Infectious safety of donor blood
Authors: Novak V.L. 
Published: July 2021

Background. The main problems of the blood service of Ukraine at the present stage include the reduction in the number of donors, low quality of donor blood components and derived drugs, high prevalence of markers of blood-borne infections among donors, lack of long-term storage of blood components. Transfusions of blood components should be considered a serious medical invasive intervention, which can have both immediate and long-term complications, including transmission of blood-borne infectious diseases.

Objective. Cover the issue of infectious safety of donor blood.

Materials and methods. Analysis of literature sources and statistics data on this topic.

Results and discussion. The modern concept of transfusiology is based, with a few exceptions, on the inexpediency and even harmfulness of transfusion of whole donor blood (WDB). When using WDB in military injuries or technological disasters, the examination should be performed not only before blood sampling, but also 6-12 weeks and 6 months after transfusion. Due to the exacerbation of the problem of infectious safety, in 2018 7.2 % of donors were withdrawn from blood donation and 1.11 % of collected blood was rejected. Viral hepatitis C was most commonly found in donors, and hepatitis B, syphilis, and HIV were less common. The prevalence of markers of HIV infection has decreased compared to the early 2000s (2009: 153 cases per 100,000 donations; 2019: 61.1 cases per 100,000 donations). The highest prevalence of HIV markers among donors in 2019 was noticed in Odesa, Khmelnytskyi and Kirovohrad regions, and the lowest in Luhansk, Sumy and Volyn regions. The highest prevalence of markers of hepatitis B among donors for the last two decades was observed in 2000 (1554.5 cases per 100,000 donations), the lowest – in 2019 (385.3 cases per 100,000 donations). The highest prevalence of markers of hepatitis B among donors in 2019 was noticed in Zakarpattia, Ivano-Frankivsk and Kirovohrad regions, the lowest – in Sumy, Rivne and Kharkiv regions. A similar situation regarding the dynamics of prevalence is observed for markers of hepatitis C (2003: 3107 cases per 100,000 donations; 2019: 539.1 cases per 100,000 donations). The highest prevalence of markers of hepatitis C among donors in 2019 took place in Ivano-Frankivsk, Rivne and Kirovohrad regions, the lowest – in Sumy and Poltava regions, Kyiv. The highest prevalence of markers of syphilis among donors in 2019 took place in Ternopil, Zakarpattia and Kirovohrad regions, the lowest – in Sumy, Kharkiv and Vinnytsia regions. In general, the worst infectious safety of donor blood was observed in Kirovohrad region, the best – in Sumy region. A separate analysis of data from registered donors and reserve donors shows that the registered donors are more reliable in terms of infectious safety. In addition to HIV, hepatitis viruses and syphilis, other infections can be transmitted with blood components. Currently, the list has expanded with a new coronavirus. It should be noted that modern test systems for detecting markers of infections are not perfect and there is a certain share of repeated results that did not coincide with the primary ones. Without the diagnosis of blood-borne infections in all donors with the help of polymerase chain reaction (PCR) it is almost impossible to guarantee the infectious safety of donor blood components and plasma preparations. Unfortunately, there is no absolutely safe donor blood and cases of blood-borne infections occur even in developed countries. Antihemophilic drugs undergo dual virus inactivation (chemical and thermal), however, the labels of these drugs do not mention the term “virus-safe”. Studies show that almost every domestic patient with severe hemophilia who has received blood transfusions is infected with blood-borne infections. Ways to prevent the transmission of these infections are the following: enhancement of medical requirements for donors, development of a system of transfusion chain procedures, creation of a national donor registry, introduction of screening of all donor blood by PCR and rapid tests (platelets), performing PCR and repeat testing of the quarantined blood, use of highly informative test systems, creation of regional reference laboratories for donor blood testing, introduction of methods of virus inactivation and virus elimination.

Conclusions. 1. Donation is the only source of blood components. 2. Problems of the blood service of Ukraine include a decrease in the number of donors, low quality of donor blood components and derived drugs, high prevalence of markers of blood-borne infections among donors, lack of methods of long-term storage of blood components, etc. 3. The prevalence of markers of major blood-borne infections among donors has declined somewhat over the past two decades. 4. There is no absolutely safe donor blood. 5. Ways to prevent the transmission of blood-borne infections are the following: enhancement of medical requirements for donor recruitment, development of a system of transfusion chain procedures, creation of a national donor registry, introduction of screening of all donor blood by PCR, creation regional reference laboratories, introduction of virus inactivation and virus elimination methods.