Personalized collection of plasma from healthy donors: A randomized controlled trial of a novel technology-enabled nomogram.

BACKGROUND: Source plasma is essential to support the growing demand for plasma-derived medicinal products. Supply is short, with donor availability further limited by the coronavirus disease 2019 (COVID-19) pandemic. This study examined whether a novel, personalized, technology-based nomogram was noninferior with regard to significant hypotensive adverse events (AEs) in healthy donors. STUDY DESIGN AND METHODS: IMPACT (IMproving PlasmA CollecTion) was a prospective, multicenter, double-blinded, randomized, controlled trial carried out between January 6 and March 26, 2020, in three U.S plasma collection centers. Donors were randomly assigned to the current simplified 1992 nomogram (control) or a novel percent plasma nomogram (PPN) with personalized target volume calculation (experimental). Primary endpoint was the rate of significant hypotensive AEs. Noninferiority (NI) was tested with a margin of 0.15%. Collected plasma volume was a secondary endpoint. RESULTS: A total of 3443 donors (mean [SD] BMI: 32 [7.74] kg/m2 ; 65% male) underwent 23,137 donations (median [range]: 6 [1-22] per subject). Ten significant hypotensive AEs were observed (six control; four experimental), with model-based AE incidence rate estimates (95% CI) of 0.051% (0.020%-0.114%) and 0.035% (0.010%-0.094%), respectively (p = .58). NI was met at an upper limit of 0.043% versus the predefined margin of 0.15%. There was no statistical difference between total AEs (all AE types: p = .32). Mean plasma volume collected was 777.8 ml (control) versus 841.7 ml (experimental); an increase of 63.9 ml per donation (8.2%; p < .0001). CONCLUSION: This trial showed that a novel personalized nomogram approach in healthy donors allowed approximately 8% more plasma per donation to be collected without impairing donor safety.

Frequency of subgroups of the antigen "a" among volunteer donors / Frecuencia de subgrupos del antígeno A en donantes voluntarios de sangre.

Introduction: The presence of weak variants of blood type A represents a challenge in the practice of immunohematology for discrepancies in the time of the classification. It is common in blood banks to perform a forward and reverse typing for the purpose of confirming the blood type, but not all the people with a subgroup A2 have developed anti-A1 antibodies. Objective: We present a descriptive, observational and transversal study that establishes the proportion of subgroups of A antigen with the analysis of manual tube technique and monoclonal antibodies like anti-A, anti-A1 (Dolichus biflorus lectins extract) and anti-H. Methods: The analysis involved a total of 818 samples of voluntary blood donor, selected by random sampling, which were initially classified as 737 of Type A, and 81 as Type AB, with a confidence level of 95% (alpha error of 5% and 3% of precision). Results: The present study evaluated the existence of the subgroups A1, A2, A1B, A2B, A intermediate and A intB. Conclusions: It is recommended the identification of subgroups in different types of blood in the laboratory and blood banks.

Introducción: La presencia de variantes débiles del grupo sanguíneo A representa un desafío en la práctica de la inmunohematología por las discrepancias en el momento de la tipificación. Es común en bancos de sangre realizar una tipificación directa e inversa con el objetivo de confirmar el grupo sanguíneo; sin embargo, no todas las personas que presentan un subgrupo sanguíneo A2 han desarrollado anticuerpos anti-A1, lo que dificulta la identificación de subgrupos de A. Objetivo: El presente estudio es descriptivo, observacional y transversal, y tiene el objetivo de establecer la proporción de los subgrupos del antígeno A en donantes de sangre mediante la técnica manual en tubo con reactivos hemoclasificadores monoclonales: anti A, anti-A1 (extracto de las lectinas Dolichus biflorus) y anti-H. Métodos: Se analizaron un total de 818 muestras provenientes de donantes de sangre (muestreo aleatorio estratificado), de los cuales 737 fueron tipificados inicialmente como A y 81 como AB, con un grado de confianza del 95% (error alfa del 5% y precisión del 3%). Resultados: Se identificó la existencia de los subgrupos A1, A2, A1B, A2B, A intermedio y A intB en donantes de sangre ecuatorianos. Conclusión: Se recomienda la implementación de la identificación de los subgrupos de A en laboratorios clínicos y bancos de sangre.

