HIV This Week

Ansah JK, Acquaye J. Ten years of preoperative autologous blood donation in Accra. Ghana Med J 2006;40:142-7.

Pre-operative autologous blood donation (PABD) is utilized to circumvent the use of allogenic blood for various reasons. Ansah and Acquaye describe the distribution in terms of demographic characteristic, trends in participation and result of screening test of the PABD programme of the Accra Area Blood Center from 1993-2003. This is a retrospective descriptive study of PABD in patients scheduled for a variety of elective surgical procedures, in different levels of institutional health care in Accra, Ghana. Data from existing records of patients who had participated in PABD were collated and analyzed. The results showed that five hundred and forty six (546) females and 89 males participated, with ages ranging between 14-74 years. Majority of the patients (76.7%) underwent gynaecological surgery. A total of 330 (52%) donated one unit only, and 299 (47.1%) donated two units. Majority of the patients (56.4%) had the surgery at the Korle-Bu Teaching Hospital. Of the donations, 21 (3.3%), 1 (0.2%), 1 (0.3%) and nil were positive for HBV, HIV I & II, HCV and VDRL respectively. A total of 848 (89.4%) autologous cross-matched units were issued out. There was a steady progressive increase in participation. In conclusion, mainly adult females scheduled for gynaecological surgeries in Korle-Bu Teaching Hospital participated, while almost equal proportions donated one or two units of blood which meets the blood needs of most elective surgeries. Therefore healthy patients going for elective surgeries in regions with limited blood supply must be encouraged to enter a Pre-operative autologous blood donation Programme. Further studies in this field should evaluate motivational factors for participation.

Editors’ note: Autologous blood transfusion, storing your own blood ahead of time in case you will need it for an elective surgical procedure, has obvious advantages for the individual but is controversial in many settings because of its potential to undermine emergency blood services if it draws resources away from them.

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Stramer SL. Current risks of transfusion-transmitted agents: a review. Arch Pathol Lab Med 2007;131:702-7.

Infectious disease testing has dramatically improved the safety of blood for transfusion in the United States, especially since the introduction in 1999 of nucleic acid amplification testing. In 2004, methods (primarily culturing) for detecting bacteria in platelets were also added. Stramer’s objective is to provide current risk estimates for the likelihood of viral transmission by test-negative blood components and to illustrate the safety improvements since the introduction of bacterial testing of platelets. The author’s data sources are published literature from 1999 through 2006 and unpublished American Red Cross data sources. The author concludes that the risk of human immunodeficiency virus and hepatitis C virus transmission through blood transfusion since the introduction of nucleic acid amplification testing is approximately 1 in 2 million. Hepatitis B virus risk, for which nucleic acid amplification testing is not performed routinely, remains at 1 in 200,000 to 500,000 using a combination of anti-hepatitis B core and hepatitis B surface antigen testing. Seven cases of transfusion-transmitted West Nile virus have been reported since the introduction of nucleic acid amplification testing in 2003, but none has been reported since system-wide implementation of processes to increase the test sensitivity for use in epidemic areas. The residual risk of receiving a bacterially contaminated platelet component with clinical consequences is estimated at approximately 1 in 75,000, if culture negative and 1 in 33,000 if not tested by culture methods.

Editors’ note: The risks of acquiring transfusion-associated infectious agents have dropped significantly in the USA and other countries with the resources to devote to assuring the safety of the blood supply. However, primary prevention starts by preventing accidents in the workplace, on the highway and elsewhere, as well as by reducing the prescribing of blood transfusion in hospitals unless absolutely necessary.