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The under-representation of women in blood donation can lead to blood shortages. We aimed to determine the factors, which encourage or impede blood donations in women. The findings can help us in designing effective recruitment strategies that could encourage women to donate blood to cover the patients’ needs. This cross-sectional study was conducted in Shiraz, Iran, from the 1st of January 2017 to the 1st of August 2017 on women aged 18–60 years old. The demographic characteristics of the participants, the reasons that motivate blood donors and the factors that discourage non-donors were surveyed. Reasons for lapses in donors were also mentioned. The most frequent reasons for blood donation were altruistic causes (94.4%), moral and personal obligations (89.1%), the feeling of responsibility (82.7%), and awareness of the positive effects on their health (77.4%). The most common deterrents in non-donors were fear of developing anemia (68.4%) or weakness and dizziness (66%), unsuitability due to certain medical conditions (62.4%), and lack of a situation in which they were asked to donate blood (61.8%). Although altruistic reasons are the chief motivating factors for women to donate blood, the overall female contribution in blood donation remains low. Therefore, it is necessary to take measures aiming at informing women about the importance of blood donation and to reduce fears based on misinformation. Confidence in the blood donation organization must be a major consideration in future recruitment strategies to reassure women about the safety of blood donation.

First published online: 15 May 2020 Positive feedback about the outcome of volunteers' prosocial actions is often thought to help motivate continued volunteers' engagement. In the context of blood donations, various collection systems have begun to provide blood donors feedback on successful utilization of their blood donation. An experiment conducted by the main NGO that supports the collection of blood in Italy studies how such feedback affects subsequent blood donations. From a sample of over 8'000 blood donors, we find that providing feedback of successful utilization decreases donations. Though surprising, these results are consistent with theoretical models in which individuals engage in prosocial behavior to sustain a positive self-image : feedback about the outcome of a recent donation can act as reminders that boost self-image and reduce the need for re-engaging soon in prosocial activities. Interestingly for policy, we also show that combining the feedback with an explicit request to sign up for a new donation can eliminate, but not overturn, the negative effect of the feedback. (C) 2020 Elsevier B.V. All rights reserved.

Objective: The aim of this study was to describe the characteristics of blood donors and the serological profile of the blood donations at the blood bank of the University Hospital Polydoro Ernani de São Thiago of the Federal University of Santa Catarina from January 2011 to December 2016. Methods: The characteristics of donors and the serological results of the donated blood were compiled from databases. Only donations with a negative serology or a positive serology confirmed by second-sample testing were included in the study. Results: A total of 14,368 donations were included in the study, of which 118 (0.8%) had a confirmed positive serology. Of the total donations, 94.3% were from spontaneous donations and 5.7% from replacement donation. Donations were predominantly from men (54.1%), individuals aged 18 to 29 years (69.1%), and repeat donors (47.7%). Detection rates were higher for HBV (0.63%), followed by syphilis (0.13%), HIV (0.05%), HCV (0.02%), and Chagas disease (0.01%). With the exception of HIV, positive results were more frequent in the older age groups. Positive results for HBV, HCV, and HIV were more frequent among first-time donors. Replacement donations were more likely to have HBV (OR 7.7; 95% CI 4.9–12.1, p

Objectives To metagenomically analyse blood units originating from the Brazilian Amazon and positive for parenterally transmitted infections (human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), human T-lymphotropic virus (HTLV), Chagas disease or syphilis). Methods Twenty plasma samples (35% HBV-positive, 10% HIV-positive, 10% HCV-positive, 20% positive for syphilis, 20% for Chagas disease, and 5% for HTLV) assembled in pools were analysed by metagenomic next-generation sequencing. The obtained raw sequencing data were submitted to a bioinformatic pipeline set up for identification of emerging viruses. The viral reads of interest were phylogenetically analysed and confirmed by PCR in the individual samples. Results The metagenomic analysis identified contigs belonging to the emerging human Gemykibivirus-2 (HuGkV-2) in two pools. The HuGkV-1 phylogeny demonstrated that the Amazonian isolate formed a separate cluster with other HuGkV-2 strains obtained from human hosts. The PCR confirmation detected HuGkV-1 DNA in three individual samples (15%). Conclusions HuGkV-2 is an emerging virus with unknown clinical impact. The detection of HuGkV-2 DNA in blood donations positive for parenterally transmitted infections showed that HuGkV-2 can be considered as an opportunistic viral agent with a hypothetic parenteral transmission route.

The emergence of Zika virus (ZIKV) in the Americas has resulted in increased nucleic acid amplification testing (NAT) of clinical samples and blood donations. New molecular diagnostic assays have been developed resulting in a corollary requirement for ZIKV reference material. To address this we have produced and calibrated two African lineage ZIKV reference materials: a highly concentrated secondary standard (NIBSC: 16/110) and a lower concentration external quality control (QC) reagent (NIBSC: 16/124) and compared their performance in three ZIKV NAT assays in relation with the First International Standard (IS) for Zika Virus NAT assays (PEI: 11468/16). In summary the African lineage ZIKV reference materials were detected by all three assays. The ZIKV lineage did not affect the performance of the secondary standard. The external QC reagent (16/124) was detected by all three assays highlighting its suitability for use as a low positive control to monitor assay performance on a regular basis. The relative potency of 16/110 to the IS was 5.49E+06IU/mL (95% CI: 1.46E+06–2.06E+07) and 16/124 to 16/110 was 8.36E+03 (95% CI: 7.83E+03–8.92E+03). The global availability of African lineage ZIKV reference materials will facilitate standardization of ZIKV molecular diagnostic assays between and within laboratories whilst preserving the IS.

