Background: Highly contagious, life-threatening diseases such as viral hemorrhagic fever (caused by Ebola, Marburg, Lassa or Krim-Kongo virus), orthopox virus infection, or pneumonic plague require special isolation of the patient for protection of the medical staff and the public. As blood and other body fluids from these patients may be dangerous for the laboratory staff, laboratory examinations must also be done under special safety conditions. Situation: In Germany, clinical centers for intensive care of patients with highly contagious diseases have been established in Berlin, Frankfurt/M., Hamburg, Leipzig, and Munich. For practical reasons, the patients’ samples for urgent routine laboratory examinations cannot be sent over long distances to one of the two biosafety level 4 laboratories in Germany (in Hamburg and Marburg), but have to be examined at the clinical unit, obeying the biosafety regulations. Concept: As it is not allowed to examine blood samples from patients with highly contagious, life-threatening diseases in our routine laboratory, blood group serological tests will be performed within the isolation unit in a separate room near the patient’s room. An especially trained laboratory staff member wearing the special protection clothing will do the tests using routine laboratory methods with minimal modifications. To avoid production of aerosols, no washing procedures with fluids will be done. To reduce the risk of injuries, only plastic materials will be used. Therefore, we will perform all tests using the gel card centrifugation method. All waste will be separately collected and disinfected before leaving the unit. Reagents and hardware will stay within the unit. The ABO bedside test of the patient will be omitted because we will use only blood group O red blood cell concentrates in this setting. Limitations: Our concept is designed for the blood supply of one or two patients with highly contagious, life-threatening diseases hospitalized in the unit at the same time. If a markedly greater number of such patients have to be isolated and treated under provisional conditions, the routine standards for blood supply probably can no longer be maintained.

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