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Mardani A. Prevention strategies of transfusion-transmitted parasitic infections (TTPIs): Strengths and challenges of current approaches, and evaluation of the strategies implemented in Iran. Parasite Epidemiol Control 2020; 9:e00141. [PMID: 32149193 PMCID: PMC7052507 DOI: 10.1016/j.parepi.2020.e00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background Several strategies are being implemented in blood transfusion centers of the world to prevent the transfusion-transmitted parasitic infections (TTPIs). The objective of this study was to determine and describe the strategies to minimize the transmission risk of parasitic agents via blood transfusion in Iran. Methods This study was conducted in the Iranian blood transfusion organization (IBTO). The data were extracted from the latest version of the “medical interview” standard operating procedure (SOP). Results The donor selection is the first and only step to reduce the risk of TTPIs in endemic and non-endemic areas of Iran. In all blood transfusion centers of the IBTO, the blood donation volunteers with a previous history of malaria, Chagas disease, visceral leishmaniasis (VL), muco-cutaneous leishmaniasis and babesiosis, as well as those with clinical toxoplasmosis, cutaneous leishmaniasis (CL) and with a history of residence in, or travel to, malaria-endemic areas are permanently or temporarily deferred from the blood donation. Conclusions Since malaria, toxoplasmosis and VL are endemic in parts of Iran, as well as the increasing travels to endemic areas and immigrations from endemic to non-endemic areas of parasitic infections, the extensive use of blood and blood components and the asymptomatic occurrence of most parasitic infections in blood donors, the donor selection strategy is not sufficient to prevent the TTPIs. Therefore, the changing of donor selection process and the use of other common preventive strategies are recommended to reduce the risk of TTPIs, especially for high-risk groups of toxoplasmosis and VL.
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Affiliation(s)
- Ahmad Mardani
- Department of Microbiology, Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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Ortalli M, De Pascali AM, Longo S, Pascarelli N, Porcellini A, Ruggeri D, Randi V, Procopio A, Re MC, Varani S. Asymptomatic Leishmania infantum infection in blood donors living in an endemic area, northeastern Italy. J Infect 2019; 80:116-120. [PMID: 31585188 DOI: 10.1016/j.jinf.2019.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/23/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Human leishmaniasis can be severe and fatal, yet in the Mediterranean region only a small percentage of infections progress to clinical disease. We evaluated the percentage of asymptomatic Leishmania infection in the Bologna province, northeastern Italy. METHODS We examined the presence of specific antibodies by Western Blot (WB) and parasitic DNA by real time PCR in peripheral blood of 240 blood donors residing in the Bologna province. RESULTS Anti-Leishmania IgG were detected by WB in 27 subjects (11.2%, 95% CI 7%-15%), while Leishmania kinetoplast DNA was detected in peripheral blood specimens of 4 out of 240 donors (1.7%, 95% CI 0.2%-3.2%). Overall, the prevalence of Leishmania infection in the blood donor cohort was 12.5%, thus indicating an elevated cumulative exposure to the Leishmania parasite in the examined municipality. CONCLUSIONS Our results suggest that a surveillance system for monitoring Leishmania infection in blood donors and/or strategies of protozoan inactivation in whole blood should be taken into consideration in areas with circulation of the Leishmania parasite.
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Affiliation(s)
- Margherita Ortalli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40100, Italy
| | | | - Serena Longo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40100, Italy
| | - Nadia Pascarelli
- Centro Regionale Sangue Emilia-Romagna, Maggiore Hospital, Bologna 40100, Italy
| | - Andrea Porcellini
- Centro Regionale Sangue Emilia-Romagna, Maggiore Hospital, Bologna 40100, Italy
| | - Deborah Ruggeri
- Centro Regionale Sangue Emilia-Romagna, Maggiore Hospital, Bologna 40100, Italy
| | - Vanda Randi
- Centro Regionale Sangue Emilia-Romagna, Maggiore Hospital, Bologna 40100, Italy
| | - Anna Procopio
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia-Romagna, Brescia 25100, Italy
| | - Maria Carla Re
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40100, Italy; Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), St. Orsola-Malpighi University Hospital, Bologna 40100, Italy
| | - Stefania Varani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40100, Italy; Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), St. Orsola-Malpighi University Hospital, Bologna 40100, Italy.