Development of standard definitions for surveillance of complications related to blood donation.

Standard definitions of donor reactions allow each blood establishment to monitor donor adverse events and compare with other organizations to develop best practices. The ISBT Haemovigilance Working Party leads a multi-organizational effort to update the 2008 ISBT standard for surveillance of complications related to blood donation. Revised definitions have been developed and endorsed by the ISBT, AABB, International Haemovigilance Network (IHN) and other international organizations.

Prevalence and determinants of declining versus stable hemoglobin levels in whole blood donors.

BACKGROUND: A too short recovery time after blood donation results in a gradual depletion of iron stores and a subsequent decline in hemoglobin (Hb) levels over time. This decline in Hb levels may depend on individual, unobserved characteristics of the donor. STUDY DESIGN AND METHODS: We used a data set of 5388 Dutch blood donors from the Donor InSight study. The statistical analysis is based on a Bayesian growth mixture model, which assumes that each donor belongs to one of several groups. Each group implies a different Hb trajectory, and donors with similar longitudinal trajectories belong to the same group. Analyses were performed for male and female donors separately. RESULTS: For both sexes the model identified four groups of donors. Stable Hb trajectories were found among 14% of male donors and 15% of female donors; declining Hb trajectories were observed in the remaining groups of donors. The percentage of donor deferrals differed strongly between groups. CONCLUSION: The model can be used to predict to which group a donor belongs, and this prediction can be updated after each donation. This is of high practical importance because early identification of donors with declining Hb levels could help to tailor donation intervals and to prevent iron deficiency and donor deferrals.

Kinetics and activation requirements of contact-dependent immune suppression by human regulatory T cells.

Naturally occurring regulatory T cells (Tregs) maintain self tolerance by dominant suppression of potentially self-reactive T cells in peripheral tissues. However, the activation requirements, the temporal aspects of the suppressive activity, and mode of action of human Tregs are subjects of controversy. In this study, we show that Tregs display significant variability in the suppressive activity ex vivo as 54% of healthy blood donors examined had fully suppressive Tregs spontaneously, whereas in the remaining donors, anti-CD3/CD2/CD28 stimulation was required for Treg suppressive activity. Furthermore, anti-CD3/CD2/CD28 stimulation for 6 h and subsequent fixation in paraformaldehyde rendered the Tregs fully suppressive in all donors. The fixation-resistant suppressive activity of Tregs operated in a contact-dependent manner that was not dependent on APCs, but could be fully obliterated by trypsin treatment, indicating that a cell surface protein is directly involved. By add-back of active, fixed Tregs at different time points after activation of responding T cells, the responder cells were susceptible to Treg-mediated immune suppression up to 24 h after stimulation. This defines a time window in which effector T cells are susceptible to Treg-mediated immune suppression. Lastly, we examined the effect of a set of signaling inhibitors that perturb effector T cell activation and found that none of the examined inhibitors affected Treg activation, indicating pathway redundancy or that Treg activation proceeds by signaling mechanisms distinct from those of effector T cells.

[Prevalence and incidence of HIV and hepatitis B among blood donors and estimated residual risk of transmission of HIV and HBV virus by blood transfusion. A study at the Provincial General Referee Hospital Bukavu, Democratic Republic of the Congo]. / Prévalence et incidence du VIH et de l'hépatite B chez les donneurs de sang et estimation du risque résiduel de transmission du virus VIH et du virus VHB par la transfusion sanguine. Une étude à l'hôpital provincial général de référence de Bukavu, République démocratique du Congo.

