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Characteristics of US Blood Donors Testing Reactive for Antibodies to SARS-CoV-2 Prior to the Availability of Authorized Vaccines
Roger YDoddaBryan RSpencera1MengXua1Gregory AFostera1PaulaSa?aJaye PBrodskyb1Susan LStramera
doi : 10.1016/j.tmrv.2021.07.001
Volume 35, Issue 3, July 2021, Pages 1-7
In the United States, many blood collection organizations initiated programs to test all blood donors for antibodies to SARS-CoV-2, as a measure to increase donations and to assist in the identification of potential donors of COVID-19 convalescent plasma (CCP). As a result, it was possible to investigate the characteristics of healthy blood donors who had previously been infected with SARS-CoV-2. We report the findings from all blood donations collected by the American Red Cross, representing 40% of the national blood supply covering 44 States, in order to characterize the seroepidemiology of SARS-CoV-2 infection among blood donors in the United States, prior to authorized vaccine availability. We performed an observational cohort study from June 15th to November 30th, 2020 on a population of 1.531 million blood donors tested for antibodies to the S1 spike antigen of SARS-CoV-2 by person, place, time, ABO group and dynamics of test reactivity, with additional information from a survey of a subset of those with reactive test results. The overall seroreactivity was 4.22% increasing from 1.18 to 9.67% (June 2020 - November 2020); estimated incidence was 11.6 per hundred person-years, 1.86-times higher than that based upon reported cases in the general population over the same period. In multivariable analyses, seroreactivity was highest in the Midwest (5.21%), followed by the South (4.43%), West (3.43%) and Northeast (2.90%). Seroreactivity was highest among donors aged 18-24 (Odds Ratio 3.02 [95% Confidence Interval 2.80-3.26] vs age >55), African-Americans and Hispanics (1.50 [1.24-1.80] and 2.12 [1.89-2.36], respectively, vs Caucasian). Group O frequency was 51.5% among nonreactive, but 46.1% among seroreactive donors (P< .0001). Of surveyed donors, 45% reported no COVID-19-related symptoms, but 73% among those unaware of testing. Signal levels of antibody tests were stable over 120 days or more and there was little evidence of reinfection. Evaluation of a large population of healthy, voluntary blood donors provided evidence of widespread and increasing SARS-CoV-2 seroprevalence and demonstrated that at least 45% of those previously infected were asymptomatic. Epidemiologic findings were similar to those among clinically reported cases.
Progression and Predictors of SARS-CoV-2 Antibody Seroreactivity In US Blood Donors
Ralph R.VassalloabLarry J.Dumontcde1Marjorie D.BravoaKelseyHazeghcHanyKamela
doi : 10.1016/j.tmrv.2021.07.003
Volume 35, Issue 3, July 2021, Pages 8-15
The second largest US blood center began testing for antibodies to SARS-CoV-2, the etiologic agent of Coronavirus Disease-2019 (COVID-19) to identify potential COVID-19 Convalescent Plasma (CCP) donors and encourage blood donation. We report the non-vaccine seroprevalence of total immunoglobulin directed against the S1 spike protein of SARS-CoV-2 in our donors. Unique non-CCP donor sera from June 01to December 31, 2020 were tested with the Ortho VITROS Anti-SARS-CoV-2 total immunoglobulin assay (reactive: signal-to-cutoff (S/C) ? 1). Multivariate regressions including age, sex, race-ethnicity, ABO, RhD, highest education level, donor experience, regional collection center and drive type factors were conducted to identify demographics associated with the presence of antibodies and with S/C values. Unique donors (n = 523,068) showed an overall seroprevalence of 6.12% over 7 months, with the highest prevalence in December 2020 around Lubbock, TX (24.3%). In a subset of donors with demographic information (n = 394,470), lower odds of antibody reactivity were associated with female sex, non-Hispanic White or Asian race/ethnicity, age ? 65, graduate education, blood Group O, and history of blood donation. In reactive donors (n = 24,028), antibody signal was associated with male sex, race/ethnicity other than non-Hispanic White, low educational attainment, age 16-17 years and geographic location. Seroprevalence continues to grow in US blood donors but varies significantly by region. Temporal trends in reactivity may be useful to estimate effectiveness of public health measures. Before generalizing these data from healthy donors to the general population, rates must be corrected for false-positive test results and adjusted to match the wider US demography.
Red Cell Exchange as Adjunctive Therapy for Babesiosis: Is it Really Effective?
