Department of Pathology

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Browsing Department of Pathology by browse.metadata.advisor "Bird, Arthur"

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    Dried plasma spot testing – the answer for making blood transfusion testing safer in africa?
    (Stellenbosch : Stellenbosch University, 2018-12) Pistorius, Charlotte; Preiser, Wolfgang; Bird, Arthur; Stellenbosch University. Faculty of Medicine and health Sciences. Dept. of Pathology. Medical Virology.
    ENGLISH ABSTRACT: Sub-Saharan Africa (SSA) has a unique set of challenges pertaining to blood transfusion. Two of the largest contributing factors are: (1) the most common disease states in SSA require large amounts of blood as a lifesaving intervention e.g. malaria, and (2) the highest burden of infectious diseases transmissible through transfusion (Tapko, Toure, & Sambo, 2014) is found in SSA. This has often led to the dichotomous donor base that exists in SSA, consisting of Voluntary Non-remunerated Blood donors (VNBD) and family or replacement donors (FRD), since transfusion centres are unable to supply the demand when relying only on VNBD. VNBD are the safest blood donors as they have no monetary incentives and are under no direct social pressure to donate. Monetary incentives have been shown to entice individuals that know or suspect 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 SSA makes transport of traditional plasma samples a logistical nightmare. Many publications evaluating the stability, suitability and ease of use of dried blood spot (DBS) and dried plasma spot (DPS) for NAT have been published. Generally results have been shown to be comparable to traditional plasma samples. DBS are being used successfully in the early infant diagnosis (EID) programs for HIV by means of PCR testing especially in Africa. Ethical approval was obtained to conduct a study to determine whether DBS and/or DPS testing would be suitable for use in a resource limited setting for blood screening. Two cohorts were included. Cohort A consisted of 900 de-identified negative new donor samples. Cohort B consisted of 100 de-identified confirmed positive donor samples, 9 procured reactive samples, and a contamination panel. After routine donor testing was completed at Western Province Blood Transfusion Service, one DBS sample and one DPS sample for each blood donor was prepared and analysed with the Ultrio Elite Assay on the Panther analyser (Hologic Inc., USA). Logistically DBS/DPS is well suited for the resource-poor countries as samples are: a.Easy to obtain (fingerpick samples could be used). b.Transport is simplified as samples will not leak or haemolyse due to high temperatures. c.Samples can be stored at room temperature. DBS/DPS samples demonstrated superb specificity. DPS samples would be suited for screening blood and reduced cost involved in NAT testing provided that the HBV sensitivity is increased. Further detailed economic viability and large-scale studies need to be performed to determine sensitivity and specificity within a specific population.