Rev. Bras. Hematol. Hemoter. vol.38 número3

w w w . r b h h . o r g

Revista

Brasileira

de

Hematologia

e

Hemoterapia

Brazilian

Journal

of

Hematology

and

Hemotherapy

Original

article

Distribution

of

serological

screening

markers

at

a

large

hematology

and

hemotherapy

center

in

Minas

Gerais,

Southeastern

Brazil

Sônia

Mara

Nunes

da

Silva

_,

_Milena

_Batista

_de

_Oliveira

_,

Edson

Zangiacomi

Martinez

a_{Fundac¸ãoCentrodeHematologiaeHemoterapiadeMinasGerais(Hemominas),BeloHorizonte,MG,Brazil} b_{UniversidadedeSãoPaulo(USP),FaculdadedeMedicinadeRibeirãoPreto(FMRP),RibeirãoPreto,SP,Brazil}

a

r

t

i

c

l

e

i

n

f

o

Articlehistory:

Received14January2016 Accepted17May2016 Availableonline11June2016

Keywords:

Bloodbanks Blooddonors Blood

Serologicaltests Screening

a

b

s

t

r

a

c

t

Objective:Toassessthedistributionofserologicalmarkersinblooddonorsatthebloodbanks oftheFundac¸ãoCentrodeHematologiaeHemoterapiadeMinasGerais(Hemominas),Brazil, betweenJanuary2006andDecember2012.

Methods:Thisisadescriptive,retrospectivestudyonblooddonorsscreenedusingserological testsformarkersoftransmitteddiseasesatthestateblood-bankingnetwork.

Results:Approximately78.9%ofthedonors wereconsidered eligibleforthestudy after clinicalscreening.Repeatdonorsrepresented68.2%ofthetotalsample,withmalesbeing predominantasblooddonors(66.8%).Totalserologicalineligibilitywas3.05%,withtotal anti-HBcbeingthemostcommonmarker(1.26%),followedbysyphilis(0.88%)andhuman immunodeficiencyvirus(0.36%).TheprevalencesofthemarkersforhepatitisC,Human T-celllymphotropicvirus,ChagasdiseaseandHBs-Agwere0.15%,0.09%,0.13%and0.18%, respectively.ThebloodbankofGovernadorValadareshadthehighestpercentageofpositive anti-HBcdonors(2.41%).Withregardtohumanimmunodeficiencyvirus,thebloodbankof AlémParaíbahadthelowestpercentageofpositivedonorswhilethebloodbanksofJuizde ForaandBetimhadthehighestpercentages.ThebloodbankinthecityofMontesClaros hadthehighestprevalenceofthemarkerforChagasdisease(0.69%).

Conclusions:DataontheprofileofserologicalineligibilitybythebloodbanksoftheFundac¸ão Hemominashighlightstheparticularitiesofeachregiontherebycontributingtomeasures forhealthsurveillanceandhelpingtheblooddonationnetworkinitsdonorselection pro-ceduresaimedatimprovingbloodtransfusionsafety.

©2016PublishedbyElsevierEditoraLtda.onbehalfofAssociac¸ ˜aoBrasileirade Hematologia,HemoterapiaeTerapiaCelular.ThisisanopenaccessarticleundertheCC BY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).

∗ _{Correspondingauthorat:FaculdadedeMedicinadeRibeirãoPreto,UniversidadedeSãoPaulo(FMRP-USP),AvenidaBandeirantes3900,}

14049-900RibeirãoPreto,SP,Brazil.

