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In the 1950's, the American Carleton Gajdusek (1923-2008) was able to find the cause for kuru, a systematically fatal neurological disease, observed mainly on the Western Highlands of New Guinea. While living for a long period with the local indigenous population and studying their customs, he evidenced the infectious origin of this pathology and its transmission mechanism, cannibalism. He also demonstrated the transmissible nature of the agent of Creutzfeldt-Jakob. His works opened an important prospective field of research in neuroscience. A Nobel prize rewarded this outstanding scientific and human adventure.

Little is known about the natural history of Hepatitis E virus (HEV) infection in immunocompetent individuals. The prevalence, the course of infection and the occurrence of transmission by transfusion were investigated in multitransfused immunocompetent patients/blood donor pairs included in a longitudinal sample repository collection and followed up between 1988 and 2010. Ninety-eight subjects aged 6-89 years and suffering from acquired haemoglobinopathies were tested for HEV markers (IgM, IgG and RNA) in serial samples collected every 2 or 3 years. Eighteen patients (18.4%) were positive for HEV-IgG at baseline with a prevalence increasing from 12.5% below 26 years to 32% above 56 years. Nine patients remained IgG positive along the study and nine lost their antibodies after a mean follow-up of 7.4 years (1-22 years). One seropositive patient showed an increase of IgG level and RNA-HEV reappearance 1 year after inclusion, suggesting a reinfection and one seroconversion, probably acquired through blood transfusion was observed. This first longitudinal study including immunocompetent individuals confirms that HEV infection is common in Western Europe and that transfusion transmission occurs probably less frequently than expected. In addition, seroreversion and reinfection seem to be common. This suggests that the anti-HEV may not persist overtime naturally. However, repeat exposure to the virus related to the high prevalence of HEV infection may result in a sustainable specific IgG response.

Anecdotes, such as found in the media and chiefly the humor journals and magazines aim at bringing revisited insights on society subjects, which can even be the most serious. Anecdotes reported here on blood transfusion and the transfusion environment, that were retrieved from French news released in the media press between the 1950s to 1980s give a view on what has been achieved since then, but also on what is at a standstill by some incapability in moving forward or in changing minds. Those anecdotes would be used to stimulate or refresh debates in transfusion related-ethics.

From blood donor collection to transfusion of the recipient, there are several layers of protection of the blood supply. These measures combined with huge progresses over the three past decades in pathogen discovery and blood testing for specific pathogens (human immunodeficiency virus (HIV), hepatitis B (HBV) and C (HCV) viruses, Human T-cell leukemia virus (HTLV)), provide the greatest safety. With the implementation of serological and molecular testing, at least in high-income countries, transfusion-transmitted infections have become extremely rare. However, for pathogen agents, which are not tested and especially those which are responsible for emerging infectious disease, it became apparent that full control of infectious disease had not been achieved. In addition, the immune status of the recipient has also an impact in the outcome of infectious diseases transmitted by transfusion. Blood safety is based on several measures: education and deferral of donors with risk factors for transmissible disease, blood testing, pathogen reduction interventions, and patient blood management. This paper proposes a review of the residual risk of transmission of infectious diseases by transfusion and of the additional interventions able to further reduce it.

The French pioneer for blood transfusion, who eventually organized the very early blood transfusion centers worldwide, went to imagine a scenario written in purpose for Charlie Chaplin, the unique character of "The Tramp" ("Charlot" in French). The movie Star was offered to feature a blood donation propagandist, and no longer the perpetual, well-known, "loser". This anecdote, besides being amusing, tells a lot on how Arnault Tzank encompassed all the difficulties in collecting blood enough to meet the demand, at all times; his proposal turns out to be extremely modern and questions nowadays marketing for blood donation.

Rapid diagnostic tests (RDTs) are routinely used in African blood centres. We analysed data from two cross-sectional studies representing 95 blood centres in 29 African countries. Standardized panels of sera containing varying concentrations of anti-human immunodeficiency virus (HIV) antibodies (Ab), hepatitis B virus antigen (HBsAg) and antihepatitis C virus (HCV) Ab were screened using routine operational testing procedures at the centres. Sensitivity of detection using RDTs was high for HIV Ab-positive samples, but low for intermediately HBsAg (51·5%) and HCV Ab (40·6%)-positive samples. These findings suggest that current RDT use in Africa could pose a hazard to blood safety.