BACKGROUND: To estimate the residual risk of transmission of HIV and HBV virus by blood transfusion in Bukavu. METHODS: Retrospective cohort study designed for exploratory purposes, which took place in Bukavu (DR Congo) between January 2001 and December 2005, among 3292 blood donors. The incidences were estimated by survival curves and Cox models. The adjusted relative risks with their confidence interval at 95% were derived from Cox models. The residual risk of viral transmission associated with the serological window is equal to the incidence rate multiplied by the duration of the serological window divided by 365. RESULTS: The prevalence among blood donors in Bukavu was 1% for HIV and 3.7% for HbsAg. The number of incident cases observed was seven for HIV and 40 for hepatitis B between 2001 and 2005. The incidence rates obtained were 3.57 for 1000 person-years (0.93/1000-6.23/1000) and 25.4 per 1000 person-years (17.6/1000-33.36/1000), respectively for HIV and hepatitis B. The residual risk was 1/4608 donations for HIV or 0.22 (0.02-0.65) and 1/257 donations for HBV or 3.90 (1.20-9.96). Also there were more seroconversions among family blood donors than in volunteer donors. The risk of seroconversion in family donors compared to volunteer donors adjusted for age, sex and residence was 7.09 (3.75-13.39) for HIV and 4.03 (2.63-6.20) for HBsAg. The same result was observed with the survival curves. CONCLUSION: The prevalences of HIV and HBsAg in Bukavu are lower than in most major cities in sub-Saharan Africa. Residual risks are especially important for hepatitis B.

Systemic lupus erythematosus serum deposits C4d on red blood cells, decreases red blood cell membrane deformability, and promotes nitric oxide production.

OBJECTIVE: Systemic lupus erythematosus (SLE) is characterized by intravascular activation of the complement system and deposition of complement fragments (C3 and C4) on plasma membranes of circulating cells, including red blood cells (RBCs). The aim of this study was to address whether this process affects the biophysical properties of RBCs. METHODS: Serum and RBCs were isolated from patients with SLE and healthy controls. RBCs from healthy universal donors (type O, Rh negative) were incubated with SLE or control serum. We used flow cytometry to assess complement fragment deposition on RBCs. RBC membrane deformability was measured using 2-dimensional microchannel arrays. Protein phosphorylation levels were quantified by Western blotting. RESULTS: Incubation of healthy universal donor RBCs with sera from patients with SLE, but not with control sera, led to deposition of C4d fragments on the RBCs. Complement-decorated RBCs exhibited significant decreases in both membrane deformability and flickering. Sera from SLE patients triggered a transitory Ca(++) influx in RBCs that was associated with decreased phosphorylation of ß-spectrin and with increased phosphorylation of band 3, two key proteins of RBC cytoskeleton. Finally, incubation with SLE sera led to the production of nitric oxide by RBCs, whereas this did not occur with control sera. CONCLUSION: Our data suggest that complement activation in patients with SLE leads to calcium-dependent cytosketeletal changes in RBCs that render them less deformable, probably impairing their flow through capillaries. This phenomenon may negatively affect the delivery of oxygen to the tissues.

[The individual selection of erythrocytes for regional clinics].

The article deals with the results of work of Krasnoyarsk kray blood center immune hematologic laboratory concerning selection of erythrocytes in 2003-2010. In Krasnoyarsk kray, the portion of transfusions of individually selected erythrocytes increases and reached 31.9%. The setting up of register of donors typed by Ab0 and Rhesus systems makes it possible to implement effectively the individual selection of erythrocytes in optimal time-frame and in amount needed in clinics.

A PCR-based strategy for Dombrock screening in Brazilian blood donors reveals a novel allele: the DO* A-WL.

