The Role of the Laboratory and Transfusion Service in the Management of Ebola Virus Disease

Abstract

The Ebola outbreak that began in 2013 infected and killed record numbers of individuals and created unprecedented challenges, including containment and treatment of the virus in resource-strained West Africa as well as the repatriation and treatment for patients in the United States and Europe. Valuable lessons were learned, especially the important role that the laboratory and transfusion service plays in the treatment for patients with Ebola virus disease (EVD) by providing data for supportive care and fluid resuscitation as well as the generation of investigational therapies such as convalescent plasma (CP). To provide treatment support, laboratories had to evaluate and update procedures to ensure the safety of laboratory personnel. Because there is no licensed EVD-specific treatment, CP was used in more than 99 patients with only 1 possible severe adverse event reported. However, given the biologic variability inherent in CP as well as the small number of patient treated in a nonrandomized fashion, the efficacy of CP in the treatment of EVD remains unknown.

Revisiting Ebola: Lessons learned from the 2014–2015

“…10 Additionally, to reduce the risk of acute or delayed hemolytic transfusion reactions, lateral flow whole blood antigen typing using the CD-marked MDmulticard (Grifols, Barcelona, Spain) was validated to antigen type patients for Rh and Kell antigens (Figure 1) so that partially phenomatched RBCs could be provided. 9 In the previously repatriated 27 patients with EVD in the 2014-2015 outbreak, frank hemorrhagic was reported in two patients and oozing from catheters reported in 14 patients. 11 Transfusion support, excluding CP, included four patients receiving whole blood, six patients receiving plasma, and five patients receiving platelets.…”

“…During the 2014 Ebola Zaire outbreak, both the Emory University and University of Nebraska Biocontainment Unit laboratories performed ABO typing safely using FDA-approved slide agglutination in a biosafety hood (Figure 1), but did not perform additional pre-transfusion testing requiring centrifugation such as screening and identification of red blood cell alloantibodies. 9 This practice was not universally accepted, as the prevalence of sickle cell disease in Africa where Ebola outbreaks are centered suggests that some EVD patients may have been previously transfused and have RBC alloantibodies. The use of appropriate PPE and barriers was suggested as an acceptable risk for pretransfusion testing including irregular RBC antibody screening.…”

Patient blood management: The best approach to transfusion medicine risk management

“…Of particular interest are the hazards of bacterial contamination, in particular for platelet concentrates [6]. Moreover, taking on ever greater importance, also due to global climate changes, are emerging pathogens [7] such as Dengue, West Nile virus, Zika virus [8], Chikungunya [9], Ebola [10], and Hepatitis E virus [11], prion transmission [12], and protozoa [13].…”

Filovirus – Auslöser von hämorrhagischem Fieber

“…Der wirkliche Nutzen von Rekonvaleszentenplasma bleibt zurzeit unklar, da die Präparate wegen der abflauenden Epidemie nur an einzelnen Patienten getestet werden konnten [95,146,147]. Deswegen besteht Forschungsbedarf für die Evaluation der Zeit der Abnahme von Plasma beim gesundeten Patienten, der Wirksamkeit, der Dosierung und der Genotyp-Neutralisation [147,148].…”