The current issues debate brings together experts around the themes of self-sufficiency (in its national and European aspects) and of needs in cellular blood products. The point of view of the manufacturer and prescribers of blood products are confronted.

La transfusion sanguine a, au cours des dernieres annees, considerablement renforce sa dimension securitaire, releguant parfois au second plan sa reflexion ethique et sur les valeurs liees au don du sang lui-meme. Cette revue a pour but d’illustrer certains de ces aspects, pour une meilleure comprehension de leurs consequences sur un plan pratique.

There has been little blood safety research in sub-Saharan Africa, often consisting of local efforts whose findings had limited impact The "Francophone Africa Transfusion Research Network" was created in May 2007 with the objective of developing common evidence-based blood safety policies that may be adapted to each country's situation. The Group's activities to date have focused mainly on obtaining epidemiological and laboratory data on blood transfusion and on suggesting blood safety strategies, particularly in the field of TTIs. To carry out such research activities, the group works closely with the National Blood Transfusion Services (NBTS), the Regional Blood Transfusion Services (RBTS), the hospital blood banks (HBB) and collection stations. For the first 5years, four research priorities were identified: (i) descriptive studies of the characteristics of francophone African blood donors and blood centers; (ii) estimation of the residual risk of transfusion-transmitted major viral infections; (iii) an analysis of blood donor deferral strategies; and (iv) a description of TTI screening strategies and an external quality assurance system (EQAS) project. During this period, seven projects have been implemented at the national level and published and five multicenter studies were conducted and published. The present review reports the main observations and recommendations from those studies that could improve blood safety statute in Africa.

Blood donation is an act of solidarity. Most often, this act is done on a volunteer basis and, depending on countries and circumstances, is not remunerated. The increase in need, the always-greater number of deferral criteria, the safety issues and the changes in the structures of our societies are among the many subjects for ethical debates. Taking these into account, the actors of the transfusion must analyze certain parameters: the value of a donation, the meaning of volunteering, the appropriateness of remunerating the act of giving a part of one's self, no longer as a donation or an expression of altruism and solidarity, but as a commercial act regimented by economic laws.

Arnault Tzanck was at the origins of French transfusion and the founder of the first blood centre worldwide. This article retraces his career and personal itinerary and that path which led him to give his build the country's first organized and modern blood transfusion structure.

Les recherches de Jean Dausset ont ete fondamentales dans l’identification des systemes d’histocompatibilite, dont la decouverte a permis l’essor des greffes d’organes et de tissus en permettant des appariements compatibles entre donneurs et receveurs. Un prix Nobel a recompense ses travaux en 1980.

The current issues debate will bring together experts around the themes of self-sufficiency (in its national and European aspects) and of needs in cellular blood products. The point of view of the manufacturer and prescribers of blood products will be confronted.

Il est un champ culturel dans lequel la representation de la transfusion sanguine et du don de sang n’a jamais ete etudiee, c’est la bande dessinee – art relativement recent puisqu’il est seulement apparu au XIX e siecle, avant de devenir un media de masse au cours du siecle suivant. Nous avons recherche, en faisant appel a des collectionneurs et en recourant aux ressources d’Internet, les bandes dessinees consacrees, tout ou partie, aux themes de la transfusion et du don de sang. Nous presentons ici certains de ces albums en indiquant le titre, le pays d’origine, l’annee de publication et le nom des auteurs. Le theme du super-heros utilisant la transfusion pour transmettre ses vertus ou ses pouvoirs revient dans les premieres bandes dessinees nord-americaines. Plus recemment, la bande dessinee a ete mise a profit dans un but promotionnel : elle transmet des images positives a l’intention d’un lectorat jeune et recourt a l’humour contre la peur de la prise de sang. D’autres volumes denoncent les mefaits de la commercialisation des produits issus du corps humain. L’image de la transfusion et du don de sang refletee par les bandes dessinees n’est pas a sous-estimer, car leur lectorat a longtemps ete les enfants, dont bon nombre, a l’âge adulte, constitueront la population des donneurs de sang potentiels. Par ailleurs, si certains anciens lecteurs de bandes dessinees sont transfuses un jour, le souvenir plus ou moins conscient de ces lectures d’enfance peut refaire surface, a la fois en termes d’espoirs et de craintes.

