The Western Cape Blood Service (WCBS) employs a robust multi-layered approach for the continued provision of safe blood products for patients.
WCBS invests in continuous donor education to promote blood donation and healthy lifestyle choices; and promote regular, voluntary and non-remunerated blood donation, as this has been proven to be a reliable source of safe blood.
Blood donors undergo a careful selection process to assess their eligibility each time they wish to donate. They must complete the blood donation self-exclusion questionnaire (SEQ); which consists of a health and lifestyle section; and must pass all the acceptance criteria in order to donate. If they realise after their donation that they did not answer the SEQ accurately or honestly, or believe that their blood may be unsafe for transfusion to a patient they can access WCBS confidential counselling. If necessary, the donation will be removed from the blood supply.
Each donation undergoes routine individual donation screening for HIV-1/2 Ag/Ab and HIV-1/2 RNA, HBsAg and HBV DNA, anti-HCV and HCV RNA, syphilis Ab or Ag and an ABO and Rh type. Only non-reactive donations are labelled and distributed to blood banks for patients. In the event that a donation is positive for infection, WCBS will contact the donor to arrange counselling and remove the blood products from the blood supply.
In the event of a reported donor or patient-initiated transfusion-transmissible infection, a look-back investigation is performed to determine the possibility of infection via previous blood product infusions. For more information about look-back investigations, click here.
WCBS also perform continuous surveillance for new emerging infections that may pose a risk to blood donors and blood safety.
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The role of the Blood Services to ensure a hepatitis-free blood supply cannot be overlooked, as it is critical to the provision of safe blood.
WCBS screens donors for hepatitis in the self-exclusion questionnaire and tests every donation for hepatitis B and hepatitis C using strict algorithms. In addition to this, WCBS performs donor-triggered and patient-triggered look-back investigations to identify possible hepatitis transmission from a blood donation.
Donors who disclose having had hepatitis in the questionnaire will have blood samples taken to test whether their blood is safe for transfusion to a patient. Donors who have confirmed hepatitis C in the past will unfortunately not be permitted to donate (even if they have received treatment), while those who have had hepatitis B may be permitted to donate depending on their antibody levels. Previous infection with hepatitis A will not preclude donation as this infection is not transmitted via blood products. Donors are also asked whether they have had recent contact with people with hepatitis or have received a hepatitis immunisation, as this may also result in temporary deferral.
First-line hepatitis B testing includes surface antigen and DNA detection using nucleic acid amplification testing. In the event that these results are positive or discordant, hepatitis B core antibodies (total), hepatitis B core IgG antibodies, hepatitis B core IgM antibodies, hepatitis B surface antibodies and qPCR will be performed.
First-line hepatitis C testing includes hepatitis C antibodies (serology) and RNA detection using nucleic acid amplification testing, and second-line testing includes hepatitis C antibodies by chemiluminescent immunoassay and electrochemiluminescence, and qPCR.
In addition to thorough testing of each donation, in the event that a donor tests hepatitis B or C positive, the blood product recipients from their prior donation (if the donor has donated before) will be traced and contacted, with assistance from the treating clinician, for testing to identify possible viral transmission. Where a blood recipient or clinician may suspect viral transmission from a blood transfusion, the donor(s) will be traced and contacted for testing to identify this. More information about look-back investigations can be viewed here.
For queries about hepatitis testing algorithms and pathogenesis of hepatitis, contact Russell Cable, Head – Donation Testing (Russell@wcbs.org.za)
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The role of the Blood Services to ensure a HIV-free blood supply cannot be overlooked, as it is critical to the provision of safe blood.
WCBS screens donors for HIV in the self-exclusion questionnaire and tests every donation for HIV using strict algorithms. In addition to this, WCBS performs donor-triggered and patient-triggered look-back investigations to identify possible HIV transmission from a blood donation.
Donors who disclose having tested positive for HIV in the questionnaire or via telephonic confidential exclusion will not be allowed to donate (even if they receive anti-retroviral treatment). Donors are also asked whether they had recent sexual contact with: a new person, multiple persons, a person who tested positive for HIV, a person who takes money or drugs or favours for sex, as this will result in temporary or permanent deferral. And donors are asked whether their sexual partner has had sexual contact with multiple persons, whether they received money, drugs or favours for sex, or are a sex worker, and whether they have been sexually assaulted, as this too may result in temporary or permanent deferral.
