{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T05:40:09Z","timestamp":1770788409217,"version":"3.50.0"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vox Sanguinis"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Screening for transfusion\u2010transmitted infections (TTIs) among blood donors is done using qualitative screening assays. Screening values that are close to cut\u2010off values lie in the uncertainty zone, often denoted as the grey zone (GZ). This scoping review evaluated studies that have assessed the GZ reactivity by supplementary tests and its consequences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Studies evaluating GZ or indeterminate or inconclusive results for TTI screening among blood donors were searched using PubMed, Scopus and Google Scholar databases. Full text for the included articles was reviewed and analysed for study characteristics, TTI screening and GZ reactivity. This included GZ range, repeat or confirmatory testing, follow\u2010up of such donors, effect on donor deferral and collected blood units.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 16 studies were included. GZ was evaluated for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, Chagas disease and human T\u2010lymphotropic virus (HTLV). GZ values ranged from 0.5 to 1.2 times sample to cut\u2010off (S\/CO) values in different studies. The protocol for repeat\/confirmatory testing was also heterogeneous. During repeat testing, many donors were found to be reactive or repeat GZ reactive. In confirmatory assays, the majority were negative, but many were positive or indeterminate. The protocol for donor follow\u2010up and deferral protocols also varied significantly among different centres.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GZ evaluation showed a small yet significant risk of TTI from samples identified within the GZ range. There is further need for follow\u2010up studies to establish TTI risk from repeat reactive or indeterminate samples, which will help in establishing uniform protocols for GZ samples.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/vox.70137","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:28:37Z","timestamp":1761179317000},"page":"102-113","source":"Crossref","is-referenced-by-count":0,"title":["A scoping review of grey zone use for transfusion\u2010transmitted infection screening among blood donors"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9228-3594","authenticated-orcid":false,"given":"Rahul","family":"Chaurasia","sequence":"first","affiliation":[{"name":"Department of Transfusion Medicine All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suhasini","family":"Sil","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chanchi","family":"Khiamniungan","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9681-3898","authenticated-orcid":false,"given":"Gopal Kumar","family":"Patidar","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hem Chandra","family":"Pandey","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-08-097037-0.00010-5"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/vox.12675"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2004.03347.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2007.01067.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.2000.40050585.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1413-8670(10)70009-X"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2010.02773.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.4103\/0973-6247.115570"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.21666"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/tme.12217"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.4103\/0973-6247.164272"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjhh.2016.11.007"},{"key":"e_1_2_9_14_1","first-page":"5","article-title":"Effect of grey zone sample testing of transfusion transmissible infectious diseases on safety of blood\u2010experience of a tertiary care referral teaching hospital blood bank from South India","volume":"5","author":"Anitha M","year":"2017","journal-title":"Int J Res Med Sci"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.9790\/487X-1810022126"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.21037\/aob.2019.06.02"},{"key":"e_1_2_9_17_1","first-page":"4701","article-title":"Effect of grey zone sample testing of transfusion transmissible infectious diseases by enzyme linked immunosorbent assay in blood safety \u2013 experience at a tertiary care hospital blood bank from Western Odisha","volume":"6","author":"Prasad CR","year":"2018","journal-title":"Sch J App Med 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