Kiely Philip, Hoad Veronica C, Wood Erica M
Australian Red Cross Blood Service, Melbourne, Victoria, Australia.
Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Vox Sang. 2018 Jul 4. doi: 10.1111/vox.12675.
False positive (FP) viral marker results in blood donors continue to pose many challenges. Informing donors of FP results and subsequent deferral can result in stress and anxiety for donors and additional complexity and workload for blood services. Donor management strategies need to balance the requirement to minimise donor anxiety and inconvenience while maintaining sufficiency of supply. Decisions about how and when to inform donors of FP results and determine deferral periods can be difficult as FP results, while often transitory, can take up to several years to resolve. Additional complexities include the interpretation of indeterminate serological confirmatory testing without detectable viral RNA or non-discriminated NAT results with concomitant anti-HBc reactivity - both may be due to FP results, but the former may also represent past infection and the later may represent occult hepatitis B infection. In this review we discuss strategies to minimise indeterminate serological confirmatory results, possible donor deferral policies and the impact on donors when notified of FP results. We also provide some new data from Australia that address the challenge of interpreting non-discriminated NAT results with concomitant anti-HBc reactivity. Ultimately, the challenge is for each blood service to develop appropriate strategies for donor management, taking into account local information and requirements.
献血者中病毒标志物假阳性（FP）结果仍然带来诸多挑战。告知献血者FP结果及随后的延期献血可能会给献血者带来压力和焦虑，也会给血液服务机构带来更多复杂性和工作量。献血者管理策略需要在尽量减少献血者焦虑和不便的同时，维持血液供应充足之间找到平衡。关于如何以及何时告知献血者FP结果并确定延期献血期限的决策可能很困难，因为FP结果虽然通常是暂时的，但可能需要长达数年才能解决。其他复杂情况包括对无法检测到病毒RNA的不确定血清学确证检测结果的解读，或伴有抗-HBc反应性的非特异性核酸检测（NAT）结果——两者都可能是FP结果，但前者也可能代表既往感染，后者可能代表隐匿性乙型肝炎感染。在本综述中，我们讨论了尽量减少不确定血清学确证结果的策略、可能的献血者延期政策以及告知献血者FP结果时对他们的影响。我们还提供了来自澳大利亚的一些新数据，这些数据解决了伴有抗-HBc反应性的非特异性NAT结果解读方面的挑战。最终，挑战在于每个血液服务机构要根据当地信息和要求制定合适的献血者管理策略。