S. Panzer, S. Engelbrecht, M. F. Cole-Sinclair, E. M. Wood, S. Wendel, S. Biagini, Z. Zhu, J.-J. Lefrere, G. Andreu, T. Zunino, J.-J. Cabaud, P. Rouger, O. Garraud, K. Janetzko, M. Muller-Steinhardt, P. van der Burg, A. Brand, P. Agarwal, T. Triyono, A. Gharehbaghian, N. Manny, O. Zelig, A. Takeshita, Y. Yonemura, H. Fujihara, K. E. Nollet, H. Ohto, K.-S. Han, V. S. Nadarajan, G. Berlin, S. G. Sandler, R. G. Strauss & H. W. Reesink

International audience; Background. Characterisation of human-associated viral communities is essential for epidemiological surveillance and to be able to anticipate new potential threats for blood transfusion safety. In high-resource countries, the risk of blood-borne agent transmission of well-known viruses (HBV, HCV, HIV and HTLV) is currently considered to be under control. However, other unknown or unsuspected viruses may be transmitted to recipients by blood-derived products. To investigate this, the virome of plasma from individuals at high risk for parenterally and sexually transmitted infections was analysed by high throughput sequencing (HTS). Materials and methods. Purified nucleic acids from two pools of 50 samples from recipients of multiple transfusions, and three pools containing seven plasma samples from either HBV-, HCV- or HIV-infected blood donors, were submitted to HTS. Results. Sequences from resident anelloviruses and HPgV were evidenced in all pools. HBV and HCV sequences were detected in pools containing 3.8x10(3) IU/mL of HBV-DNA and 1.7x10(5) IU/mL of HCV-RNA, respectively, whereas no HIV sequence was found in a pool of 150 copies/mL of HIV-RNA. This suggests a lack of sensitivity in HTS performance in detecting low levels of virus. In addition, this study identified other issues, including laboratory contaminants and the uncertainty of taxonomic assignment of short sequence. No sequence suggestive of a new viral species was identified. Discussion. This study did not identify any new blood-borne virus in high-risk individuals. However, rare and/or viruses present at very low titre could have escaped our protocol. Our results demonstrate the positive contribution of HTS in the detection of viral sequences in blood donations.

Originally pasted on walls and on locations reserved specially for that purpose, the poster is a medium for advertising and promotion to be seen on the streets and in public places. More recently, it has spread, in a smaller format, on dedicated indoor sites: billboards, columns, street furniture, and so forth. For transfusion, it appeared early on that the poster constitutes an important medium to promote blood donation. Thousands of posters supporting regional, national, or international blood donation campaigns have been created all over the planet, with a great variability of images, symbols, and slogans, which are particularly revealing about the image and the reality of blood donation. The topic is rich in information, particularly sociologic, on the variety of ways in which transfusion organizations promote blood donation. The authors present in this article the results of a study based on a total of 283 posters from nations on every continent, divided into 24 different themes.

INTRODUCTION: The World Health Organization (WHO) recommends the creation of national blood transfusion services. Burkina Faso has a CNTS (Centre National de Transfusion Sanguine—National Blood Transfusion Center) but it currently covers only 53% of the national blood supply versus 47% produced by independent hospital blood banks. STUDY DESIGN: To evaluate blood collection, testing, preparation, and prescription practices in the regions of Burkina Faso that are not covered by the CNTS, a cross-sectional survey was conducted. METHODS: Data were collected by trained professionals from May to June 2009 at 42 autonomous blood centers not covered by the CNTS. RESULTS: Blood collection was supervised in all sites by laboratory technicians without specific training. There was no marketing of community blood donation nor mobile collection. Donation was restricted to replacement (family) donors in 21.4% of sites. Predonation screening of donors was performed in 63.4% of sites, but some did not use written questionnaires. Testing for HIV, hepatitis B virus, and syphilis was universal, although some sites did not screen for hepatitis C virus. In 83.3% of the sites, blood typing was performed without reverse ABO typing. In 97.6% of the sites, nurses acted alone or in conjunction with a physician to order blood transfusions. CONCLUSION: Shortcomings in non-CNTS blood centers argue for the development of a truly national CNTS. Such a national center should coordinate and supervise all blood transfusion activities, and is the essential first step for improving and institutionalizing blood transfusion safety and efficacy in a developing country.

