ISSN 2531-1379 VOLUME 47, ISSUE 1, JANUARY/MARCH, 2025 HEMATOLOGY TRANSFUSION AND CELL THERAPY
TRATAMENTO PARA PACIENTES RECÉM-DIAGNOSTICADOS Descubra mais sobre uma nova opção terapêutica para PACIENTES INELEGÍVEIS AO TMO MIELOMA MÚLTIPLO Referência: 1. Richter J, Pan D, Salinardi T, Rice MS. Real-world multiple myeloma frontline treatment and outcomes by transplant in the United States. eJHaem. 2023;4(4):984-994. doi:10.1002/jha2.739 Pacientes que não são indicados ao transplante logo na linha de frente estão associados a pior prognóstico da doença e estudos mostram que é importante considerar um tratamento eficaz já na primeira linha para obter melhores resultados de longo prazo! VEJA CONTEÚDOS QUE TRANSFORMAM CONHECIMENTO EM PRÁTICA CLÍNICA. Explore todos os detalhes do estudo em nosso artigo EXCLUSIVO no portal Sanofi Conecta! MAT-BR-2405594/JAN2025 1
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TaggedH1Hematology, Transfusion and Cell Therapy TaggedP ISSN 2531-1379 print version ISSN 2531-1387 online versionTaggedEnd EDITOR INCHIEF Eduardo Magalh~aes Rego, Ribeir~ao Preto, Brazil DEPUTYEDITOR Erich Vinicius de Paula, Campinas, Brazil ASSOCIATE EDITORS Alfredo Mendrone Junior S~ao Paulo, Brazil Belinda Pinto Sim~oes Ribeir~ao Preto, Brazil Behnaz Bayat Giessen, Germany Carla Luana Dinardo S~ao Paulo, Brazil CarlosS ergio Chiattone S~ao Paulo, Brazil C armino Antonio de Souza Campinas, Brazil DanteM ario Langhi Junior S~ao Paulo, Brazil Dimas Tadeu Covas Ribeir~ao Preto, Brazil Elvira Deolinda Rodrigues Pereira Velloso S~ao Paulo, Brazil Fabiola Traina Ribeir~ao Preto, Brazil Helio Moraes de Souza Uberaba, Brazil Irene Lorand-Metze Campinas, Brazil Jos e Orlando Bordin S~ao Paulo, Brazil Luis Fernando S. Bouzas Rio de Janeiro, Brazil Marcelo Pasquini Wisconsin, USA M arcio Nucci Rio de Janeiro, Brazil Marcos Borato Viana Belo Horizonte, Brazil Marcos de Lima Cleveland, USA Margareth Castro Ozelo Campinas, Brazil Maria Helena Pitombeira Fortaleza, Brazil Maria Stella Figueiredo S~ao Paulo, Brazil Marilda de Souza Gon¸calves Salvador, Brazil Nelson Hamerschlak S~ao Paulo, Brazil Nelson Spector Rio de Janeiro, Brazil Nicola Conran Campinas, Brazil PauloS ergio da Silva Santos S~ao Paulo, Brazil Roberto Passetto Falc~ao Ribeir~ao Preto, Brazil Rodrigo Tocantins Calado Ribeir~ao Preto, Brazil Sara Teresinha Olalla Saad Campinas, Brazil Silvia Maria Meira Magalh~aes Fortaleza, Brazil Valder Arruda Philadelphia, USA Vanderson Rocha S~ao Paulo, Brazil Vania Tietsche de Moraes Hungria S~ao Paulo, Brazil Editorial Board Alois Gratw€ohl Basel, Switzerland Alvaro Urbano-Ispizua Barcelona, Spain Andrea Bacigalupo Genoa, Italy ^Angelo Maiolino Rio de Janeiro, Brazil Antonio Fabron J unior Marilia, Brazil Christian Gisselbrecht Paris, France Corrado Tarella Turin, Italy Daniel Tabak Rio de Janeiro, Brazil DavidG omez Almaguer Mexico City, Mexico Elbio A. DAmico S~ao Paulo, Brazil Enric Carreras Barcelona, Spain Eugenia Maria Amorim Ubiali - Ribeir~ao Preto, Brazil Fernando Ferreira Costa, Campinas, Brazil Frederico Luiz Dulley S~ao Paulo, Brazil Gino Santini Genoa, Italy Guillermo Dighiero Montevideo, Uruguay Guillermo Ruiz-Arguelles Puebla, Mexico Jesus Fernando San Miguel Salamanca, Spain Jo~ao Carlos Pina Saraiva Bel em, Brazil La ercio de Melo Belo Horizonte, Brazil L ılian Maria Castilho Campinas, Brazil Linamara Rizzo Batistella S~ao Paulo, Brazil Lucia Mariano da Rocha Silla Porto Alegre, Brazil Marcos Antonio Zago Ribeir~ao Preto, Brazil Maria de Lourdes L. F. Chauffaile S~ao Paulo, Brazil Maria do Socorro P. de Oliveira Rio de Janeiro, Brazil Mario Cazolla Pavia, Italy Mary Evelyn Flowers Seattle, USA Nelson Abrahin Fraiji Manaus, Brazil Nelson J. Chao Durham, USA Paul M. Ness Baltimore, USA PauloC esar Naoum S~ao Jos e do Rio Preto, Brazil Raul C. Ribeiro Memphis, USA Raul Gabus Montevideo, Uruguay Ricardo Pasquini Curitiba, Brazil Richard K. Burt Chicago, USA Sergio Giralt New York, USA V^ania Tietsche Hungria S~ao Paulo, Brazil Vicente Odone Filho S~ao Paulo, Brazil PAST EDITORS Antonio P. Capanema 1973-1981; Milton A. Ruiz 1981-1990; Carlos S. Chiattone 1991-1994; Milton A. Ruiz 1995-2014; Fernando Ferreira Costa 2015-2022. The Hematology, Blood Transfusion and Cell Therapy succeeded the Revista Brasileira de Hematologia e Hemoterapia (Brazilian Journal of Hematology and Hemotherapy) , ISSN 1516-8484, which succeeded the Boletim da Sociedade Brasileira de Hematologia e Hemoterapia (Bulletin of the Brazilian Society of Hematology and Hemotherapy) ISSN 0102-7662, which was published from 1973 to 1998 with 179 issues in 20 volumes. 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It is distributed for free to regional libraries and Medical, Pharmacy and Biochemistry Schools in Brazil and sister societies in South, Central and North America and Europe. 2023 Associa¸c~ao Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved. All rights reserved and protected by law 9.610 - 19/02/98. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission in writing from ABHH and the Publisher. 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Board Of Directors 2024-2025 President Angelo Maiolino Vice-President Eduardo Magalh~aesRego Administrative Director Glaciano Nogueira Ribeiro Vice Administrative Director Silvia Maria Meira Magalh~aes Scientific Director Carmino Antonio de Souza Vice-Scientific Director Dimas Tadeu Covas Financial Diretor Celso Arrais Rodrigues da Silva Vice Financial Director Leny Nascimento da Motta Passos Director of Communications Renato Sampaio Tavares Vice-Director of CommunicationsVania T. de Moraes Hungria Director of Institutional RelationsCarlosS ergio Chiattone Vice-Director of Institutional RelationsDante Langhi Junior Director of Professional PracticeEdvan de Queiroz Cruso e Vice-Director of Professional PracticeJos e Francisco Comenalli Marques Jr Director Social Action BoardJorge Vaz Pinto Neto Vice-Director Social Action BoardViolete Petitto Laforga Emeritus Scientific Director Roberto Passetto Falc~ao General Manager AlineAch^e Deliberative Committee Elected 2022-2025 Thiago Xavier Carneiro Aderson da Silva Araujo Silvia Maria Meira Magalh~aes Renato Sampaio Tavares Karina Correia Barcelos Jo~ao Paulo de Oliveira Guimar~aes Angelo Maiolino Carla Luana Dinardo Eduardo Magalh~aesRego Monika Conchon Renato Luiz