Plasma collection and supply in Europe: Proceedings of an International Plasma and Fractionation Association and European Blood Alliance symposium

At the symposium organized by the International Plasma and Fractionation Association and European Blood Alliance, experts presented their views and experiences showing that the public sector and its blood establishments may strengthen the collection and increase the supply of plasma using the right strategies in plasma donor recruitment, retention and protection, scaling-up collection by increasing the number of donors within improved/new infrastructure, supportive funding, policies and legislation as well as harmonization of clinical guidelines and the collaboration of all stakeholders. Such approaches should contribute to increased plasma collection in Europe to meet patients' needs for plasma-derived medicinal products, notably immunoglobulins and avoid shortages. Overall, presentations and discussions confirmed that European non-profit transfusion institutions are committed to increasing the collection of plasma for fractionation from unpaid donors through dedicated programmes as well as novel strategies and research.

White paper on pandemic preparedness in the blood supply

BACKGROUND AND OBJECTIVES

In March 2020, the WHO declared the SARS-CoV-2 corona virus a pandemic which caused a great disruption to global society and had a pronounced effect on the worldwide supply of blood.

MATERIALS AND METHODS

In 2022 an on-line meeting was organised with experts from Austria, Canada, Germany, Greece, Netherlands and United States to explore the opportunities for increasing preparedness within blood systems for a potential future pandemic with similar, or more devastating, consequences. The main themes included the value of preparedness, current risks to the blood supply, supply chain vulnerabilities, and the role of innovation in increasing resiliency and safety.

RESULTS

Seven key recommendations were formulated and including required actions at different levels.

CONCLUSION

Although SARS-CoV-2 might be seen as a unique event, global health risks are expected to increase and will affect blood transfusion medicine if no preparedness plans are developed.

Hepatitis E and blood donation safety in selected European countries: a shift to screening?

The public health implications of hepatitis E virus (HEV) in Europe have changed due to increasing numbers of hepatitis E cases and recent reports of chronic, persistent HEV infections associated with progression to cirrhosis in immunosuppressed patients. The main infectious risk for such immunosuppressed patients is exposure to undercooked infected pork products and blood transfusion. We summarised the epidemiology of HEV infections among blood donors and also outlined any strategies to prevent transfusion-transmitted HEV, in 11 European countries. In response to the threat posed by HEV and related public and political concerns, most of the observed countries determined seroprevalence of HEV in donors and presence of HEV RNA in blood donations. France, Germany, Spain and the United Kingdom (UK) reported cases of transfusion-transmitted HEV. Ireland and the UK have already implemented HEV RNA screening of blood donations; the Netherlands will start in 2017. Germany and France perform screening for HEV RNA in several blood establishments or plasma donations intended for use in high-risk patients respectively and, with Switzerland, are considering implementing selective or universal screening nationwide. In Greece, Portugal, Italy and Spain, the blood authorities are evaluating the situation. Denmark decided not to implement the HEV screening of blood donations.

Pneumococcal antibody levels in children with PID receiving immunoglobulin

OBJECTIVES

Clinical data are lacking on optimal levels of specific antipneumococcal antibodies (PnPsAbs) in patients with primary immunodeficiency (PID) receiving intravenous immunoglobulin (IVIG) replacement. Objectives were to conduct a prospective multicenter study providing data on total immunoglobulin G (IgG) and peak/trough levels of PnPsAbs specifically targeting the 16 most prevalent pneumococcal serotypes in IVIG-treated children with PID; to compare trough PnPsAb levels with those measured in healthy adults and the IVIG product; and to evaluate PnPsAb protection correlates with thresholds based on World Health Organization.

METHODS

Patients received 7 consecutive IVIG infusions. Total IgG and PnPsAb levels were determined on plasma samples obtained before and after infusion.

RESULTS

Twenty-two children with PID were treated with IVIG (mean weekly dose: 0.10 g/kg). The mean trough and peak levels of total IgG were 7.77 and 13.93 g/L, respectively. Trough and peak geometric mean concentrations and distribution curves differed between serotypes and showed wide dispersion (0.17-7.96 µg/mL). In patients (89%-100%), antibodies against most serotypes reached trough levels ≥ 0.2 µg/mL, a threshold considered protective against invasive pneumococcal infection. For several serotypes, trough levels reached ≥ 1.0 to 1.3 µg/mL, the level found in adults. Trough geometric mean concentrations correlated well with the PnPsAb contents of the IVIG product.

CONCLUSIONS

In IVIG-treated children with PID, protective PnPsAb levels for most pathogenic serotypes were obtained. A correlation was observed between PnPsAb levels in patients and in the IVIG product. This offers the potential to improve infection prevention by adapting the IVIG product and dose according to epidemiology.

Specific protein content of pools of plasma for fractionation from different sources: impact of frequency of donations

Background and Objectives

Plasma pools for the production of human plasma medicinal products are distinguished according to the collection method (recovered or apheresis plasma) and the donor remuneration status. National regulations and the physical status of the donor determine the donation frequency and plasma volume per session. Relevant protein contents of different types of pools have not fully been compared.

Materials and Methods

We compared the levels of total protein, 15 main relevant plasma protein markers, and anti-B19 and anti-Streptococcus pneumoniae IgG in single-type pools of donations from different countries (Belgium, Finland, France, the Netherlands, Germany, United States). Both recovered plasma from non-remunerated donors and apheresis plasma from remunerated and non-remunerated donors were studied.

Results

Pools from paid US high-frequency, high-volume plasmapheresis donors showed significantly lower total protein (−9%), albumin (−15%), total IgG (−24%), IgM (−28%), hemopexin (−11%) and retinol-binding protein (−10%) but higher C1-inhibitor, pre-albumin and C-reactive protein contents than pools from unpaid European Union (EU) or US whole-blood or plasmapheresis donors. In contrast to pools from compensated EU plasmapheresis donors, pools from unpaid whole-blood or plasmapheresis donors showed no significant differences, whatever the collection method or country. Reductions in specific protein contents correlated well with protein half-life.

Conclusion

These results should be taken into account with regard to donor health management and protein recovery.

Parvoviruses and blood products

Erythrovirus B19 (B19), a small isocahedral, non-enveloped virus (18-26 nm), is a ubiquitous infection agent in industrialised countries. Depending on the infected host, B19 has a wide range of disease manifestations from asymptomatic (the majority) to severe, including persistent infection. The risk of B19 transmission by blood products is enhanced by a high virus titre in the infected donor, by pooling of a large number of donations, and by the virus's resistance to effective inactivation methods such as heat and solvent-detergent treatments. B19-DNA has been detected in single donations, in manufacture plasma pools and in plasma derivatives (clotting factors, albumin, antithrombin III and immunoglobulins) produced by different processes. B19 transmission is mostly found in patients treated with clotting factors, as shown by a higher seroprevalence in treated haemophiliacs, by the presence of B19 DNA, and by active seroconversion. Chronic B19 infection can successfully be treated with polyvalent intravenous immunoglobulins. The key role of neutralising anti-B19 antibodies and of the virus titre has been demonstrated by B19 transmission after infusion of several B19-positive plasma batches treated with solvent-detergent. Two strategies can be followed to reduce the B19 risk: (1) reducing the viral load in the manufacture plasma pool by discarding B19-DNA-positive donations; (2) developing new strong virus inactivation methods. The physico-resistant properties of B19 make it a good model for new emergent viruses capable of infecting blood products.