Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Widespread Zika screens not cost effective

Saá P et al. New Engl J Med. 2018;378:1778-88. doi: 10.1056/NEJMoa1714977

Key clinical point: Individually screening all blood donations for Zika virus was low yield and costly.

Major finding: Testing confirmed only 8 authentic cases and cost nearly $42 million over 15 months.

Study details: Screening and confirmatory testing of 4,325,889 donations of blood in the United States during 2016-2017.

Disclosures: American Red Cross and Grifols Diagnostic Solutions provided funding. Grifols makes a test used in the study. Dr. Saá disclosed research support from Grifols but had no other conflicts of interest.

Source: Saá P et al. New Engl J Med. 2018;378:1778-88. doi: 10.1056/NEJMoa1714977

Citation:

Saá P et al. New Engl J Med. 2018;378:1778-88. doi: 10.1056/NEJMoa1714977

Commentary:

Despite these findings, it would be premature to stop testing U.S. blood donations for Zika virus, wrote Evan M. Bloch, MBChB; Paul M. Ness, MD; Aaron A.R. Tobian, MD, PhD; and Jeremy Sugarman, MD, MPH, in an editorial accompanying the study.

Nonetheless, “actual and perceived risks to the blood supply seem to be conflated,” the experts wrote. They noted that the United States currently has no active areas of Zika virus transmission and that confirmed mosquito-borne, locally acquired infections fell from 226 in 2016 to two the following year.

There is no historical precedent for ending a policy of testing blood donations for pathogens, they added. Consequently, ending widespread screening “may actually prove to be far more challenging than the decision to start.” For now, a precautionary, risk-based approach should entail “continuous review” of screening policies and “reassessment as new data emerge.”

The editorialists are with Johns Hopkins University and Johns Hopkins University’s Bergman Institute of Bioethics, both in Baltimore. They reported having no relevant conflicts of interest. These comments are from their editorial (New Engl J Med. 2018;378:19:1837-41).

This Week's Must Reads

Intensity modulated radiation therapy may be preferable in children with extremity nonrhabdomyosarcoma soft-tissue sarcomas, Source: Rao A et al. Intl J Rad Oncology*Biology*Physics; Jan. 2019, 38-44. https://doi.org/10.1016/j.ijrobp.2018.09.005

TAO: Nonwhite ethnicity, limb infection predict poor prognosis, Le Joncour A et al. Arthritis Rheumatol. 2018;70(Suppl 10): Abstract 1885

Thrombolysis for acute ischemic stroke safe in GI malignancy, Inohara T et al. Circulation. 2018 Nov 6;138[suppl 1], Abstract A12291

Ten years of anastrozole boosts disease-free survival, Ohtani S et al. SABCS 2018, Abstract GS3-04

Must Reads in Transfusion Medicine

Patient blood management in stem cell transplant, Jambhekar N et al. AABB 2018, Abstract PBM3-ST4-22

Study evaluates rapid bacterial testing of platelets, Booth AL et al. AABB18, Abstract INV4

Adding mobile apheresis to community blood drives, Anthony D et al. AABB 2018, Poster BBC 135

Study assesses blood delivery errors, Vossoughi S et al. AABB 2018, Abstract QT4

Restrictive transfusion strategy in CV surgery doesn't raise long-term risk, Mazer CD et al. N Engl J Med. 2018 Aug 26. doi:10.1056/NEJMoa1808561