TouficTannousabTracey A.ChevescJoseph D.Sweeneyac
doi : 10.1016/j.tmrv.2021.06.004
Volume 35, Issue 3, July 2021, Pages 16-21
Human babesiosis is a parasitic disease prevalent in the Northeastern and Midwestern United States (US). Treatment with antibiotics is the standard of care but red cell exchange (RCE) has been used as an adjunctive treatment in more severe disease. Data for the efficacy of RCE in the treatment of babesiosis has been based on case reports and case series. An English language literature search was conducted for cases of babesiosis treated with RCE since 1980 and relevant laboratory and clinical outcome data were extracted. Similar data were obtained on severe cases of babesiosis referred for RCE in our hospitals in the time period 2000 to 2020. Fifty reports including forty-one individual case reports and nine case series were retrieved. There were 108 patients that underwent RCE with an overall mortality rate of 20%. Some patients had more than one RCE. The patients varied in the level of anemia and evidence of compromise of renal or pulmonary function. The pre-RCE level of parasitemia varied between 1.7% to 85% with the vast majority >10%. The post-RCE level of parasitemia varied between 1% to 10%. Since 2000, 32 patients were referred for RCE in our hospitals and RCE was performed on 23 of 32. There were more patients treated with RCE in the second decade as compared to the first decade, 19 versus 4 respectively. The overall mortality was 22% similar to the national data. Comparing the cohort treated with RCE to the 9 patients who were treated only with antibiotics, there were similar levels of parasitemia and laboratory parameters. The overall number of days needed to achieve a parasite count <1% was similar between the two cohorts and mortality for the antibiotics only cohort was 0%. More than 40 years after the first reported case of RCE in severe babesiosis it cannot be concluded that this adjunctive therapy favorably influences the clinical outcome. Since there is largely equipoise, a registry of severe patients treated with or without RCE could identify a benefit or otherwise.
Anemia-Induced Bleeding in Patients with Platelet Disorders
SwarniThakara1NadiaGabarinb1AkashGuptacMichaelRadfordbTheodore E.WarkentinabcDonald M.Arnoldab
doi : 10.1016/j.tmrv.2021.06.001
Volume 35, Issue 3, July 2021, Pages 22-28
Anemia is not only a consequence of bleeding, but also a modifiable risk factor for bleeding in patients with thrombocytopenia or platelet function defects. In this review we outline the mechanism of anemia-induced bleeding in patients with platelet disorders, which involves a disturbance in normal red blood cell (RBC) rheology and reduced platelet margination to the endothelial surface due to a decrease in RBC mass, leading to impaired primary hemostasis and bleeding. Biologically, anemia reduces the mass of RBCs in the central column of flowing blood through a vessel resulting in fewer platelets coming into contact with the endothelial surface at the periphery of the flowing blood column. Thus, anemia results in impaired primary hemostasis. Von Willebrand factor (vWF) is another component of primary hemostasis and vWF deficiency, especially a deficiency of the highest vWF multimers, can also manifest with bleeding when concomitant anemia occurs. Clinically, patients at greatest risk for anemia-induced bleeding include patients with hematological malignancies in whom anemia and thrombocytopenia occur as a result of the underlying disease or the myelotoxic effects of treatment; patients with renal insufficiency with uremic thrombocytopathy and hypoproliferative anemia; and patients with inherited or acquired bleeding disorders affecting primary hemostasis (eg, Bernard-Soulier syndrome, von Willebrand disease) with chronic blood loss and iron deficiency anemia. Underlying abnormalities of any components of primary hemostasis plus concomitant anemia may result in major bleeding disorders; therefore, correction of remediable abnormalities—most notably, correction of the anemia— would be expected to have important clinical benefit. In this review we discuss how the correction of the anemia may lead to improvement of bleeding outcomes in patients with a primary hemostatic defect, supported by evidence from animal models, clinical trials and clinical experience.
Neonatal Platelet Transfusions: Starting Again
Carmel MariaMooreM.D.Anna ECurley
doi : 10.1016/j.tmrv.2021.06.003
Volume 35, Issue 3, July 2021, Pages 29-35
Preterm neonates with severe thrombocytopenia are frequently prescribed prophylactic platelet transfusions despite no evidence of benefit. Neonatal platelet transfusion practice varies, both nationally and internationally. Volumes and rates of transfusion in neonatology are based on historic precedent and lack an evidence base. The etiology of harm from platelet transfusions is poorly understood. Neonates are expected to be the longest surviving recipients of blood produce transfusions, and so avoiding transfusion associated harm is critical in this cohort. This article reviews the evidence for and against platelet transfusion in the neonate and identifies areas of future potential neonatal platelet transfusion research.
