Impact of societal and legal context on the blood supply of African-ancestry populations in Western countries: A review of practices and the French example.

In Western countries, blood supply agencies encounter impediments in providing blood groups defined as rare or of interest, notably for sub-Saharan African ancestry (SSAA) recipients. To establish warning levels and anticipate future blood needs, an estimate of the current carriers of rare blood groups, both potential patients or donors, is crucial but complex. Indeed, if the strict needs can be estimated in medical terms, the modalities of blood product collection must be considered from an interdisciplinary perspective, at the interface of biological data and social norms. Here, we aim to understand how legal choices and a set of representations of otherness may influence the supply of rare blood for SSAA populations. After examining these issues, considering different norms and limits that govern French society, we compare this data with those of four Western countries facing the same difficulties (United States, United Kingdom, Italy and the Netherlands). This work began as part as the reflections of Social Lab, an institutional programme created by the French Blood Establishment (EFS). How can we effectively improve the qualitative blood coverage for SSAA populations? There is no unique solution, but there are many more or less effective answers. Comparison across countries reveals a strong influence of the socio-political histories and ethical choices before technical and medical considerations. We consider that an institutional policy is required to resolve recruitment issues of SSAA donors sustainably. Lastly, we introduce a working group called the EFS Social Lab, which aims to set up a monitoring mechanism for donors and societal trends to make blood donation effective.

Noncompliance with blood donor selection criteria - Complidon 2017, France.

BACKGROUND: Blood donor selection, consisting of a pre-donation questionnaire and interview, excludes potential donors who may be at risk of transfusion-transmissible infections. Assessing the reasons for noncompliance with blood donor selection criteria is important to maintain a high level of viral safety of blood products. STUDY DESIGN AND METHODS: An anonymous French online survey of a sample of blood donors (Complidon) was conducted from September to December 2017. Data were poststratified to be representative of all donors who donated blood between July 2016 and December 2017. RESULTS: Of 420,190 solicited donors, 108,386 completed the survey (26%). Overall, noncompliance was estimated at 5.6%. The least respected criteria regarded sex with more than one partner during the previous 4 months for donors (1.9%) and for donors' partners (1%), travel-related criteria (1.2%) and sex between men during the previous 12 months (0.73% of men). Reasons for noncompliance differed according to criteria. Donors who were non-compliant to sexuality-based criteria mainly said they did not want to be excluded or that the questions were too personal. Conversely, donors who were exclusively non-compliant to criteria other than sexuality-based criteria more often mentioned their non-compliance during the pre-donation interview but were nevertheless authorized to donate blood. CONCLUSION: Despite noncompliance to blood donor criteria being relatively low in France, it still represents a threat to blood safety. Accordingly, improved communication is important to ensure that donors fully understand each selection criterion and to emphasize to health professionals the importance of listening carefully without judging during pre-donation interviews.

The evolving blood donor deferral policy for men who have sex with men: impact on the risk of HIV transmission by transfusion in France.

BACKGROUND: Blood donation deferral for men who have sex with men (MSM) in France was reduced from permanent to 12 months in July 2016. To inform a further reduction of the deferral period, an HIV risk assessment was conducted with two scenarios: S1, 4-month deferral; S2, 4-month deferral only in the case of more than one sexual partner (i.e., similar to other blood donors). METHODS: Baseline HIV residual risk (RR) was calculated from July 2016 to December 2017, using the Incidence Rate-Window Period method. The impact of both scenarios on RR was assessed using data from surveys on MSM and blood donors, to estimate 1) the number of additional MSM expected to donate in each scenario and 2) HIV incidence among these donors. RESULTS: Baseline HIV RR was estimated at 1 in 6,380,000 donations. For S1, an additional 733 MSM donors, and an additional 0.09 HIV-positive donations were estimated, yielding an unchanged RR of 1 in 6,300,000. For S2, these numbers were estimated at 3102 and 3.92, respectively, yielding an RR of 1 in 4,300,000. Sensitivity analyses showed that, under worst-case assumptions, the RR would equal 1 in 6,225,000 donations for S1 and 1 in 3,000,000 for S2. CONCLUSION: For both scenarios, the HIV RR remains very low. For S1, the risk is identical to the baseline RR. For S2, it is 1.5 times higher, and sensitivity analysis shows that this estimate is less robust than for S1. The French Minister of Health announced that S1 will be implemented in April 2020.

Noncompliance to blood donor selection criteria by men who have sex with men - Complidon 2017, France.