Guerino Cunha Rodolfo Delfini Can¸cado Talita Maira Bueno da Silveira Vanderson Rocha Vaneuza Araujo Moreira Funke Elected 2024-2027 Leny Nascimento da Motta Passos Edvan de Queiroz Cruso e Jorge Vaz Pinto Neto Gustavo Henrique Silveira Marcos Daniel de Deus Santos Amanda Pifano Soares Ferreira Glaciano Nogueira Ribeiro Adriana Alves Scheliga Clarisse Lopes de Casto Lobo Roberto Jos e Pessoa de Magalh~aes Celso Arrais Rodrigues da Silva Jos e Eduardo Bernardes Jos e Francisco Comenalli Marques J unior V^ania Tietsche de Moraes Hungria Violete Petitto Laforga Lifelong Deliberative Committee Carlos Sergio Chiattone Carmino Antonio de Souza DanteM ario Langhi J unior Dimas Tadeu Covas Eur ıpedes Ferreira Fernando Ferreira Costa H elio Moraes de Souza H elioRamos Jo~ao Carlos Pina Saraiva Jos e Orlando Bordin Jos eKerbauy Marco Antonio Zago Milton Artur Ruiz Nelson Ibrahim Fraiji Nelson Hamerschlak Nelson Spector Orion de Bastos Ricardo Pasquini Roberto Passetto Falc~ao Romeu Ibrahim de Carvalho Sara Teresinha Olalla Saad Therezinha Verrastro de Almeida Ubiratan Ouvinha Peres Past Presidents of Sociedade Brasileira de Hematologia e Hemoterapia 1950 Walter Oswaldo Cruz 1951 Michel Abujamra 1954 Darcy Lima 1955 Jos e Candido C. Villela 1957 Joaquim M. Barreto 1959 Oswaldo Kessler Ludwing 1961 Walter Hupsel 1963 Rui Faria 1965 Orion Bastos 1967 Ubiratan Ouvinha Peres 1970 Oswaldo Mellone 1973 Pedro Cl ovis Junqueira 1975 Pedro Cl ovis Junqueira 1977 Maria Nazareth Petrucelli 1979 Celso Carlos de C. Guerra 1981 Jacob Rosenblit 1983 Luiz Gast~ao M. Rosenfeld 1985 Augusto Luiz Gonzaga 1987 Helio Ramos 1988 Milton Artur Ruiz 1990 Nelson Hamerschlak 1992Eur ıpedes Ferreira 1994 Jo~ao Carlos Pina Saraiva 1996 Jo~ao Pedro E. M. Pereira 1998 Celso Carlos de C. Guerra 2000 Dante M ario Langhi Junior 2002 Dante M ario Langhi Junior 2004 Carlos S ergio Chiattone 2006 Carlos S ergio Chiattone 2008 Carlos S ergio Chiattone Past Presidents of Col egio Brasileiro de Hematologia 1965 Hildebrando M. Marinho 1967 Michel Abujamra 1969 Romeu Ibrahim de Carvalho 1971 Paulo Barbosa da Costa 1973 Romildo Lins 1975 Renato Rego Failance 1977 Dilson Jos e Fernandes 1981 Jos eKerbauy 1985 Eurico Coelho 1989 Romeu Ibrahim de Carvalho 1993 Jos eKerbauy 1997 Roberto Passetto Falc~ao 2005 Jos e Orlando Bordin Past Presidents of Associa¸c~ao Brasileira de Hematologia, Hemoterapia e Terapia Celular 2009 Carlos S ergio Chiattone Jos e Orlando Bordin 2010-2013: Carmino Antonio deSouza 2014-2017: Dimas Tadeu Covas 2018-2021: Dante Langhi J unior Associa¸c~ao Brasileira de Hematologia, Hemoterapia e Terapia Celular
Associazione Italo-Brasiliana di Ematologia Board of Directors President Carlos S. Chiattone (Brazil) Vice-President Stefano Luminari Scientific Director −Brazil Carmino Antonio de Souza Treasurer −Brazil Natalia Zing Honorary PresidentsGino Santini and Angelo Maiolino and Ricardo Pasquini Scientific Director −ItalyMaurizio Martelli Treasurer −ItalyLuca Arcaini Board of Advisors - Brazil Eduardo Magalh~aes Rego, Eliana C. M. Miranda, Guilherme Duffl es, Irene de Almeida Biasoli, Marcia Torresan Delamain, Milton Artur Ruiz, Sergio A.B. Brasil, Thais Fischer Board of Advisors - Italy Angelo Michelle Carella, Gian Luca Gaidano, Ignazio Majolino, Maurizio Martelli, Robin Fo a, Teodoro Chisesi Associazione Italo-Brasiliana di Ematologia Viale Benedetto XV 16100 - Genoa GE Italy Eurasian Hematology Oncology Group Board of Directors President Giuseppe Saglio Vice-President Birol Guvenc General Secretaryehmus Ertop Member Ahmad Ibrahim, Lebanonn Member Burhan Ferhanoglu, Turkiye Member Carmino de Souza, Brazil Member Claudio Cerchione, Italy Member Jean FranO´ ois Rossi, France Member Moshe Mittelman, Israel Member Tariq Mughal, USA Member Vera Donnenberg, USA Eurasian Hematology Oncology Group www.ehog.net - sekreterlik@hematoloji.org.tr Yurt Mahallesi Kurttepe Cad. 71517 Sokak No.2 Sabahattin Akg€un Apt. Kat.1 Daire.1 ¸Cukurova - Adana Phone: 00 90 555 881 01 99 Sociedade Brasileira de Oncologia Pedi atrica Board of Directors - 2023-2024 President Nevi¸colino Pereira de Carvalho Filho 1st Vice-President Flavia Delgado Martins 1st SecretaryMaristela Francisco dos Reis 1st Treasurer Carolina Madalena Souza Pinto Alvares 2nd Vice-President Mario Jos e Aguiar de Paula 2nd SecretaryAnnemeri Livinalli 2nd Treasurer Patrick Rezende Godinho Members of Advisory Board Andrea Maria Capellano, Elione Soares de Albuquerque, Elvis Terci Valera, Simone dos Santos Aguiar, Val eria Pereira Paiva Sociedade Brasileira de Oncologia Pedi atrica www.sobope.org.br - sobope@uol.com.br / sobope@sobope.org.br 94/53 04077-020 S~ao Paulo-SP Phone: 55 11 5052-7537
TaggedH1CONTENTSTaggedEnd Original Articles Transmitted blood infections and emerging vector-borne diseases in blood donors in northern Portugal Ana Mota and Margarida Fonseca Cardoso ................................................................................................103734 Lower doses of dacarbazine (modified BEACODD) as a safer strategy with equal effectiveness in an intensive treatment protocol of Hodgkin’s lymphoma: a preliminary retrospective analysis of a single public center in Brazil Larissa Hilario Dulley, Arthur Gomes Oliveira Braga, Guilherme Garcia Rodrigues, Sergio Costa Fortier, CarlosS ergio Chiattone and Talita Maira Bueno da Silveira ......................................................................103682 Is galactomannan a useful tool for triage and diagnosis of oral invasive aspergillosis? Maria J ulia Pagliarone, Lara Maria Alencar Ramos Innocentini, Fernanda Bortolotto, Vanessa Tonetto Marques Galves, Hilton Marcos Alves Ricz, Tatiane Cristina Ferrari, Renato Luiz Guerino Cunha, Belinda Pinto Sim~oes and Leandro Dorigan de Macedo ...............................................................................103687 An approach to autologous stem cell mobilization: trying to define good mobilizers Sara Montolio Chiva, Paula Gomez Fernandez, Antonio Manuel Guti errez Garcia, Maria del Carmen Ballester Ruiz, Antonia Sampol Mayol and Albert Perez Monta~na ...............................103688 Validation of an automated quality control method to test sterility of two advanced therapy medicinal products: Mesenchymal stromal cells and their extracellular vesicles Carolina Kymie Vasques Nonaka, Zaquer Suzana Munhoz Costa-Ferro, Ana