A pilot study on screening blood donors with individual-donation nucleic acid testing in China

Nucleic Acid Amplification Testing for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus in Blood Donors at a Tertiary Care Hospital Blood Bank

Objective The objective was to assess the efficacy of nucleic acid amplification testing (NAAT) in conjunction with serology for detecting hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in donor blood products. Methodology This retrospective cross-sectional study aimed to evaluate the use of NAAT and viral serology in screening donor blood products for HBV, HCV, and HIV. The study was conducted at the Dr Ishrat-ul-Ebad Khan Khan Institute of Blood Diseases at Dow University of Health Sciences in Karachi, Pakistan, from April 2018 to May 2022. All blood products, after preparation, were screened for HBV, HCV, and HIV types I and II using electrochemiluminescence immunoassay on the Roche cobas e 601 analyzer (Roche, Basel, Switzerland). For further confirmation, blood products with negative viral serology underwent NAAT using the cobas TaqScreen MPX test version 2.0 (Roche) on the cobas s 201 system (Roche) to detect the window period of replicating viruses. Simple calculations were performed to determine the NAAT yield and yield rate for each virus, as well as the total number of viruses in seronegative donors. Results A total of 46,455 donors visited the Dr Ishrat-ul-Ebad Khan Khan Institute of Blood Diseases for blood donation. Of these, 6.97% (n = 3,240) tested positive for HIV, HBV, or HCV during serology screening, making them ineligible for donation. The remaining 93.02% (n = 43,215) of seronegative donors underwent NAAT to detect infections during the window period. NAAT revealed a reactivity of 0.044% (n = 19) for HBV, 0.009% (n = 4) for HCV, and 0.00% (n = 0) for HIV. The total NAAT yield rate for HBV was 1 in 2,252, and for HCV, it was 1 in 11,111. The overall NAAT yield rate for all viruses was 1 in 1,886 (0.053%) donor blood products. Conclusions These findings highlight the effectiveness of NAAT in identifying blood-borne infections during the window period. Consequently, routine NAAT screening for all seronegative blood donors is a crucial step that can reduce the burden of transfusion-transmitted infections and enhance the safety of blood products, especially in underdeveloped countries like Pakistan.

Establishing a screening strategy for non-discriminatory reactive blood donors by constructing a predictive model of hepatitis B virus infection status from a single blood center in China

Background

When employing the transcription-mediated amplification method for screening blood donors, there are some non-discriminatory reactive results which are screening assay reactive but HBV-DNA discriminatory assay negative. This raises concerns regarding the possibility of false positives among donors, which may lead to permanent deferral of blood donors and affect blood supply. This study aimed to elucidate the infection status of these non-discriminatory reactive blood donors and develop and validate a model to predict individualized hepatitis B status to establish an optimal screening strategy.

Methods

Supplementary tests were conducted on initial non-discriminating reactive donations to determine their HBV infection status, including repeat testing, viral load, serological marker detection, and follow-up. Primary clinical variables of the donors were recorded. Based on the Akaike information criterion, a stepwise forward algorithm was used to identify the predictive factors for information and construct a predictive model. The optimal screening strategy was determined through cost-effectiveness analysis.

Results

At the Blood Center of Zhejiang Province, 435 cases of initial non-discriminatory reactive donations were collected over two successive periods and sub-categorized through repeated testing into the following three groups: non-repeated positive group, non-discriminated positive group, and non-repeated HBV-DNA positive group. The HBV discriminatory rate increased after repeated testing (110/435, 25.29%). According to supplementary tests, the HBV-DNA positivity rate was 65.52% (285/435), and occult HBV infection was a significantly different among groups (χ2 = 93.22, p < 0.01). The HBV serological markers and viral load in the non-repeated positive group differed from those in the other two groups, with a lower viral load and a higher proportion of false positives. The predictive model constructed using a stepwise forward algorithm exhibited high discrimination, good fit, high calibration, and effectiveness. A cost-effectiveness analysis indicated that utilizing repeated discriminatory testing and the predictive model is an extremely beneficial screening approach for non-discriminatory reactive blood donors.