E-mailaddress:edson@fmrp.usp.br(E.Z.Martinez). http://dx.doi.org/10.1016/j.bjhh.2016.05.005

Introduction

InBrazil,uptothe1960s,transfusionproceduresweremostly performedbyprivate hospitalblood bankswithno govern-mentalregulation.Paradoxically,theimportanceofbloodas essentialtothehealthcaresystemwasfirstlynotedwiththe BrazilianRevolutionof1964.Thearmy,inviewofthe immi-nenceofanarmed conflict,foundthatstocksofbloodand componentswouldbeinsufficienttomeettheneedsinthe eventofarmedcombat.1_{Itwasatthattimethatthefirstpublic}

initiativesweretakeninBraziltotrytonormalizethisactivity. Thefirstgovernmentalactwasthecreationofanational hemotherapycommissionaimedatsetting apolicyto reg-ulatetheblood collection procedure,including storageand transfusion.2 _{This commission formulated basic rules for}

donorsandbloodtransfusionbyestablishingthemandatory serologicalscreeningtestsneededforsafebloodtransfusions. In1980,theFederalGovernmentimplementedtheNational ProgramonBloodandBloodDerivativeswiththe participa-tionofthecivilsociety,inordertodefineapolicyforblood anditscomponentsinBrazil,thusensuringtheavailability, safetyandamountoftheseproducts.3

Theregionalblood-bankingnetworkofthestateofMinas GeraiswasthusestablishedinJune1982withtheobjectiveof implementingthepoliciesproposedbytheNationalProgram onBloodandBloodDerivatives.In1985,the blood-banking network of Minas Gerais was officially inaugurated, and becameknownastheCentrodeHematologiaeHemoterapia deMinasGerais(Hemominas)andthen Fundac¸ão Hemom-inasfour years later.4 _{Today, Fundac¸ão Hemominasis one}

ofthe largest blood screeningservices inBrazil.Itis com-prisedof21bloodbanksatthefollowingsites:AlémParaíba, Belo Horizonte, Shopping Estac¸ão (Belo Horizonte), Betim, Diamantina,JuizdeFora,Divinópolis,GovernadorValadares, PatosdeMinas,SeteLagoas,MontesClaros,Uberlândia, Itu-iutaba,SãoJoãoDel Rei, Manhuac¸u,Pouso Alegre,Hospital JúliaKubitscheck(BeloHorizonte),Uberaba,PonteNova, Pas-sos,andPoc¸osdeCaldas.5

Fundac¸ãoHemominasreceivesabout280,000blooddonors peryearandaccountsfor91%ofbloodtransfusionsinMinas Gerais.Epidemiologicalinformationonthediseasesidentified amongblooddonorcandidatesisimportanttogatherdata onthebloodbanksofFundac¸ãoHemominas,thusenablinga reductionoftherisksofdiseasetransmissionandensuringthe qualityofdonatedblood.6_{Withtheincreaseintransfusions,}

andconsequentlyinthetransmissionofblood-bornediseases, hemotherapyservices are notonlydeveloping blood bank-ing services, but researching these diseases. Subsequently manydevelopmentsoccurredwithinafewyearsincludinga shiftfrompaidtovoluntarydonation,andautologousblood donations.Theimprovementinserologicalscreeningtests, rigoroustransfusionrequirementsandstandardizationof pro-cedureshavebeenessentialforthesafetyofblooddonation andtransfusion.7

The transmission of infectious diseases through blood transfusionischaracterizedbyahigher-riskofadverse reac-tionsinthebloodrecipient.Theidentificationofpathogens bymeans ofserologicaltestsisone wayofpreventingthe disseminationoftheseinfectiousagentsduringtransfusion.

InBrazil,theMinistryofHealthestablishedthatserological testsmustbeperformedforeveryblooddonationregarding the following pathogens: hepatitisB virus (HBV), hepatitis C virus (HCV), humanimmunodeficiency virus (HIV) types 1 and 2, humanT lymphotropic virus (HTLV) types 1 and 2,Trypanossomacruzi,Treponemapallidum,andPlasmodiumin malaria-endemicareas(includingmolecular tests).Another importantprocedureadoptedtominimizethe risksof con-taminationistheclinicalandepidemiologicalscreeningofthe candidates’healthstatus,habits,andriskybehaviortohelp todeterminepossiblerisksofblooddonationinrespecttothe healthofdonorsandrecipients.8–10 _{Inordertostandardize}

theserologicalscreeningproceduresthroughoutthestateof MinasGerais,Fundac¸ãoHemominascreatedaserology cen-terinMay2005toserveall21bloodbanks,thusaccounting forcomplementaryserologicalscreeningandexamsforboth donors and patients. Today, this serology center isone of thelargestdonorscreeninglaboratoriesinBrazil,performing abouttwomilliontestsperyear.5