Background: Fourth generation HIV assays, which detect both HIV p24 antigen and HIV antibodies are widely used in HIV screening. The combination of markers enables the fourth generation assays to shorten the window of detection, which is important in real-world testing scenarios. The Elecsys® HIV Duo assay is a fourth generation assay, which provides an overall result based on both the detection of the p24 antigen and HIV antibodies, and lists the sub-results for the antibody and antigen units. Objectives and study design: The performance of the Elecsys® HIV Duo assay was assessed at five international centres and compared with other available fourth generation assays. Results: The specificity of the Elecsys® HIV Duo assay in 13,328 blood donor samples was 99.87% (95% confidence interval [CI] 99.80–99.93) and was 100% (95% CI 99.63–100) in 1000 routine diagnostic samples. Sensitivity was assessed in 139 seroconversion panels; the Elecsys® HIV Duo assay detected a greater number of positive samples/number of bleeds compared with other assays investigated. An individual analysis of those seroconversion panels also shows that the Elecsys® HIV Duo assay compared to other fourth generation assays detected HIV up to 2 days earlier than other assays. The Elecsys® HIV Duo assay also detected 125/130 ‘early seroconversion’ samples assessed, which was greater than the number detected with comparator fourth generation assays. Conclusion: These results indicate that the Elecsys® HIV Duo assay is appropriate for use in the diagnosis of HIV and for screening of blood donations and is sensitive for the early detection of HIV.

Does social recognition motivate repeat contributors? We conduct large-scale experiments among members of Italy's main blood donors association, testing social recognition both through social media and in peer groups. We experimentally disentangle visibility concerns, peer comparisons and simple ask effects, and we study how exposure to different norms of behavior affects giving. Overall, asking increases giving by 20.4 percent. However, a simple ask to donate is at least as effective as asks that emphasize social recognition. Using peer groups, we show that visibility concerns do not generate additional donations, and we find that donations respond weakly and non-monotonically to social norms of giving. In an original study and two subsequent replications, we find no evidence that donors give blood for the prospect of their donations being observed by others on social media. Overall, our findings caution against over-reliance on social recognition to promote good citizenship.

Most countries prohibit compensation for plasma donations, and Canada continues to consider a ban. Foremost among reasons for prohibition is the worry that compensated plasma will decrease uncompensated blood donations. Using difference-in-differences analysis of data containing plasma and blood donations in Canada spanning a period in which the country's only three paid-plasma centers began operating, we examine whether the introduction of paid-plasma decreased blood donations overall and among young donors. We find no evidence of a decrease but rather a small increase. We replicate this finding in U.S. cities that experienced the introduction of paid-plasma over a similar time period.

Background Numerous studies have indicated that miRNAs might play significant roles in the development of hepatitis B virus (HBV) infection. while the miRNAs in occult HBV infection (OBI) are still largely unknown. Methods Initially, 15 HBV infection-related miRNAs in plasma of 10 OBI and 10 healthy controls (HCs) was analyzed by qRT-PCR. Significantly dysregulated miRNAs were subsequently validated in another 64 OBI, 20HCs, 31 chronic hepatitis B (CHB) and 20 asymptomatic HBsAg carriers (ASC). Furthermore, the potential biological functions and molecular mechanisms of miR-451a in HBV infection were investigated using HBV-expressing hepatoma cell lines. Results Compared to HCs, plasma miR-451a and miR-340-3p were significantly up-regulated in OBI, ASC and CHB patients, while no significant difference was found among OBI, ASC and CHB patients. ROC curve analysis indicated that both plasma miR-451a and miR-340-3p could moderately distinguish OBI from HCs, with AUCs of 0.76 and 0.78, respectively. When combined, the differentiation efficiency of this miRNA panel was better, with an AUC of 0.82. While, they both could not specifically separate the stage of chronic HBV infection. Functional experiments showed that overexpression of miR-451a might suppress HBV replication and gene expression in hepatoma cell lines. Mechanistically, miR-451a might inhibit HBV replication and gene expression by directly targeting ATF2. Conclusions A plasma panel, including miR-340-3p and miR-451a that might suppress HBV replication by targeting ATF2, has the potential as biomarkers for HBV infection. In the setting of blood donations, this panel would be more practical to moderately differentiate OBI in HBsAg-negative donors.

We use a field experiment to study how social image concerns affect a commonly used strategy to attract new donors: pledges to engage in a charitable activity. While waiting for their appointment, visitors to a local government office are offered sign-ups for blood donations in a crowded waiting room. We randomly vary the visibility of the pledge to donate and the organization for which blood donations are solicited (charitable vs. commercial). Our setting provides natural variation in who observes the pledge. We do not find that visibility increases pledges to donate. Exploring heterogeneity in treatment effects, we find that visibility increases pledges when participants are observed by friends or family. Almost all subjects renege on their pledge.

