Evaluation of syphilis screening results in donors applying to a transfusion center of a tertiary hospital

Öz

Aim: In blood banking, the significance of diagnosing syphilis, a condition caused by Treponema pallidum, cannot be overstated. It necessitates the adoption of the most appropriate algorithm for catching possible cases among donors, thereby minimizing donor loss. The World Health Organization in 2003, and the European Centre for Disease Prevention and Control in 2010, advised starting syphilis screenings with Treponemal tests. This study aimed to investigate the outcomes of confirmatory tests conducted on blood donor candidates with reactive Enzyme-Linked Immunosorbent Assay (ELISA) test results in syphilis screening. Material and Methods: In this retrospective study, 69,127 donors who applied as blood donors to the blood bank of Ankara Gülhane Training and Research Hospital between 2014 and 2021 were examined. Specimens from donor candidates who tested reactive in the syphilis screening test were dispatched to the Microbiology Reference Laboratory of the Turkey Public Health Institution for verification tests. The Fluorescent Treponemal Antibody Absorption (FTA-ABS) or Treponema Pallidum Hemagglutination Assay (TPHA) tests were utilized as the verification tests. Results: Reactive test results were obtained repeatedly in 128 donors (0.18%). As a confirmatory test, TPHA was administered to 32 donors, resulting in 11 positive outcomes (34.3%) (False positivity ratio = 65.7%). FTA-ABS was performed as a verification test on 96 donors, with 59 (61.4%) testing positive (False positivity ratio = 38.6%). Out of 48 donors with an ELISA signal-to- cutoff ratio above five, the FTA-ABS test was conducted on 42, yielding 41 positive and one negative result. Conclusion: The transmission of Treponema pallidum through blood transfusion is a significant adverse event, so the most suitable tests should be used for the screening of blood donors. This study suggests that using FTA-ABS as a confirmatory test for ELISA-reactive donors improves syphilis detection accuracy.

Anahtar Kelimeler

• Blood donor screening
• confirmatory tests
• syphilis
• Treponema pallidum

Proje Numarası

2023-213

Etik Beyan

The study was performed in accordance with the Declaration of Helsinki, and was approved by the Ankara Gülhane Training and Research Hospital Ethics Committee (Date: 16.05.2023, Decision No: 2023-213).

Üçüncü Basamak Bir Hastanenin Transfüzyon Merkezine Başvuran Donörlerde Sifiliz Tarama Sonuçlarının Değerlendirilmesi

Öz

Amaç: Kan bankacılığında Treponema pallidum'un neden olduğu sifiliz tanısı halk sağlığı açısından önemlidir. Donörler arasındaki olası vakaların yakalanması ve böylece donör kaybının en aza indirilmesi için en uygun algoritmanın benimsenmesi gerekmektedir. 2003 yılında Dünya Sağlık Örgütü ve 2010 yılında Avrupa Hastalık Önleme ve Kontrol Merkezi, sifiliz taramalarına Treponemal testlerle başlanmasını tavsiye etti. Bu çalışmada, kan bağışçısı adaylarında sifiliz taramasında reaktif Enzime Bağlı İmmünosorbent Test (ELISA) sonuçları ile yapılan doğrulayıcı testlerin sonuçlarının araştırılması amaçlandı. Gereç ve Yöntemler: Retrospektif olarak yapılan bu çalışmada, 2014-2021 yılları arasında Ankara Gülhane Eğitim ve Araştırma Hastanesinin kan bankasına kan bağışçısı olarak başvuran 69.127 bağışçı incelendi. Sifiliz tarama testinde reaktif çıkan donör adaylarından alınan örnekler, doğrulama testleri için Türkiye Halk Sağlığı Kurumu Mikrobiyoloji Referans Laboratuvarı'na gönderildi. Doğrulama testleri olarak Floresan Treponemal Antikor Emilimi (FTA-ABS) veya Treponema Pallidum Hemaglütinasyon Testi (TPHA) testleri kullanıldı. Bulgular: 128 donörde (%0,18) tekrar tekrar reaktif test sonuçları elde edildi. Doğrulayıcı bir test olarak 32 donöre TPHA uygulandı ve 11 pozitif sonuç (%34,3) elde edildi (Yanlış pozitiflik oranı = %65,7). FTA-ABS, doğrulama testi olarak 96 donörde yapıldı ve 59'unun (%61,4) testi pozitif çıktı (Yanlış pozitiflik oranı = %38,6). ELISA sinyal-kesme oranı beşin üzerinde olan 48 donörden 42'sinde FTA-ABS testi yapıldı ve 41 pozitif ve bir negatif sonuç elde edildi. Sonuçlar: Kan transfüzyonu ile ilişkili Treponema pallidum bulaşması önemli bir istenmeyen olay olduğundan, kan donörlerinin taranması için en uygun testlerin kullanılması gerekmektedir. Bu çalışma, FTA-ABS'nin ELISA-reaktif donörler için doğrulayıcı bir test olarak kullanılmasının, sifiliz tespit doğrulanmasını arttırdığını göstermektedir.

Anahtar Kelimeler

• Kan donör taraması
• doğrulama testleri
• sifiliz
• Treponema pallidum

Proje Numarası

2023-213

Kaynakça

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