Le risque transfusionnel infectieux a ete considerablement reduit, notamment vis-a-vis des trois virus majeurs (virus de l’immunodeficience humaine, virus des hepatites B et C), par la mise en place de mesures specifiques preventives, de sorte que d’autres complications transfusionnelles, notamment les accidents immunologiques, ont aujourd’hui pris le pas, en termes de frequence et de danger, sur les complications infectieuses classiques. Le risque infectieux des produits sanguins labiles n’est cependant pas totalement maitrise en raison de la possibilite d’une contamination bacterienne et de l’emergence ou de la reemergence d’agents viraux. Des techniques de reduction des pathogenes, efficaces sur l’ensemble des agents infectieux (sauf les prions), seront probablement, dans les prochaines annees, applicables sur la totalite des produits sanguins labiles.

Ces debats d’actualite transfusionnelle portent sur les themes suivants : quelle est la place de la transfusion dans les anemies hemolytiques severes ? Faut-il avoir peur du plasma viro-attenue au bleu de methylene ? Les risques transfusionnels infectieux : mythe ou realite ? Compatibilite ABO et transfusion de plaquettes : comment conserver les plaquettes ? Incompatibilite ABO, hemolyse aigue et transfusion dans la greffe hematopoietique.

BACKGROUND: Improving blood safety without introducing nucleic acid testing in blood screening may be possible using antigen/antibody (Ag/Ab) combination assays, especially in resource-poor countries. STUDY DESIGN AND METHODS: To evaluate the potential reduction of human immunodeficiency virus (HIV)-transmitted infection using such an assay, a study was carried out aimed to compare the routine strategy for blood screening (S1), combining a rapid test (Determine HIV-1/-2, Inverness) and an enzyme immunoassay (human HIV-1/-2, Human Diagnostic) with an HIV Ag/Ab assay (S2, Genscreen ULTRA HIV Ag-Ab, Bio-Rad) in 2000 blood donations tested in Cameroon. Western blot and HIV RNA polymerase chain reaction were used to confirm the infection in reactive donors, and genotype was determined in HIV RNA-positive samples. RESULTS: Of the 2000 donors, 3.1% were positive with S1 and 4.3% with S2. Of the 97 samples positive with S1 and/or S2 tested for confirmation, 54.7% were positive, 38.1% indeterminate, and 7.2% negative. There were significant differences between S1 and S2 in terms of sensitivity (S1, 79.2%; S2, 100%), irrespective of the genotype, and in specificity (S1, 99.0; S2, 98.3%). The most frequent genotype (49%) was CRF02_AG. CONCLUSIONS: A testing strategy using Genscreen ULTRA HIV Ag/Ab could prevent 55 HIV transmissions per 10,000 donations. However, this would be at a cost of discarding 170 per 10,000 negative donations that would test false positive, showing that the implementation of new techniques in blood screening need an optimization before routine use. Using confirmatory assays, HIV Ab prevalence in blood donors in Cameroon was estimated at 2.65%.

Before frequency and age limits were established for blood donations, certain individuals were exceptional in the frequency and the number of blood donations over their life. We call them "superdonors" and describe their common characteristics through some examples. The physiologic characteristics allowing these individuals to give blood several hundred times without developing an anemia are unknown.

Since its discovery, human parvovirus B19 (B19V), now termed erythrovirus, has been associated with many clinical situations (neurological and myocardium infections, persistent B19V DNAemia) in addition to the prototype clinical manifestations, i.e., erythema infectiosum and erythroblastopenia crisis. In 2002, the use of new molecular tools led to the characterization of three different genotypes of human B19 erythrovirus. Although the genomic organization is conserved, the geographic distribution of the different genotypes varies worldwide, and the nucleotidic divergences can impact the molecular diagnosis of B19 virus infection. The cell cycle of the virus remains partially unresolved; however, recent studies have shed light on the mechanism of cell entry and the interactions of B19V proteins with apoptosis pathways.