Objectives The reduction in blood viscosity and iron store were proposed to be connected to the reduction in the risk of cardiovascular disease (CVD) among multiple blood donors. Herein, we evaluated the modulation of serum lipids levels in accordance with donation events. Furthermore, atherogenic impacts on the risk of CVD were investigated. Materials and methods A total of 100 voluntarily male donors were included in the study. Fifty donors were multiple time donors (MTD) and 50 were single time donors (STD). Levels of serum lipids were determined and atherogenic indices including TG/HDL and CHO/HDL ratios were calculated. QRISK2 parameters were determined to evaluate the 10-years risk of developing CVD. Results Among MTD, there were significantly higher serum levels of triglycerides (TG) and very low-density lipoproteins (VLDL) combined with significantly lower HDL level. These modulations were significantly correlated to the extent of donation. Both CHO/HDL and TG/HDL ratios were also significantly higher among MTD. However, only TG/HDL ratio was strongly correlated to the donation extent even when controlled for age, BMI and smoking status. Despite the significant difference in QRISK2 parameters between study groups, none of these parameters was correlated to the extent of donation when controlling for age, BMI and smoking status. Conclusion We demonstrate that multiple blood donation is associated with an unfavorable modulation of serum levels of lipids that is influenced by donation extent. This modulation is not associated with an increased risk of CVD but may weakly contribute in a higher risk for coronary heart disease (CHD).

Less than 1% of South-Africans donate blood annually. New donors are required, especially from Millennials, who are large in numbers and influential. Being more receptive to social media communications and altruistic, millennials are the hope of safe blood supply. However, the drivers of millennials’ positive attitude and behavioural intentions (BI) towards donating blood need examination. This study used ideas from Social Cognition Theory, Health Belief Model and Theory of Planned Behaviour to examine how social media communications impact blood donation attitudes and behavioural intention through some socio-psychological outcomes among young adult Millennials at a university in South-Africa. Quantitative data was collected from 650 respondents. Structural equation modelling results revealed that social media communications positively impacted awareness, perception, peers, family, and behavioural intention. Motivation, awareness, peers and family positively influenced attitudes, which in turn, predicted blood donation intention. Blood donations agencies and public policy-makers should seek ways to convert Millennials’ positive attitudes and BI into actual blood donation.

Purpose In this study we aimed to propose an algorithm for initial anti HCV EIA reactive blood donations in Turkey where nucleic acid amplification tests are not yet obligatory for donor screening. Methods A total of 416 anti HCV screening test reactive donor samples collected from 13 blood centers from three cities in Turkey were tested in duplicate by Ortho HCV Ab Version 3.0 and Radim HCV Ab. All the repeat reactive samples were tested by INNO-LIA HCV Ab 3.0 or Chiron RIBA HCV 3.0 and Abbott Real Time HCV. Intra-assay correlations were calculated with Pearson r test. ROC analysis was used to study the relationship between EIA tests and the confirmatory tests. Results The number of repeat reactive results with Ortho EIA were 221 (53.1%) whereas that of microEIA, 62 (14.9%). Confirmed positivity rate was 14.6% (33/226) by RIBA and 10.6% (24/226) by NAT. Reactive PCR results were predicted with 100% sensitivity and 95% specificity with S/CO levels of 8.1 with Ortho EIA and 3.4 with microEIA. Conclusions Repeat reactivity rates declined with a second HCV antibody assay. Samples repeat reactive with one HCV antibody test and negative with the other were all NAT negative. All the NAT reactive samples were RIBA positive. None of the RIBA indeterminate or negative samples were NAT reactive. Considering the threshold values for EIA kits determined by ROC analysis NAT was decided to be performed for the samples above the threshold value and a validated supplemental HCV antibody test for the samples below.

This article theoretically and experimentally examines the twin problems of free-riding and coordination failure faced by blood banks, by investigating the effects of information provision on the efficiency of blood donation. We augment a standard linear public goods game, incorporating the following features of blood donation: multiplicity of public goods (to reflect intertemporal coordination issues), current and upcoming upper bound demands (to incorporate the perishable nature of blood and the embargo period of consecutive donations), and semi-binary choices (to account for individual options to withhold donations or make donations and when). We analyze whether a provision of deterministic information on the potential blood demand (full information) would improve the efficiency of blood donation when compared to the provision of probabilistic information (partial information). The theory predicts that if each individual maximizes the payoff-sum of all players, then the full information provision would achieve donation efficiency in equilibrium. The results of laboratory experiment show that the full information provision does not improve the efficiency of donation, on an average. We find that full information improves intertemporal coordination, but it worsens the free-riding problem. Although information helps individuals to direct donations in response to the demand, it drives individuals to withhold donations to avoid potential wastage against the risk of donation over the upper bound. When the predicted total demand is relatively small, that is, when strategic uncertainty about others’ donation matters for achieving efficiency, the provision of information about intertemporal demand in upper bounds tends to lower efficiency because the "donation withholding'' effect becomes dominant.

Since November 2015, Puerto Rico has reported active mosquito-borne transmission of Zika virus. Because of the potential for Zika virus to be transmitted through transfusion of blood components, and because a high percentage of persons infected with Zika virus are asymptomatic, the Food and Drug Administration (FDA) recommended that blood collections cease in areas of the United States affected by active vector-borne transmission of Zika virus until laboratory screening of blood donations or pathogen reduction technology (PRT) for treatment of blood components can be implemented. To inform efforts to maintain the safety and availability of the blood supply in Puerto Rico, CDC, in collaboration with the Puerto Rico Department of Health, conducted a rapid assessment of blood collection and use on the island. A total of 139,369 allogeneic red blood cell (RBC) units, 45,243 platelet units, and 56,466 plasma units were collected in or imported to Puerto Rico during 2015, and 135,966 allogeneic RBC units, 13,526 therapeutic platelet units, and 25,775 plasma units were transfused. Because of the potential for local Zika virus transmission in areas with a competent mosquito vector, other areas of the United States should develop plans to ensure local blood safety and adequacy. Blood collection organizations and public health agencies should collaborate to maintain the safety and availability of local blood supplies in accordance with FDA guidance.

