Improving the screening of blood donors with syphilis rapid diagnostic test (RDT) and rapid plasma reagin (RPR) in low- and middle-income countries (LMIC).

BACKGROUND: Syphilis testing conventionally relies on a combination of non-treponemal and treponemal tests. The primary objective of this study was to describe the positive predictive value (PPV) of a screening algorithm in a combination of a treponemal rapid diagnostic test (RDT) and rapid plasma reagin (RPR) test at Komfo Anokye Teaching Hospital (KATH), Ghana. MATERIALS AND METHODS: From February 2014 to January 2015, 5 mL of venous blood samples were taken from 16 016 blood donors and tested with a treponemal RDT; 5 mL of venous blood was taken from 526 consenting initial syphilis sero-reactive blood donors. These RDT reactive samples were confirmed with an algorithm, applying the Vitros® /Abbott-Architect® algorithm as gold standard. RESULTS: A total of 478 of 526 RDT reactive donors were confirmed positive for syphilis, making a PPV of 90·9%. Of the 172 (32·7%) donors who were also RPR positive, 167 were confirmed, resulting in a PPV of 97·1%. The PPV of the combined RDT and RPR (suspected active syphilis) testing algorithm was highest among donors at an enhanced risk of syphilis, family/replacement donors (99·9%), and among voluntary donors above 25 years (98·6%). DISCUSSION: Screening of blood donors by combining syphilis RDT and RPR with relatively good PPV may provide a reasonable technology for LMIC that has a limited capacity for testing and can contribute to the improvement of blood safety with a minimal loss of donors.

A novel strategy for screening blood donors for syphilis at Komfo Anokye Teaching Hospital, Ghana.

OBJECTIVE: To implement and describe a novel syphilis screening strategy for blood donors. BACKGROUND: The seroprevalence of syphilis in blood donors is often high in low- and middle-income countries (LMIC) although the proportion of infectious donations is probably low. Syphilis screening may not happen at all; or the use of non-specific screening tests, which have high false positive rates, results in many donations being discarded unnecessarily. This can have a critical effect on already inadequate blood supplies. MATERIALS AND METHODS: Blood donors were screened at the time of donation with an anti-treponemal rapid diagnostic test (RDT) and blood collected irrespective of the result. Units screening negative for syphilis, human immunodeficiency virus (HIV) and hepatitis B and C were released to stock. RDT screen-positive units were re-tested with rapid plasma reagin (RPR) - units testing negative were released to stock and test-positive units discarded. RESULTS: Of the 2213 blood donors, 182 (8·2%; 182/2213) screened positive by RDT. In addition, 38 out of these 182 (20·9%) were RPR positive on post-donation testing. Over 2 months there was a 79% reduction in blood units discarded due to a positive syphilis screen. CONCLUSION: In other LMIC, this novel strategy can contribute to improving blood safety without jeopardising blood supply.

Attitudes towards blood donation and transfusion in Bamenda, Republic of Cameroon.

OBJECTIVES: This study was conducted in Bamenda, Cameroon. The objectives of the study were to develop a theoretical framework to better understand local attitudes towards blood donation and transfusion, to identify factors that motivate and deter blood donation and to identify interventions to improve the supply of blood for transfusion at Bamenda Regional Hospital. BACKGROUND: The supply of blood for transfusion in sub-Saharan Africa is insufficient. Cameroon has no national blood service and the collection and screening of blood is the responsibility of individual hospitals. At Bamenda Regional Hospital patient relatives recruit replacement blood donors, who may or may not be family members, and shortages of blood and delays in transfusion are frequent. MATERIALS AND METHODS: Qualitative research methods were used: direct observation, in-depth interviews, focus group discussions and a simulation exercise. Participants were clinical and laboratory staff, patient relatives, blood donors, secondary school students and community members. RESULTS: Attitudes towards blood donation and transfusion fit a transanctionalist framework of health decision making. Deterrents to blood donation are multiple and varied. Some form of compensation is often expected, even by family members, although the blood donation is still considered 'voluntary' by the donor. CONCLUSION: This study confirms that interventions to improve the blood supply must take into account local attitudes and conditions. In Bamenda, a variety of pragmatic approaches are required including education around specific biological misperceptions identified in the study and the retention of replacement donors as repeat donors. Issues around compensation for blood donation require further work.

Prevalence and molecular basis of alpha thalassaemia in British South Asians.

