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Vox Sanguinis

C Pistorius

Virology, Western Cape Blood Service, Cape Town, South Africa

Background: Africa has a unique set of challenges regarding safe blood transfusion.

Two of the largest contributing factors are: 1) The most common disease states in Sub‐Saharan Africa (SSA) require large amounts of blood as lifesaving interventions e.g.

malaria, 2) the highest burden of infectious diseases transmissible through transfusion (Tapko, Toure, & Sambo, 2014) is found in SSA.

This has often led to the binary donor base that exists in SSA, consisting of Voluntary Non‐remunerated Blood donors (VNBD) and family or replacement donors (FRD) as transfusion centres are unable to supply the demand when relying only on VNBD.

Voluntary non‐remunerated donors are the safest blood donors as they have no incentive (other than altruistic motives) and are not under social pressure to donate, both factors that may induce individuals knowing or suspecting themselves to be infected with a blood‐borne agent to donate blood.

Nucleic Acid Testing (NAT) in conjunction with serological testing is the gold standard for testing, however, the vast distances and high temperatures of Africa makes transport of traditional plasma samples a logistical challenge.

Many publications evaluating the stability, suitability, and ease of use of dried blood spots (DBS) for NAT have been published.

Generally, results have been shown to be comparable to traditional plasma samples.

DBS is being used successfully in the early infant diagnosis (EID) programs for HIV by means of PCR testing, especially in Africa.

Aims:

To demonstrate that DBS and/or dried plasma spot (DPS) testing is suitable for blood donor screening and can make NAT testing more widely available in Africa

To determine the diagnostic sensitivity and specificity of testing DPS and DBS samples, in comparison to testing of plasma samples.

Methods: 900 negative new donor samples and 100 confirmed positive donor samples, as defined by routine blood safety screening done at Western Cape Blood Service, were screened using a dried blood spot kit.

After routine testing was completed, one DBS sample and one DPS sample for each blood donor were prepared and analysed with the Ultrio Elite Assay on the Panther analyser.

Results:

Invalid rate: 5 DBS invalids 0.56%

Specificity (n=900)

DBS: 100%

DPS: 100%

Human immunodeficiency Virus (HIV)

DBS (n=30): 96.67%

DPS (n=40): 97.50%

DBS (n=33): 57.58%

DPS (n=50): 58.00%

DBS (n=2): 100%

DPS (n=10): 100%

Overall Accuracy: 98%

Summary/Conclusions: DBS/DPS can be used as a sample for screening blood donors as the invalid rate was 0.56%, and only found on DBS samples.

Logistically DBS/DPS is well suited for the resource‐poor countries as samples are:

‐ Easy to obtain (fingerpick samples could be used.)

‐ Transport is simplified as samples will not leak or haemolyse due to high temperatures.

‐ Samples can be stored at room temperature

DBS/DPS demonstrated acceptable specificity.

The Ultrio Elite performed well with regards to HIV and HCV sensitivity.

Sensitivity with regard to HBV was not as high but this could be due to very low and erratic viral loads.

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