Due to their extended indications, intravenous immunoglobulins (IVIg) are increasingly used in hospital setting. After injection, classical IVIg half-life reaches more than 3weeks. IVIg result from the pooling of many blood donations and contain all natural antibodies usually found in the general population. Administered antibodies are known to interfere with many diagnostic assays, particularly those used for infectious serology. It is not recommended to perform serological determination after IVIg infusion. It is recommended to keep a delay of at least 4months after IVIg infusion before doing any serological assay; failure to do so will result in misinterpretation of biological findings. Interpretation of any serological test after IVIg administration should be particularly cautious.

This paper is based on the design and development of an in-house algorithm system to Estimate Total Hemoglobin in human blood using the Arduino based Embedded system. In our present society, monitoring Hemoglobin of subjects is very important in hospitals to keep track of low/high hemoglobin count during operations, delivery, dialysis, blood donations, perform stress test, monitoring patients in intensive care units, etc. is often done using invasive methods. In our approach, we have designed a finger probe using five LEDs on a multi-chip having wavelengths 670 nm/770 nm/810 nm/850 nm and 950 nm, and a single silicon photo detector with an inbuilt trans-impedance amplifier to acquire the signals through the finger using the Photoplethysmography (PPG) principle. The non-invasive method can be replaced in hospitals and homes to monitor the total hemoglobin level which is in real-time, painless, and infection-free from needles. We have tested our system on 8 subjects for three and five wavelengths and the values were compared to the hemoglobin measured using invasive methods in the pathology laboratory. The result demonstrates that the five wavelengths PPG method significantly improves the measurement accuracy of total hemoglobin, reducing the mean absolute error between the reference and the estimated hemoglobin values from 1.3778 g/dL for three wavelengths PPG to 0.3499 g/dL for five wavelengths PPG. The five wavelengths PPG system designed showed good linearity to estimate hemoglobin with the Regression Coefficient (R2 = 0.964) compared to three wavelengths PPG system with the Regression Coefficient (R2 = 0.688).

Running a cost-effective human blood transfusion supply chain challenges decision makers in blood services world-wide. In this paper, we develop a Markov decision process with the objective of minimising the overall costs of internal and external collections, storing, producing and disposing of blood bags, whilst explicitly considering the probability that a donated blog bag will perish before demanded. The model finds an optimal policy to collect additional bags based on the number of bags in stock rather than using information about the age of the oldest item. Using data from the literature, we validate our model and carry out a case study based on data from a large blood supplier in South America. The study helped achieve an overall increase of 4.5% in blood donations in one year.

Hepatitis E virus (VHE) is a RNA, non-enveloped, enterically transmitted virus. VHE is present all around the world, with different distribution of its genotypes. VHE of genotypes 1 and 2 predominate in Asia, Africa and in Mexico, responsible for outbreaks transmitted through contaminated water, with an increased mortality in pregnant women. Genotype 3 VHE are globally distributed, with an animal reservoir (swine mainly) endemic in high-income countries. They are transmitted by the ingestion of raw or poorly cooked meat, and possibly by other routes (water, molluscs?) not yet firmly established. Rare post-transfusion hepatitis E cases have been reported. The prevalence of viremic blood donations is around 5 to 10,000 in Europe and in France. Screening tests and/or alternative strategies for viral elimination could be implemented soon.

We study incentivized voluntary contributions to charitable activities. Motivated by the market for blood donations in Germany, we consider a setting where different incentives coexist and agents can choose to donate without receiving monetary compensation. We use a model that interacts image concerns of agents with intrinsic and extrinsic incentives to donate. Laboratory results show that a collection system where compensation can be turned down can improve the efficiency of collection. Image effects and incentive effects do not crowd each other out. A significant share of donors turn down compensation. Heterogeneity in treatment effects suggests gender-specific preferences over signaling.

The current issues debate will bring together experts around the themes of self-sufficiency (in its national and European aspects) and of needs in cellular blood products. The point of view of the manufacturer and prescribers of blood products will be confronted.

Commercial companies or public service mission, today all organizations must manage their brand. For a public service organization, also, the brand is an asset that enhances its visibility to the various partners. A brand is a collection of signs that distinguishes it, it or the products and services it offers. In recent years, we are witnessing the valorization of public service mission brand in an objective of visibility but also for internal cohesion. Developing a brand brings benefits in its identification and knowledge by users but also within the institutional environment. This value can also be an economic booster. With a strong brand, the organization may reduce communication expenses. In recent years, we attend an important development of the territory marks. Concerning the Etablissement francais du sang (EFS) when it was created in 2000, it is the act of donation of blood, which was enhanced by the "Don du sang" logotype and not the institution. As a consequence, the logotype "EFS" was very discreet. But more than 10 years after, this situation has to evolve. The EFS is not just a blood transfusion organization. Beyond blood donations, the EFS has developed other activities (cell and tissue therapy, IHR, clinics, research, etc.). With the "new generation" blood centers, it is an opportunity to think over the brand EFS. This is why EFS has decided to develop a brand strategy, the ground of all communication policies.