BACKGROUND AND OBJECTIVES: In France, blood donation deferral for men who have sex with men (MSM) was reduced from permanent to 12 months in July 2016. Assessing noncompliance (rate and reasons) with this criterion is important to maintain a high level of viral safety in blood products. MATERIALS AND METHODS: An anonymous online survey (Complidon) of a sample of blood donors was conducted in 2017. Data were post-stratified to be representative of all those who donated blood between July 2016 and December 2017. A multivariable analysis was performed to assess factors associated with noncompliance. RESULTS: Among male donors, 0·73% [95% CI: 0·63-0·83] reported having sex with men in the 12 months preceding their donation. Factors associated with noncompliance were as follows: young age, a low educational level, concerns about privacy, and better knowledge of donor selection criteria and the window period than compliant men. More than half of noncompliant MSM donors (57·6% [95% CI: 50·6-64·3]) felt that sexual orientation should not be a criterion for donation, 47·2% [95% CI: 40·4-54·0] did not disclose their male-to-male sexual relations in order to avoid being excluded from donating, 40·5% [95% CI: 34·0-47·4] reported using condoms and 21·8% [95% CI: 16·7-27·9] had the same male partner for at least 12 months. CONCLUSION: Complidon showed that compliance with blood donation criteria in MSM was high, but not optimal, especially among younger men. HIV residual risk did not increase after the implementation of 12-month deferral. Data from Complidon helped French policymakers to assess the additional HIV risk posed by increased access to blood donation for MSM.

[The blood donor]. / Le donneur de sang.

The blood donor. In France, every year, 1.6 million people perform one or more voluntary blood donations. These 3 millions annual donations allow the preparation of labile blood products by the French blood establishment: concentrates of red blood cells, platelets, therapeutic plasma; as well as plasma-derived medicinal products by the laboratory of the French fractionation and biotechnologies laboratory: immunoglobulins, albumin, clotting factors. This article reviews the ethical and medical aspects of this social and humanitarian act that needs to be regulated to ensure the safety of both donors and recipients.

Le donneur de sang. En France, chaque année, 1,6 million d'individus effectuent un ou plusieurs dons de sang bénévoles. Ces 3 millions de dons annuels permettent la préparation de produits sanguins labiles par l'Établissement français du sang : concentrés de globules rouges, de plaquettes, plasma thérapeutique ; ainsi que des médicaments dérivés du sang par le Laboratoire du fractionnement et des biotechnologies : immunoglobulines, albumine, facteurs de coagulation. Cet article fait le point sur les aspects éthiques et médicaux de cet acte social et humanitaire qui nécessite d'être encadré dans l'intérêt des donneurs et des receveurs.

Context and social perceptions of blood donation in donors found positive for human immunodeficiency virus in France.

BACKGROUND: In France, information collected during postdonation interviews showed that a majority of human immunodeficiency virus (HIV)-infected donors were not eligible to donate as per donor selection criteria. In the interest of blood safety, this study aimed to explore the mechanisms of noncompliance with blood donor selection criteria, notably the permanent deferral of men who have sex with men (MSM). STUDY DESIGN AND METHODS: Semistructured individual interviews were conducted with 32 blood donors found positive for HIV between mid-2011 and 2014. Topics such as the experience and motivations for donating blood, understanding of selection criteria, sexual risk management, and opinions on donor selection were discussed. Transcripts were analyzed inductively. RESULTS: More than 50% of study participants were noncompliant with donor selection criteria. Reasons for nondisclosure of risk factors in the predonation questionnaire or the predonation interview included stigma, test-seeking motivations, symbolic attachment to blood donation, and context of donation. Compliance to donor criteria was seen as secondary by donors who reaped personal benefits from the symbolism of their donation. Donors lacked self-reflexivity in their assessment of risky sexual behavior. The "window period" and the underlying epidemiologic arguments for donor selection criteria were poorly understood. Nearly all participants disapproved of the permanent ban on blood donations from MSM. CONCLUSION: This study demonstrated the need for more communication on the epidemiologic basis for donor selection criteria and on the window period to facilitate donor compliance. These findings have already advanced improvements to predonation documents, in a larger context of 2016 donor selection criteria revision.

Blood donation on posters: a worldwide review.

Originally pasted on walls and on locations reserved specially for that purpose, the poster is a medium for advertising and promotion to be seen on the streets and in public places. More recently, it has spread, in a smaller format, on dedicated indoor sites: billboards, columns, street furniture, and so forth. For transfusion, it appeared early on that the poster constitutes an important medium to promote blood donation. Thousands of posters supporting regional, national, or international blood donation campaigns have been created all over the planet, with a great variability of images, symbols, and slogans, which are particularly revealing about the image and the reality of blood donation. The topic is rich in information, particularly sociologic, on the variety of ways in which transfusion organizations promote blood donation. The authors present in this article the results of a study based on a total of 283 posters from nations on every continent, divided into 24 different themes.