BACKGROUND: Sub-Saharan Africa remains the epicenter of the human immunodeficiency virus (HIV) pandemic. However there is a lack of multicenter data on the risk of transfusion-transmitted HIV from blood centers in sub-Saharan Africa. STUDY DESIGN AND METHODS: The incidence of HIV infections in the blood donations collected in the main blood banks of five countries (Burkina Faso Congo Ivory Coast Mali and Senegal) was determined to estimate the current transfusion risk of HIV infection using the incidence rate/window period model. RESULTS: The risk of transfusion-transmitted HIV infections associated with the window period varied from 1 in 90200 donations (Senegal) to 1 in 25600 (Congo). Considering the five participating blood centers as a whole the incidence rate of HIV-positive donors per 100000 person-years was 56.6 (95% confidence interval [CI] 47.1-67.9); the residual risk (RR) was 34.1 (95% CI 7.8-70.7) per 1 million donations which represents 1 in 29000 donations (95% CI 1/128000-1/14000). CONCLUSION: RR estimates varied according to the country. This is potentially due to a lower incidence of HIV infection in the general population or to a more efficient selection of blood donors in the countries with the lowest risk. The estimates of the transfusion risk of HIV infection in each country are important both to assess the impact of current preventative strategies and to contribute data to policy decisions to reinforce transfusion safety.

Before the advent of electronic means of communication, postal stamps were one of the main international promotion tools on the planet and still remains an important support for the wide diffusion of a message. Since 1942, the promotion of blood donation has been one of them. To highlight these recurring or specific characteristics, the authors gathered and studied a large part of the stamps produced in the world on the theme of transfusion and blood donation. They analyzed and compared the characteristics of 189 stamps issued from 87 states: country of emission, year (when given), face value, slogans, expressions or wording, possible surtaxes, dominant colors, the notion of series, the themes of the illustrations, the symbols, the type of message, the national specificities, or the international characteristics. Along with national peculiarities, to certain traditions of representation, and a big variability of illustrations, symbols, and slogans, this set of postage stamps wears above all a clear, strong, and unique message: human solidarity through blood donation.

Ces debats d’actualite transfusionnelle portent sur les themes suivants : les banques de sang placentaire ; la prevention de l’allo-immmunisation anti-RH1 (anti-D) apres transfusion de concentres de plaquettes RH1 incompatibles ; la recherche dans les etablissements de transfusion ; l’apport de la biologie moleculaire en immuno-hematologie ; les echanges d’information entre les etablissements de transfusion et les etablissements de soins.

A la fin des annees 1950, l’Irlandais Denis Burkitt parcourut l’Afrique pour elucider l’epidemiologie et la genese de ces tumeurs de la face auxquelles son patronyme a ete associe sous le nom de « lymphome de Burkitt ». L’article retrace l’histoire de cette aventure medicale et scientifique, qui aboutit, grâce a ce medecin Irlandais, a la decouverte, par Anthony Epstein et Yvonne Barr du virus responsable de la tumeur. Malgre les faibles moyens therapeutiques dont il disposait en terre Africaine, Burkitt parvint a obtenir les premieres guerisons de cette pathologie jusque-la mortelle.

Background and Objectives Autologous transplantation of either bone marrow (BM) or peripheral blood (PB) mononuclear cells (MNC) induces therapeutic angiogenesis in patients with peripheral arterial occlusive disease. Yet, the precise nature of the cellular product obtained from BM or PB and used in these therapeutic strategies remains unclear. Materials and Methods We have analysed the characteristics of BM-MNC and PB-MNC collected without mobilization and implanted in patients with critical limb ischaemia in a clinical trial of cellular therapy including 16 individuals treated by BM-MNC and eight by PB-MNC. These MNCs were characterized by cell counts, viability assessment and enumeration of leucocyte subsets, CD34 stem and endothelial progenitor cells (EPCs) (CD34+/CD133+/VEGF-R2+) by flow cytometry. Mean fluorescence intensity ratios were determined for CD34, CD133 and VEGF-R2 markers. All analyses were simultaneously performed in two laboratories. Results Accuracy and reliability between both laboratories were achieved. BM-MNCs and PB-MNCs were quantitatively and qualitatively heterogeneous and quite different from each other. Stem cells and EPCs were significantly more present in BM- compared to PB-cell products, but with similar mean fluorescence intensity ratios. A weakly positive correlation was observed between CD34+ cell counts and EPCs levels, confirming the specificity of cell identification. Conclusion A great variability was observed in cell product characteristics according to their origin and also between individuals. These data stress the necessity of optimal characterization of cell products especially in multicentric clinical trials.