African American adults are half as likely to donate blood than whites. In order to understand this difference, African American and white participants completed a survey regarding demographics, medical and donation history, and motivators and barriers. The most agreed upon motivators to blood donation were more convenient place and times, being asked and taking less than hour. Motivator responses which differed by race included donating for infectious disease test and reward, and assurance donating is safe. The most agreed upon barriers were not having a convenient place, not knowing where (response differed by race) and fear of needles, pain and feeling faint.

High-profile disasters can cause large spikes in philanthropy and volunteerism. By providing temporary positive shocks to the altruism of donors, these natural experiments help identify heterogeneity in the distributions of the latent altruism which motivates donors. This study examines gender heterogeneity of volunteer response by blood donors following the most devastating Bushfires in Australia's history. Using difference in differences analyses, we observe a sharp increase in blood donations after the 2009 Victorian Bushfires. Several key features of this increase are consistent with the predictions of a model where the distribution of latent altruism has smaller variance among women than men. First, the highest increase in donations occurs among previous non-donors, lapsed donors and less frequent donors. Further, the increase in donations following the Bushfires, compared to non-disaster periods, is substantially greater for females than males; the proportional increase in the number of females donating for the first time after the disaster is approximately twice the proportional increase for men. Notably, this gender gap decreases with the frequency with which people have previously donated.

We investigate the impact of direct cash payments on whole blood donations. The German blood collection system is based on both, paid and unpaid blood donations. We take advantage of a quasi-natural experiment, in which one blood donation site changes its compensation scheme from paid to unpaid, while all other donation sites maintain their payment schemes. We show that cash payments increase donation volume without affecting blood quality. This result casts doubt on the notion that monetary incentives crowd out intrinsic motivation to donate blood. Policymakers should thus reconsider direct cash payments to address public health concerns about blood shortages.

Background : Nationally, minorities are underrepresented in community blood donation programs. The reason for this disparity is poorly understood. To better understand why minorities do not donate, first, accurate blood donor and donation data are needed. Methods : Donor and donation demographic data were collected for 2004–2007 from a single blood collection agency in the Atlanta, Georgia, metropolitan area. Population data from the same area were acquired from the US Census. Donor and donation rates per 1000 population were calculated by race/ethnicity, gender, and age. Results : Of the 389340 blood donations reported by donors aged 16 to 69 years (98.7% of all donations), the collections were from white (77.7%), African American (16.3%), Hispanic (2.3%), Asian (2.2%), and other (1.6%) donors. Forty- to 49-year-olds (26.8%) donated the highest percentage of units. The blood donor rates were 11 perl 000 population for whites, 6 per 1000 for African Americans and 3 per 1000 population for Hispanics. The blood donation rates were 77 donations per 1000 population for whites, 22 per 1000 population for African Americans and 10 per 1000 population for Hispanics. Conclusion : Minorities are underrepresented in the blood donor pool. New recruitment strategies are needed to increase minority blood donor and donation rates.

Aim: This study examined whether the Theory of Planned Behavior adds significantly to the prediction of intention and actual blood donation of the general Israeli population. Background: In most developed countries and in Israel in particular there is a chronic shortage of blood for transfusions. This raises questions about methods of increasing blood donations. Design: This is a correlational quantitative study. Methods: A questionnaire was created based on a review of the literature and the Theory of Planned Behavior. The questionnaire was distributed among a convenience sample of 190 Israeli Jewish men and women, aged 17‐60. Results: Israelis’ perceived behavioral control of their blood donations, their subjective norms and their attitude regarding blood donation, predicted their intention to donate blood. It seems that intention predicted actual blood donations. A conspicuous finding is that members of the Ethiopian Jewish community displayed an extremely limited intention to donate blood. Conclusions: The results of this study show that a number of various educational and practical strategies may be used to encourage the population to donate blood. These include: reducing perceived barriers, directing interventions specifically at the population most likely to donate blood and forming a reserve of regular donors. a 2010 Elsevier Ltd. All rights reserved.

The European regulation on blood and blood components is declined in four directives: the Directive 2002/98/EC known as "mother Directive" and three directives called "daughter Directives" 2004/33/EC, 2005/61/EC and 2005/62/EC. It constitutes a common basis of provisions of quality and safety of blood in the European Union (EU), thus guaranteeing this safety and this quality with the whole of the citizens circulating in Member States of the Union. It cannot prevent a Member State for maintaining or introducing more stringent protective measures. It encourages the anonymous, voluntary and unpaid blood donations. It envisages many provisions for the prospective blood donor eligibility, the blood collection, the testing, processing, storage, transport, distribution and issuing of blood and blood components and the haemovigilance. In the field of the haemovigilance, this European regulation widened the field of competence of the national systems to the notification of serious adverse events of the transfusion chain and the serious adverse reactions, which have occurred in the blood donors. The European directives were transposed in the French national law between 2004 and 2007 by legislative and lawful ways.

