HCV NAT-Positive, Seronegative Repeat Donor
A 38-year-old repeat blood donor gives a whole blood unit. Serologic screening for HIV, HBV, HCV, and syphilis is negative, but individual-donation HCV NAT is reactive on the initial assay. The donor is asymptomatic and reports no risk factors. The unit has been processed into RBCs, a platelet concentrate, and plasma. The platelets are 2 days old and have not been issued; one RBC unit was shipped to a hospital 12 hours ago. The donor's prior donations were 2 years and 5 years ago. The medical director must decide what to do with the current components, the donor, and prior recipients.
1. What immediate actions should be taken for the current components and the donor?
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Quarantine all co-components and do not release them. Perform a confirmatory or discriminatory NAT assay. If the result is confirmed positive, permanently defer the donor, counsel the donor, and notify the receiving hospital to quarantine the shipped RBC unit. Initiate recipient lookback and document all actions. Do not release any component based on a single reactive NAT result.
2. How should the donor's prior donations be evaluated?
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Trace prior donations according to the center's HCV lookback procedure. Notify consignees of prior donations, quarantine any components still in inventory, and arrange recipient testing and counseling. The 2-year and 5-year donations may fall outside the typical window-period lookback interval, but they must still be evaluated under the written policy. Document the lookback outcome.
3. What if the repeat NAT is negative on a second assay?
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Treat the initial result as a possible false positive, but follow the validated algorithm and the center's policy before releasing components. If the confirmatory result is negative and there are no other deferral criteria, the donor may be eligible for reentry under policy. The components may be released only after the medical director documents that the donor is not confirmed positive and all release criteria are met.