Prevention Of Post-transfusion Hepatitis Research Articles

輸血後肝炎の予防に対する静注用ヒト免疫グロブリン製剤(乾燥スルホ化ヒト免疫グロブリン)の使用経験

輸血後肝炎の予防に対する静注用ヒト免疫グロブリン製剤(乾燥スルホ化ヒト免疫グロブリン)の使用経験

Significance of blood HCV RNA screening in the prevention of post-transfusion hepatitis C

To investigate the significance of blood HCV RNA screening in the prevention of post-transfusion hepatitis C. Totally 56,400 anti-HCV negative blood samples collected from Jan. 2000 to Dec. 2003 were tested for HCV RNA by RT-PCR, and the patients who received the HCV RNA negative blood were followed up. The HCV RNA positive rate was 2.5 per thousand (146/56,000) and none of the patients followed up suffered from HCV infection. HCV RNA screening for the anti-HCV negative blood samples is very effective and feasible for prevention of post-transfusion hepatitis C.

International Forum Hepatitis C Virus RNA Testing by Nested PCR in Blood Preparations in Yugoslavia

Patients receiving any kind of human blood preparations are in permanent danger of any infection including hepatitis C (HCV) infection. Testing for the presence of HCV in blood preparations is one of the steps towards safe medical treatment. One of the approaches for this testing is a detection of HCV nucleic acid. In this paper we describe a simple method for isolation of HCV RNA from blood preparations and control of HCV RNA presence in 19 intravenous and intramuscular products, manufactured in the National Blood Transfusion Institute in Belgrade. RT-PCR was performed according the rules saving RNA. Primers were located in 5' conserved region. Seven out of 19 batches of gamma-globulin, albumin, anti-tetanus and anti-rabies immunoglobulin preparations were found to be HCV RNA positive. For the time being, the PCR method is too expensive for routine HCV RNA testing of hundreds of blood donors per day. Serological screening test of blood donors and nested PCR testing for HCV RNA in blood preparations could be an efficient combination of tests in prevention of posttransfusion hepatitis C.

Successful prevention of posttransfusion hepatitis B by the combined use of immunoglobulin, vaccine and interferon

Successful prevention of posttransfusion hepatitis B by the combined use of immunoglobulin, vaccine and interferon

Rare detection of hepatitis B and hepatitis C virus genomes by polymerase chain reaction in seronegative donors with elevated alanine aminotransferase.

Since screening for antibody to hepatitis C virus (HCV) was introduced in 1990, posttransfusion hepatitis has been reduced to nearly background levels. This has led to reconsideration of the value of testing donated blood for elevated alanine aminotransferase (ALT). The contribution of ALT testing in detecting seronegative infection was evaluated by the performance of polymerase chain reaction (PCR) for hepatitis B virus (HBV) or HCV in plasma from ALT-elevated blood units. Testing was performed on 375 units of plasma, derived from an equivalent of 47,500 blood donations, with a highly sensitive hemi-nested PCR procedure. Using a triplet of primers directed at the conserved regions of HBV DNA and 5'-noncoding regions of HCV RNA, the hemi-nested PCR assay can reliably amplify 10 viral molecules to levels detectable in ethidium bromide-stained agarose gels. Pools of plasma from groups of four donors were screened with hemi-nested PCR. For any reactive pools, the plasma from individual donors was retested twice on different aliquots. Two of 375 units, both with midrange ALT elevation, were repeatedly reactive in hemi-nested PCR (one each for HBV DNA and HCV RNA). However, samples from the two suspect donors tested 9 and 5 months later revealed no seroconversion, elevated ALT, or viral genomes in hemi-nested PCR. The lack of confirmed HBV or HCV infection in this study representing an estimated 47,500 voluntary blood donations suggests that routine ALT testing for further prevention of posttransfusion hepatitis after exclusion of HBV- and/or HCV-seropositive blood may be superfluous.