Because of demographic changes, the worldwide shortage of blood will likely be aggravated in the foreseeable future. Hence, the retention of already active blood donors (BDs) is becoming more and more important. Moreover, a substantial increase in blood donations could be achieved by a relatively small increase in BD return. Blood donation services are therefore well advised to understand their BDs' motivations to become regular and committed BDs and to consider this in planning BD retention programs. Focusing on the published literature of the last decade, we summaries some key recommendations in considering BD retention strategies. Whereas starting a career as a BD is mainly driven by external stimuli, becoming a committed BD needs a well-developed identity role; that is, a BD with a high level of intrinsic motivation. Active communications with the BD right from the beginning, introducing distinct measures to support the development of a BD's distinct identity, increasing convenience of the blood donation process, having well-trained and motivated staff, applying distinct measures to reduce anxiety as well as adverse events, making BDs satisfied with their blood donation experience, appropriate use of incentives, quickly recapturing temporarily deferred BDs, and appealing to BDs' personal motivations and moral norms--all of these are major keys to achieving this important aim.

Les biotheques d'echantillons de donneurs ou de receveurs de sang sont un outil precieux pour les enquetes d'hemovigilance et pour la recherche biologique et epidemiologique, notamment pour la securite vis-a-vis des agents transmissibles par le sang. Ce texte decrit les principales biotheques transfusionnelles existant en France et relate leurs avantages et leurs limites. La biotheque nationale des dons de sang, constituee dans un but medicolegal, conserve des echantillons de chaque don sur une periode de cinq annees. La biotheque du projet Blood and Organ Transmissible Infectious Agents (BOTIA) engrange des echantillons apparies de donneurs et de receveurs dans un but de recherche. Conservees sur une longue periode de temps, de telles biotheques transfusionnelles pourront etre utiles en termes de sante publique, comme reflet de l'etat biologique d'une population a un instant donne.

Modern transfusion medicine in Europe has successfully handled the major threats to a safe blood supply by “classical viral” transfusion-transmitted pathogens like HCV and HIV. However, this was only managed by utilizing major financial and expert resources. Today, European harmonisation of optimal use of blood components in clinical hemotherapy, uniform quality standards for blood donations, testing and component production as well as an increasing cost pressure in clinical care are tasks, which need our full attention. Modern cellular therapies and regenerative medicine are novel treatment options, which can only be handled by a close cooperation between clinicians and transfusion medicine specialists. Future challenges comprise proactive measures like pathogen inactivation for all blood components in order to diminish threats to blood safety by (re-)emerging pathogens, an adequate blood supply bearing in mind the ongoing ageing of most European populations and political decisions regarding a potential open “blood market” in Europe, which in our opinion should not be supported by the European Union.

Since the publication of observations of variant Creutzfeld-Jacob disease (vCJD) having occurred in the UK due to transfusion of infected packed red cells, the risk of vCJD transmission by blood transfusion is established. In France, no such case has yet been reported, but among the French vCJD cases observed, three individuals, having entered the disease in 2004, are past blood donors. Thus, some individuals transfused in their past are at risk of developing a vCJD. The lack of available assay prevents the diagnosis of the infection in these recipients and the implementation of a specific screening of blood donations. In the UK and in France, several measures to ensure transfusion safety have been applied to reduce the risk of contamination by the variant.

This paper studies the effects of reminders, and frames used to invoke higher levels of empathy and altruistic motives on the willingness to donate blood. We have conducted a randomized field experiment with 3236 blood donors from Bosnia and Herzegovina, in order to test how effective frames were when used in letters soliciting blood donation. Further, we tested the effectiveness of the letter itself which served as a specific reminder, making the need for blood more salient. Our baseline group did not receive any letter. Another seven groups received letters which differed in terms of goal framing; whether a specific victim was identified; and the gender of a victim. We found that a reminder of the need for blood in the form of a simple letter increases the probability of coming to donate blood by 63% relative to the baseline group, suggesting that reminder letters may serve as a cost effective policy tool. At the same time, we found that the framing of the letter had relatively little effect when donors are allowed longer period to make their donation decision.

Chairman to the French Institutional Review Board, Professor Didier Sicard raises blood donation issues from an ethical standpoint. The contaminated blood scandal focused on the necessity of reducing transfusion risks and regarded blood safety as an ethical mandatory requirement, a debatable subject to deal with. The author proposes to reconsider the nature of unpaid blood donations while advising not to scorn the remunerated gift when such is the case. As for the use of blood, he questions the solutions based on a zero risk perspective, in particular an excessive auto-transfusional practice or a restrictive use of blood, lately regarded as essential. Starting from the blood donation concern this article leads us to think over both our society's fears and the precautionary principle abuses.