BACKGROUND: Determination of the molecular basis underlying the antigens in the Dombrock blood group system has shown various rearrangements between the alleles associated with DO(*) A and DO(*) B. Based on this, we employed a PCR-based strategy to screen DO alleles (DO(*) A, DO(*) B, HY(*) 1, HY(*) 2 and JO) in Brazilians. METHODS: We tested DNA of 278 Brazilian blood donors by PCR-RFLP on plates of 96 wells to determine the 793A/G (DO(*) A/DO(*) B), 323G/T (HY), 350C/T (JO) and 898C/G (HY(*) 1/HY(*) 2) single nucletide polymorphisms. In order to confirm the results sequence analysis was also performed. RESULTS: When samples of these donors were analyzed, a novel allele combination, the DO(*) A allele (793A and 323G) associated with 898G was identified and designated as DO(*) A-WL allele. This new allele encoding 300Val is the same as HY(*) 1 at nucleotide 898 on the molecular background of DO(*) A. Among the 556 alleles analyzed by PCR-RFLP, 3 were DO(*) A-WL and 78 were DO(*) B-WL. This represents an overall frequency of 0.5% for DO(*) A-WL and 14% for DO(*) B-WL across the population studied. CONCLUSION: Molecular screening of Brazilians revealed one novel allele, the DO(*) A-WL. Our data highlight the importance of testing a cohort of different populations to determine DO haplotypes and to establish reliable genotyping tests for predicting Do(a)/Do(b) status.

O group is a protective factor for COVID19 in Basque population.

ABO blood groups have recently been related to COVID19 infection. In the present work, we performed this analysis using data from 412 COVID19 patients and 17796 blood donors, all of them from Gipuzkoa, a region in Northern Spain. The results obtained confirmed this relation, in addition to showing a clear importance of group O as a protective factor in COVID19 disease, with an OR = 0.59 (CI95% 0.481-0.7177, p<0.0001) while A, B and AB are risk factors. ABO blood groups are slightly differently distributed in the populations and therefore these results should be replicated in the specific areas with a proper control population.

Enhanced classification of Chagas serologic results and epidemiologic characteristics of seropositive donors at three large blood centers in Brazil.

BACKGROUND: A major problem in Chagas disease donor screening is the high frequency of samples with inconclusive results. The objective of this study was to describe patterns of serologic results among donors to the three Brazilian REDS-II blood centers and correlate with epidemiologic characteristics. STUDY DESIGN AND METHODS: The centers screened donor samples with one Trypanosoma cruzi lysate enzyme immunoassay (EIA). EIA-reactive samples were tested with a second lysate EIA, a recombinant-antigen based EIA, and an immunfluorescence assay. Based on the serologic results, samples were classified as confirmed positive (CP), probable positive (PP), possible other parasitic infection (POPI), and false positive (FP). RESULTS: In 2007 to 2008, a total of 877 of 615,433 donations were discarded due to Chagas assay reactivity. The prevalences (95% confidence intervals [CIs]) among first-time donors for CP, PP, POPI, and FP patterns were 114 (99-129), 26 (19-34), 10 (5-14), and 96 (82-110) per 100,000 donations, respectively. CP and PP had similar patterns of prevalence when analyzed by age, sex, education, and location, suggesting that PP cases represent true T. cruzi infections; in contrast the demographics of donors with POPI were distinct and likely unrelated to Chagas disease. No CP cases were detected among 218,514 repeat donors followed for a total of 718,187 person-years. CONCLUSION: We have proposed a classification algorithm that may have practical importance for donor counseling and epidemiologic analyses of T. cruzi-seroreactive donors. The absence of incident T. cruzi infections is reassuring with respect to risk of window phase infections within Brazil and travel-related infections in nonendemic countries such as the United States.

Phenotype frequencies of blood group systems (Rh, Kell, Kidd, Duffy, MNS, P, Lewis, and Lutheran) in north Indian blood donors.