Conclusion

Nearly two-third (65.52%) of the non-discriminatory reactive blood donors were HBV-DNA positive. Our innovative approach of constructing a predictive model as a supplementary screening strategy, combined with repeated discriminatory experiments, can effectively identify the infection status of non-discriminatory reactive blood donors, thereby increasing the safety of blood transfusions.

The impact of nucleic acid testing to detect human immunodeficiency virus, hepatitis C virus, and hepatitis B virus yields from a single blood center in China with 10-years review

BACKGROUND

Since 2010, the Blood Center of Zhejiang province, China, has conducted a pilot nucleic acid amplification testing (NAT) screening of blood donors for Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human immunodeficiency virus (HIV). This study aims to assess the results of NAT testing over 10 years to establish the effects and factors influencing NAT yields of HBV, HCV, and HIV.

METHODS

Blood donations from seven different blood services were screened for HBV DNA, HCV RNA, and HIV RNA using 6 mini pools (6MP) or individual donation (ID)-NAT method between August 1, 2010, and December 31, 2019, at the NAT centralized screening center. We compared 3 transcription-mediated amplification (TMA) assays and 2 polymerase chain reaction (PCR) assays. Further, HBV, HCV, and HIV NAT yields were calculated and donor characteristics and prevalence of HBV NAT yields analyzed. Donors with HCV and HIV NAT yield were also followed up.

RESULTS

1916.31 per million donations were NAT screening positive overall. The NAT yields for HBV, HCV, HIV and non-discriminating reactive were 1062.90 per million, 0.97 per million, 1.45 per million, and 850.99 per million, respectively, which varied in the seven blood services and different years. HBV NAT yields were higher than those of HCV and HIV and varied across demographic groups. Risk factors included being male, old age, low education level, and first-time donors. We found no differences in NAT yields of HBV, HCV, and HIV between the 3 TMA and 2 PCR assays; nonetheless, statistically, significant differences were noted between the five assays.

CONCLUSION

In summary, NAT screening in blood donations reduces the risk of transfusion-transmitted infections and shortens the window period for serological marker screening. Therefore, a sensitive NAT screening method, ID-NAT workflow, and recruitment of regular low-risk donors are critical for blood safety.

Characteristic of HBV nucleic acid amplification testing yields from blood donors in China

BACKGROUND

Nucleic acid amplification testing (NAT) for blood screening has been previously performed in some countries to determine NAT yields. The current study sought to explore the non-discriminating reactive NAT yields using individual-NAT (ID-NAT) and characteristics of HBV NAT yields through a 10-year retrospective analysis in Zhejiang, China.

METHODS

Blood donations were analyzed using individual-NAT mode by the transcription-mediated amplification (TMA) method. Supplementary HBV serological tests were performed using chemiluminescent immunoassay, and HBV viral load assay was performed by real-time polymerase chain reaction. Follow-up studies were performed in partial donors with low HBV viral loads.

RESULTS

Non-discriminating reactive NAT yields and HBV NAT yields varied in different years. The yields ranged from 853.73 per million to 2018.68 per million and 624.60 per million to 1669.50 per million, respectively. In the 476 NAT yields, 19 were probable window periods (WP), 33 probable occult hepatitis B virus infections (OBIs), 409 were confirmed OBIs and 15 were chronic HBV infections. ID-NAT results were categorized in four groups, and the findings showed that the levels of HBV DNA viral loads were different in the four different groups (χ² = 275.02, p < 0.01). HBV viral load distribution was significantly different between anti-HBs positive and anti-HBc positive samples (χ² = 49.429, p < 0.01). Notably, only 42.03% donors were NAT repeated positive in the 138 repeat donors' follow up tests.

CONCLUSION

NAT screening of blood donations can reduce the risk of transfusion-transmitted HBV infections. Positive proportions of anti-HBs and anti-HBc are correlated with the HBV viral load level. However, low level of viral load donors pose risks in HBV NAT assays, and show fluctuating state for HBV viral load and leads to non-repeated NAT results during follow up studies.