Daratumumab: Beyond Multiple Myeloma
KiranEjazaJohn D.RobackbSean R.StowellbHarold C.Sullivanb
doi : 10.1016/j.tmrv.2021.06.002
Volume 35, Issue 3, July 2021, Pages 36-43
Daratumumab (DARA) is the biological name of an Immunoglobulin G1k human monoclonal antibody. DARA the first-in-class therapy targeting CD38 expressing- plasma cells (PC) and plasma blasts. It has been approved for the treatment of multiple myeloma. It is also being examined in the setting of other hematologic malignancies. As DARA targets PCs, it could potentially be used to treat many other disease processes that are antibody mediated. In fact, several case reports and case series report experiences of using DARA to treat a variety of antibody-mediated disorderss. The aim of this review is to present a summary of the literature thus far regarding the application of DARA beyond its uses in multiple myeloma and other hematologic diseases. Specifically, we address uses of DARA as an immunologic modulator in various antibody mediated processes.
Platelet Component False Positive Detection Rate in Aerobic and Anaerobic Primary Culture: A Systematic Review and Meta-Analysis
JessicaCoreanaSandra K.WhiteaRobert L.SchmidtabBrandon S.WalkerbMark A.FisherabRyan A.Metcalfab
doi : 10.1016/j.tmrv.2021.05.001
Volume 35, Issue 3, July 2021, Pages 44-52
Septic reactions from platelet transfusions are one of the leading causes of transfusion-associated mortality. The FDA guidance for platelet bacterial risk control includes bacterial culture using both aerobic and anaerobic bottles. Several studies have reported false positive rates (FPR) of culture, but these data have not been summarized or influencing factors analyzed. A systematic review and meta-analysis was performed according to published guidelines to assess the false positive rate and influencing factors. Eighteen studies were included for analysis. The combined aerobic/anaerobic FPR was 2.4 events per thousand (EPT) with a prediction interval of 0.5 to 5.7, while the aerobic FPR rate was 1.0 EPT (prediction interval: 0.2-2.2) and the anaerobic rate was 1.8 EPT. Estimates were based on a total of almost 5 million units tested. The rate of false positives due to instrument error was between 0.5-1.7 EPT, while it was between 0.3-1.0 EPT for sampling contamination based on whether only aerobic, anaerobic, or aerobic/anaerobic cultures were performed. The FPR is approximately 2 to 5 times higher than the literature reported true positive rate of 0.5 EPT.
Increased Nucleated RBCs in Cord Blood: Not an Exclusion Criterion but a Quality Indicator for Hematopoietic Progenitor Cell Transplantation
SueShinabc1Hye RyunLeed1Jong HyunYoonabcByoung JaeKimbeNamheeKimacHyunwoongParkacEun YounRohabc
doi : 10.1016/j.tmrv.2021.05.002
Volume 35, Issue 3, July 2021, Pages 53-59
Increased nucleated red blood cell (NRBC) counts have been reported to be associated with adverse fetal outcomes, and cord blood units (CBUs) with increased NRBC counts require a 2nd questionnaire to determine their suitability for transplantation. However, a recent study demonstrated a positive correlation of NRBCs with CD34+ cells and total nucleated cells (TNCs). We evaluated the association between the NRBC count and hematopoietic progenitor cell (HPC) content (TNC and CD34+ cell counts) in Korean full-term newborn CBUs. In addition, we assessed whether an increased NRBC count is associated with newborn health problems that impair CBU safety. Among the 32,876 units processed from May 2006 to December 2018, a total of 23,385 CBUs with a TNC count ? 7 × 108 and reliable perinatal information were analyzed to assess the association of the NRBC count with CBU parameters, and the newborns associated with 457 CBUs that required the 2nd questionnaire due to an increased NRBC (? 15 NRBCs/100 WBCs) were assessed at one year for health problems that threatened CBU safety. The majority of the CBUs that required the 2nd questionnaire due to an increased NRBC count (96.9%) were determined to be suitable for transplantation. Those with an increased NRBC count showed significantly higher CD34+ cell and TNC counts and a higher rate of transplantation (P < 0.001, < 0.001 and 0.025, respectively). NRBCs showed a significant positive correlation with TNCs and CD34+ cells and a significant negative correlation with birth weight (all P < 0.001; adjusted r = 0.185, 0.369 and - 0.029, respectively). In the multiple linear regression analysis, NRBCs showed independent and positive correlations with TNCs and CD34+ cells after adjustments for birth weight and gestational age (all P < 0.001; ? = 0.182, adjusted R2 = 0.053 and ? = 0.367, adjusted R2 = 0.418). An increased NRBC count in full-term normal delivery is a surrogate marker of HPCs in CBUs rather than an exclusion criterion for CBU safety. Moreover, providing the NRBC count together with the NRBC-corrected TNC count will be useful for clinicians to select CBUs for transplantation.
A Platelet Inventory Management Assessment: Is a Pathogen Reduced Only Inventory Financially Feasible?
LouiseHelanderaSusanPotterveldbMaryBergb
doi : 10.1016/j.tmrv.2021.07.002
Volume 35, Issue 3, July 2021, Pages 60-61