Carolina Palmeira Arraes, Thamires Lopes Weber, Luciana Souza de Arag~aoFran¸ca, Katia Nunes Silva and Bruno Solano de Freitas Souza ................................................................................................ .....................103727 Effect of blood groups on acquired and congenital thrombotic thrombocytopenic purpura and clinical correlation: Multi-center Turkish cohort study Cevat _Ilteri¸sKıkılı, Damla Ortaboz, Melek Yana¸sık, Muhlis Cem Ar and Sevgi Kalayo gluBe¸sı¸sık ...........103723 Unraveling thalassemia intermedia: Novel insights of a hemoglobin Jax [HBA2:c.44G>C] and deletional a 0-thalassemia interaction phenotype Sitthichai Panyasai, Kanokwan Jaiping, Pisuttinee Khantarag, Patcharee Nochod and Surada Satthakarn ................................................................................................................................ .......103739 Twice or once a day? Filgrastim dosing schedule for peripheral hematopoietic stem cells mobilization Mehmet Bakırta¸s, Bahar Uncu Ulu, Tu g¸ceNurYi geno glu, Semih Ba¸scı,Ali Kılın¸c, Tahir Dar¸cın, FatmaNurb€uke ¸Sarkı¸sla,Derya ¸Sahin, Nuran Ahu Baysal, Dicle _Iskender, Merih Kızıl ¸Cakar, Mehmet Sinan Dal and Fevzi Altunta¸s ................................................................................................ ........103738 Evaluation of the role of serum soluble ST2 as a diagnostic biomarker for cancer-associated venous thromboembolism Eman Mohamed Abdellatif, Emad Hamdy Hamouda Mohammed and Azza Mohamed Amin Darwish ................................................................................................ ...................103740 TaggedFigure TaggedEnd Hematology, Transfusion and Cell Therapy www.htct.com.br TaggedFigure TaggedEnd Volume47•Number 1•January/March 2025
Assessing the role of bronchoscopy in the management of patients with acute leukemia—a transversal study and proposal of evaluation Jos e Vanildo Rodrigues de Oliveira, Carlos Wilson de Alencar Cano, Jos e Vivaldo Moreira Feitosa J unior, Guilherme Carneiro Barreto, Fernanda Rodrigues Mendes, Raphael Costa Bandeira de Melo, Elvira Deolinda Rodrigues Pereira Velloso, Vanderson Rocha, Eduardo Magalh~aes Rego and Wellington Fernandes da Silva ....................................................................................................................103741 Impact of blueberry extract on hematological response in phenylhydrazine-induced hemolytic anemia Daniela Drosdowski, Patrick T€urck, Silvio Tasca, Gabriel de Lima Rosa, Edson Fernando Muller Guzzo, Sara Elis Bianchi, Adriana Simon Coitinho, Cristina Campos Carraro, Adriane Bell o-Klein, Alexandre Luz de Castro, Valquiria Linck Bassani and Alex Sander da Rosa Araujo ................................103744 Case Reports STAT5B::RARa-positive acute promyelocytic leukemia: Role of next generation sequencing in detection of a rare malignancy Indranil Dey, Sushant Vinarkar, Mayur Parihar and Deepak Kumar Mishra ............................................103726 Complex somatic mutation landscape in myeloid cells in a patient with VEXAS syndrome: First Brazilian case report Fabíola Reis de Oliveira, Adriane Souza Lima, Carlos Roberto Faria Jr, Thaise Oliveira Quaresma, Marcio M. Mourani, Lauro Wichert-Ana, Paulo Louzada Jr, Fernanda Gutierrez-Rodrigues, Neal S. Young and Rodrigo T. Calado ................................................................................................ ..........103686 Rare case of discrepant ABO typing between mother and newborn caused by para-Bombay AB phenotype Tatiane Aparecida de Paula Vendrame, Giovana Faria Devides, Nayara Morais Silva, Marcela Cust odio Mendes, M arciaL eia Morais Sampaio, Marcia Miyuki Nakamura, Greice Ap.Chetta de Klerk, Lilian Castilho, Afonso Cortez, Flavia Roche Moreira Latini and Carine Prisco Arnoni ................................................................................................ ....................................103742 Review Articles Ponatinib in the treatment of patients with chronic myeloid leukemia and increased cardiovascular risk: A review of management strategies Tomasz Sacha and Katarzyna Krawczyk ....................................................................................................103675 When innovation meets patient blood management −a new way to see bleeding Guilherme Rabello, Rosangela Monteiro, Bianca Meneghini and Fabio Biscegli Jatene ...............................103691 From the mechanism of action to clinical management: A review of cardiovascular toxicity in adult treated with CAR-T therapy Frank Nunes, Breno Moreno de Gusm~ao, Franciely Bueno Wiginesk, Euler Manenti, Juliana Soares, Mizianne Garcia Freitas, Juliane Dantas Seabra-Garcez, Alexandre Manoel Varela, Jo~ao Pedro Passos Dutra, Bruno Cesar Bacchiega, T^aniaF elix Lorenzato da Fonseca Peixoto, Carolina Maria Pinto Domingues de Carvalho e Silva, Renato D. Lopes and Ariane Vieira Scarlatelli Macedo ................................................................................................ .................103693 Letters to the Editor Assessing the contribution of myelofibrosis to a leukoerythroblastic blood picture Stephen E. Langabeer ................................................................................................ ...................................103735 Imetelstat as a novel therapeutic approach for myelodysplastic syndrome Ammara Waheed Arain, Anushka Andani, Aayat Kashif and Radeyah Waseem ....................................103724 Chronic lymphocytic leukemia diagnosis: how many more algorithms and scoring systems do weneed? Daniel Mazza Matos ................................................................................................ ....................................103668
Congenital thrombotic thrombocytopenic purpura and human leukocyte antigen analysis−an amazing clue Cevat _Ilteri¸sKıkılı,DemetKıvan¸c,Hayriye ¸Sent€urk ¸Cift¸ci, Mustafa M. €Ozbalak, Mustafa N. Yenerel, MelihaNal¸cacı, FatmaS.O guz and Sevgi K. Be¸sı¸sık ...................................................................................103746 Images in Clinical Hematology Dysmegakaryopoiesis in myelodysplastic syndrome: Beyond cell dysplasia Maria Mirele da Silva Ribeiro, Francisco D ario Rocha Filho, Howard Lopes Ribeiro Junior, Priscila da Silva Mendon¸ca, Ronald Feitosa Pinheiro and Silvia Maria Meira Magalh~aes .........................103725 A rare case of circulating anaplastic lymphoma kinase-negative anaplastic large cell lymphoma Radu Chiriac and Lucile Baseggio ................................................................................................ ................103743