[Ensuring the safety of donated blood]. / Assurer la sécurité du don du sang.

Blood donation is the only way of collecting the main components namely red blood cells, platelets and plasma. While chemical treatments and analyses help to control transfusion contamination risks, the best precaution remains the respect of very strict regulations by the donor.

Transfusion, blood donation, and postage stamps: a worldwide review.

Before the advent of electronic means of communication, postal stamps were one of the main international promotion tools on the planet and still remains an important support for the wide diffusion of a message. Since 1942, the promotion of blood donation has been one of them. To highlight these recurring or specific characteristics, the authors gathered and studied a large part of the stamps produced in the world on the theme of transfusion and blood donation. They analyzed and compared the characteristics of 189 stamps issued from 87 states: country of emission, year (when given), face value, slogans, expressions or wording, possible surtaxes, dominant colors, the notion of series, the themes of the illustrations, the symbols, the type of message, the national specificities, or the international characteristics. Along with national peculiarities, to certain traditions of representation, and a big variability of illustrations, symbols, and slogans, this set of postage stamps wears above all a clear, strong, and unique message: human solidarity through blood donation.

Pictorial representation of transfusion over the years.

BACKGROUND: The writings of the 17th and 19th centuries about experiments and debates about transfusion were often analyzed and discussed in articles and books, but an analysis of illustrations of transfusion during this pioneering epoch can throw new light on the subject. The first transfusion attempts were as sensational as they were spectacular, and their illustration permitted both focusing attention and giving a scientific iconography, almost technical, to doctors and scholars of the time. STUDY DESIGN AND METHODS: We describe several illustrations of historical transfusions and point out common characteristics and differences, through the major elements used by illustrators. RESULTS: Nineteen illustrations are shown and commented upon. The transfusion imagery, through the representation of the three actors of transfusion (recipient, donor, doctor) varied considerably over time, as did representation of the procedures of transfusion. CONCLUSION: This series of illustrations over three centuries reveals what the use and function of picturing transfusion over the course of time were: on the one hand, a didactic intent, in offering a documentary source concerning procedures and necessary instruments, and on the other, the function of legitimization, representing the act with a subtext such as numbered titles or in a scientific article, brought transfusion into the category of technical practices that were regulated by rules.

Serum transferrin saturation increase is associated with decrease of antibacterial activity of serum in patients with HFE-related genetic hemochromatosis.

OBJECTIVES: Patients with type 1 (HFE-related) genetic hemochromatosis are usually excluded from blood donation on the basis that this disease may facilitate bacterial infections. The aim of the present study was to evaluate the serum antibacterial effect against Salmonella enterica Typhimurium LT2 in relation to iron status. METHODS: Serum samples were collected in 26 iron-overloaded (homozygous C282Y mutation) and 35 iron-depleted hemochromatosis patients and 33 healthy control subjects. The antibacterial activity of sera and iron parameters were tested for each patient. RESULTS: Serum from normal controls had an antibacterial effect against Salmonella Typhimurium LT2. The antibacterial effect decreased from the 1:2 to the 1:8 dilution and was always significantly lower in the iron-overloaded group. In both control and iron-depleted patients, a positive correlation was found between the decrease of antibacterial effect and the increase of both serum iron and transferrin saturation. CONCLUSIONS: These results (a) support the view that chronic iron overload decreases serum antibacterial effect against Salmonella enterica Typhimurium LT2, (b) favor the interest of including, besides serum ferritinemia, serum transferrin saturation levels as a further criterion for iron-depletive treatment efficacy, and (c) provide an argument for not discouraging the use of blood from iron-depleted hemochromatosis patients for transfusion.

[Haemovigilance donors: methods and results]. / Hémovigilance donneurs: modalités et résultats.

There is no official definition of haemovigilance donors. However, it concerns the observation and management of Serious Adverse Events observed in blood donors (SAEDs), Post Donation Informations (PDI), and donor epidemiologic survey. The French Decree of 1 February 2006 imposes the declaration of the SAEDs. In 2006, 196 SAEDs were notified for 2599978 donations (7.5/100,000 donations). The incidence of the SAEDs was of 7/100,000 whole blood donations and 10.7/100,000 aphaeresis donations. Donors that are more susceptible to present a SAED are: women, women under 30, repeat donor and aphaeresis donor. For 2/3 of donors having presented a SAED, a medical consultation was prescribed and 1/3 was hospitalized. Vasovagal reaction is the most frequent category. Seven thousand three hundred and sixty one PDI were notified in 2005. The risks of infection represented the principal cause (mainly ENT). Concerning donor epidemiologic survey, the viral residual risk clearly decreased since 1992 and for the period of 2003-2005 it 1/2600000 for HIV, 1/6500000 for HCV and 1/1000000 for HBV. The first national data already give useful information. This information will permit a better care of blood donors and of blood component recipients as well.