Frequency of Hepatitis B, C and HIV Infections among Transfusion-Dependent Beta Thalassemia Patients in Dhaka

Transfusion transmitted infections have remained a major deterrent to public health, particularly among the patients with transfusion-dependent Beta thalassemia in developing countries. Although proper donor selection through adoption of WHO-advised infection panel has lowered the rate of infections, the multi-transfused patients are not free of risk. In this study, we screened 148 transfusion-dependent Beta thalassemia patients to determine the frequency of Hepatitis C Virus (HCV), Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) using the ELISA method. Among them, infected cases with HCV, HBV and HIV were 13.51%, 3.37% and 0%, respectively. Moreover, 2% of the patients were found to be co-infected with both HBV and HCV. The percentage of infections in the patients with frequent transfusion interval (≤30 days) was significantly higher (p < 0.0005) than that in the patients with less frequent transfusion intervals (>30 days). Immunochromatography (ICT)-based rapid test kits are usually used to screen and confirm these infections in the blood of the patients. However, ICT-based tests are not sensitive enough to detect the infections. So, a combination of both Nucleic Acid testing (NAT) and serological testing are suggested to significantly reduce the risk of viral infections during blood transfusion.

Impact of an unusual disulfide transformation on detection of isothermal amplification products

Detection of infectious pathogens such as HIV-1, HPV, and SARS-CoV-2 from biospecimens is critical to healthcare. Particularly sensitive and specific diagnostic techniques to accomplish this include molecular amplification and detection tests of nucleic acids from pathogens. Such tests are comprised of reagent compositions to facilitate hybridization of primers and probes that are complementary to specifically amplified sequences of the analyte target. One of these reagents from an isothermal molecular assay occasionally changed its physical appearance over time, generating interest into the cause of the transformation and suitability of the reagent in diagnostic testing. A preliminary hypothesis was that the 2,2′-dithiodipyridine component was the pre-chromophoric compound of its distinctly yellow reduced form, 2-thiopyridine. However, under oxidizing conditions, 2-thiopyridine is a minor constituent of hybridization reagents and not a major contributor to the yellow colour. Instead, a new yellow compound was isolated from coloured hybridization reagent, identified as 1-(2′-pyridyl)-2-thiopyridone and determined to be the result of an intramolecular cyclic rearrangement and sulfur extrusion from 2,2′-dithiodipyridine under acidic and oxidizing conditions. Neither the appearance of 1-(2′-pyridyl)-2-thiopyridone, nor the concomitant depletion of 2,2′-dithiodipyridine reduced the sensitivity or specificity of in vitro diagnostic screening assay results for detecting amplified nucleic acids from viral pathogens, ensuring the safety of tested blood transfusion products.

Initial trends of individual donation nucleic acid testing in voluntary & replacement donors from a tertiary care centre in north India

Background & objectives:

Individual donation nucleic acid testing (ID-NAT) is considered as sensitive technology to assess blood safety from viral transfusion-transmissible infections (TTIs) in blood donors. The present study was aimed to analyze the results of ID-NAT for three years (2013-2015) with special reference to different types of donors and their age ranges in a tertiary care centre in north India.

Methods:

The results of ID-NAT for three years were retrospectively analyzed at our centre. A total of 168,433 donations were tested with ID-NAT, of which 10,467 were tested with Procleix^® Ultrio^® reagents and 157,966 were tested with Procleix^® UltrioPlus^® reagents, and the results were compared with those of serology to calculate the NAT yield in voluntary, replacement, first-time and repeat donors.

Results:

A combined NAT yield was observed as one in 1031 out of 167,069 seronegative donations with HBV yield as one in 1465, HCV yield as one in 3885 and HIV-1 as one in 167,069. Yield for co-infection (HCV and HBV) was one in 41,767. A high NAT yield was observed in replacement donors (1 in 498) as compared to voluntary donors (1 in 1320).

Interpretation & conclusions:

Addition of NAT to serology improved the blood safety in our centre interdicting possibility of 150 TTIs annually. It has also reemphasized the safety of voluntary over replacement donors. The results also highlight the need of proper counselling, notification and referral guidelines of NAT yield donors in our country and other countries which lack them.