Economic donor screening for anti-HIV in the developing world.
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Biomedical subjects
Publications and source records attributed to L V Milner.
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The skin of the antecubital fossae of 90 subjects, chosen at random but eligible to be blood donors, was sampled using sterile swabs. This sampling was done prior to disinfection. The swabs were inoculated into a selective culture medium and 'incubated' at blood bank refrigerator temperature for a total of 6 weeks. The results show that there were a number of cold-growing Gram-negative bacilli (GNB) on the skin tested. One of the GNB carriers found was subjected to frequent testing both before and after skin disinfection. The routine skin disinfection regime for blood donors was used in an attempt to establish its effectiveness. Despite regularly being able to culture Pseudomonas fluorescens prior to swabbing, no swabs taken after disinfection showed growth. This volunteer was subjected to a skin biopsy to establish whether the skin disinfection might be simply superficial. No growth occurred in the medium into which biopsy tissue, after disinfection, was inoculated. We conclude that although GNB may be present on donors' skin, the disinfection procedure, as used by us prior to donation, was effective.
An improved sensitivity to low levels of hepatitis B surface antigen (HBsAg) was demonstrated when ELISA results were interpreted by a statistical method. The absorbance of each test well was compared with the mean absorbance of all low-colour test samples. Those wells with an absorbance of more than two standard deviations above the mean were referred for confirmatory tests. Samples containing 1.0 ng/ml of HBsAg were reliably detected by a rapid assay technique (1.5 h). Predictive value analysis showed greater sensitivity than was possible from a direct comparison of test samples with controls.
Screening blood donations for anti-HTLV-III with a modification to a commercially available test kit has so far been found satisfactory--the reagent cost is less than R1.00 a donation. Should all transfusion services adopt this method, South Africa's total blood donations could be tested at a cost of about R650 000, instead of R2.7 million or more, a year.
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A technique is described which allows testing for HBsAg by hemagglutination inhibition in capillary tubes. The test is rapid, and compares favorably in sensitivity to radioimmunoassay. The equipment is simple, and its design eliminates the risk of infection from the HBsAg reagents.
Reactions reported after transfusion of 19,126 units of whole blood and of 42,678 units of red blood cells were analysed. The reaction rate with whole blood was about two and one-half times as great as with red blood cells.
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