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Most dengue virus (DENV) infections remain asymptomatic. This increases the risk of DENV transfusion transmission (TT-DENV) during outbreaks. We evaluated DENV viremia in 8475 blood donations assembled in minipools for the presence of DENV RNA. The tested samples were obtained between February and May, 2016, during a large DENV outbreak in Ribeirão Preto city, northeast region of the São Paulo State, Brazil. The DENV RNA + samples were serotyped and screened for DENV NS1. We also tested a significant number of plasma samples (n = 372) to estimate the DENV seroprevalence among blood donors in the region. We detected three DENV RNA + samples in the tested blood donations (n = 3/8475, 0.04%). From these, two samples were further serotyped as DENV-1 and one sample as DENV-2. All DENV RNA positive samples were negative for anti-DENV IgG, indicating the presence of primary acute infection. Moreover, two of the DENV RNA + samples were also NS1 antigen positive (antigenemia). The anti-DENV IgG seroprevalence among blood donor population was 50.8% (n = 189/372). Our results are in accordance with the presence of DENV primary infection in blood donors which can lead to transfusion transmission of the infection to recipients. Measures to exclude such donors should be adopted to prevent TT-DENV.

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CASE REPORT: A 26-year-old woman with sickle cell disease (SCD) on chronic transfusion therapy complained of severe arthralgia, myalgia, abdominal pain, headache, and fever 24 hours after transfusion of a red blood cells (RBCs). Dengue virus (DENV) infection was suspected and the patient was hospitalized for clinical support and RBC transfusion, to lower the hemoglobin S to less than 30%. The patient's clinical condition improved approximately 8 days after the onset of symptoms. RESULTS: DENV type 2 (DENV-2) TaqMan real-time polymerase chain reaction was negative in the patient's pretransfusion sample while the posttransfusion sample was positive (Ct, 27.8), suggesting a high viral load and an acute infection. To investigate DENV transfusion transmission (TT-DENV) the stored donor serum was tested and was also positive (Ct, 25.8). Molecular typing confirmed the presence of DENV-2. The phylogenetic analysis of the DENV-2 strains obtained from both donor and patient samples were classified as the Southeast Asia-American genotype (Genotype III) and demonstrated 100% genomic identity, indicating TT-DENV. CONCLUSION: This is the first description of TT-DENV in a SCD patient. A presumed high viral load in the transfused RBC unit probably determined the early clinical manifestation. In endemic regions dengue fever should be considered as differential diagnosis in SCD patients with fever and acute pain crisis, mainly during DENV outbreaks.

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BACKGROUND: In 2015, there was a large Zika virus (ZIKV) outbreak in Brazil. The proportion of asymptomatic infections is very high, and it is possible for transfusion-transmitted ZIKV (TT-ZIKV) infection to occur. The prevalence of asymptomatic ZIKV infection among Brazilian blood donors during this epidemic outbreak is unknown. STUDY DESIGN AND METHODS: Plasma samples obtained between October 2015 and May 2016 from 1393 volunteer blood donors were tested for ZIKV RNA. The viral load was quantified using an in-house standard curve. Additionally, positive ZIKV RNA samples were tested for anti-ZIKV immunoglobulin (Ig)M and anti-ZIKV IgG. RESULTS: Of the 1393 blood samples, ZIKV RNA was detected in 37 (n = 37/1393; 2.7%). The median infection viral load detected was 7714 copies/mL (ranging from 135-124,220 copies/mL). The majority of the positive samples (70.3%) exhibited a viral load of approximately 103 copies/mL. Six samples that were positive for ZIKV RNA were also positive for anti-ZIKV IgM and IgG (n = 6/37; 13.5%). CONCLUSION: This is the first study evaluating the prevalence of ZIKV RNA among Brazilian blood donors, which was relatively high and might lead to TT-ZIKV infection. It is unclear whether the simultaneous presence of anti-ZIKV IgM and IgG in RNA-positive donations or the viral load influences transfusion transmission of the infection. This study also adds to the global understanding of ZIKV prevalence in blood donors during outbreaks and the transfusion impact of the infection.

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Os procedimentos em hemoterapia são complexos e caros. Exigem processos controlados e validados, equipamentos calibrados e monitorados e insumos qualificados, validados e inspecionados antes e durante o uso. Isto acarreta, além dos gastos diretos, gastos indiretos especificamente relacionados à garantia da qualidade e da segurança transfusionais, além dos gastos indiretos usuais de qualquer produto ou serviço. Procurando avaliar com maior aproximação estes custos e buscando evitar as distorções das apropriações de custos por rateios, o presente estudo utilizou o sistema de Custeio Baseado em Atividades - ABC, para apurar o custo médio do Módulo de Coleta de sangue total no Hemocentro de Ribeirão Preto - SP, unidade sede, no primeiro semestre de 2006. O maior impacto no custo médio apurado se deveu aos custos monetários diretos, entretanto os custos indiretos não foram desprezíveis. O custo médio obtido para desempenho das atividades que compõem o Módulo de Coleta foi de R$ 35,20, que é 68,75 por cento superior ao valor pago na tabela SIA/SUS para este módulo. A metodologia desenvolvida pode ser aplicada aos outros procedimentos dos serviços de hemoterapia, permitindo a avaliação dos custos de seus processos, evitando desperdícios, aprimorando o seu funcionamento e gerando evidências objetivas que demonstrem os custos reais da hemoterapia de qualidade para as instâncias financiadoras públicas e privadas.

The procedures in hemotherapy are complex and expensive. They demand a controlled and validated process. They also require calibrated and monitored equipment and qualified and validated materials, inspected before and during use. This causes, apart from direct expenses, indirect expenses related to the guarantee of quality and transfusional safety, as well as the usual indirect costs of any product or service. The present study used the Activity-Based Costing system - ABC, to find the mean cost of collection of whole blood units in a Regional Blood Center in Ribeirão Preto, during the first semester of 2006, in order to assess these costs more carefully and to try to avoid the cost distortions due to separation of blood components. Although the indirect costs were not negligible, the major impact on the mean cost was related to direct monetary costs. The mean cost to perform the activities that compose the collection of blood units was R$ 35.20, which is 68.75 percent higher than the value paid by the Brazilian government for this unit. The developed methodology can be applied to other procedures of services in hemotherapy allowing the evaluation of process costs, avoiding waste, improving performance and generating objective evidence to demonstrate the real cost of quality hemotherapy activities for public and private fund source.

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