Prevention of posttransfusion hepatitis B and C by screening for antibody to hepatitis C virus and antibody to HBcAg

Screening of blood donors by testing for antibody to HBcAg and antibody to hepatitis C virus is commonly done. However, the applicability of these screening tests may vary depending on the prevalence of hepatitis B virus and hepatitis C virus infection in various populations. We have therefore prospectively evaluated 158 adult patients who received blood or blood products during open-heart surgery in Hong Kong to compare the efficacy of various serological screening tests in the prevention of posttransfusion hepatitis. Serum from five (0.5%) donors was positive for antibody to hepatitis C virus by second-generation enzyme immunoassay; in two, optical-density readings in enzyme immunoassay were greater than 2.0, but only one was positive for hepatitis C virus RNA by reverse transcription-polymerase chain reaction. The latter donor was also positive for antibody to HBcAg and had elevated serum ALT activity. The recipient of a unit of this donor's blood was the only one in whom posttransfusion hepatitis C developed (0.1% per unit transfused). Screening with antibody to hepatitis C virus was more specific than that with antibody to HBcAg or ALT in excluding donors from transmitting hepatitis C (99.6%, 79.4% and 98.8%, respectively). Both the sensitivity and negative predictive value of screening for antibody to hepatitis C virus were 100%, but the positive predictive value was only 20%. Forty-five blood recipients were considered susceptible to hepatitis B virus infection because testing for hepatitis B serology in serum (HBsAg, antibody to HBsAg and antibody to HBcAg) was negative before being transfused. Asymptomatic hepatitis B seroconversion developed in three (6.7%) recipients (1.1% per unit transfused).(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention of posttransfusion hepatitis B and C by screening for antibody to hepatitis C virus and antibody to HBcAg

Prevention of posttransfusion hepatitis B and C by screening for antibody to hepatitis C virus and antibody to HBcAg

Prospective assessment of donor blood screening for antibody to hepatitis C virus and high-titer antibody to hepatitis B core antigen as a means of preventing post-transfusion hepatitis.

Since November 1989, the Japan Red Cross has been screening blood donors for hepatitis C virus antibody (anti-HCV) with 1st generation assay and high-titer antibody to hepatitis B virus core antigen (HBcAb). To clarify the effectiveness of the new screening tests for the prevention of post-transfusion hepatitis, the incidence of post-transfusion hepatitis after the introduction of new tests (December 1989 to September 1990) was compared with the incidence before the in introduction (January 1982 to December 1987). The incidence of "definite" post-transfusion hepatitis was 10.3% (205/1991) with a mean transfusion volume of 10.2 units before the screening, and 3.9% (11/282) with a mean transfusion volume of 14.6 units after the introduction of the new screening tests. Statistical analysis revealed a significant decrease of post-transfusion non-A, non-B hepatitis after the introduction of new tests (chi 2 = 10.9, P < 0.01). The incidence of "probable" post-transfusion hepatitis was 12.4% (246/1991) and 11.7% (33/282) respectively. No significant change was observed between the rates of "probable" post-transfusion hepatitis before and after the introduction of the new tests. It was concluded that anti-HCV and high-titer anti-HBc screening of volunteer blood donors could contribute to the prevention of the post-transfusion non-A, non-B hepatitis in Japan.

Gamma Globulin Prophylaxis to Reduce Post-Transfusion Non-A, Non-B Hepatitis After Cardiac Surgery with Cardiopulmonary Bypass

A prospective, randomized study of immune serum globulin (ISG) for prevention of post-transfusion hepatitis was performed on 196 patients (100 controls without gammaglobulin or placebo and 96 who received ISG) undergoing valve replacement or coronary artery bypass with extracorporeal circulation. The dose of ISG was 2 ml i.m. at premedication and 2 ml i.m. on postoperative day 3. Probable non-A, non-B hepatitis developed postoperatively in ten of the 100 controls and two of the 96 in the ISG group. Two ISG patients and three controls with non-A, non-B hepatitis still have increased serum aminotransferase values after 3-5 years, but liver biopsy revealed hepatitis, which histologically was very mild, in only two control and two ISG patients. Low-dose gamma globulin thus reduced the incidence of acute, probable non-A, non-B hepatitis in cardiac surgery with cardiopulmonary bypass.