BACKGROUND: Blood donors are routinely screened for antibodies to human T-cell lymphotropic viruses type I and II (HTLV-I and HTLV-II) in the United States, Canada, Japan, and some European countries. Previous reports from our group in relatively small numbers of donors have shown a zero prevalence of HTLV-I/II markers in our region. In this study, seven blood banks in the north and west of Greece participated in order to determine whether mandatory screening of blood donations for HTLV-I/II infection should be established. METHODS: Sera from 51,714 consecutive donors were investigated for anti-HTLV-I/II using two commercially available enzyme immunoassays (EIAs). Reactive samples in one or both EIAs were repeatedly evaluated further by Western blot, which is specific for both confirmation and differentiation of HTLV-I and HTLV-II seroreactivities. Investigation for HTLV DNA was also done in all EIA-reactive donors, irrespective of the WB result, using a combination assay based on the polymerase chain reaction (PCR) and a DNA EIA. RESULTS: A total of 115 donors (0.222%; 95% CI 0.018-0.26%) were initially considered reactive for anti-HTLV-I/II by EIAs. However, only 7 of the 115 were confirmed as positive by WB (five HTLV-I and two HTLV-I/II). Thus, the prevalence of anti-HTLV-I/II in donors from northern and western Greece was 0.013% (95% CI 0.003-0.023%). Interestingly, the majority of WB-confirmed anti-HTLV-positive individuals were detected in the blood bank of Corfu (5/7, all anti-HTLV-I). This prevalence (5/15383; 0.032%; 95% CI 0.004-0.061%) was six times the prevalence found at the other blood banks combined (2/36331; 0.0055%; 95% CI 0-0.013%), but it was not statistically significant. None of the EIA-reactive donors had detectable HTLV DNA. CONCLUSIONS: The very low prevalence of confirmed anti-HTLV-I/II infection markers in northern and western Greek blood donors, together with the negative PCR results in EIA-reactive subjects, indicates that anti-HTLV-I/I routine screening is not really justified in this area of our country. However, the increased prevalence of WB-confirmed anti-HTLV-I-positive donors in the Corfu blood bank calls for further prospective and careful investigation in order to address whether this finding represents a real cluster phenomenon of HTLV infection.

Resume L'evolution du risque residuel viral lie aux produits sanguins labiles, est un indicateur important pour evaluer l'impact des mesures dediees a l'amelioration de la securite transfusionnelle virale. L'evolution des differentes estimations du risque residuel est analysee sur neuf periodes chevauchantes de trois ans, de 1992 a 2002. Ces estimations sont par ailleurs comparees aux resultats du depistage genomique viral (DGV) mis en place pour le VIH-1 et le VHC en juillet 2001. Methodes. – Le risque residuel etant principalement du a l'existence de la fenetre immunologiquement silencieuse qui separe la date de la contamination de celle ou apparaissent les marqueurs depistes, il est estime pour chacun des trois virus majeurs (VIH, VHB, VHC) par la multiplication du taux d'incidence (seroconversions observees chez les donneurs connus dans la periode d'etude) par les durees respectives des fenetres serologiques. Les sept premieres periodes d'etude ont uniquement pris en compte les donnees emanant du groupe de travail GATT de la SFTS (representant plus de 50 % des dons collectes a l'echelon national) ; enfin les deux dernieres ont englobe la totalite des dons. Resultats. – Sur la periode 2000–2002, les risques residuels sans le DGV etaient estimes a 1/1 400 000 dons pour le VIH, 1/1 000 000 pour le VHC et 1/400 000 pour le VHB. Avec le DGV, le risque residuel lie au VIH est reduit de pres de moitie (1/2 500 000) et de pres de sept fois pour le VHC (1/6 650 000). Sur les 4,9 millions de dons testes avec le DGV entre le 01/07/2001 et le 30/06/2003, deux dons VIH positifs et un don VHC positif ont ete ecartes grâce au DGV. Pour le VIH, le gain observe est en accord avec les previsions ; en revanche, il se trouve en deca des previsions pour le VHC (4 dons en fenetre serologique prevus). Le risque residuel global (VIH, VHC, VHB) sans DGV a chute de 1/65 000 a 1/235 000 de 1992 a 2002. Depuis l'introduction du DGV, ce risque global est estime a 1/325 000, soit 28 % de moins que sans DGV. Conclusion. – Les resultats du DGV consolident la validite du modele utilise pour evaluer le risque residuel viral transfusionnel. Cependant le gain attribuable au DGV est limite car le risque residuel au moment de sa mise en place, etait minime.

International audience

Is the recommendation of the WHO, endorsed by all member states, that all blood donations should be voluntary and non-compensated ethically coherent and realizable in practice? In a recent paper, Farrugia et al have argued for a plurality of both compensated and non-compensated systems, claiming that, from both an ethical and practical perspective, the classical concept of the 'the gift relationship', advocated over 40 years ago by Richard Titmuss, is unnecessary and inadequate. This paper focuses on the ethical aspects of this debate, considering the concepts of altruism, reciprocity and social solidarity as they apply to the procurement of blood and blood products, as well as evidence regarding safety of different sources of blood and the motivations of regular donors. It concludes with a discussion of the view summarized in a recent publication by Campbell (2009), that, although the body may be monetized, doing so would result in a loss of human value.

Blood donor suitability criteria are designed to protect both the blood donor and blood recipient from harm. The risks for allogeneic (community) whole blood donors who give blood and for blood recipients who receive it are described. Blood donor suitability criteria are based on science, informed medical opinion, and regulatory rules. The criteria for many common conditions are described. Blood donor suitability criteria influence donor demographics and lead to specific deferral patterns. Age, gender, and hemoglobin deferral patterns are described. Finally, the negative effect of short-term temporary deferrals on future blood donations was reviewed.

