Evaluation of the red blood cell and plasma transfusion guidelines.
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OBJECTIVES: To determine physicians' preferred content and format for the Guidelines for Red Blood Cell and Plasma Transfusion for Adults and Children before development in order to guide the development process. To obtain physicians' recommendations about the Guidelines' content, format, dissemination and future directions after development to guide future work on the Guidelines. DESIGN: Pre-post Guidelines qualitative design using 20 focus groups (nine pre and 11 post). STUDY PARTICIPANTS: One hundred and seven physicians (5-11 per group) who used at least 1 unit of blood over the past 6 months; with a minimum of 1 year in practice and not retired. A total of 24 physicians attended both pre and post focus groups. In general, specialties of participants included: general practice, surgery pediatrics, obstetrics/gynecology and hematology/oncology. Years of practice ranged from 1 to 35 years (mean = 7 years). MAIN OUTCOME MEASURES: Pre Guidelines focus groups made recommendations on the content and format of the Guidelines; post Guidelines focus groups made recommendations on the same areas along with dissemination and future directions. RESULTS: Three main components of the Guidelines were evaluated: content, format and dissemination. The content, which followed as much as possible that recommended by pre Guidelines focus groups, was deemed appropriate by post Guidelines focus groups, with minor gaps noted (e.g. information on alternatives to blood products). The format addressed many of the concerns raised by pre Guidelines focus groups; however, the post Guidelines focus groups were concerned about the lack of visual aids and categorization of information. The dissemination strategy was successful at diffusing the Guidelines, with some concerns expressed about reaching specific physician target groups. CONCLUSION: The pre-post focus group method was useful in conducting an evaluation of the Guidelines and this method which examined content, format and dissemination could contribute to evaluations of other guidelines. (+info)
Risk of transfusion-transmitted human T-cell lymphotropic virus-type I in Latin America.
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In a recent publication, G. Schmunis et al presented data from Latin America on blood quality and on important approaches to preventing human immmunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and other infectious diseases that may be transmitted by blood transfusion. Mass screening between 1987 and 1988 in Peru of blood from more than 90,000 donors highlighted potential problems in the donor population, and it also uncovered inappropriate practices related to the use of blood transfusions. Since then, adequate screening of the blood supply for HIV was implemented and new transfusion-related AIDS cases have been prevented during the past 8 years. (+info)
Evaluation of four automated high-sensitivity C-reactive protein methods: implications for clinical and epidemiological applications.
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BACKGROUND: C-reactive protein (CRP) can provide prognostic information about the risk of developing atherosclerotic complications in apparently healthy patients. This new clinical application requires quantification of CRP concentrations below those traditionally measured in the clinical laboratory. METHODS: The Dade Behring BN II, the Abbott IMx, the Diagnostic Products Corporation IMMULITE, and the Beckman Coulter IMMAGE are four automated analyzers with high-sensitivity CRP (hs-CRP) methods. We evaluated these assays for precision, linearity, and comparability with samples from 322 apparently healthy blood donors. RESULTS: The imprecision (CV) of the BN II, IMx, IMMULITE, and IMMAGE methods was < or = 7.6%, < or = 12%, < or = 9.8%, and < or = 9.7% at 3.5 mg/L, respectively. The BN II, IMx, IMMULITE, and IMMAGE methods were linear down to < or = 0.30, < or = 0.32, < or = 0.85, and 2.26 mg/L, respectively. CRP concentrations demarcating each quartile in a healthy population were method dependent. The IMx method gave results comparable to the BN II method for values in the reference interval. The IMMULITE method had a positive intercept compared with the BN II method. The IMMAGE method demonstrated more scatter and a positive intercept compared with the BN II method, which may reflect the fact that it is a less sensitive assay. CONCLUSIONS: The four hs-CRP methods exhibited differences in results for a healthy population. Additional standardization efforts are required to ensure that hs-CRP results can be related to large-scale epidemiologic studies. (+info)
Genotypic analysis of hepatitis C virus in blood donors in Indonesia.
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A study was conducted to describe the genetic diversity of hepatitis C virus (HCV) in a population of positive blood donors from throughout Indonesia. Repeat analysis by reverse transcription-polymerase chain reaction (RT-PCR) of 102 anti-HCV positive samples showed that 67 gave HCV-specific positive signals by the PCR for the 5'-untranslated genomic region of HCV. Further genotypic analysis on 64 HCV RNA-positive samples indicated that 57 belonged to the following individual genotypes: 1a, 1b, 2a, 2b, and 3b. The predominant HCV genotypes in this donor population were 1b (57.8%), 2a (17.2%), and 3b (10.9%). The core sequences of the 4 indeterminate samples when aligned with published sequences of various HCV genotypes showed a range of homology from 16.16% to 78.67%. Comparative analysis of genotypic representation from other anti-HCV-positive study populations, including polytransfused pediatric and adult renal dialysis groups, is now being carried out to determine the potential genotypic association with mechanistic HCV spread. (+info)
Short report: occurrence of Leishmania donovani DNA in donated blood from seroreactive Brazilian blood donors.