Lean management and medical laboratory: application in transfusionnal immuno-hematology.

Despite a common use in industrial applications, only a few studies describe the lean management methods in medical laboratory. These tools have been evaluated in analysis laboratory of blood donors, especially in immuno-hematology sector. The aim was to optimize the organization and maintain team cohesion and strong staff involvement in a restructuring context. The tools used and the results obtained are presented in this study.

[Blood transfusion - safety of the inventory]. / Transfusion sanguine : en toute sécurité d'approvisionnement.

Over the years, transfusion medicine has been faced to many different problems, notably those related to transmission of pathogens. Major progresses have been accomplished in terms of security. However, nowadays, the discipline is confronted to the day-to-day variability and availability of blood products. More and more donors are excluded from blood donation due to various reasons, and the donor selection criteria have increased over the years, influencing the number of donors able to give blood. This paradox represents one of the constraints that transfusion medicine should resolve in the future. This paper presents some aspects either common or different between France and Switzerland.

Transfusion and blood donation in comic strips.

The representation of blood transfusion and donation of blood in the comic strip has never been studied. The comic strip, which is a relatively recent art, emerged in the 19th century before becoming a mass medium during the 20th century. We have sought, by calling on collectors and using the resources of Internet, comic strips devoted, wholly or in part, to the themes of transfusion and blood donation. We present some of them here in chronologic order, indicating the title, country of origin, year of publication, and names of authors. The theme of the superhero using transfusion to transmit his virtues or his powers is repeated throughout the 20th century in North American comic strips. More recently, comic strips have been conceived from the outset with a promotional aim. They perpetuate positive images and are directed toward a young readership, wielding humor to reduce the fear of venipuncture. Few comic strips denounce the abuse of the commercialization of products derived from the human body. The image of transfusion and blood donation given by the comic strips is not to be underestimated because their readership is primarily children, some of whom will become blood donors. Furthermore, if some readers are transfused during their lives, the impact of a memory more or less conscious of these childhood readings may resurface, both in hopes and in fears.

Transfusion and blood donation on the screen.

BACKGROUND: In the 20th century, blood transfusion has become an indispensable therapy in carrying out and improving many medical and surgical applications. Its scope of influence goes well beyond that of medicine, because blood donation, an action with high social significance, is completely connected to progress in the field. STUDY DESIGN AND METHODS: The purpose of this research was to study, through films that show transfusion or blood donation, the impression that has been given to the public in the course of the 20th century and its sociologic impact. To accomplish this, we have used various sources from Histories of Cinema and from the Internet to identify films from different countries and from different epochs that touch on this theme. RESULTS: With these two components, the act of donation and the act of transfusion, the relatively short history of blood transfusion is distinguished by upheavals in both the medical and the sociopolitical fields of the past century. Movies, the most commonly shared cultural event and mirror of society, have simultaneously gone through their first century by showing the diversity of our feelings and the human condition. CONCLUSION: Through various cinematographic references, the authors offer an analysis of the use, by the Seventh Art, of values and illustrations that use blood donation and transfusion.

Quantitative assessment of hematopoietic chimerism after bone marrow transplantation by real-time quantitative polymerase chain reaction.

We have developed a real-time quantitative polymerase chain reaction (PCR) assay using TaqMan technology (Applied Biosystems, Foster City, CA) for monitoring donor cell engraftment in allogenic hematopoietic stem cell transplant recipients. For this purpose, we selected 19 specific sequence polymorphisms belonging to 11 human biallelic loci located on 9 different chromosomes. Using a set of specially designed primers and fluorogenic probes, we evaluated the 19 markers' informativity on a panel of 126 DNA samples from 63 recipient/donor pairs. In more than 90% of these pairs, discrimination between recipient and donor genetic profile was possible. By using serial dilutions of mixed DNAs, we evaluated the linearity and sensitivity of the method. A linear correlation with r higher than 0.98 and a sensitivity of 0.1% proved reproducible. Fluorescent-based PCR of short tandem repeats (STR-PCR) and real-time PCR chimerism assay were compared with a panel of artificial cell mixtures. The main advantage of the real-time PCR method over STR-PCR chimerism assays is the absence of PCR competition and plateau biases, and results evidenced greater sensitivity and linearity with the real-time PCR method. Furthermore, different samples can be tested in the same PCR run with a final result in fewer than 48 hours. Finally, we prospectively analyzed patients who received allografts and present 4 different clinical situations that illustrate the informativity level of our method. In conclusion, this new assay provides an accurate quantitative assessment of mixed chimerism that can be useful in guiding early implementation of additional treatments in hematopoietic stem cell transplantation.