First-line HIV testing includes HIV 1/2 antigen/antibody combination and HIV 1/2 RNA detection using nucleic acid amplification testing. In the event that these results are positive or discordant, HIV 1/2 antigen/antibody confirmatory testing by chemiluminescent microparticle immunoassay, Western Blot, antiretroviral screen, and other tests, as required, will be performed.
In addition to thorough testing of each donation, in the event that a donor tests HIV positive, the blood product recipients from their prior donation (if the donor has donated before) will be traced and contacted, with assistance from the treating clinician, for testing to identify possible viral transmission. Where a blood recipient or clinician may suspect viral transmission from a blood transfusion, the donor(s) will be traced and contacted for testing to identify this. More information about look-back investigations can be viewed here.
For queries about HIV testing algorithms and pathogenesis of HIV, contact Russell Cable, Head – Donation Testing (Russell@wcbs.org.za)
Visit our website for more information.
The role of the Blood Services to ensure a syphilis-free blood supply cannot be overlooked, as it is critical to the provision of safe blood.
WCBS screens donors for syphilis in the self-exclusion questionnaire and tests every donation for syphilis using strict algorithms. Donors who disclose in the questionnaire having tested positive for syphilis will not be allowed to donate until three months after successful treatment is completed, and donors who have sexual contact with a person who is infected will not be allowed to donate for three months, subject to donation acceptance criteria.
First-line syphilis testing includes Treponema Pallidum detection by automated serological testing. In the event that these results are positive or discordant, a Rapid Plasma Reagin test and manual Treponema Pallidum Haemagglutination Assay (TPHA) will be performed to determine infection status.
For queries about syphilis testing algorithms and pathogenesis of syphilis, contact Russell Cable, Head – Donation Testing (Russell@wcbs.org.za)
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The role of the Blood Services to ensure that patients with complicated crossmatches receive blood as required cannot be overlooked, as it is critical to blood management of the patient.
Blood banks will search the patient transfusion history (known patients) to prepare for the crossmatch. In the case of a patient with sickle cell anaemia as well as a patient with thallasaemia, blood bank will type the patient for C, E, c, e, K, Fya, Fyb, Jka, Jkb, S and s and try to find donors with as close an antigen match as possible.
WCBS adopts a four-fold approach to blood management for these patients by:
- seeking to recruit foreign (non-South African) donors, who will provide blood with the highest crossmatch compatibility for these patients.
- performing extended phenotyping for clinically significant antigens on mostly black donor blood donations. The donor’s phenotype results are printed on the donor label to facilitate blood banks and immunohaematology laboratory to select suitable blood for crossmatch testing.
- escalating complicated crossmatches from blood banks to the immunohaematology laboratory for red cell typing the patient and finding antigen negative blood. Providing typed antigen negative blood from the beginning of the patient’s transfusion regimen effectively reduces their risk of alloimmunisation.
- various laboratories being able to search for suitable blood electronically, effectively reducing blood banks turnaround time.
For queries about complicated crossmatches, contact your closest Blood Bank.
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The WCBS therapeutic phlebotomy programme is a well-established service that has been operating for many years and has assisted thousands of people who are required to donate blood for the management of specific medical conditions.
The advantages of using this service include:
- Our therapeutic service is offered at all of our fixed and mobile donation sites making it convenient for patients to access.
- WCBS is able to assist patients at intervals prescribed by their referring clinician, with eight phlebotomies permissible per prescription.
- Highly skilled and experienced staff are available at the donation venues to assist patients with managing anxiety surrounding blood donation, providing them with refreshments and occasional donation gifts.
- Therapeutic donors are charged for their first donation as their unit is discarded as per international guidelines, but provided their blood is suitable for transfusion purposes, they are not charged thereafter. People who do not meet the standard criteria for blood donation (e.g. they use teratogenic drugs) are charged for donation as their blood is discarded.
Please note that frail or ill patients should not be bled at WCBS facilities but rather venesected in hospital settings in the event of collapse. The referring doctor remains ultimately responsible for the management of their patient and renewal of their bleeding interval prescription.
For more information about WCBS therapeutic phlebotomy, contact the Specialised Donations team (phlebotomy@wcbs.org.za).
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For more information, contact Hayley Alie, Hospital Liaison Officer (hayleya@wcbs.org,za).