Theobjectiveofthepresentstudyistodescribethe preva-lence ofserological screeningmarkers amongblood donor candidates ofthe Fundac¸ãoHemominasbetween2006and 2012.ThestateofMinasGeraisisoneofthe27statesofBrazil withapproximately20millioninhabitantsdistributedamong 853towns.With586,522,122km2_{,theareaofthestateofMinas}

Gerais,thefourthlargeststateofBrazil,correspondsto6.89% ofthenationalterritory;2,525,800km2_{areinurbanareas.The}

cityofBeloHorizonte,locatedinthecentralregion,hasa pop-ulationofabout2.4millionpeople.Thesouthernregionofthe stateismoreindustrializedandeconomicallydeveloped,thus ithasgoodsocialindicators.Ontheotherhand,thenorthern regionisoneofthepoorestregionsinBrazil,becauseofthe droughtandlackofeffectivegovernmentpolicies,with ineffi-cientenvironmentalsanitaryservicesandhighchildmortality andilliteracyrates.

Methods

Design

Thisdescriptiveretrospectivestudyincludedallblooddonors screened usingserological tests formakersof blood-borne diseasesattheFundac¸ãoHemominas.Thetestswere manda-toryduringtheperiodofthestudyfrom2006to2012,even forrepeat donorsaspriornegativeserologicaltestsdonot sparethemfrompossibleserologicalineligibility.Theblood bank atPoc¸osdeCaldas wasinaugurated in2010.All data were collected from computerizedrecords ofthe Fundac¸ão Hemominas.

The present study was approved in June 2013 by the ResearchEthicsCommitteeoftheHospitaldasClinicasofthe FaculdadedeMedicinadeRibeirãoPretodaUniversidadede SãoPaulo(FMRP-USP:#356.616).

Serologicalscreeningtests

To determine HBsAg: PRISM (Abbott, CMIA) in 2006: MonolisaTM _{HBsAg ULTRA (Biorad) in 2007–2012 and}

ARCHITECT®_{HBsAgAssay(Abbott,CMIA)in2012.}

To determine human immune deficiency virus (HIV) – method1:PRISM(Abbott,CMIA)in2006,GSHIV-1/HIV-2PLUS OEIA(Biorad)in2007and2008,HIVAg/AbCombination(EIE, Murex)in2008and2009andARCHITECT®_{HIVAg/AbCombo}

(Abbott,CMIA)in2009–2012.

To determine human immune deficiency virus (HIV) – method 2: HIV-1.2.0 (EIE, Murex) in 2006 and 2007, GenscreenTM _{ULTRA HIVAg-Ab (EIE, Biorad) in2007–2012}

andVITROSAnti-HIV1+2Assay(OrthoClinicalDiagnostics, CMIA)in2012.

TodeterminehepatitisCvirus(HCV):Anti-HCV-version4.0 (EIE,Murex)in2006and2007,HepatitisCVirusEncoded Anti-gen(Recombinantc22-3,c200andNS5)ORTHO®_HCVVersion

3.0ELISATestSystemin2007–2009,HCVAg/AbCombination (EIE,Murex)in2009–2011,andMonolisaTM_{HCVAg-AbULTRA}

Assay(EIE,Biorad)in2011and2012.

TodeterminehepatitisBcoreantibody(HBc):totalanti-HBc (IgGandIgM–ELISA Test SystemOrtho-Clinical Diagnos-tics)in2006and2007,MONOLISAAnti-HBcPLUSAssay(EIE, Biorad)in2007–2012andARCHITECT® _{Anti-HBcII(Abbott,}

CMIA)in2011and2012.

To determine Chagas disease: CHAGAS TEST ELISA BIOS CHILEin2006and2007andGOLDELISACHAGAS(REM)in 2007–2012.