BACKGROUND: We here report the first study of antigen and phenotype frequencies of various blood group systems by gel technology in north Indian blood donors. STUDY DESIGN AND METHODS: A total of 1240 regular repeat voluntary north Indian blood donors of O blood group were included for red cell antigen typing of Rh (D, C, E, c, e) and Kell (K) blood group systems. Out of these, 317 donors were randomly selected for typing of other blood group antigens: Jk(a), Jk(b), k, Kp(a), Kp(b), Fy(a), Fy(b), M, N, S, s, Le(a), Le(b), P(1), Lu(a), Lu(b) and Xg(a). Calculations of antigen and phenotypes frequencies were expressed as percentages and for allele frequencies under the standard assumption of Hardy-Weinberg equilibrium. RESULTS: Out of 1240 O group blood donors, 93.39% were Rh D and 5.56% were K positive. Amongst Rh antigens, e was the most common (98.3%) followed by D, C (84.76%), c (52.82%) and E (17.9%) with DCe/DCe (R(1)R(1), 43.8%) being the most common phenotype. In Kell blood group system, we found k antigen to be 100% and a rare phenotype Kp (a+b+) was found in 0.95% of the donors. For Kidd and Duffy blood group systems, Jk (a+b+) and Fy (a+b-) were the most common phenotypes (49.21% and 43.85%, respectively). In the MNS blood group system, M+N+S+s+ (19.55%) was the most common whereas M-N+S+s- (1.26%) was least common phenotype found. We found rare Lu (a+b+) and Lu (a-b-) phenotypes in 0.95% and 3.15% of the donors, respectively. Xg(a) antigen was seen in 86.67% and 62.6% of female and male donors, respectively. CONCLUSIONS: Knowledge of red cell antigen phenotype frequencies in a population is helpful in terms of their ethnic distribution, in creating a donor data bank for preparation of indigenous cell panels, and providing antigen negative compatible blood to patients with multiple alloantibodies.

Low retention rate of voluntary blood donors: contribution of an original method based on a composite classification (results of a monocentric study in the Democratic Republic of Congo).

INTRODUCTION: in order to improve the safety of blood transfusion, the retention of voluntary donors remains a major concern in the Democratic Republic of Congo. Nevertheless, retention is still difficult to assess because of the lack of local studies. The present study establishes the donors' profile and regularity, as well as regularity-associated factors, at the Provincial Blood Transfusion Centre in Bukavu. METHODS: this descriptive and analytical cross-sectional study included the records of 387 out of 773 blood donors during the period from 2015 to 2017. Donor retention and its associated factors were measured. The composite approach used here considered the number of blood donations, their frequency, the previous regularity of donors and the inter-donation interval. RESULTS: we bring to light an important loss of regular voluntary donors in the centre. Only 23.8% of them were still regular donors in 2017. The majority of donors registered in the centre are young males and have no income. On the contrary, factors associated with the profile of a regular donor in 2017 were: age at least 46 years old, being a woman and working in the formal sector. The composite classification highlighted that an important proportion of former regular donors, namely 72.8% (N=161/221), had not given blood in 2017. CONCLUSION: the use of a composite classification to assess the regularity of voluntary blood donors provides more accurate information that will enable the improvement of donors' awareness and retention as well as the possible reinstatement of former donors.

Effects of RHD gene polymorphisms on distinguishing weak D or DEL from RhD- in blood donation in a Chinese population.

BACKGROUND: Weak D or DEL red blood cell units may be mistyped as RhD- by current serology assays, which can lead to incompatible transfusion to RhD- recipients and further cause anti-D immunization. Molecular RHD blood group typing is a very effective method for overcoming current technical limits. The purpose of this study was to identify RHD single-nucleotide polymorphisms (SNPs) and compare the genotype prevalence among confirmed RhD- individuals in a Chinese population as well as explore effective biomarkers for current weak D or DEL detection before blood transfusion. METHODS: In the present study, 125 weak D (1, 2, 3, and 4.1) or DEL and 185 RhD- blood samples from donors detected by current standard serology were collected. Genotyping system was used to analyze the SNPs of RHD in each sample. RESULTS: Seven SNPs (rs592372, rs11485789, rs6669352, rs3118454, rs1053359, rs590787, and rs3927482) were detected in the RHD region. Rs3118454, rs1053359, rs590787, and rs3927482 showed significant differences between the weak D (1, 2, 3 and 4.1) or DEL and RhD- groups. Further combined analysis of the allelic distribution of these four SNPs revealed their higher frequencies in the RhD- group. CONCLUSION: The SNPs rs3118454, rs1053359, rs590787, and rs3927482 in RHD showed a significantly higher frequency among an RhD- Chinese population and are potential biomarkers.

