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A risk-based decision-making approach to assessing risk of Babesia in U.S. blood supply

Due to the increasing threat of transfusion-transmitted babesiosis to the U.S. blood supply, the AABB tasked the Ad Hoc Babesia Policy Working Group with using the Alliance of Blood Operators’ risk-based decision-making framework to assess the risks and benefits of performing Babesia testing on the nation’s blood supply. The assessment considered patient safety, product availability, sector sustainability, and technology availability. The working group assessed safety risk, economic and operational impact, reimbursement equity, and ethical considerations and stakeholder feedback from two consultations and concluded that a regional approach to donor screening for Babesia in endemic states was the most appropriate. Furthermore, it concluded that nucleic acid testing using a ribosomal RNA template was the recommended platform for donor testing because it was the most cost-effective, resulted in no wasted units, and identified a similar number of infections as antibody plus DNA-based PCR. The working group also recommended that the AABB collect data to further identify risks in endemic states. It suggested that it is necessary to periodically re-evaluate which states receive “endemic” status since the geographic area affected by Babesia microti is likely to expand. In conclusion, the working group reported that public awareness of the Babesia threat is the first line of defense for the nation’s blood supply, and the AABB should work with the appropriate agencies to provide general education about the health risks from B. microti.

Ward SJ, Stramer SL, Szczepiorkowski ZM, et al. Assessing the risk of Babesia to the United States blood supply using a risk-based decision-making approach: Report of AABB’s Ad Hoc Babesia Policy Working Group (original report). Transfusion. 2018;58:1916–1923.

Correspondence: Dr. Susan L. Stramer at susan.stramer@redcross.org