Original article TaggedAPTARAH1Transmitted blood infections and emerging vector-borne diseases in blood donors in northern PortugalTaggedAPTARAEnd TaggedAPTARAPAnaMota a,b,c, Margarida Fonseca Cardoso d,e,* TaggedAPTARAEnd TaggedAPTARAP aServi¸co de Imuno-Hemoterapia da Unidade Local de Sa ude Santo Ant onio, Porto, Portugal bEscola Superior de Sa ude, Universidade Fernando Pessoa, Porto, Portugal c Environment & Healthy Life Styles da TL7 do RISE Health, Universidade Fernando Pessoa, Porto, Portugal dICBAS - Instituto de Ci^encias Biom edica Abel Salazar, Universidade do Porto, Porto, Portugal e CIIMAR, Universidade do Porto, Porto, Portugal TaggedAPTARAEnd TAGGEDAPTARAPARTICLE INFO Article history: Received 10 October 2023 Accepted 27 September 2024 Available online 8 February 2025TaggedAPTARAEnd TAGGEDAPTARAPA B S T R A C T Background: Screening of transfusion-transmissible infectious agents of blood components is carried out in order to guarantee the safety of the transfusion process. The objective of this investigation was to characterize cases positive for transfusion-transmissible infectious agents in blood donations in the North of Portugal. Method: Data from 2010 to 2022 of the Local Health Unit-Santo Antonio were used for this study. In specific epidemiological situations, malaria, Chagas disease and West Nile virus were screened. Main results: Over 12 years, the health unit, received 137,751 donations with 108 positive tests. The proportions of human immunodeficiency viruses, syphilis, human hepatitis viruses type B and C varied between 0 and 44/100,000 donations. In this period, two cases of malaria were detected in 2020−2021, and 21 were detected in 2022 corresponding to 52.1/ 1000 donations screened. In 2022, two cases of Chagas disease and no cases of West Nile virus were detected. Conclusion: These results highlight the importance of a rigorous investigation at the time of donation in which the donor’s history, including origin and movement in areas of greater geographic risk, are assessed. The recent and increasing detection of cases of malaria and Chagas disease confirms the presence of emerging infectious diseases transmitted by vectors, including mosquitoes, in blood donors. The increased risk of vector-borne diseases in Europe is a public health problem and represents a new challenge in screening donations. 2025 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier España, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).TaggedAPTARAEnd TaggedAPTARAEndTaggedAPTARAPKeywords: Blood transfusion Blood donors Mandatory tests Infectious diseases Emerging infectious diseases VectorsTaggedAPTARAEnd TaggedAPTARAH1IntroductionTaggedAPTARAEnd TaggedAPTARAPBlood is a vital element with a therapeutic use that, until today, cannot be substituted. In this sense, blood donation is a solidarity and voluntary act that definitely contributes to TaggedAPTARAEnd * Corresponding author. Instituto de Ci^encias Biom edicas de Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal. E-mail address: mcard@icbas.up.pt (M.F. Cardoso). https://doi.org/10.1016/j.htct.2025.103734 2531-1379/ 2025 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier España, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). TaggedAPTARAEndhematol transfus cell ther. 2025;47(1):103734 TaggedAPTARAFigure TaggedAPTARAEnd Hematology, Transfusion and Cell Therapy www.htct.com.br TaggedAPTARAFigure TaggedAPTARAEnd
saving lives. As blood is a biological product and, therefore, not without risks, it is necessary to use all available means to reduce the possible transmission of infection.1 TaggedAPTARAEnd TaggedAPTARAPScreening for transfusion-transmissible infectious (TTI) agents of blood components is essential to ensure the safety of the transfusion process. Regarding the risk of transmission of infections, until recently the main concern was infection with human immunodeficiency viruses type 1 or 2 (HIV 1/2) and human hepatitis viruses type B (HBV) and C (HCV).2 Climate change and globalization, with the possibility of rapid access to more distant parts of the world, appears to be changing the initial profile of blood-borne viral diseases.1,3,4 The European tendency for high temperature peaks as well as periods of drought with severe and increasingly long and hot summers, creates ideal conditions for the invasion of mosquitoes normally associated with tropical temperatures.3 It is known that many tropical diseases associated with transmission by vectors, such as mosquitoes, are endemic in some parts of Africa, the Americas and Asia, causing severe illness in more than one billion people around the world. Several species with vectorial capacity, capable of spreading diseases such as Chikungunya, Dengue fever, Yellow fever, Zika, West Nile virus, malaria and Chagas disease, have been observed in Europe.5,6 TaggedAPTARAEnd TaggedAPTARAPThe HIV epidemic had a major impact on the blood supply at the end of the 20th century, with the first case associated with transfusion dating back to 1982.7-9 Over the last few decades, the transmission of infection associated with the transfusion process has progressively decreased, making its risk residual.10 The selection of potential blood donors has become more rigorous, either by addressing medical history and risk behaviors with a more detailed and targeted questionnaire, or by introducing new serological and molecular tests.TaggedAPTARAEnd TaggedAPTARAPIn the 1960s, more than 30% of patients who received multiple transfusions developed post-transfusion hepatitis, 25% of which were caused by HBV. With the implementation of sensitive tests and new policies on voluntary blood donation, there was a significant reduction in the incidence of the disease,11,12 partly also due to the measures taken due to the HIV infection epidemic.TaggedAPTARAEnd TaggedAPTARAPIn Portugal, according to national legislation, in accordance with European directives,13 the analysis of donations of whole blood or blood