Normative evaluation of blood banks in the Brazilian Amazon region in respect to the prevention of transfusion-transmitted malaria

Abstract

ObjectiveTo evaluate blood banks in the Brazilian Amazon region with regard to structure and procedures directed toward the prevention of transfusion-transmitted malaria (TTM).MethodsThis was a normative evaluation based on the Brazilian National Health Surveillance Agency (ANVISA) Resolution RDC No. 153/2004. Ten blood banks were included in the study and classified as ‘adequate’ (≥80 points), ‘partially adequate’ (from 50 to 80 points), or ‘inadequate’ (<50 points). The following components were evaluated: ‘donor education’ (5 points), ‘clinical screening’ (40 points), ‘laboratory screening’ (40 points) and ‘hemovigilance’ (15 points).ResultsThe overall median score was 49.8 (minimum = 16; maximum = 78). Five blood banks were classified as ‘inadequate’ and five as ‘partially adequate’. The median clinical screening score was 26 (minimum = 16; maximum = 32). The median laboratory screening score was 20 (minimum = 0; maximum = 32). Eight blood banks performed laboratory tests for malaria; six tested all donations. Seven used thick smears, but only one performed this procedure in accordance with Ministry of Health requirements. One service had a Program of External Quality Evaluation for malaria testing. With regard to hemovigilance, two institutions reported having procedures to detect cases of transfusion-transmitted malaria.ConclusionMalaria is neglected as a blood–borne disease in the blood banks of the Brazilian Amazon region. None of the institutions were classified as ‘adequate’ in the overall classification or with regard to clinical screening and laboratory screening. Blood bank professionals, the Ministry of Health and Health Surveillance service managers need to pay more attention to this matter so that the safety procedures required by law are complied with.

Strategy to improve malaria surveillance system preventing transfusion-transmitted malaria in blood banks using molecular diagnostic

“…Conversely, the risk of transmitting malaria by blood transfusion in countries where parasite transmission is endemic can be high, and the healthcare systems clearly need alternative measures to prevented TTM, including tools for detecting the parasite or its components in the blood of potentially infected donors [ 2 , 7 , 11 ].…”

“…Malaria screening is mandatory in endemic regions and the directives of the Brazilian National Health Surveillance Agency (ANVISA) and the Brazilian Ministry of Health require high sensitivity tests. In spite of this, malaria screening in Brazilian blood banks relies on questionnaire data followed by microscopic examination of thick smears, which has several limitations, such as low counts of parasitaemia in asymptomatic patients which may lead to liability to human error [ 11 ].…”

“…In the last 40 years, the increased frequency of blood transfusion in medical practice and increase in travelling between countries in which malaria is absent and those where malaria is endemic reveals a clinical and public health problem [ 4 , 8 ]. Moreover, the urbanization of malaria transmission areas in countries where the disease is endemic has contributed to an increased possibility of accidental transmission of Plasmodium infections through blood transfusion [ 11 ]. However, there is a paucity of officially registered data, which depends on appropriate tools for detection of malaria parasites.…”

“…In general, transfusion malaria is not registered by national authorities. Since 2002, the official data reported only 4 cases transmitted by transfusions from the blood banks located in the Brazilian malaria-endemic area [ 11 ].…”

We need to talk more about transfusion-transmitted malaria in Plasmodium vivax endemic areas

“…In the timely paper published by Freitas & Duarte in this issue of the Revista Brasileira de Hematologia e Hemoterapia, 8 the first extensive evaluation of nine blood banks from the Brazilian Amazon point to non-uniform and imprecise adopted practices. The standardization of national policies is urgent and the evaluated impact of these policies needs to be shared with similar endemic areas throughout the world.…”