TodeterminehumanT-lymphotropicretroviruses(HTLV)I/II: ELISA HTLV-I/II rp21 ELISA Ortho Diagnostics® _{System in}

2006–2011,GOLDELISAHTLVI/II(REM)in2011and2012and ARCHITECT®_{rHTLV-I/II(Abbott,CMIA)in2012.}

Todeterminesyphilis:ICE*Syphilis(Murex)in2006and2007; andBioelisaSyphilis3.0(Biokit)in2007–2012.

Thepresentstudydidnotusetheconfirmatorytestresults ofinitiallypositiveresults.

Results

Atotalof2,361,879blooddonorcandidateswereinterviewed inFundac¸ãoHemominasbloodbanksfromJanuary2006to December 2012,with 1,864,553 donationsbeing considered eligibleafterclinicalscreening(Table1).Thisscreening con-sistsofevaluatingtheclinicalandepidemiologicalhistoryof candidates,and their healthstatus,habits andbehavior to determinewhethertheycanbeconsideredforblood dona-tionwithoutriskingtheirhealthorthatoftherecipient.11,12

Theoverall percentageofdonationsfrom clinicallyeligible donorsofallthebloodbankswas78.9%,rangingfrom73.2% inMontesClarosto87.2%inPonteNova.Thepercentageof donationsfromrepeatdonors(68.2%)wasabout twicethat offirst-timedonors(31.8%)duringtheperiodofthestudyin allbloodbanksexceptforPoc¸osdeCaldaswhere61.2%and 38.8%werefirst-timeandrepeatdonors,respectively(Table2). ItshouldberememberedthatthePoc¸osdeCaldasbloodbank wasinauguratedin2010.Thedistributionofdonationsfrom eligibledonorsstratifiedbygenderfoundapredominanceof men(66.2%),exceptforthebloodbankofDiamantinawhere

50.2% ofthe donorsweremen(Table3). Table3shows the distributionofeligibledonorsstratifiedbyage.

Consideringtheclinicallyeligibledonors,Figure1shows thepercentagesofdonationsfromdonorswithpositive sero-logyforsyphilis,anti-HBc,Chagasdisease,HTLV,HBsAG,HCV, andHIVateachbloodbank.ThebloodbankinGovernador Val-adareshadthehighestpercentageofpositiveanti-HBcdonors (Figure1b).PositivityfortheserologicalmarkerforChagas dis-easewasmorecommonintheMontesClarosandDiamantina bloodbanks;thecitiesaresituatedinthenorthernregionof thestateandtheJequitinhonhaValley,respectively,wherethe disease isendemic.13,14 _{SerologicalmarkersforHBs-Agand}

HCVweremorecommonlyobservedinthePoc¸osdeCaldas bloodbank(Figure1eandf).

Discussion

Despite all the technological advancesin recent years,the productionofbloodcomponents andblood derivativesstill dependson blooddonation. However,thenumber ofblood donorsdoesnotfulfillthecurrentdemandinBrazil.15_Inthis

work,themeanpercentageofclinicallyeligibledonorsinthe Hemominasbloodbankswas78.9%,avaluesimilartothat reportedbytheannualreportontheproductionofblood com-ponentsin2013asthepercentageofclinicaleligibilitywas closeto81.4%nationally.16_Rohretetal.,17_{conductedastudy}

attheHospitalSantoAngeloinSouthernBrazil,andreported aclinicaleligibilityof73.6%for2005–2015.

In this work, the percentage of donations from repeat donors(68.2%)wasapproximatelytwiceashighasfor first-timedonors(31.8%).Thesepercentagesaresimilartothose observed throughout the country,16 _{as the percentages of}

donorsisestimatedat63.1%and36.9%forrepeatand first-time donors, respectively. However, ahigher percentageof first-timedonors(61.2%)wasobservedinthePoc¸osdeCaldas bloodbank;thisfindingcanbeexplainedasthebloodbank wasimplantedonlyin2010.