components includes, and is mandatory, the search for HBsAg, anti-HBc, anti-HCV and anti-HIV 1/2 antibodies. Nucleic acid tests (NATs) for HIV, HBV and HCV must also be carried out, as well as testing for antibodies of human T-lymphotropic virus types I and II (HTLV 1/2) inall first donations, in donors from areas of high prevalence and in those whose sexual partners or parents come from these areas. Because it is related to high-risk behaviors and because it is considered a risk factor for other sexually transmitted infectious diseases, a serological study for syphilis is carried out. Additional analyzes are recommended for certain components and donors in specific epidemiological situations, such as malaria, Chagas disease and West Nile virus.4,14 TaggedAPTARAEnd TaggedAPTARAPThe infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), known as coronavirus disease 2019 (COVID-19), has brought a major challenge to medicine globally, and in particular to transfusion medicine.1 A decrease in the number of donations was seen, partly due to prophylactic isolation measures (lockdown) that restricted people’s travel to transfusion medicine services, as well as the public’s fear of contracting the infection while traveling to hospital units. Clinical blood needs were unpredictable, in part due to the cancellation of elective surgeries and non-urgent interventions, while blood demand for emergency situations and patients on chronic transfusion support remained relatively unchanged.15 In Portugal, since the state of emergency was declared on March 18, 2020, a contingency plan was adopted that was capable of guaranteeing the sustainability, safety and supply of blood and its components. Compared to 2019, in 2020 there was a 7% reduction in the total number of donations. However, blood reserves always remained at sufficient levels to meet the needs of patients.16 The Association for the Advancement of Blood and Biotherapies (AABB), the Centers for Disease Control and Prevention (CDC), and the World Health Organization did not recommend additional measures to be implemented in the screening of blood donations. During the pandemic period, in Portugal, as in the rest of Europe, all donations remained in quarantine for 14 days, in order to enable their discard in the event of a positive result for SARS-CoV-2 infection.1, 17 TaggedAPTARAEnd TaggedAPTARAPThe objective of this investigation was to characterize cases with a positive result for TTI that require mandatory screening in blood donations in a population of volunteer donors in the North of Portugal.TaggedAPTARAEnd TaggedAPTARAH1Materials and methodsTaggedAPTARAEnd TaggedAPTARAPThis is a retrospective study of blood donations carried out in the Immunohemotherapy service of the Local Health Unit (LHU)-Santo Ant onio from January 1, 2010 to December 31, 2022. Data collection was carried out using the blood management computer database. Viral markers for HIV, HBV, HCV, and syphilis were evaluated in all donors; HTLV 1/2 research was carried out only for the donor’s first donation. Informed consent regarding the donation comes from completing a survey that is initiallyfilled out by the donor and validated by the clinician during a consultation. This survey contains information about travel. In this situation, the clinician, with the support of the Portuguese blood donation center (IPST) website, assesses the geographic risk, and depending on the risk zone, chooses to make a request for tests for malaria, Chagas and West Nile virus. To study this 12-year time segment, four periodsweredefined: 2010−2017, 2018−2019, 2020−2021, 2022: TaggedAPTARAEndTaggedAPTARAP- 2010−2017: corresponds to the start of the definitive computerization of the donor process.TaggedAPTARAEnd TaggedAPTARAP- 2018−2021 was divided into two periods due to the COVID19 pandemic, despite there being no changes in terms of screening technology. The period 2018−2019 corresponds to the two years that preceded the pandemic and 2020 −2021 covers the two years of high incidence of Sars-Cov2.TaggedAPTARAEnd TaggedAPTARAP- The 4th period corresponds only to 2022, given the limited data available.TaggedAPTARAEnd TaggedAPTARAEnd2 hematol transfus cell ther. 2025;47(1):103734
TaggedAPTARAPThe study focused on donors with positive results for TTI, in which true positives (TP) were identified. Thedefinitionsof TP results related to the TTIs are presented below: TaggedAPTARAEndTaggedAPTARAP- HIV 1/2: repeatedly positive chemiluminescence results with positivity in additional Western-Blot or Innolia tests or positive result for NAT.TaggedAPTARAEnd TaggedAPTARAP- HBV: chemiluminescence result repeatedly positive for HBsAg or positive result for NAT. Anti-HBc positivity leads to the study of anti-HBs titers. It is considered a past infection if anti-HBc is positive with HBsAg and NAT being negative. Until October 2014, the donation was accepted if the anti-HBs value was greater than 10 IU/mL. After 2014, the donation began to be accepted for a value equal to or greater than 100 IU/mL.14 This procedure is performed on all donations.TaggedAPTARAEnd TaggedAPTARAP- HCV: repeatedly positive chemiluminescence results with positivity in supplementary tests by Recombinant ImmunoBlot Assay (RIBA) or Innolia or positive result for NAT.TaggedAPTARAEnd TaggedAPTARAP- HTLV 1/2: repeatedly positive chemiluminescence results with positivity in additional tests by Innolia.TaggedAPTARAEnd TaggedAPTARAP- Syphilis: an active infection was considered when it corresponds to the presence of a positive chemiluminescence test (combined treponemal test - IgM and IgG), confirmed by a positive non-treponemal test, such as Venereal Disease Research Laboratory (VDRL). Samples that are enzymatic immunoassay (EIA) positive and VDRL negative indicate a past infection with syphilis, and in this case, the donation is discarded and the donor is suspended.TaggedAPTARAEnd TaggedAPTARAP- Malaria: search for antibodies against Plasmodium, associated with the onset of malaria through repeatedly positive serological results with confirmation by molecular testing. The screening is carried out by the IPST. Positive serology, even with a negative molecular test, does not allow acceptance of the donation. In Portugal, and with regard to blood donations, the malaria test is requested for donors with a history