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Leishmania infection in blood donors: A new challenge in leishmaniasis transmission? PLoS One 2018; 13:e0198199. [PMID: 29902188 PMCID: PMC6001978 DOI: 10.1371/journal.pone.0198199] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/15/2018] [Indexed: 11/26/2022] Open
Abstract
Transfusion-transmitted leishmaniasis has been a concern in regions endemic for the disease. Whether immediate or delayed, the risks posed by this mode of transmission call for careful assessment. The purpose of this study was to detect Leishmania infection in blood donors living in an endemic area and to investigate progression to the disease in these individuals. Immunofluorescent antibody test, enzyme-linked immunosorbent assay, leishmaniasis rapid test, and the polymerase chain reaction were applied to 430 donors in an initial evaluation. Of those donors with at least one positive test, 50 were reevaluated four years later by the same methods, as were 25 controls who had been negative on the same tests. In the first evaluation, Leishmania infection was detected in 41.4% (95% CI: 36.7–46.1) of donors (n = 430). None of the 75 reevaluated individuals had developed the disease, but retesting revealed positivity in at least one test in 36.0% (95% CI: 25.1–46.9) of donors. Of the 50 initially testing positive, 50% remained so on retesting. Of the 25 initially negative controls, two tested positive in the subsequent evaluation. The severity of the parasitosis and the risk of transfusion transmission warrant investigation of the potential inclusion of methods for Leishmania detection into blood banks for effective screening of infected donors.
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A systematic review and meta-analysis of the prevalence of Leishmania infection in blood donors. Transfus Apher Sci 2017; 56:544-551. [DOI: 10.1016/j.transci.2017.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 06/05/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022]
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Strategies for reducing the risk of transfusion-transmitted leishmaniasis in an area endemic for Leishmania infantum: a patient- and donor-targeted approach. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:130-136. [PMID: 28488962 DOI: 10.2450/2017.0201-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/16/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND In the Balearic Islands, as in other areas of the Mediterranean basin, there is a significant proportion of asymptomatic Leishmania (L.) infantum-infected blood donors, who may represent an important threat to transfusion safety. The Balearic Islands blood bank, located in an area endemic for L. infantum, carried out a study of donors and patients to investigate the impact of this infectious disease on blood safety in the region. MATERIALS AND METHODS Twenty asymptomatic Leishmania-infected blood donors were followed-up between 2008 and 2011 to investigate the evolution of Leishmania infection in asymptomatic carriers. Their blood was periodically tested for anti-Leishmania antibodies by western blot and for Leishmania DNA by quantitative polymerase chain reaction (qPCR). Additionally, the prevalence of L. infantum infection was investigated in a group of 68 multiply transfused patients to ascertain the risk of transfusion-transmitted leishmaniasis (TTL) in the region, taking into account regular blood component production practices such as pre-storage leucodepletion and pathogen reduction technology. RESULTS All 20 donors remained asymptomatic over the study period (2008-2011). Most donors had repeatedly positive qPCR results, either persistently or intermittently, but showed no symptoms of Leishmaniasis. Levels of parasitaemia were remarkably low in asymptomatic donors, with values ≤1 parasite/mL. Despite multiple transfusions received over 15 years, no transfused patient studied was infected with L. infantum. DISCUSSION L. infantum-infected donors can remain asymptomatic for at least 3 years. In our region, no cases of TTL were detected, despite an active search in multiply transfused patients. This seems to be related to two independent variables: (i) a low concentration of the parasite in the peripheral blood of asymptomatic carriers and (ii) the application of methods with proven efficacy against TTL, such as leucodepletion and pathogen reduction technology.
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Jimenez-Marco T, Fisa R, Girona-Llobera E, Cancino-Faure B, Tomás-Pérez M, Berenguer D, Guillen C, Pujol A, Iniesta L, Serra T, Mascaró M, Gascó J, Riera C. Transfusion-transmitted leishmaniasis: a practical review. Transfusion 2016; 56 Suppl 1:S45-51. [DOI: 10.1111/trf.13344] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/15/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Teresa Jimenez-Marco
- Fundació Banc de Sang i Teixits de les Illes Balears
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca, Spain
| | - Roser Fisa
- Laboratori de Parasitologia, Facultat de Farmàcia; Universitat de Barcelona; Barcelona Spain
| | - Enrique Girona-Llobera
- Fundació Banc de Sang i Teixits de les Illes Balears
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca, Spain
| | - Beatriz Cancino-Faure
- Laboratori de Parasitologia, Facultat de Farmàcia; Universitat de Barcelona; Barcelona Spain
| | - Miriam Tomás-Pérez
- Laboratori de Parasitologia, Facultat de Farmàcia; Universitat de Barcelona; Barcelona Spain
| | - Diana Berenguer
- Laboratori de Parasitologia, Facultat de Farmàcia; Universitat de Barcelona; Barcelona Spain
| | - Carmen Guillen
- Laboratori de Parasitologia, Facultat de Farmàcia; Universitat de Barcelona; Barcelona Spain
| | - Alba Pujol
- Laboratori de Parasitologia, Facultat de Farmàcia; Universitat de Barcelona; Barcelona Spain
| | - Laura Iniesta
- Laboratori de Parasitologia, Facultat de Farmàcia; Universitat de Barcelona; Barcelona Spain
| | - Teresa Serra