Profile of blood donors who presented adverse reactions to the donation.

OBJECTIVE: identify the adverse reactions presented by blood donors and outline their sociodemographic profile. METHOD: a quantitative, cross-sectional retrospective study of 780 records of blood donors from a public hemocenter in the southern region of Brazil, from December 2015 to January 2016. For the analysis the descriptive statistics was used. RESULTS: it was identified that throughout 12 months, the total blood donors corresponded to 27,300 people, in which 780 developed at least one reaction. They were characterized by female and recurrent donors, single, with a complete average level of education, ranging from 16 to 30 years, who triggered between 1 and 3 reactions. Mild reactions were more frequent, followed by moderate and severe reactions. CONCLUSION: There is a high rate of adverse reactions from donors emphasizing the need for changes in hemotherapy care practices.

Molecular studies of DO alleles reveal that JO is more prevalent than HY in Brazil, whereas HY is more prevalent in New York.

Because of the scarcity of anti-Hy and anti-Jo(a), hemagglutination typing for the Dombrock blood group system antigens, Hy and Jo(a), is not feasible. The molecular bases associated with these antigens have been determined, making it possible to distinguish HY and JO from wild-type DO. This provides a tool to predict the probable phenotype of patients and to screen for antigen-negative donors. PCR-RFLP assays and a microchip assay were used to determine the frequency of HY and JO alleles in donors from Brazil and New York. DNA from random Brazilian donors, 288 by PCR-RFLP and 599 by the bead array method (BeadChip, BioArray Solutions, Warren, NJ), was tested to determine 323G/T (HY+/HY-) and 350C>T (JO+/JO-) single-nucleotide polymorphisms. In New York, 27,226 donors who self-identified as being African American were tested by hemagglutination with anti-Gy(a). Nonreactive and weakly reactive samples were tested by PCR-RFLP for the same alleles as listed above. In Brazil, 30 (3.4%) of the samples were JO/DO and 13 (1.4%) were HY/DO. In New York, of the samples that had HY or JO alleles, 14 were homozygous HY/HY 132 were heterozygous HY/DO, 13 were heterozygous HY/JO, 14 were heterozygous JO/DO, and 3 were homozygous JO/JO. These results show that in donors from Brazil, JO (30 alleles) is more than twice as prevalent as HY (13 alleles), whereas in donors from New York, HY (173 alleles) was more than five times more common than JO (33 alleles).

Molecular analyses of GYPB in African Brazilians.

The molecular background of variant forms of GYPB is not well studied in Brazilians of African descent. The present study was carried out to determine the molecular bases of the S-s- phenotype and the frequency of GYPB*S silent gene for the S-s+ phenotype in a blood donor population of African Brazilians. In this study, 165 blood samples from African Brazilians (Northeastern Brazil) who phenotyped as S-s- (n = 17) and S-s+ (n = 148) by hemagglutination were selected. Allele-specific (AS)-PCR and PCR-restriction fragment length polymorphism (RFLP) were used to identify the variant forms of GYPB. In 13 of 17 S-s- samples (76.5%), both GYPB were deleted. In 137 of the 148 S-s+ samples (92.6%), the AS-PCR was consistent with the S-s+ phenotype. In 4 of the S-s- samples (23.5%) and 11 of the S-s+ samples (7.4%), the AS-PCR showed the presence of a GYPB*S allele associated with silencing of S. In the 4 donors with the S-s- phenotype, there was homozygosity (or hemizygosity) for the GYP(P2) allele (n = 2), homozygosity (or hemizygosity) for the GYP(NY) allele (n = 1), and heterozygosity for the GYP(P2) and GYP(NY) alleles (n = 1). In the 11 donors with the S-s+ phenotype, there was heterozygosity for GYP(P2) allele (n = 8) and heterozygosity for GYP(NY) allele (n = 3). This study reports for the first time the molecular mechanisms responsible for the S-s- phenotype in a population of African Brazilians and provides new information about the frequency and molecular bases of the GYPB*S silent gene (7.4%) in this population.

