Robert Crookes

Impact of individual-donation nucleic acid testing on risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission by blood transfusion in South Africa.

BACKGROUND: In 2005, the South African National Blood Service introduced individual‐donation (ID) nucleic acid test (NAT) screening for human immunodeficiency virus (HIV) RNA, hepatitis C virus (HCV) RNA, and hepatitis B virus (HBV) DNA. At the same time the use of ethnic origin to prioritize the transfusion of blood according to a hierarchy of residual risk was discontinued.

Correlation of in vitro platelet quality measurements with in vivo platelet viability in human subjects

Background and Objectives  Changes in in vitro platelet quality parameters during platelet storage are associated with a decrease of in vivo platelet viability after platelet transfusion. Many attempts have been made to identify the most predictable in vitro parameters for in vivo performance. We used a riboflavin‐based ultraviolet (UV) light treatment process designed to inactivate pathogens and white blood cell (WBC) contaminants in blood products as a model system in which to study the correlation of in vitro cell quality with in vivo viability.

Characterization of occult hepatitis B virus strains in south african blood donors

Since October 2005, all blood units collected in South Africa were screened individually for human immunodeficiency virus (HIV)‐1, hepatitis B and C virus (HBV, HCV) genomes uncovering preseroconversion window period (WP) infections for each virus and occult HBV infections (OBIs) defined as persistent HBV DNA without detectable hepatitis B surface antigen (HBsAg). Samples identified as HBsAg‐negative/DNA‐positive were confirmed by combining real‐time quantitative polymerase chain reaction, nested amplification, anti‐HBc and anti‐HBs. Amplified basic core promoter/precore, pre‐S/S, and whole genome were sequenced, analyzed, and compared to 73 HBsAg+ strains. Genotype was determined by phylogenetic analysis. From 109 samples examined, 54 were classified as OBI, 14 as WP, 20 as false‐positive, five as other classification, and 16 as undetermined due to lack of serological or follow‐up data. OBI donors were predominantly males (67%), median age 31 years, black (54%), with normal alanine aminotransferase levels. Viral load ranged between unquantifiable and 518 IU/mL (median 5 IU/mL). Genotype A1 was more frequent (23 strains) than genotype D (seven strains). Genotype A1 strains were little mutated. In the major hydrophilic region, 56.5% strains were wild type or with few amino acid substitutions. Most important, all 13 full genome sequences presented 1 to 7 mutations known to or assumed to negatively impact viral replication. In particular, 6/13 sequences had a stop codon in the HBx gene translated into deletion of 117 or 19‐25 C‐terminus amino acids not found in 15 HBeAg+ HBsAg+ strains. One WP sequence with an HBx stop codon suggested infectivity. Conclusion: Genotype A1 OBIs are different from genotype A2 and D OBIs in that there is little evidence of immune pressure as a major factor involved in OBI genesis. Limited replication appears mostly related to genetic viral defects. (HEPATOLOGY 2009.)

Hepatitis B virus transmission by blood transfusion during 4 years of individual-donation nucleic acid testing in South Africa: estimated and observed window period risk

BACKGROUND: Since October 2005, a total of 2,921,561 blood donations have been screened by the South African National Blood Service for hepatitis B virus (HBV) by individual‐donation nucleic acid testing (ID‐NAT). Over 4 years, 149 hepatitis B surface antigen–negative acute‐phase HBV NAT–positive donations were identified (1:19,608). The lookback program identified one probable HBV transmission.