of malaria and donors born in or coming from an endemic area (according to decree-law 267/2007, later revised and amended by decree 185/2015).13 A positive serological test for malaria leads to the entire blood unit being discard, even if the molecular biology test for malaria is negative. According to the European guidelines the donor is temporarily suspended and the serological test is repeated after three years to assess whether the result remains positive. The donor can only be accepted if the serological test is negative. If the molecular biology test is positive, the donor is referred for a specialist consultation. The test used for malaria screening was the EIA of Bio-Rad, designed to detect antibodies. The molecular test used was the VIASURE Malaria Real-Time PCR Detection Kit (CerTest, Biotec), designed for the qualitative and quantitative detection of DNA of Plasmodiumspecies, including the main malaria species that infect humans: Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, Plasmodium knowlesi.TaggedAPTARAEnd TaggedAPTARAP- Chagas disease: the serological test should be requested for donors born in or coming from an endemic area. The Alinity i Chagas test is a chemiluminescent microparticle immunoassay (CMIA) used for the qualitative detection of antibodies against Trypanosoma cruzi (according to decreelaw 267/2007, and later revised and amended by decree 185/2015).13 A repeatedly positive serological test leads to the entire blood unit being discarded and the elimination of the donor. If the test is positive, the donor is referred for a specialist consultation.TaggedAPTARAEnd TaggedAPTARAP- West Nile Virus: was only screened when there was information about a geographical risk, mainly in southern Europe. Donations from donors coming from those areas were evaluated by a molecular test, the Cobas WNV test, a real-time polymerase chain reaction (PCR) test to detect West Nile virus. The screening is carried out by the IPST.TaggedAPTARAEnd TaggedAPTARAPAll donations with a TP result for TTI were discarded. All non-negative analytical results that were not confirmedasTP were considered false positives. Donations with a false positive result, even with a negative NAT test, were also discarded.TaggedAPTARAEnd TaggedAPTARAPFor each donation, the age, sex and birthplace of the respective donors were recorded.TaggedAPTARAEnd TaggedAPTARAH2Statistical analysisTaggedAPTARAEnd TaggedAPTARAPDistribution by sex and place of birth are reported as percentages, and age is reported as a mean § standard deviation. Positive tests and the number of confirmed TP were counted for each infection in each of the four time periods. Based on these values, the confirmation rates for each of the infections are reported by calculating the percentage of TP in positive tests. In the total number of donations, the prevalences of positive tests and TPs were also estimated, dividing the number identified by the total number of donations and multiplying by 100,000 or by 1000 depending on the total number of donations. The Statistical Package for Social Sciences (SPSS) version 26 was used for statistical analysis.TaggedAPTARAEnd TaggedAPTARAH1ResultsTaggedAPTARAEnd TaggedAPTARAPBetween 2010 and 2022, the LHU-Santo Ant onio received 137,751 donations. This study is focused on 455 donations with positive results for TTIs; 54.1% corresponded to male donors, with an average age of 42.2 (§13.1) and 1.5% from outside Portugal.TaggedAPTARAEnd TaggedAPTARAPTable 1 presents the positive tests obtained in donations collected between 2010 and 2022 for HIV 1/2, syphilis, HCV, HBV, HTLV 1/2, malaria and Chagas disease, and the corresponding number of tests confirmed as positive. A total of 19 individuals were tested for West Nile virus, 11 in 2016, four in 2017, two in 2018, and two in 2019, but none tested positive.TaggedAPTARAEnd TaggedAPTARAPIt was from 2020 onwards that screening for malaria and Chagas disease became recommended for donors from risk areas or traveling to areas of the world where there are endemic levels for these two diseases. In the years 2020−2022, 638 requests for malaria screening and 743 for Chagas disease were analyzed. In the period from 2020 to 2022, 23 donors tested positive for antibodies against Plasmodium and had a confirmatory molecular test for malaria of which the majority were from Portugal, with only one from Brazil, one from India, four from Mozambique and one from Poland. This situation implies the suspension of donations for 3 years. It should be hematol transfus cell ther. 2025;47(1):103734 3
noted that there were positive and confirmed tests for Chagas disease only in 2022 (two cases), both from Portugal.TaggedAPTARAEnd TaggedAPTARAH1DiscussionTaggedAPTARAEnd TaggedAPTARAPThis investigation arose with the purpose of characterizing cases of transfusion-transmissible infections that require the mandatory screening of blood donations from volunteer blood donors in the North of Portugal. The study covered 12 years (2010−2022) of donations at the LHU-Santo Ant onio, with a change in the profile of transmissible infectious diseases identified during this period. The study shows a small number of donors who were confirmed as having HIV 1/2, HCV, HBV or HTLV 1/2, ranging between 0 and 13 per 100,000 donations, and syphilis, ranging between 25 and 44 per 100,000. These reduced values contrast with the observed proportion of positive results in donations screened for malaria, which increased by around 100 times compared to previous results, with 8.5 and 52.1 per 1000 registered in 2020−2021 and 2022, respectively, or even Chagas with 6.8 per 1000 in 2022. In this period there was a total of 19 individuals tested for West Nile virus, but all of them tested negative.TaggedAPTARAEnd TaggedAPTARAPDuring the pandemic period (2020−2021), there was a drop in blood donations around the world, although there were no records of transfusion transmission of COVID-19.1 In Portugal16 there was a reduction of around 4% of donations compared to 2018−2019. In the LHU-Santo Ant onio this reduction was around 2%. This difference was due to a policy to raise awareness in the Immunohemotherapy Service among all the LHU-Santo Ant onio staff. Until the start of the pandemic, the institution’s professionals were not motivated to donate blood. This criterion took into