Amongtheeligibledonors,therewasapredominanceof men(66.2%).SantosandMacedo18_{reportedapercentageof}

63.8%ofmaledonorsinastudyconductedbetween2005and 2009attheCampoMourãobloodbank,stateofParaná.Similar datawerereportedbytheAgenciaNacionaldeVigilancia San-itaria(ANVISA),whosestudyevaluatedtheprofileofdonors andnon-donorsthroughoutBrazil.19_{Amongthedonor}

popu-lationinBrazil,menwerefoundtobepredominant(65.67%); 61.02%insoutheasternBrazil,63.97%inthesouthernregion, 70.95%intheNortheast,75.25%innorthernBraziland75.96% inthecentral-westernregion.

Inthepresentstudy,42.8%ofeligibleblooddonorswere inthe 18- to29-yearage groupand 57.1%were older than 29yearsold.Similarresultsarefoundacrossthecountry,16

with the majorityofthe blood donorsbeing older than 29 years(57.08%).Otherstudiesshowthatthenumberofblood donationsincreasesastheagedecreases.18,20

Another factor affectingthe decrease inthe number of blooddonationsistherateofserologicalineligibility.In2002, the serologicalineligibility raterangedfrom 10% to20%in Brazilianblood banks.21 _{Thisrateisveryhighcomparedto}

Table1–Distributionofblooddonationsaccordingtoeligibilityandineligibilityofblooddonorcandidates.

Bloodbank Blooddonations

Eligible % Ineligibility % Dropouts % Total

AlémParaíba 23,313 81.3 5272 18.4 105 0.37 28,690

Betim 72,000 79.3 18,501 20.4 249 0.27 90,750

Diamantina 23,860 79.1 6151 20.4 167 0.55 30,178

Divinópolis 108,370 83.6 20,392 15.7 795 0.61 129,557

BeloHorizonte 485,827 73.7 156,701 23.8 16,888 2.56 659,416

HospitalJúliaKubitscheck 81,283 76.1 25,031 23.4 454 0.43 106,768

GovernadorValadares 91,756 78.7 22,881 19.6 1884 1.62 116,521

Ituiutaba 26,802 86.0 4231 13.6 115 0.37 31,148

JuizdeFora 208,148 82.6 42,479 16.9 1425 0.57 252,052

Manhuac¸u 38,575 79.3 9753 20.1 314 0.65 48,642

MontesClaros 114,375 73.2 40,867 26.2 1023 0.65 156,265

Passos 47,424 85.3 7983 14.4 200 0.36 55,607

PousoAlegre 88,328 83.2 17,151 16.2 668 0.63 106,147

PatosdeMinas 46,093 82.9 9347 16.8 154 0.28 55,594

Poc¸osdeCaldasa _{19,481 79.5 4897 20.0 132 0.54 24,510}

PonteNova 42,405 87.2 6059 12.5 167 0.34 48,631

SãoJoãodelRei 39,938 86.5 6059 13.1 161 0.35 46,158

SeteLagoas 59,788 82.3 12,561 17.3 317 0.44 72,666

Uberaba 108,578 82.3 22,435 17.0 966 0.73 131,979

Uberlândia 138,209 81.0 31,745 18.6 646 0.38 170,600

Total 1,864,553 78.9 470,496 19.9 26,830 1.14 2,361,879

a _{From2010to2012.}

Table2–Distributionofblooddonorsasfirst-timeorrepeatdonors.