The impact of individual donation NAT screening on blood safety – the South African experience

South Africa is in the midst of an escalating HIV/AIDS pandemic with an estimated 5·3 million people infected [1]. The prevalence in women attending public antenatal care reached 27·9% in 2003, while 11·4% of the overall population is infected [2], predominantly through heterosexual and perinatal transmission. The epidemic has also had a serious impact on blood safety and as a result, the South African National Blood Service (SANBS) in 1999 implemented a risk management policy that safeguarded the supply of blood against the threat of the HIV pandemic was implemented [3]. Using race as a risk indicator however, was not acceptable in the South African socio-political milieu [4] and that risk management programme was replaced with a new risk management policy on 3 October 2005. This model is based on donor status, i.e. regular repeat, lapsed or first-time donor, as the major risk indicator. The model is underpinned by donor education, exclusion of donors who have been exposed to high-risk behaviour, and individual donation NAT (ID NAT) screening for HIV, HBV and HCV of all donations. The aim of this study was to assess the impact of the introduction of ID NAT for HIV, HCV and HBV on the safety of the blood supply of SANBS as assessed in the context of the Donor Status Risk Management Model

The impact of human immunodeficiency virus infection on obstetric hemorrhage and blood transfusion in South Africa

Globally, as in South Africa, obstetric hemorrhage (OH) remains a leading cause of maternal mortality and morbidity. Although blood transfusion is critical to OH management, the incidence and predictors of transfusion as well as their relation to human immunodeficiency virus (HIV) infection are poorly described.

Human immunodeficiency virus‐1 infection correlates strongly with herpes simplex virus‐2 (genital herpes) seropositivity in South African and United States blood donations

BACKGROUND: In South Africa, human immunodeficiency virus‐1 (HIV‐1) infection correlates with herpes simplex virus‐2 (HSV‐2; genital herpes) seropositivity in genitourinary disease clinic attendees. HSV‐2 infection may be a marker for risk behavior and/or directly facilitate HIV‐1 transmission. The rate of HSV‐2 infection in HIV‐infected South African and US blood donations was assessed, and whether the infections were correlated in donors screened and found negative for high‐risk behavior by predonation interview was questioned.

Molecular investigation of two possible cases of accidental HIV-1 transmission in South Africa.

HIV-1 sequences from two possible transmission cases in South Africa were examined for evidence of genetic linkage. HIV-1-seropositive blood samples were obtained from a donor and recipient within 8 months following a blood transfusion and from a healthcare worker and her patient within 10 months following a needle-stick injury. A 700-bp region in env and 550-bp region in gag were analyzed. All sequences were phylogenetically associated with HIV-1 subtype C, the predominant HIV-1 subtype in South Africa. The nucleotide sequences from the blood transfusion case grouped together significantly with a bootstrap value of 100%. These samples were 98% and 100% identical in the predicted amino acid sequences of env and gag, respectively. In contrast, sequences from the needle-stick case showed only 67% and 80% amino acid identity in env and gag, respectively, and were separated on a phylogenetic tree. Molecular analysis suggested that HIV transmission occurred in the blood transfusion case but not in the case of the needle-stick injury. These data emphasize the need for molecular investigation of epidemiologically linked cases of HIV transmission.

Leucocyte depletion of blood components - guidelines of the blood transfusion services of South Africa

Extracted from text ... Leucocyte depletion of blood components - guidelines of the Blood Transfusion Services of South Africa Arthur Bird, Robert Crookes Leucocytes in blood components are responsible for a number of adverse effects associated with blood transfusion. In many instances the pathogenesis has not been elucidated precisely, but it is likely that it is immunologically mediated. Potential mechanisms include clonal deletion or anergy, induction of suppressor cells, production of anti-idiotypic antibody, suppression of natural killer (NK) cell activity and several others.1 As a consequence a number of clinicians prefer to use leucocyte-depleted components. The clinical indications advanced for depleting blood components of leucocytes (leucodepletion) are as follows: (i) avoidance of febrile non-haemolytic transfusion reactions (FNHTRs); (ii) reduction ..

Risk factors for peripartum blood transfusion in South Africa: a case-control study: PERIPARTUM BLOOD TRANSFUSION IN AFRICA

Obstetric hemorrhage (OH) and access to peripartum blood transfusion remains a global health challenge. The rates of peripartum transfusion in South Africa exceed those in high‐income countries despite comparable rates of OH. We sought to evaluate factors associated with peripartum transfusion.