Value of DNA-based assays for donor screening and regulatory issues.

Hemagglutination, the gold standard method to detect the presence or absence of blood group antigens on RBCs, has served the transfusion community well for decades. It is simple, and, when done correctly, it has a specificity and sensitivity that is appropriate for most testing in the vast majority of patients requiring blood transfusion. The limitations of hemagglutination for screening donor blood include that both testing and data entry are labor-intensive, that the required antibody is not always commercially available, and that it may be limited in volume, weakly reactive, or costly. These scenarios can make it difficult to screen for large numbers of antigen-negative blood donors. The knowledge of the molecular bases of blood group antigens makes it possible to screen donors to predict their antigen status. High-throughput platforms provide a means to test relatively large numbers of donors, thereby opening the door to change the way antigen-negative blood is provided to patients. This review discusses testing for blood group antigens by hemagglutination and bead chip technology. It also reviews regulatory issues, including validation and training, and suggests an algorithm for screening and confirming blood types of donors.

[Infectious markers among blood donors in Democratic Republic of Congo (DRC)]. / Marqueurs infectieux chez les donneurs de sang en République Démocratique du Congo (RDC).

In sub-saharian Africa, two factors account for the difficulties encountered to reach optimal blood safety: high frequency in the general population of various infections of which some are transmissible by blood transfusion and a still insufficient proportion of voluntary donors which constitute the safest group. The Kisangani transfusion center in DRC does not escape from this rule since in addition to voluntary blood donors (29.2%), its blood supply is mainly assured by family (or replacement) donors (69.2%). Persistence of a few remunerated donors (1.6%) was also noted at the period of the study. In this study, we determined seroprevalence of HIV, HBV and of syphilis infections in these three categories of donors and defined their characteristics by a retrospective analysis carried out on 3.390 subjects between January 2003 to December 2004. It revealed that 4.7% of the donors were positive for HIV, 5.4% for HBV and 3.7% for syphilis. There were significant differences according to studied groups : voluntary blood donors (n=989; HIV+ = 2.2%; VHB+ =3%; syphilis+ = 1.1%), family donors (n = 2.345; HIV+ = 4.6%; HBV+ = 4.9%; syphilis+ = 3.6%) and remunerated donors (n=56; HIV=50%; HBV+ = 64.3%; syphilis+ = 53.6%). These results indicate that it is necessary to intensify promotion of voluntary donation by a policy of information and education and to abolish practice of remunerated donation. Within the limits of possible, family donation should be gradually discouraged.

Risk Factors for Cytomegalovirus Infection After Allogeneic Hematopoietic Cell Transplantation in Malignancies: Proposal for Classification.

AIM: To identify and classify risk factors for cytomegalovirus (CMV) infection and disease in patients receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT), treated mainly for acute leukemia. MATERIALS AND METHODS: A literature search was performed;eligible trials were clinical studies assessing the risk factors for CMV infection or disease in multivariate analysis. RESULTS: Early reactivation in the setting of allo-HSCT took place mainly in patients without CMV prophylaxis, while late reactivation mainly in those patients who had completed previous prophylaxis or were on anti-CMV strategy based on pre-emptive prophylaxis. We propose classifying risk factors for CMV reactivation and CMV disease in patients after allo-HSCT as major and minor ones. Three major risk factors for CMV reactivation and CMV disease were found: (i) CMV-negative donor CMV-positive recipient serostatus, (ii) acute or chronic graft-versus-host disease, and (iii) unrelated or mismatched donor. CONCLUSION: CMV reactivation should be regarded as a continuous function of recipient and donor CMV-seropositivity and recipient immune suppression, caused by conditioning, immunosuppressive therapy and human leukocyte antigen disparity between donor and recipient.