Unit Blooddonations

First-timedonors % Repeatdonor % Total

AlémParaíba 8119 28.3 20,571 71.7 28,690

Betim 35,393 39.0 55,358 61.0 90,750

Diamantina 11,468 38.0 18,710 62.0 30,178

Divinópolis 40,940 31.6 88,617 68.4 129,557

BeloHorizonte 216,948 32.9 442,468 67.1 659,416

HospitalJúliaKubitscheck 45,803 42.9 60,965 57.1 106,768

GovernadorValadares 35,888 30.8 80,633 69.2 116,521

Ituiutaba 7631 24.5 23,517 75.5 31,148

JuizdeFora 68,306 27.1 183,746 72.9 252,052

Manhuac¸u 13,377 27.5 35,265 72.5 48,642

MontesClaros 44,536 28.5 111,729 71.5 156,265

Passos 16,015 28.8 39,592 71.2 55,607

PousoAlegre 38,850 36.6 67,297 63.4 106,147

PatosdeMinas 14,899 26.8 40,695 73.2 55,594

Poc¸osdeCaldasa _{15,000 61.2 9510 38.8 24,510}

PonteNova 13,908 28.6 34,723 71.4 48,631

SãoJoãodelRei 21,140 45.8 25,018 54.2 46,158

SeteLagoas 21,872 30.1 50,794 69.9 72,666

Uberaba 33,391 25.3 98,588 74.7 131,979

Uberlândia 47,768 28.0 122,832 72.0 170,600

Total 751,253 31.8 1,610,626 68.2 2,361,879

a _{From2010to2012.}

studied,themeanrateofserologicalineligibilityin2013was 3.43%.14_{Similardatawerefoundinthepresentwork,asthe}

rateofserologicalineligibility atthe Fundac¸ãoHemominas was3.05%.Thefrequentchangesinthebrandsofscreening testkitsduetothebiddingnormsthathavetobefollowedby governmentblood bankstopurchaseproducts,contributed totheserologicalineligibility.Thisphenomenonoccurseven

whenhigh-sensitivityandspecificitytestsareused.Different testkitbrandsproducedifferentfalse-positiveratesand, con-sequently,itismorelikelythattheresultsofahealthyblood donorare positiveto atleast oneofthe brands used.This wouldnothappenifthesamebrandofkitwerealwaysused.21

Table3–Distributionofblooddonorsstratifiedbygenderandage.

Unit Eligibletodonateblood Gender(%) Age(%)

Men Women 18–29years Olderthan29 Under18

AlémParaíba 23,313 80.5 19.5 31.6 68.4 –

Betim 72,000 61.7 38.3 42.2 57.7 0.03

Diamantina 23,860 50.2 49.8 55.9 44.1 0.05

Divinópolis 108,370 67.6 32.4 55.9 44.1 0.05

BeloHorizonte 485,827 63.9 36.1 52.1 47.9 0.06

HospitalJúliaKubitscheck 81,283 66.6 33.4 45.4 54.5 0.03

GovernadorValadares 91,756 65.5 34.5 40.0 59.9 0.10

Ituiutaba 26,802 66.9 33.1 43.4 56.5 0.10

JuizdeFora 208,148 66.6 33.4 40.6 59.3 0.10

Manhuac¸u 38,575 73.2 26.8 47.2 52.8 0.02

MontesClaros 114,375 59.5 40.5 37.5 62.4 0.09

Passos 47,424 74.6 25.4 54.0 45.9 0.05

PousoAlegre 88,328 76.6 23.4 37.2 62.7 0.08

PatosdeMinas 46,093 64.7 35.3 35.3 64.6 0.05

Poc¸osdeCaldas(a) _{19,481 69.8 30.2 39.9 60.0 0.11}

PonteNova 42,405 68.5 31.5 40.5 59.4 0.13

SãoJoãodelRei 39,938 69.3 30.7 38.2 61.6 0.16

SeteLagoas 59,788 66.8 33.2 45.8 54.0 0.13

Uberaba 108,578 68.7 31.3 45.2 54.7 0.11

Uberlândia 138,209 65.9 34.1 43.5 56.5 0.07

Total 1,864,553 66.2 33.8 44.5 55.4 0.06

a _{From2010to2012.}

markersforsyphilis,anti-HBc,Chagasdisease,HTLV,HBsAG, HCV, and HIV. Of the 1,864,553 clinically eligible donors referredforserological testingbetween 2006and 2012,the total anti-HBc (IgM/IgG) was the commonest serological markerfound (1.12% ofblood donors)followed by syphilis (0.98% ofthe study population). Data from a national sur-veyin2012onthedistributionofserologicalineligibilitydue to blood-borne disease markers reported a predominance of anti-HBc (1.47%), followed by syphilis (0.67%), and HIV (0.36%).16_{Inthenorthernregion,approximately5.16%ofblood}

donorsareineligibilitybecauseofserologicalresults,withthe prevalenceoftheanti-HBcmarkerbeing3.77%.16_Ontheother

