The integration of high-throughput testing of blood donors for cardiovascular disease risk assessment and prevention.

BACKGROUND AND OBJECTIVES: Some blood centers provide health screening as a public health measure and to encourage donation. The goal of the current study was to provide cardiovascular disease (CVD) screening to donors using high-throughput testing and web-based communications. MATERIALS AND METHODS: CVD risk screening was offered to donors at selected mobile drives in a large metropolitan area. Risk factors were determined by donor questionnaire, laboratory testing (total cholesterol, HDL levels and hemoglobin A1c), and blood pressure measurement. Results were reported to participants via mail and website. A 60-day follow up web-based survey was sent to participants via email to assess the impact of the program on donor's behavior. RESULTS: 9435 donors, 17-75 years old participated with the following risk factors: 61.3% BMIs>25, 28.8% high total cholesterol, and 31.4% lower than recommended HDL levels. 25.3% of donors that responded to the follow up survey went to see their health care provider based on screening results and 9% of these received new or modified treatment. CONCLUSION: In our sample, blood donors are healthier than the general population, but many still have CVD risk factors, particularly obesity. CVD screening can be successfully used to make donors aware of this important health information and some donors act on this information.

Cardiovascular disease risk assessment and prevention in blood donors.

BACKGROUND: Blood centers have implemented public health initiatives, including cardiovascular disease (CVD) screening, to improve donor and community health and serve as an incentive to donate. STUDY DESIGN AND METHODS: CVD risk screening and counseling were performed at mobile blood drives in diverse neighborhoods. Risk factors were determined by point-of-care testing (total cholesterol, high-density lipoprotein, and hemoglobin A1c levels), interviews, and physical examinations (body mass index, waist circumference, and blood pressure). Results were confidentially relayed to participant by health counselors. A 60-day follow-up survey was sent to some participants. RESULTS: Over 11 months, 2406 participants (44% male; mean age 28 ± 16; 67% minority racial/ethnic group) were screened at 290 mobile drives. A total of 92% of participants had medical insurance. A total of 14% had none, 26% one, 33% two, and 27% three or more risk factors. A total of 72% of teenage participants had at least one risk factor. A total of 18% of participants who were taking medications for risks were poorly controlled. A total of 15% had newly identified risks. A total of 711 participants completed follow-up survey: 21% sought medical care, 51% were motivated to change their lifestyle, 81% were pleased with screening, 48% were more likely to donate, and 62% recommended donation to friends and family because of the screening. CONCLUSION: CVD risk screening and counseling can occur during a mobile blood drive. A majority of participants screened had risk factors. Follow-up surveys showed that the program was well received. Further studies are planned to evaluate long-term effects of the program on donor health and donor return rates.

ABO-mismatched platelet transfusions: strategies to mitigate patient exposure to naturally occurring hemolytic antibodies.

Clinically significant hemolysis is a rare but potentially severe complication of administering an ABO-mismatched platelet transfusion. Platelet products from Group O donors, particularly single donor platelets (SDP) are most commonly implicated in these reactions. This is due to the presence of unusually high titers of anti-A which can be found in the plasma of some Group O donors and the large plasma volume of SDPs. These products can cause significant hemolysis when infused into a Group A or AB recipient. Random donor platelets from Group O donors have also been implicated. In practice, platelets are frequently transfused across ABO barriers though, ideally, in order to prevent or mitigate these reactions, platelet transfusions that are matched for ABO should be administered. However, limited availability of donor platelets as well as an abundance of Group O donors makes this a difficult standard to adhere to since often out-of group products are the only ones available. Methods to improve the safety of Group O products have focused on defining a safe level of isohemagglutinins so that the risk of hemolysis is alleviated when mismatched products are transfused. Determining the critical titer which defines a level above which a mismatched product should not be administered has been challenging. Non-standardized methods of isohemagglutinin titering and varying reports in the literature where products with a wide range of titers have been implicated in acute hemolytic transfusion reactions have made it difficult to determine a cut-off for labeling a product as high titer and thereby restricting its use to O recipients. Standards in the US place the responsibility for designing and implementing policies for the use of mismatched platelet products on each individual hospital transfusion service. Compliance requires only that there be an existing written policy which addresses the transfusion of products containing incompatible ABO antibodies but no specific procedures are required. In sharp contrast, European strategies have defined the low-end titer for which an out-of-group transfusion should not be given to an ABO-incompatible recipient. This testing is performed centrally at the Blood Centers who then make the determination on the status of a "dangerous donor". The progress in this European strategy may serve the US to stimulate a re-examination of its practices and policies for the advancement of platelet transfusion safety.

Exchange transfusion for malaria and Babesia infection.

Malaria accounts for about 2 million deaths per year. Although most cases occur in children in sub-Saharian Africa, fatal infections are seen increasingly in industrialized countries. In 1992, over 900 malaria cases were reported in the United States and a third of these were caused by Plasmodium falciparum. Fatal infections are related to the magnitude of the parasitemia and the immune status of the host. P falciparum poses the greatest threat of death because it invades red cells of all ages, is often drug resistant, and is the only one of the plasmodia species that produces microvascular disease. The risk of death is correlated with the parasite load in immune naive individuals. Babesiosis is generally a subclinical infection in most normal hosts, but it can be life threatening in asplenic patients, older, or immunocompromised individuals. The role of exchange transfusion (ET) in the treatment of these infections is controversial. The Centers for Disease Control recommends that ET be performed in P falciparum infection when parasitemia is equal or greater than 10%. In patients with coma, renal failure, or adult respiratory distress syndrome, ET is recommended regardless of the level of parasitemia even if less than 10%. ET has been advocated to reduce the level of parasitized red blood cells (RBCs), to remove cytokines, and to improve the rheologic properties of the blood. Dramatic improvement has been reported, but there are conflicting reports that question the need for exchange transfusion. This review examines the pathophysiology of severe infection and its treatment, with an emphasis on the role of exchange transfusion.

Seroprevalence of Chagas infection in the donor population.

We retrospectively calculated the prevalence and epidemiologic characteristics of Chagas infection in the New York blood donor population over three years utilizing the New York Blood Center's database of the New York metropolitan area donor population. Seventy Trypanosoma cruzi positive donors were identified from among 876,614 donors over a 3-year period, giving an adjusted prevalence of 0.0083%, with 0.0080% in 2007, 0.0073% in 2008, and 0.0097% in 2009. When filtered only for self-described "Hispanic/Latino" donors, there were 52 Chagas positive donors in that 3-year period (among 105,122 self-described Hispanic donors) with an adjusted prevalence of 0.052%, with 0.055% in 2007, 0.047% in 2008, and 0.053% in 2009. In conclusion, we found a persistent population of patients with Chagas infection in the New York metropolitan area donor population. There was geographic localization of cases which aligned with Latin American immigration clusters.