Implementing NAT for Screening of Donors’ Blood: Benefits versus Cost

Background: One of the major risks of blood/blood products transfusion is transmission of infectious agent (TTIs: Transfusion Transmitted Infections). Objective: Our study aimed to assess nucleic acid testing (NAT) in the Egyptian Central blood bank of Ain Shams University Hospitals in concordance with a highly sensitive technique (Chemiluminescence) and to evaluate the cost/benefit outcomes for this implementation. Methods: 6750 blood units from donors were tested for viruses (HCV, HBV and HIV) using two assay systems in parallel (COBAS e 601 ROCHE and NAT Individual testing using Procleix® Ultrio Elite Assay). NAT yield and serology yield were calculated. Results: Total number of positive results by chemiluminescence were 3% including 2.1% positive for HCV, 0.8% positive for HBV and 0.1% positive for HIV. In parallel, the samples were NAT tested resulting in 78 positive samples of which 46.1% were HCV positive, 53.9% were HBV positive but by chemiluminescence only 39 samples were positive and 3 negative samples “NAT yield” that were positive by HBV core Ab (ELISA) (occult HBV), 2% were positive by chemiluminescence only (Serology yield); 80.4% were positive for HCV Ab, 12 % for HBsAg and 7.5% for HIV Ag-Ab. All HIV positive results by serology were negative by NAT and Western blot technique. Conclusions: NAT is very sensitive and crucial technique in screening for donors’ blood, but in developing countries with limited resources other screening protocols can be adopted to diminish the cost with reaching the maximal safety.