OBJECTIVES: To determine the prevalence and molecular basis of alpha thalassaemia in the British South Asian population, and the implications for genetic screening for haemoglobin disorders. METHODS: 397 South Asian Subjects were screened for haemoglobinopathy with measurement of bull blood count, haemoglobin electrophoresis, haemoglobin A2 quantification, and plasma ferritin determination. alpha Globin gene mapping was successfully performed on 266 stored buffy coat samples using a Southern blot technique after hybridisation with Bg/II and BamHI. RESULTS: Of the 266 subjects in whom gene mapping was performed, 28 had a single alpha+ thalassaemia deletion and one was homozygous for this deletion (gene frequency 0.056). Half of the heterozygotes had normal mean cell haemoglobin (MCH) values. A further 16 subjects had probable non-deletional alpha+ thalassaemia. None had alpha 0 thalassaemia. CONCLUSIONS: alpha Thalassaemia is by far the commonest haemoglobinopathy in British South Asian subjects, but is not a cause of serious genetic risk. Screening and counselling should focus on subjects with more marked red cell hypochromia (MCH < 25 pg), thus concentrating resources on subjects of different ethnic origins who may carry the alpha 0 thalassaemia gene.

Glove usage and reporting of needlestick injuries by junior hospital medical staff.

The use of gloves when conducting invasive procedures and the reporting of needlestick injuries have been strongly encouraged. Despite this, neither practice appears to be universal. In order to determine the rates of glove usage and needlestick injury reporting, we conducted a survey of junior doctors in three hospitals in the UK. Of the 190 respondents, the majority rarely wore gloves for venesection, insertion of intravenous cannulas or arterial blood gas sampling. For more major procedures (insertion of central venous lines, insertion of thoracostomy tubes, suturing) gloves were invariably worn. Only 17.5% of needlestick injuries were reported. The rates of glove usage and needlestick injury reporting were lower than previous studies have demonstrated in North America. Surgeons suffered the most needlestick injuries and were the least likely to report them. The low reporting rate may have serious implications, particularly in view of the new Government guidelines on needlestick injuries which involve HIV-infected blood. By failing to use gloves and report needlestick injuries, junior doctors, in particular surgeons, are placing themselves and patients at increased risk of blood-borne transmissible diseases.

The acceptability to women in Mombasa, Kenya, of the donation and transfusion of umbilical cord blood for severe anaemia in young children.

BACKGROUND AND OBJECTIVES: Severe anaemia, for which a blood transfusion can be life saving, is common in hospitalized children in sub-Saharan Africa but blood for transfusion is often in short supply. Umbilical cord blood is usually thrown away but could be a useful source of red cells for small volume transfusions in young children in this setting. The objective of this study was to evaluate the attitudes of women using the maternity services of the provincial hospital in Mombasa, Kenya, towards cord blood donation and transfusion, and essential aspects of this process including informed consent and the acceptability of screening for human immunodeficiency virus (HIV) infection. MATERIALS AND METHODS: A structured questionnaire was developed based on data provided by focus group discussions with women attending the hospital's maternity unit and administered to women who had recently delivered at the hospital. RESULTS: Of the 180 women who completed a questionnaire, the donation and transfusion of cord blood were acceptable to 81% and 78%, respectively. Ninety per cent of women who supported cord blood donation were willing to undergo further HIV testing at the time of delivery. Seventy-seven per cent of women wanted informed consent to be sought for cord blood donation and 66% of these felt they could make this decision alone. CONCLUSION: The donation of umbilical cord blood and its transfusion are acceptable to the majority of women delivering at Coast Provincial General Hospital, Mombasa. Findings from the study will benefit the planned cord blood donation programme at this facility.

Umbilical-cord blood for transfusion in children with severe anaemia in under-resourced countries.

Shortage of blood for transfusion contributes substantially to mortality of children with severe anaemia in sub-Saharan Africa. Umbilical-cord blood could be an additional and readily available source of blood. We aimed to show whether it is possible to gather cord blood in a busy Ghanaian labour ward. Mean volume of each blood sample obtained from the umbilical cord was 85 mL (SD 28.0). This amount of blood is sufficient to raise the haemoglobin concentrations of 28 (21%) of 131 children needing transfusions in the same hospital, by 30 g/L. Further work is needed to improve the sterility of cord blood and to establish the resource and logistical implications of scaling-up for sub-Saharan Africa transfusion services.