account the greater exposure of these professionals to viral diseases transmitted by blood. Thesignificant decrease in the number of donations from regular donors led to a campaign to motivate all professionals to donate, appealing to and focusing on professionals who provide administrative services. This procedure has been in force since 2020, which has made more donors loyal. In terms of impact, it can be seen that when the institution’s staff became part of the immunohemotherapy donors, there were no relevant changes in the detection of TTIs.TaggedAPTARAEnd Table 1 – TaggedAPTARACaptionNumber of positive results for transfusion-transmissible infectious agents, confirmed number of true positives (TP), and estimated prevalence in the total blood donations for each period. TaggedAPTARAEnd PeriodTaggedAPTARAEnd Total donationsTaggedAPTARAEnd Positive resultsTaggedAPTARAEnd Proportion of positive resultsTaggedAPTARAEnd TPTaggedAPTARAEnd %TP /PositiveTaggedAPTARAEnd Proportion ofTPTaggedAPTARAEndTaggedAPTARAEndTaggedAPTARAEndTaggedAPTARATbody HIV1/2TaggedAPTARAEnd 2010−2017TaggedAPTARAEnd 93,667TaggedAPTARAEnd 49TaggedAPTARAEnd 52.3/100,000TaggedAPTARAEnd 8TaggedAPTARAEnd 16.33%TaggedAPTARAEnd 8.5/100,000TaggedAPTARAEndTaggedAPTARAEnd 2018−2019TaggedAPTARAEnd 18,268TaggedAPTARAEnd 2TaggedAPTARAEnd 10.9/100,000TaggedAPTARAEnd 0TaggedAPTARAEnd TaggedAPTARAEnd 2020−2021TaggedAPTARAEnd 17,958TaggedAPTARAEnd 5TaggedAPTARAEnd 27.8/100,000TaggedAPTARAEnd 2TaggedAPTARAEnd 40.00%TaggedAPTARAEnd 11.1/100,000TaggedAPTARAEndTaggedAPTARAEnd 2022TaggedAPTARAEnd 7858TaggedAPTARAEnd 2TaggedAPTARAEnd 25.5/100,000TaggedAPTARAEnd 0TaggedAPTARAEnd TaggedAPTARAEnd SyphilisTaggedAPTARAEnd 2010−2017TaggedAPTARAEnd 93,668TaggedAPTARAEnd 137TaggedAPTARAEnd 146.3/100,000TaggedAPTARAEnd 41TaggedAPTARAEnd 29.93%TaggedAPTARAEnd 43.8/100,000TaggedAPTARAEndTaggedAPTARAEnd 2018−2019TaggedAPTARAEnd 18,268TaggedAPTARAEnd 20TaggedAPTARAEnd 109.5/100,000TaggedAPTARAEnd 8TaggedAPTARAEnd 40.00%TaggedAPTARAEnd 43.8/100,000TaggedAPTARAEndTaggedAPTARAEnd 2020−2021TaggedAPTARAEnd 17,958TaggedAPTARAEnd 12TaggedAPTARAEnd 66.8/100,000TaggedAPTARAEnd 6TaggedAPTARAEnd 50.00%TaggedAPTARAEnd 33.4/100,000TaggedAPTARAEndTaggedAPTARAEnd 2022TaggedAPTARAEnd 7858TaggedAPTARAEnd 4TaggedAPTARAEnd 50.9/100,000TaggedAPTARAEnd 2TaggedAPTARAEnd 50.00%TaggedAPTARAEnd 25.5/100,000TaggedAPTARAEndTaggedAPTARAEnd HCVTaggedAPTARAEnd 2010−2017TaggedAPTARAEnd 93,668TaggedAPTARAEnd 110TaggedAPTARAEnd 117.4/100,000TaggedAPTARAEnd 3TaggedAPTARAEnd 2.73%TaggedAPTARAEnd 3.2/100,000TaggedAPTARAEndTaggedAPTARAEnd 2018−2019TaggedAPTARAEnd 18,268TaggedAPTARAEnd 14TaggedAPTARAEnd 76.6/100,000TaggedAPTARAEnd 1TaggedAPTARAEnd 7.14%TaggedAPTARAEnd 5.5/100,000TaggedAPTARAEndTaggedAPTARAEnd 2020−2021TaggedAPTARAEnd 17,958TaggedAPTARAEnd 14TaggedAPTARAEnd 78.0/100,000TaggedAPTARAEnd 0TaggedAPTARAEnd TaggedAPTARAEnd 2022TaggedAPTARAEnd 7858TaggedAPTARAEnd 6TaggedAPTARAEnd 76.4/100,000TaggedAPTARAEnd 0TaggedAPTARAEnd TaggedAPTARAEnd HBVTaggedAPTARAEnd 2010−2017TaggedAPTARAEnd 93,668TaggedAPTARAEnd 22TaggedAPTARAEnd 23.5/100,000TaggedAPTARAEnd 9TaggedAPTARAEnd 40.91%TaggedAPTARAEnd 9.6/100,000TaggedAPTARAEndTaggedAPTARAEnd 2018−2019T aggedAPTARAEnd 18,268TaggedAPTARAEnd 6TaggedAPTARAEnd 32.8/100,000TaggedAPTARAEnd 0TaggedAPTARAEnd TaggedAPTARAEnd 2020−2021TaggedAPTARAEnd 17,958TaggedAPTARAEnd 7TaggedAPTARAEnd 39.0/100,000TaggedAPTARAEnd 1TaggedAPTARAEnd 14.29%TaggedAPTARAEnd 5.6/100,000TaggedAPTARAEndTaggedAPTARAEnd 2022TaggedAPTARAEnd 7858TaggedAPTARAEnd 6TaggedAPTARAEnd 76.4/100,000TaggedAPTARAEnd 1TaggedAPTARAEnd 16.67%TaggedAPTARAEnd 12.7/100,000TaggedAPTARAEndTaggedAPTARAEnd HTLV1/2a TaggedAPTARAEnd 2010−2017TaggedAPTARAEnd 33,167TaggedAPTARAEnd 13TaggedAPTARAEnd 39.2/100,000TaggedAPTARAEnd 1TaggedAPTARAEnd 7.69%TaggedAPTARAEnd 3.0/100,000TaggedAPTARAEndTaggedAPTARAEnd 2018−2019TaggedAPTARAEnd 1840TaggedAPTARAEnd TaggedAPTARAEnd 2020−2021TaggedAPTARAEnd 2860TaggedAPTARAEnd 1TaggedAPTARAEnd 35.0/100,000TaggedAPTARAEnd 0TaggedAPTARAEnd TaggedAPTARAEnd 2022TaggedAPTARAEnd 1080TaggedAPTARAEnd TaggedAPTARAEnd Malariab TaggedAPTARAEnd 2010−2017TaggedAPTARAEnd TaggedAPTARAEnd 2018−2019TaggedAPTARAEnd TaggedAPTARAEnd 2020−2021TaggedAPTARAEnd 235TaggedAPTARAEnd 2TaggedAPTARAEnd 8.5/1000TaggedAPTARAEnd 2TaggedAPTARAEnd 100%TaggedAPTARAEnd 8.5/1000TaggedAPTARAEndTaggedAPTARAEnd 2022TaggedAPTARAEnd 403TaggedAPTARAEnd 21TaggedAPTARAEnd 52.1/1000TaggedAPTARAEnd 21TaggedAPTARAEnd 100%TaggedAPTARAEnd 52.1/1000TaggedAPTARAEndTaggedAPTARAEnd Chagasb TaggedAPTARAEnd 2010−2017TaggedAPTARAEnd TaggedAPTARAEnd 2018−2019TaggedAPTARAEnd TaggedAPTARAEnd 2020−2021TaggedAPTARAEnd 451TaggedAPTARAEnd 0TaggedAPTARAEnd TaggedAPTARAEnd 2022TaggedAPTARAEnd 292TaggedAPTARAEnd 2TaggedAPTARAEnd 6.8/1000TaggedAPTARAEnd 2TaggedAPTARAEnd 100%TaggedAPTARAEnd 6.8/1000TaggedAPTARAEndTaggedAPTARAEnd WestNileTaggedAPTARAEnd 2010−2017TaggedAPTARAEnd 15TaggedAPTARAEnd 0TaggedAPTARAEnd TaggedAPTARAEnd Virusb TaggedAPTARAEnd 2018−2019TaggedAPTARAEnd 4TaggedAPTARAEnd 0TaggedAPTARAEnd TaggedAPTARAEnd 2020−2021TaggedAPTARAEnd TaggedAPTARAEnd 2022TaggedAPTARAEnd TaggedAPTARAEndTaggedAPTARAEnd HIV 1/2: Human immunodeficiency virus types 1 or 2; HBV: human hepatitis virus type B; HCV: human hepatitis virus type C; HTLV 1/2: human T-lymphotropic virus types I and II.TaggedAPTARAEnd a The HTLV 1/2 test is only performed on thefirst donations. b Test performed according to the assessment of the geographic risk. TaggedAPTARAEnd4 hematol transfus cell ther. 2025;47(1):103734