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Human visceral leishmaniasis (kala-azar) transmitted by blood transfusion has been described in previous reports. Seroprevalence of antibodies to Leishmania donovani was shown to be related to prior blood transfusions in multiply transfused hemodialysis patients in Natal, Rio Grande do Norte, Brazil. In this study, a possible correlation between seroreactivity and the presence of L. donovani DNA was investigated in asymptomatic healthy blood donors. Sera were tested using the fucose mannose ligand (FML) ELISA, which was shown to have a sensitivity of 100%, a specificity of 96-100%, reliability, and diagnostic and prognostic potential for the detection of human and canine kala-azar, respectively. Leishmanial DNA was assessed by the polymerase chain reaction (PCR) and dot-blot hybridization techniques in blood and bone marrow samples. Among 21 FML-seroreactive asymptomatic blood donors, 5 (24%) were positive by the PCR and 9 (43%) were positive in a dot-blot assay of blood samples, showing a significant correlation (chi2 = 14.24, P < 0.01). No Leishmania DNA was detected in 20 FML non-reactive blood donors. Our results point to the need for control of transmission of kala-azar by blood transfusion in areas endemic for this disease. (+info)
Single vs twice daily G-CSF dose for peripheral blood stem cells harvest in normal donors and children with non-malignant diseases.
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The optimal dose and schedule of G-CSF for mobilization of peripheral blood stem cells (PBSC) is not well defined. G-CSF mobilization was performed in a group of healthy donors and paediatric patients for autologous back-up before receiving allogeneic stem cell transplant. Seventeen consecutive subjects who received G-CSF at 5 microg/kg/dose twice daily (group A) were compared with a historical control group of 25 subjects who received a single daily dose of 10 microg/kg/day G-CSF (group B). Double blood volume apheresis for PBSC collection was started on day 5. G-CSF was continued and apheresis repeated until the targeted CD34+ cell dose was achieved. Both groups were comparable for sex, age, body weight and reason for PBSC collection. Over two-thirds of the subjects in both groups were less than 16 years of age. The G-CSF priming and apheresis were well tolerated. When the first day apheresis products were analyzed, group A resulted in significantly higher yield of total nucleated cells (5.91 vs 3.92 x 108/kg, P = 0. 013), mononuclear cells (5.73 vs 3.92 x 108/kg, P = 0.017), CD34+ cells (2.80 vs 1.69 x 106/kg, P = 0.049) and colony-forming units (107 vs 54 x 104/kg, P = 0.010) as compared with group B. We conclude that the two dose schedule is more efficient in mobilizing PBSC in normal donors and children with non-malignant diseases. This approach may reduce the number of aphereses required and thus reduce the transplant cost. (+info)
Cell-mediated immunity to hepatitis B surface antigen in blood donors with persistent antigenaemia.
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Cellular immunity to the hepatitis B surface antigen (HBsAg) and a liver-specific lipoprotein was studied, using the leucocyte migration test, in 38 asymptomatic blood donors found to have HBsAg in the serum. Sensitization to HBsAg was found in 26% and was related to the presence of liver damage, being detected in 47% of those with elevated serum aspartate aminotransferase but in only 13% with normal enzyme levels. The frequency of sensitization to this antigen in those with chronic persistent or chronic aggressive hepatitis on biopsy was also higher than in those with unrelated or minimal changes. The findings using the liver-specific lipoprotein as antigen were similar and there was a correlation between the results obtained with this and the hapatitis B surface antigen. This study supports the hypothesis that a T-lymphocyte response to hepatitis B virus antigen can initiate an autoimmune reaction to antigens such as liver-specific lipoprotein on the hepatocyte surface, and that this reaction may be of importance in the production of chronic liver damage. In the absence of the T-cell response, the autoimmune reaction cannot occur and the virus is able to establish a harmless symbiotic union with the host. (+info)
An analysis of a preoperative pediatric autologous blood donation program.
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OBJECTIVE: To determine the efficacy of a pediatric autologous blood donation program. DESIGN: A retrospective study of patient charts and blood-bank records. SETTING: The Children's Hospital of Eastern Ontario, Ottawa, a tertiary care, pediatric centre. PATIENTS: One hundred and seventy-three children who received blood transfusions for a total of 182 procedures between June 1987 and June 1997. INTERVENTIONS: Autologous and homologous blood transfusion required for major surgical intervention, primarily spinal fusion. MAIN OUTCOME MEASURES: Surgeons' accuracy in predicting the number of autologous blood units required for a given procedure, compliance rate (children's ability to donate the requested volume of blood), utilization rate of autologous units and rate of allogeneic transfusion. RESULTS: The surgeons' accuracy in predicting the number of autologous units required for a given procedure was 53.8%. The compliance rate of children to donate the requested amount of blood was 80.3%. In children below the standard age and weight criteria for blood donation the compliance rate was 75.5%. The utilization rate of autologous units obtained was 84.4% and the incidence of allogeneic transfusion was 26.6%. CONCLUSIONS: There was a high rate of compliance and utilization of predonated autologous blood in the children in the study. Preoperative blood donation programs are safe and effective in children, even in those below the standard age and weight criteria of 10 years and 40 kg. (+info)