開心術における赤血球濃厚液単独使用の有用性に関する検討 新鮮血使用例との比較

We have tried to save the blood in open-heart surgery, then concentrated the diluted blood remained in the reservoir after cardiopulmonary bypass (CPB), and transfused it to the patients through venous line. Also we have primed extracorporeal circuit with concentrated red blood cells. In this study, we compare the results of this method with it produced through transfusion and the priming of fresh whole blood and fresh frozen plasma, and investigate the effectiveness and safety in the usage of concentrated red blood cells as the priming fluid. (Material and Method) From January, 1984 to December, 1987, 84 adult patients underwent coronary artery bypass surgery. We classified them into two groups, depending on their priming fluid for extracorporeal circuit, fresh whole blood or concentrated red blood cells. In group I consisted of 41 patients, fresh whole blood was used for the priming and in group II, consisted of 43 patients, in which concentrated red blood cells were applied and the blood components remained in the reservoir after weaning from CPB were concentrated and returned to patients. In these two groups, we compare the hemodynamic functions and the hematorogical data and also evaluate the safety through the usage of concentrated red blood cells in open-heart surgery. (Results) The components and average amount of blood used in group I were 11.6±5.5 units of fresh whole blood and 8.2±5.9 units of fresh frozen plasma. In group II, they were 6.1±3.0 units of concentrated red blood cells and almost no fresh whole blood or fresh frozen plasma were required. The diluted volume of 1, 315±320ml in the CPB reservoir was concentrated to 620±275ml of blood components and transfused. The values of hemoglobin and hematocrit were significantly higher in group I than these in group II, but there were no significant differences in cardiac index, pulmonary capillary wedge pressure and stroke work index among hemodynamic functions. The incidence of post-transfusion hepatitis was 3/41(7.3%) in group I, while zero in group II. (Conclusion) Concentrated red blood cells could be applied safely as the priming fluid for CPB in open-heart-surgery, and are clearly effective in prevention of post-transfusion hepatitis. These results indicate that this method has a big advantage.

Retrospective investigation of transfusion-related non-A, non-B viral hepatitis associated with M2 antigen

A retrospective study of transfusion-related non-A, non-B viral hepatitis was conducted in seven patients. Findings showed that six recipients had been exposed to at least one unit of blood possessing a putative serological marker for non-A, non-B hepatitis, the M2 antigen or anti-M2IgM. The M2 markers were associated with non-A, non-B hepatitis that developed 3-7 weeks after transfusion. It sees increasingly probable that M2 markers may be useful for diagnosis and/or prevention of post-transfusion hepatitis.

The effect of human immunoglobulin in the prevention of post-transfusion hepatitis following open heart surgery in children: H. Tachibana, M. Miyashita, Y. Hosokawa, et al. Jap J Thorac Surg 35:119–122, (February), 1982

The effect of human immunoglobulin in the prevention of post-transfusion hepatitis following open heart surgery in children: H. Tachibana, M. Miyashita, Y. Hosokawa, et al. Jap J Thorac Surg 35:119–122, (February), 1982

9 - The Dominant Role of Non-A, Non-B in the Pathogenesis of Post-transfusion Hepatitis: A Clinical Assessment