Standardisation of NAT assays is necessary before the introduction of such assays for routine screening of blood and blood products for viral contaminants such as HBV, HCV, and HIV-1. Standardisation can be achieved by the use of well-characterised reference materials (working reagents) to validate each assay run. Working reagents for HCV, HIV-1, HBV, HAV, and human parvovirus B19 have been established by the NIBSC. Such reagents and reference panels are also available from other official medicinal control laboratories and commercial organisations. However, the nucleic acid content of these reagents are expressed in many different units, e. g. genome equivalents/ml, copies/ml, PCR detectable units/ml, making comparisons of results from laboratories using different reagents difficult. The establishment of internationally accepted standards against which all working reagents could be calibrated, using a common standard unit of measurement, IU, would overcome this major problem. The first International Standard for HCV RNA assays was established in 1997. This reagent, 96/790, is a lyophilised preparation of a genotype 1 isolate and the concentration of the standard is 10(5) IU/ml. Two further International Standards have since been established; for HIV-1 and HBV, containing 10(5) IU/ml and 10(6) IU/ml respectively. The establishment of the HCV International Standard has been critical in the introduction of mandatory testing. Since 1st July 1999, all batches of blood products marketed in Europe have to be prepared from plasma pools tested and found non-reactive for HCV RNA using a validated assay which can detect a sample containing 100 IU/ml of HCV RNA. In Germany, screening of blood donations for HCV RNA by NAT has been mandatory since 1st April 1999. The minimum sensitivity of assays should be 5000 IU/ml for a single donation.

Biological tests and clinical practices are both required for the safety of donors and patients in immunohematology. Therefore, the objectives are to require: 1) biological analysis of anti-erythrocyte antibodies and antigens; 2) compatibility tests; 3) analysis for the biological qualification of blood donations; 4) genotyping; 5) qualitative and quantitative studies on antigens and antibodies; 6) clinical stages prior and after biological tests including systems of information, automation and computerization.

Validation of HCV-NAT assays is an important prerequisite for the use of NAT for screening plasma or blood donations. The main NAT features to be validated are specificity, detection limit and robustness. Preliminary experience in Germany obtained with different methodical and logistic approaches shows the feasibility of HCV-NAT as a screening test for blood donations.

In this report we present the accumulated data on nucleic acid testing (NAT) for hepatitis C virus (HCV) RNA of blood donations by the Blood Transfusion Service of Baden-Württemberg in the period between March 1997 and March 1999. An extra barcoded blood sample was collected from each donor. Samples were tested by NAT in mini-pools of maximally 96 samples. First-time and repeat donors were tested separately. RT/HCV-PCR was performed with the COBAS HCV Amplicortrade mark, versions 1.0 and 2.0 from Roche Diagnostic Systems. Many modifications have been introduced to the original protocol since the implementation of NAT screening aiming at an increase in the sensitivity and specificity of the assay. NAT positive pools containing serologically positive samples were detected. Initially, reactive pools were identified that could not be confirmed by secondary pooling and single testing procedures. So far, no serologically negative but NAT positive sample has been found.

The major application of blood irradiation is for the prevention of graft-versus-host disease on immunodeficient patients by the abrogation of T-lymphocytes. Despite screening of blood donations, transfusion associated transmission of infections due to contaminated blood products is common. Hence, there is potential for the application of irradiation for the inactivation of pathogenic microbes in blood products. Literature on the effect of radiation on blood components is reviewed in order to make a rational decision on the feasibility of their irradiation.

At least 20 different hematopoietic drugs (see Table 1) are currently under investigation. These most likely will impact on all aspects of transfusion therapy. Which agents to use and in what combinations will be the subject of scrutiny for many years to come as scientists try to recreate and enhance the process of hematopoiesis. Perhaps someday blood cells and hematopoietic progenitor cells can be manufactured for therapy with genetically selected phenotypes to avoid immune destruction and rejection. If this comes to pass, blood donations as we know them today, as a valuable adjunct to medical care, will fade into history, supplanted by the use of hematopoietic growth factors.

The impact of transfusion reactions related to bacterial contamination (TRBC) of labile blood products (LBP) was identified in France soon after the implementation of the haemovigilance system. The aims of our communication were: 1) to confront published data on TRBC with available French data; 2) to describe measures implemented in France to prevent TRBC. Bacterial contamination of whole blood at the collection stage is found in 0.6 to 3% of blood donations. Systematic bacteriological controls detect frequent contaminations of LBP that vary according to studies and the nature of the product. The incidence of clinical TRBC was only estimated in recipients with malignant diseases. Based on French haemovigilance data, the incidence was estimated to two per 100,000 delivered units. The measures taken were the diffusion of information and recommendations and the implementation of studies. In the framework of the Bacthem study (a national case-control study on LBP-related bacterial contamination), standardised diagnostic criteria are applied to suspected TRBC notified to the Centre National d'Hemovigilance. Expected results should allow us to estimate the incidence of TRBC in France and to determine the recipients or situations at risk more precisely, in order to target additional preventive measures. Preliminary results, 11 months after the beginning of the study, show the feasibility and the relevance of completing the surveillance with specific studies within the haemovigilance network.

Agents that are transmissible by blood or its derivatives typically have long incubation periods, may often be asymptomatic for several years and can set up carrier or latent persistent infections. Examples are hepatitis B virus (HBV), hepatitis C virus (HCV), the human immunodeficiency viruses (HIV 1 and 2) and cytomegalovirus. The prevention of transfusion-transmitted infection (TTI) is based on the exclusion of potential blood donors who are not fit and well, the education of donors to exclude themselves if they are at risk of contracting TTIs, the laboratory screening of all blood donations for evidence of infection with a range of potential TTIs, physical removal of white cells in those cases where the agent is cell associated, viral inactivation procedures for pooled plasma derivatives, detection of viral genomes in plasma pools and the avoidance of unnecessary transfusions.