Vandewalle G, Baeten M, Bogaerts K, Vandekerckhove P, Compernolle V
Belgian Red Cross Flanders Blood Service, Mechelen, Belgium.
Vox Sang. 2014 May;106(4):354-60. doi: 10.1111/vox.12115. Epub 2013 Nov 30.
The effectiveness of the confidential unit exclusion (CUE) as a safety measure to the blood supply is debated. We therefore investigated the usefulness of CUE in our donor population.
Data of CUE use, donor deferrals due to different degrees of sexual or blood exposure and data of confirmed positive transfusion-transmissible infection (TTI) markers were analyzed for the study period January 1, 2004 to December 31, 2009.
The CUE user tended to be of young age, male and first time donor whereas the CUE non-responder was more likely to be older, first time donor without a clear sex predilection. CUE had low sensitivity (0·33%) and low positive predictive value (0·02%) in detecting TTI marker positive donations. Of 46 incident cases, one donor designated his pre-conversion donation as CUE positive. 29·6% of the donors deferred due to reported sex or intravenous drug related risk factors on the donor history questionnaire had ticked 'I do practice risk behavior' on the CUE form. Deferrals for all sexual or blood-blood contact related risk factors were 19·2 times higher among CUE positive donors than among CUE negative donors (95% CI, 18·5-19·9).
Although CUE use is associated with higher rates of TTI risk, CUE has low efficiency to detect window period donations. Moreover, misuse results in a significant loss of units. Our data indicate a low risk perception among donors, hence efforts should focus on improving donor knowledge of and on donor's responsibility to disclose TTI risk.
保密单位排除（CUE）作为一种血液供应安全措施的有效性存在争议。因此，我们调查了CUE在我们献血人群中的实用性。
分析了2004年1月1日至2009年12月31日研究期间CUE的使用数据、因不同程度性接触或血液接触导致的献血者延期数据以及确诊的输血传播感染（TTI）标志物阳性数据。
使用CUE的献血者往往年龄较小、为男性且是首次献血者，而不响应CUE的献血者更可能年龄较大、是首次献血者且无明显性别倾向。CUE在检测TTI标志物阳性献血方面敏感性较低（0.33%）且阳性预测值较低（0.02%）。在46例发病病例中，有1名献血者将其血清转化前的献血指定为CUE阳性。在献血者病史问卷中因报告的性接触或静脉注射毒品相关风险因素而延期的献血者中，有29.6%在CUE表格上勾选了“我确实有危险行为”。与CUE阴性献血者相比，CUE阳性献血者因所有性接触或血液 - 血液接触相关风险因素导致的延期率高19.2倍（95%可信区间，18.5 - 19.9）。
尽管使用CUE与较高的TTI风险率相关，但CUE检测窗口期献血的效率较低。此外，滥用会导致大量血液单位流失。我们的数据表明献血者的风险认知较低，因此应努力提高献血者对TTI风险的认识以及献血者披露TTI风险的责任意识。
