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Pasteurized blood samples for transfusion compatibility testing during the coronavirus disease 2019 outbreak

Published online by Cambridge University Press:  16 April 2020

Run Yao ,
Yamei Shen ,
Ying Tan ,
Pengcheng Zhou ,
Bijuan Li ,
Xuegong Fan  and
Ning Li
Run Yao
Affiliation:
Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, 410007, Hunan, China
Yamei Shen
Affiliation:
Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, 410007, Hunan, China
Ying Tan
Affiliation:
Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, 410007, Hunan, China
Pengcheng Zhou
Affiliation:
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China
Bijuan Li
Affiliation:
Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, 410007, Hunan, China
Xuegong Fan
Affiliation:
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China Key Laboratory of Viral Hepatitis, Hunan Province, Changsha, China
Ning Li*
Affiliation:
Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, 410007, Hunan, China
*
Author for correspondence: Li Ning, E-mail: liningxy@csu.edu.cn
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Abstract

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Type
Letter to the Editor
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 9 , September 2020 , pp. 1112 - 1114
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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

To the Editor—In December 2019, a novel coronavirus pneumonia (COVID-19) was reported in Wuhan, China. As of April 2, 2020, 82,774 confirmed cases had been reported in China and 874,995 confirmed cases had been reported in other countries. No vaccine or antiviral therapeutics are yet available to prevent or treat COVID-19.Reference She, Jiang and Ye1 Preventing infection is the current priority for disease control.

The SARS-CoV-2 virus is transmitted from person to person through droplets or direct contact.Reference Chan, Yuan and Kok2 However, non-respiratory samples are also potential sources of COVID-19 infection.Reference Judson and Munster3 Virus-laden aerosols generated from blood-sample centrifugation pose risks for laboratory staff and broader nosocomial transmission.Reference Judson and Munster3,Reference Ong, Tan and Chia4 Traditional precautionary measures for infectious-sample processing include tertiary protection and operating in the biological safety cabinet. Preventive resources have been limited during this multiregional outbreak, posing huge risks to laboratory staff. Therefore, effective methods to ensure the safety of laboratory staff in low-resource settings are needed.

Pasteurization at 56°C for 30 minutes has been recommended to inactivate coronavirus, which might decrease the infectivity of samples and aerosols. To reduce infections and ensure safe and effective transfusion, we investigated the effects of pasteurization on transfusion compatibility testing.

Methods

Blood samples were collected from Xiangya Hospital, Central South University. Each sample was divided into 2 groups, an experimental group and a control group. Experimental samples were treated by pasteurization. The results of blood-group typing, irregular antibody screening, and cross-matching were compared between these 2 groups. Finally, samples of suspected SARS-CoV-2 were treated with pasteurization. Treated samples were used to test transfusion compatibility. Patients with suspected COVID-19 then received red blood cell (RBC) transfusion, and the effectiveness and safety of these transfusion were evaluated.

Results

The agglutination intensities of A, B antigens and anti-A, anti-B antibodies of the samples in the 2 groups were 4+. The forward and reverse types were consistent in the ABO blood group. In the Rh blood group, the agglutination intensity of D antigen was reduced from 4+ to between 2+ and 3+ after heat treatment (Fig. 1). Regarding the effect of heat treatment on irregular antibody screening, our results showed that the response pattern of panel cells remained unchanged after heat treatment when the agglutination intensity was negative(-), uncertain(±) or zero, and 1+, 2+, or 3+, respectively. However, the agglutination intensities of samples rating 4+ were reduced to 3+ after heat treatment (Fig. 2). Finally, no effect of heat treatment on the primary cross-matching was observed.

Fig. 1.

The results of blood group typing.

Fig. 2.

The results of irregular antibodies screening. I, II, III represent panel cells no. 1, no. 2, and no. 3, respectively (Shanghai Blood Biomedical, Shanghai, China).

Our results indicated that heat treatment did not affect the results of transfusion compatibility testing. The RBC transfusion in patients were safe and effective based on elevated 24-hour hemoglobin results or improved symptoms, with no hemolytic reactions or other adverse transfusion reactions.Reference Carson, Grossman and Kleinman5

Discussion

We have demonstrated that pasteurization did not affect the results of transfusion compatibility testing and that blood transfusion based on this improved testing were safe and effective. Because the heat-inactivation method was simple, efficacious, and cost-effective, it could be employed for the protection of laboratory staff, especially in resource-poor regions during the COVID-19 pandemic.

Since virus activity testing was not available in our laboratory, we were unable to determine whether the virus can still be contagious after thermal inactivation. Reports indicated that SARS-CoV-2 was sensitive to heat and thermal inactivation could efficiently eliminate the coronavirus infectivity.Reference Rabenau, Cinatl and Morgenstern6 Heat treatment causes RBCs to rupture and form RBC fragments, which may have affected the detection results. Especially in gel microcolumns, false-positive results are likely. Therefore, the classic test-tube method should be used to instead of blood-type cards to perform blood-group typing of the heat-treated samples. However, irregular antibody screening and cross-matching could be performed using the anti–human-globulin card method.

In conclusion, during the COVID-19 pandemic, pasteurization can be used to test transfusion compatibility, to protect laboratory staff from infected samples, and to ensure safe and effective transfusion. Moreover, pasteurization is convenient and quick and suitable for use in hospitals.

Acknowledgments

None.

Financial support

This study was supported by the National Natural Science Foundation of China (grant no. 81873574) and by the Emergency Special Science and Technology Plan Project of COVID-19 Epidemic of Changsha City (grant no. 37935).

Conflicts of interest

All authors report no conflicts of interest relevant to this article.

References

She, J, Jiang, J, Ye, L, et al.2019 novel coronavirus of pneumonia in Wuhan, China: emerging attack and management strategies. Clin Transl Med 2020;9:19.CrossRefGoogle ScholarPubMed
Chan, JF, Yuan, S, Kok, KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020. doi: 10.1016/S0140-6736(20)30154-9.CrossRefGoogle Scholar
Judson, SD, Munster, VJ. Nosocomial transmission of emerging viruses via aerosol-generating medical procedures. Viruses 2019;11(10): pii: E940.10.3390/v11100940CrossRefGoogle ScholarPubMed
Ong, SWX, Tan, YK, Chia, PY, et al. Air, Surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA 2020. doi: 10.1001/jama.2020.3227.CrossRefGoogle Scholar
Carson, JL, Grossman, BJ, Kleinman, S, et al.Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med 2012;157:49–58.CrossRefGoogle ScholarPubMed
Rabenau, HF, Cinatl, J, Morgenstern, B, et al.Stability and inactivation of SARS coronavirus. Med Microbiol Immunol 2005;194(1–2):1–6.10.1007/s00430-004-0219-0CrossRefGoogle ScholarPubMed
Figure 0

Fig. 1. The results of blood group typing.

Figure 1

Fig. 2. The results of irregular antibodies screening. I, II, III represent panel cells no. 1, no. 2, and no. 3, respectively (Shanghai Blood Biomedical, Shanghai, China).