered plasma?

BACKGROUND: In most countries, the plasma for derivative production includes two types of plasma, apheresis plasma (AP) and recovered plasma (RP). However, the plasma recovered from whole blood is not permitted for manufacture in China. Because of the lack of source plasma and the surplus of RP, the Chinese government is considering allowing RP as an equivalent source for the production of plasma derivatives. It is known that human blood can be contaminated by various infectious agents. The objective of the study was to evaluate if infectious risk would increase by enacting this policy. STUDY DESIGN AND METHODS: The samples from the two types of blood donors from January 1 to December 31, 2013, were collected. Supplementary testing was conducted and the residual risk (RR) of human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus (HCV) in the two types of blood donors and donations were calculated through the incidence-window period model. Prevalence of the markers of hepatitis E virus, hepatitis A virus, severe fever with thrombocytopenia syndrome bunyavirus, cytomegalovirus, B19, and West Nile virus was calculated. RESULTS: No significant difference was found in the RR of the three pathogens in the two types of blood donors. However, after the quarantine period, the RR of HCV and HIV in AP was significantly lower than that in RP. A quarantine period of 2 years will make the infectious risk of RP not significantly different than that of AP. CONCLUSIONS: Our data demonstrate that allowing RP to be used for the manufacture of plasma derivatives will not increase its infectious disease risk if coupled with a 2-year inventory hold.