The Oklahoma Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome Registry: a community service.

The Oklahoma Thrombotic ThrombocytopenicPurpura-Hemolytic Uremic Syndrome (TTP-HUS) Registry has enrolled all 335 consecutive patients from central, western and southeastern Oklahoma who had their first episode of clinically diagnosed TTP or HUS from 1989 through 2005; follow-up is complete for 333 patients. Identifying all patients is possible since plasma exchange is the essential treatment for all adults and some children with these disorders and since the Oklahoma Blood Institute (OBI) is the sole provider of plasma exchange services for this region. Patients in the Oklahoma TTP-HUS Registry have come from 46 counties and have been treated in 16 hospitals; 227 physicians have provided the principal care for these patients. A support group formed in 1996 has met 3 times each year, averaging 17 former patients plus 16 additional family members and friends. Registry data are an important source of information for physicians and their patients, providing a complete community perspective of these uncommon disorders.

The future of automated red blood cell collection.

Automated red blood cell (RBC) collection is a newer but well-established form of donor apheresis. The technologies comprising and supporting apheresis have undergone significant advancements through the past 50 years, and we anticipate further improvements in devices and systems for automated RBC collection. Multiple factors must be considered in implementing automated RBC collections, but these procedures provide a way to draw additional RBC products that meet cGMP, regulatory, blood collector economic and donor objectives while maintaining or improving RBC availability. The continuing need for RBCs, accompanied by shrinking donor availability, would indicate that automated RBC collections will grow.

Evaluation of a new Trypanosoma cruzi antibody assay for blood donor screening.

BACKGROUND: This multicenter prospective study was designed to evaluate the performance characteristics of a new commercially available enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies to Trypanosoma cruzi in blood donors, the ORTHO T. cruzi ELISA Test System (Ortho-Clinical Diagnostics). STUDY DESIGN AND METHODS: Assay specificity was evaluated among 40,665 serum and ethylenediaminetetraacetate (EDTA) plasma specimens from volunteer blood donors and 481 T. cruzi antibody-negative specimens from a high-risk population. Sensitivity was evaluated among 106 T. cruzi-infected subjects identified by parasite detection, among 93 radioimmunoprecipitation assay (RIPA)-positive specimens from high-risk subjects, and 662 specimens presumed positive for the presence of T. cruzi antibodies by serologic methods. Also assessed were the equivalence of serum and plasma as specimen sources, performance equivalence of automated and semiautomated processing methods, nonspecific reactivity in specimens from other disease states or clinical conditions, and assay precision. RESULTS: Assay specificity was 99.998 percent in volunteer blood donors and 99.4 percent among high-risk subjects. Sensitivity was 100 percent among specimens positive by parasite detection, or by serologic methods, and 98.9 percent among RIPA-positive specimens from high-risk subjects. No differences were demonstrated between serum and plasma or between semiautomated and automated processing methods. Cross-reactivity was observed with known positive leishmaniasis specimens. Total inter- and intraassay variability was less than 10 percent with both the automated and the semiautomated methods. CONCLUSION: The ORTHO T. cruzi ELISA Test System is an effective, qualitative assay for screening blood donors for immunoglobulin G antibodies to T. cruzi. The assay was licensed for donor screening by the FDA in December 2006.

Convenience, the bane of our existence, and other barriers to donating.

BACKGROUND: To prevent donor loss and improve retention, it is important to understand the major deterrents to blood donation and to identify factors that can be effectively addressed by blood centers. STUDY DESIGN AND METHODS: A 30-item self-administered questionnaire was completed in 2003 by 1705 first-time and 2437 repeat US donors who had not donated in 2 to 3 years. Asian, Hispanic, black, and white first-time and repeat donors rated the importance of deterrents to donation in their decision to not return with a 1 to 5 scale. Categorical analysis of variance methods were used to compare the importance of deterrents between first-time and repeat donors of different race or ethnicity. RESULTS: Not having a convenient place to donate was most commonly cited as an important or very important reason for not returning by 32 to 42 percent of first-time and 26 to 43 percent of repeat respondents. Although bad treatment and poor staff skills were less of a barrier than convenience, they were more important for minority donors. Other factors such as physical side effects, foreign travel, or length of the process appeared less important. CONCLUSION: Inconvenience is a major barrier to donating, suggesting that mobile collections and increased hours of operation might help recapture lapsed donors. The finding that lapsed minority donors were more likely to give bad treatment and poor staff skills as important reasons to not donate is disconcerting in light of the changing donor demographics and increased efforts to recruit these donors.

Seasonal blood shortages can be eliminated.

PURPOSE OF REVIEW: This review is designed to help readers understand seasonal blood shortages and provide solutions through the use of technology that can increase the number of red blood cell units collected and the use of recruitment and marketing initiatives that appeal to the increasingly diverse donor base. RECENT FINDINGS: Seasonal shortages are, in reality, mostly shortages of group O red blood cells and occur most commonly during midsummer and early winter. The shortages occur primarily from increased use of group O red blood cells at times of decreased donor availability. While reducing the disproportionate use of red cells will help, blood centers can more quickly reduce the seasonal deficits by using automated red cell technology to collect double red blood cell units; targeted marketing programs to provide effective messages; seasonal advertising campaigns; and recognition, benefits, and incentives to enhance the donor motivation donation threshold. A multi-level approach to increasing blood donations at difficult times of the year can ensure that donations are increased at a time when regular donor availability is decreased. SUMMARY: Seasonal blood shortages can be eliminated by understanding the nature of the shortages, why and when they occur, and using more sophisticated recruitment and marketing strategies as well as automated collection technologies to enhance the blood supply.

Innovations in blood donor screening and blood collection.

Blood donor screening and blood collection are two of the donor-focused activities inherent in the process of maintaining an adequate blood supply. Donor screening represents procedures to provide safety for both donors as well as recipients. Donor medical history questions are so cumbersome that self-administered manual, computer-assisted, or on-line donor questions are under consideration in order to reduce time involved in the screening process. Blood collection procedures remain primarily based on whole blood donations, but apheresis donations are increasing steadily. The yield of multiple transfusible units per donation, as well as quality and reproducibility per product, support the use of apheresis procedures or other automated whole blood techniques to help offset blood shortages.