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca, Spain
| | | | - Joan Gascó
- Son Espases University Hospital; Majorca Spain
| | - Cristina Riera
- Laboratori de Parasitologia, Facultat de Farmàcia; Universitat de Barcelona; Barcelona Spain
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Improving platelet transfusion safety: biomedical and technical considerations. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 14:109-22. [PMID: 26674828 DOI: 10.2450/2015.0042-15] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/16/2015] [Indexed: 12/25/2022]
Abstract
Platelet concentrates account for near 10% of all labile blood components but are responsible for more than 25% of the reported adverse events. Besides factors related to patients themselves, who may be particularly at risk of side effects because of their underlying illness, there are aspects of platelet collection and storage that predispose to adverse events. Platelets for transfusion are strongly activated by collection through disposal equipment, which can stress the cells, and by preservation at 22 °C with rotation or rocking, which likewise leads to platelet activation, perhaps more so than storage at 4 °C. Lastly, platelets constitutively possess a very large number of bioactive components that may elicit pro-inflammatory reactions when infused into a patient. This review aims to describe approaches that may be crucial to minimising side effects while optimising safety and quality. We suggest that platelet transfusion is complex, in part because of the complexity of the "material" itself: platelets are highly versatile cells and the transfusion process adds a myriad of variables that present many challenges for preserving basal platelet function and preventing dysfunctional activation of the platelets. The review also presents information showing--after years of exhaustive haemovigilance--that whole blood buffy coat pooled platelet components are extremely safe compared to the gold standard (i.e. apheresis platelet components), both in terms of acquired infections and of immunological/inflammatory hazards.
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Drawz SM, Marschner S, Yañez M, García de Coca A, Feys HB, Deeren D, Coene J. Observational study of corrected count increments after transfusion of platelets treated with riboflavin pathogen reduction technology in additive solutions. Transfusion 2015; 55:1745-51. [PMID: 25702711 DOI: 10.1111/trf.13026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/29/2014] [Accepted: 01/06/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Mirasol pathogen reduction technology (PRT) treatment inactivates bacteria, viruses, and parasites in plasma products and platelets (PLTs) suspended in plasma and PLT additive solutions (PAS). Few clinical studies exist documenting transfusions with PAS. This study objective was to evaluate the count increments of PRT-treated PAS-C and PAS-E buffy coat (BC) PLTs in routine use observational settings. STUDY DESIGN AND METHODS PLT pools of five or six BCs were collected, processed, and suspended in PAS-C or PAS-E, respectively. Products were exposed to ultraviolet light in the presence of riboflavin and then transfused into 19 patients with hematologic diseases. Patients were monitored for PLT corrected count increment (CCI) at 1 and 24 hours and for any adverse events in the 72 hours after transfusion. Sterility monitoring was performed with a microbial detection system (BacT/ALERT, bioMérieux). RESULTS The PAS-E products had significantly higher PLT concentrations and counts than the PAS-C products. The mean CCIs of per-protocol (PP) units at 1 and 24 hours were 11,900 (n=27) and 5500 (n=30), respectively. Seventy-eight percent of PP transfusions classify as successful with CCIs at 1 hour of higher than 7500, and 63% higher than 4500 at 24 hours. One patient was excluded from all analyses as she was refractory to Mirasol-treated PLT transfusions and follow-up untreated transfusion products. No adverse events were observed and no contaminated products were detected by BacT/ALERT. CONCLUSION PRT-treated BC PLTs in PAS-C or PAS-E demonstrate PLT transfusion success rates in hematology patients with thrombocytopenia that are comparable to previous studies examining PLTs stored in plasma.
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Affiliation(s)
- Sarah M Drawz
- Department of Lab Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium
| | | | - José Coene
- Blood Service of the Belgian Red Cross-Flanders, Mechelen, Belgium
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Mansueto P, Seidita A, Vitale G, Cascio A. Transfusion transmitted leishmaniasis. What to do with blood donors from endemic areas? Travel Med Infect Dis 2014; 12:617-27. [DOI: 10.1016/j.tmaid.2014.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 10/11/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
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Girona-Llobera E, Jimenez-Marco T, Galmes-Trueba A, Muncunill J, Serret C, Serra N, Sedeño M. Reducing the financial impact of pathogen inactivation technology for platelet components: our experience. Transfusion 2013; 54:158-68. [DOI: 10.1111/trf.12232] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 03/25/2013] [Accepted: 03/25/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Enrique Girona-Llobera
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Teresa Jimenez-Marco
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Ana Galmes-Trueba
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Josep Muncunill
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Carmen Serret
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Neus Serra
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
| | - Matilde Sedeño
- Fundació Banc de Sang i Teixits de les Illes Balears; Majorca Spain
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS); Majorca Spain
- Son Espases University Hospital; Majorca Spain
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