TaggedAPTARAPAlthough HIV is no longer considered an epidemic, it continues to be a subject of concern to ensure blood quality.1 In the last 12 years, the number of TP for HIV has been very low, just ten donations. The most recent data on the Portuguese population point to a reduction in the number of new HIV cases, however the rates recorded in Portugal are among the highest in Europe.18 For donors in Portugal, both prevalence and incidence decreased between 2016 and 2020, but an increase was recorded in 2021.16 TaggedAPTARAEnd TaggedAPTARAPIn the case of syphilis infection, the test currently used allows the identification of both acute infections and past and resolved infections. In the case of active syphilis infections, there was a significant decrease in the number of cases at the LHU-Santo Ant onio over the years under study, however, in all periods analyzed, syphilis was identified in the donations screened. Data from the National Serological Survey from 2015 to 2016 for the Portuguese population19 point to a seroprevalence of 2.4%. A study for the city of Rome describes a decline in the cases of sexually transmitted diseases, especially syphilis for the spring 2020 period with the strict lockdown.20 Similarly, for Madrid there was a decrease in sexually transmitted diseases in the first half of 2020, when compared with the same period in 2019. All these results suggest that the reduction in sexually transmitted diseases during the COVID-19 pandemic reflects the decrease in sexual contacts due to social distancing.21,22 Despite the convergence of data, it is considered that this interpretation should be cautious, since, in this pandemic period, many people were not followed up in hospitals for diagnosis.TaggedAPTARAEnd TaggedAPTARAPIn the case of HCV infection, no case was confirmed in the donations tracked from 2020 onwards, with only three cases confirmed in the period 2010−2017 and one in 2018−2019. In these two periods, the estimated prevalences were 3.2 and 5.5 per 100,000, respectively. The 2018−2019 values are close to the data published for blood donors in Portugal in 2018 and 2019, 4.43 and 7.48/100,000 respectively. For the period 2010 −2017, the estimated prevalence in the LHU-Santo Ant onio donors is below that of national donors, which is around 10/ 100,000.16 TaggedAPTARAEnd TaggedAPTARAPRegarding HBV infection, nine cases were confirmed as positive in thefirst period from 2010 to 2017 corresponding to 9.6 per 100,000 donations, zero in 2018−2019, one case in 2020 −2021 and one in 2022. This downward trend was reported nationally,16 and it would be expected given the mandatory vaccination of newborns since 2000.TaggedAPTARAEnd TaggedAPTARAPIn the 12 years of the study, only one HTLV 1/2 infection was found in the period 2010−2017, which confirms the low endemicity of this infection in Portugal.23 TaggedAPTARAEnd TaggedAPTARAPThe second millennium brought new routines to blood banks, as a result of new epidemics and emerging diseases attributed to climate change and migration.1,4,6 The LHUSanto Antonio began to include screening for diseases such as West Nile virus, and more recently research for malaria and Chagas disease. In a total of 638 tests for Plasmodium carried out between 2020 and 2022, 23 positive results were confirmed. In 2020 and 2021, the number of reported cases of malaria in Portugal were 59 and 79, respectively,24 however these values may be below the real figure due to underreporting25 and the fact that cases can only be detected in situations of acute illness. Until thefirst half of the 20th century, malaria was one of the main causes of deaths in Portugal; it was considered eradicated in 1958. It initially predominated in urban areas and became an increasingly rural disease, with a special focus on agricultural areas of rice, where it became endemic, due to the presence of the mosquito that transmits malaria.26 TaggedAPTARAEnd TaggedAPTARAPRegarding Chagas disease, in 743 test requests there were two positive cases. This confirms the presence in Portugal of tropical diseases associated with transmission by vectors, in blood donors, as has been observed in the general European population,5,6,24,27 confirming the importance of a rigorous investigation at the time of the donation in which the donor’s history is assessed, including travel for leisure or work to areas of greater geographic risk for these diseases.4,28 TaggedAPTARAEnd TaggedAPTARAH1ConclusionTaggedAPTARAEnd TaggedAPTARAPThis epidemiological study allowed the investigation of the occurrences and significant changes of diseases transmitted by blood in donations from a population of donors in the North of Portugal over 12 years (2010−2022). The study puts into perspective and confirms the need to annually monitor donations in Portugal, paying special attention to emerging infectious diseases that have already started to be part of the screening panel, initially with testing for the West Nile virus and, currently, with testing for malaria and Chagas disease. It is necessary to adopt the World Health Organization recommendations27 for the risk of Dengue fever, Zika and Chikungunya outbreaks on the European continent, as a result of the climate crisis that facilitates the spread of mosquitoes that carry diseases with a higher incidence in the southern hemisphere.TaggedAPTARAEnd TaggedAPTARAPThe increase in the average life expectancy of the population, the low birth rate, the increasingly strict criteria in the selection of donors, as well as the inherent complexity of surgical and oncological procedures are factors that, as a whole, increase the need for blood. In Portugal, in the last decade the aging index has been steadily worsening. Since 2000, the number of elderly people has surpassed the number of young people in Portugal. All of these factors contribute to the imbalance between blood consumption and blood supply. This aging also extends to donors, which is why donation motivation campaigns among younger people (universities, sports associations and similar organizations) is a serious bet to attract donors who can improve this situation. It is urgent to invest in strategies that29 retain existing donors and implement new ones that attract more people to donate blood.TaggedAPTARAEnd TaggedAPTARAPOn the other hand, the 2021 census indicates that the population of foreign nationals living in Portugal will be around 800 to 900 thousand people30 and although in practice it is not possible to reverse the aging pyramid, they alert us to the need to a rigorous screening of ’new and emerging’ viral diseases transmitted by blood, often associated with the movement of people for work or leisure.31 TaggedAPTARAEnd TaggedAPTARAPThe results obtained show the need to combine the promotion of the appeal for blood donation with the attention and expansion of the type of tests for diseases transmitted by blood, fundamental to guarantee the safety of the transfusion process, not only in Europe but in countries outside Europe. Testing updates must follow international information on hematol transfus cell ther. 2025;47(1):103734 5
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