hand,ineligibilityduetosyphilisinthisregionofBrazil(0.26%) isfarlowerthanthenationalaverage(0.67%).Thehighestrates inBrazilforHIVandHTLVmarkersare inthenortheastern region(0.66%and0.28%ofblooddonors,respectively). Over-all ineligibility inthis region is4.39%.Thecentral-western regionhasaprevalenceofHIVmarkersof0.26%,thelowest ratefoundinBrazil.Totalserologicalineligibilityinthisregion is2.76%.SoutheasternBrazilhasthelowestrateof serologi-calineligibility(2.68%),whereasthesouthernregionhasthe second-highestprevalenceofanti-HBcmarkers(1.94%).16

InthestudybySallesetal.21_{whoevaluatedblooddonors}

atthe Fundac¸ão Pro-Sangue, the blood bank in SãoPaulo, the prevalence of markers for syphilis was 1.1% between 1992and2001.Theauthorsusedtwosimultaneousteststo investigate syphilis infections [enzyme immunoassay(EIA) andvenerealdiseaseresearchlaboratory(VDRL)].Using dif-ferentscreeningalgorithms,Baião23_{identifieddifferentrates}

attheblood-bankingnetworkofSanta Catarina(HEMOSC). From January 2009 to July 2011, using VDRL for screening andELISAandFTA-ABSasconfirmatorytests,0.28%of pos-itiveresultswerefoundforsyphilis.BetweenJuly2011and

September 2012,0.68% ofpositiveresultswerereportedfor syphilisusingchemiluminescentmicroparticleimmunoassay (CMIA)toscreenandVDRLandFTA-ABStoconfirmpositive test results. Soussumi,24 _{usingnon-treponemal anti-bodies}

(Reaginas)toscreenforsyphilis,foundaprevalenceof1.3% amongfirst-timeblood donorsattendingthe bloodbankof RibeirãoPretobetween1996and2001.However,Rodrigues25

reported aprevalenceof0.61%forsyphilisinblooddonors ofthe bloodbank ofGoiásbetween2002and 2011usinga non-treponemaltest(VDRL).Inanotherstudy performedat the Fundac¸ãodeHematologiaeHemoterapiadoAmazonas (HEMOAM)between2000and2004,Ferreiraetal.26_alsoused

aVDRLtestandfoundaprevalenceof1.98%.

There issignificant variability inthe prevalenceofHCV amongblooddonors(rangingfrom0.34%to1.8%)reportedby Brazilianstudies.27–29_{Comparisonsbetweentheprevalenceof}

markersindifferentservicesandregionsshouldbecautious, astheycanvaryduetotheuseofdifferentserological tech-niquesaswellasbytheuse ornotofconfirmatorytests.28

TheprevalenceofHCVmarkersintheFundac¸ãoHemominas was0.15%,withthebloodbankatPoc¸osdeCaldashavingthe highestrate(0.24%)andthebloodbanksofDiamantinaand PatosdeMinashavingthelowestfrequencies.Accordingto theannualreportontheproductionofbloodcomponents pub-lishedin2013,16_{theprevalencesofHCVmarkersinthestates}

ofTocantins(0.09%)andSantaCatarina(0.14%)weresimilar totheratefoundbytheFundac¸ãoHemominas(0.15%).

oftheuseofnon-intravenousillicitdrugs.Thishighlightsthe importanceofmonitoringandrefining theprocessofblood donorselection.30

There were significant differencesin the prevalencesof anti-HBcmarkersbetweensomebloodbanks.Thebloodbank ofGovernadorValadareshadthehighestrateofanti-HBc pos-itivedonors(2.41%);theprevalencewassignificantlyhigher thantheothersixbloodbanks.ThebloodbankofSãoJoão DelReihadthelowestrateofpositiveresultsforthismarker (0.61%).Onehypothesisforthehighprevalenceofanti-HBcin themiddleregionoftheValedoRioDocemaybethe prox-imitytothestatesofBahiaandEspíritoSantothatreported positiveratesforanti-HBc of2.97%and 1.81%,respectively. Accordingtothe annual reportonthe productionofblood componentsfrom2013,16_{theprevalenceoftheHBs-Agmarker}