Despite the exclusion of commercial donors and the introduction of sensitive radioimmunoassays for hepatitis B surface antigen, approximately 8 to 10 per cent of prospectively followed patients continue to develop post-transfusion hepatitis. Serological evaluation of these residual hepatitis cases showed them to be distinct from hepatitis B, hepatitis A, cytomegalovirus and the Epstein-Barr virus. These cases have been tentatively designated non-A, non-B and now compromise approximately 90 per cent of post-transfusion hepatitis. There is increasing evidence that non-A, non-B hepatitis is also spread by routes other than blood. In the absence of a specific serological test, the diagnosis of non-A, non-B hepatitis depends on the clinical exclusion of non-viral causes of hepatocellular injury and on the serological exclusion of other known hepatitis viruses. The clinical pattern of non-A, non-B hepatitis is characterized as follows: (1) The incubation period tends to be intermediate between type A and type B hepatitis, but considerable overlap exists. Most cases occur between five and 12 weeks after percutaneous exposure: (2) Non-A, non-B hepatitis tends to be less acutely severe than type B hepatitis; two thirds to three quarters of cases are anicteric, demonstrate only mild to moderate transaminase elevations and are symptomatically mild. Individual cases may, however, be clinically and biochemically severe and cannot be distinguished from acute type A or type B hepatitis. (3) A striking feature of non-A, non-B hepatitis is its propensity to progress to chronic liver disease. Up to 50 per cent of patients have elevated transaminase values in excess of one year and the majority of such patients, when biopsied, demonstrate histological features of chronic active hepatitis. Approximately 10 per cent show features of cirrhosis. Despite these histological changes, the chronic liver disease of non-A, non-B hepatitis seems, in most cases, to be slowly resolving rather than rapidly progressing. Non-A, non-B hepatitis has now been repeatedly induced in chimpanzees using human acute and chronic phase inocula. These studies establish the existence of a transmissible agent and of a chronic asymptomatic carrier state. Transmission appears to be very similar to that for type B hepatitis. Additional studies in humans and chimpanzees suggest that there may be more than one non-A, non-B agent. At present, there is no confirmed serological test for detecting this agent(s). The development of such a test would represent a major breakthrough in the prevention of post-transfusion hepatitis and in better defining the epidemiological pattern and clinical consequences of this increasingly prevalent disease.

What is the Importance of the ‘Small Pool Concept’ in the Preparation of Fraction I and Cryoprecipitates for the Prevention of Post-transfusion Hepatitis?

What is the Importance of the ‘Small Pool Concept’ in the Preparation of Fraction I and Cryoprecipitates for the Prevention of Post-transfusion Hepatitis?

Prevention of post-transfusion hepatitis: Role of sensitive hepatitis B antigen screening tests, source of blood and volume of transfusion

Aliquots from units of blood were screened by radioimmunoassay (RIA) and reverse passive hemagglutination (RPHA) shortly after transfusion. Recipients of positive units, as well as control subjects, were followed prospectively for evidence of either post-transfusion hepatitis (PTH) or exposure to hepatitis B (HB). There was a significant correlation between receipt of either an RPHA-positive or RIA-confirmed positive unit and the subsequent development of PTH or HB exposure. Recipients of all volunteer units had a lower incidence of PTH than did recipients of all commercial units. The frequency of PTH and HB exposure was not statistically different In groups receiving 1 to 5, 6 to 10, 11 to 20 and ≥21 units of blood. The PTH seen in the study presented over a wide clinical spectrum, but it was usually anicteric and frequently asymptomatic.

Prevention of post-transfusion hepatitis. Role of sensitive hepatitis B antigen screening tests, source of blood and volume of transfusion: Koretz RL, Gitnick GL with the assistance of Mitchell JE, Damus K, Ritman SG, Golub L, Kash PL: Am J Med 59: 754–760, 1975

Prevention of post-transfusion hepatitis. Role of sensitive hepatitis B antigen screening tests, source of blood and volume of transfusion: Koretz RL, Gitnick GL with the assistance of Mitchell JE, Damus K, Ritman SG, Golub L, Kash PL: Am J Med 59: 754–760, 1975

Prevention of posttransfusion hepatitis by gamma-globulin. Preliminary report.

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Prevention of posttransfusion hepatitis by gamma-globulin. Preliminary report

Prevention of posttransfusion hepatitis by gamma-globulin. Preliminary report

Alcohol sponge baths.

Alcohol sponge baths.