Ces debats d’actualite transfusionnelle portent sur les themes suivants : les indications de l’irradiation des produits sanguins labiles ; le phenotypage des concentres erythrocytaires dans les myelodysplasies ; les indications actuelles du plasma frais congele ; la transfusion de granulocytes ; les exigences transfusionnelles dans la prise en charge therapeutique des hemopathies malignes et dans les greffes de moelle ; l’attente des cliniciens sur les produits sanguins viro-attenues ; les plasmas therapeutiques a utiliser dans le traitement des microangiopathies thrombotiques (MAT) ; l’experience d’un an de dosage d’hemoglobine predon ; le site de realisation des examens d’immunohematologie ; et les axes de recherche a developper en transfusion.

BACKGROUND: In the 20th century, blood transfusion has become an indispensable therapy in carrying out and improving many medical and surgical applications. Its scope of influence goes well beyond that of medicine, because blood donation, an action with high social significance, is completely connected to progress in the field. STUDY DESIGN AND METHODS: The purpose of this research was to study, through films that show transfusion or blood donation, the impression that has been given to the public in the course of the 20th century and its sociologic impact. To accomplish this, we have used various sources from Histories of Cinema and from the Internet to identify films from different countries and from different epochs that touch on this theme. RESULTS: With these two components, the act of donation and the act of transfusion, the relatively short history of blood transfusion is distinguished by upheavals in both the medical and the sociopolitical fields of the past century. Movies, the most commonly shared cultural event and mirror of society, have simultaneously gone through their first century by showing the diversity of our feelings and the human condition. CONCLUSION: Through various cinematographic references, the authors offer an analysis of the use, by the Seventh Art, of values and illustrations that use blood donation and transfusion.

Since the publication of observations of variant Creutzfeld-Jacob disease (vCJD) having occurred in the UK due to transfusion of infected packed red cells, the risk of vCJD transmission by blood transfusion is established. In France, no such case has yet been reported, but among the French vCJD cases observed, three individuals, having entered the disease in 2004, are past blood donors. Thus, some individuals transfused in their past are at risk of developing a vCJD. The lack of available assay prevents the diagnosis of the infection in these recipients and the implementation of a specific screening of blood donations. In the UK and in France, several measures to ensure transfusion safety have been applied to reduce the risk of contamination by the variant.

Platelet concentrates account for near 10% of all labile blood components but are responsible for more than 25% of the reported adverse events. Besides factors related to patients themselves, who may be particularly at risk of side effects because of their underlying illness, there are aspects of platelet collection and storage that predispose to adverse events. Platelets for transfusion are strongly activated by collection through disposal equipment, which can stress the cells, and by preservation at 22 °C with rotation or rocking, which likewise leads to platelet activation, perhaps more so than storage at 4 °C. Lastly, platelets constitutively possess a very large number of bioactive components that may elicit pro-inflammatory reactions when infused into a patient. This review aims to describe approaches that may be crucial to minimising side effects while optimising safety and quality. We suggest that platelet transfusion is complex, in part because of the complexity of the “material” itself: platelets are highly versatile cells and the transfusion process adds a myriad of variables that present many challenges for preserving basal platelet function and preventing dysfunctional activation of the platelets. The review also presents information showing - after years of exhaustive haemovigilance - that whole blood buffy coat pooled platelet components are extremely safe compared to the gold standard (i.e. apheresis platelet components), both in terms of acquired infections and of immunological/inflammatory hazards.