inBrazilrangedfrom0.07%inthestateofEspíritoSantoto 0.43%inthestateofParaíba.ThestateofSãoPaulohadthe lowestrate foranti-HBc (0.76%),whereas the highestrates werereportedinRondônia(4.38%)andAcre(4.33%).Despite evidence that immunization against hepatitis B virus can producean immune response, the anti-HBc marker is not consideredaneutralizingantibody,anditspresencedoesnot indicate recoveryfrom hepatitisBinfection.31 _{Even so,the}

exclusionofanti-HBc-positivedonorsisacontroversialissue asahighnumberofthesedonorsarenotallowedtodonate bloodand thereisevidenceoffalse-positiveresults.Inany case,itshouldbestressedthatdonorswhoarepositiveonly forthehepatitisBmarkeraredefinitelyconsideredineligible fordonation.28_{Ontheotherhand,anti-HBcisanimportant}

markertodetect occult hepatitisB,which ischaracterized bythepresenceofHBVDNAinthebloodserumof HBs-Ag-negativeindividuals.32

Inthiswork,theprevalenceofthemarkerofChagas dis-easeforresearchpurposeswas0.18%.Datafromtheannual report on the production of blood components in 201314

reportedthattheprevalenceofChagasdiseaseinBrazilranged from0.02%inthestateofEspíritoSantoto0.54%inthestate ofRiodeJaneiro.AccordingtoLacaz,33_{inthestateofMinas}

Gerais,whereChagasdisease wasdiscovered,the epidemic is high as the parasite has domestic habits, and is found in virtually all the state. However, there has been a great decreaseinthe occurrenceofnewcasesofChagas disease inrecentdecades.Thiswaspossiblythankstothe epidemio-logicalsurveillancepracticedincommunitiestocontrolvector transmission,alliedwiththeNationalProgramforChagas Dis-easeControlandruralsocioeconomicfactors.Infact,notonly wasaruralexodusobserved,butalsoimprovementinincome andhousingconditions,thesupplyofelectricity,andaccess toeducationandhealthcare.34_{However,theseimprovements}

were notassignificantinthe northernsemi-arid regionof thestate ofMinasGerais,wherethe socioeconomic condi-tionsofthelocalpopulationarestillprecariousandworrying, mainlyintheruralzone,thusitisconsideredoneofthe poo-restregionsofBrazil.Theseconditionsmayaccountforthe re-emergenceofChagasdiseaseinthisregion,asitsspatial distributioniscoincidentwiththatofotherpoorpopulations asthediseaseisdirectlyrelatedtosocioeconomicconditions. TheprevalenceofHIVmarkersforresearchpurposeswas 0.052%inthisstudy.From2003to2013,thedistributionof inel-igibleblooddonorswhowerepositiveforHIV(types1and2)

inthefiveregionsofBrazilwere0.02%and10.14%inRibeirão Preto35_{andBelém,respectively.}36_{TheprevalenceofHIV}

mark-ersforresearchpurposeswas0.36%inBrazil,rangingfrom 0.18%inthestateofPiauíto1.32%inthestateofParaíba.16

Conclusion

The constant assessment of epidemiological data is of paramountimportanceforthecontrolandevaluationofboth blood donorrecruitment strategiesand public health poli-cies as a whole. It is fundamental to implement policies thatuseinformationasmanagementtoolstoplan interven-tionprojectsandfollow-upactionsintheareaoftransfusion medicine,particularlyfortherecruitmentofblooddonors.The presentationofdataonserologicalineligibilityfoundinthe bloodbanksofthestateofMinasGeraisshowsusthe peculiar-itiesofeachregion,thuscontributingtohealthsurveillance measuresandassistingtotheblood-bankingnetworkandits donorselectionproceduresaimingatimprovingtransfusion safety.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

Acknowledgments

This work was supported by FAEPA (process number 1449/2014)andConselhoNacionaldeDesenvolvimento Cien-tíficoeTecnológico(CNPq,Processnumber307767/2015-9).

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