Biomedical subjects
Publications and source records attributed to U Sugg.
An unusual case of a 37 degrees C-active irregular anti-A1 is reported. Apparently consisting mainly of IgG, the antibody appeared in an A2B recipient only two days after massive transfusion of A1-cells in absence of previous transfusion. It was associated with severe hemolysis and renal failure which was reversed after exchange transfusion.
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A prospective study of the incidence of post-operative hepatitis was carried out in 417 patients following open-heart surgery. During the observation period 16 (3.8%) patients contracted hepatitis (15 non-A, non-B hepatitis; 1 hepatitis B). Fibrin seal was used intraoperatively in 19 patients; post-operatively there was no evidence of hepatitis in any of these cases. Thus fibrin seal should not be grouped with "high hepatitis-risk" preparations.
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A prospective study of post-transfusion hepatitis was conducted in 97 adult patients undergoing open heart surgery. Twelve patients developed presumed non-A, non-B hepatitis (five of these were hospitalized and three were jaundiced), and all 12 had received clotting factors from pooled plasma (fibrinogen, factor VIII, factor IX complex) from different manufacturers. Of the remaining 85 patients none received these high risk plasma derivatives and none developed hepatitis. Multiple peak ALT elevation seems to be an indication of development of chronic non-A, non-B hepatitis. In addition to the 12 cases of presumed non-A, non-B hepatitis, nine cases of serological changes related to hepatitis B virus were observed as follows: six early booster reactions of anti-HBs, but not anti-HBc, in anti-HBs and anti-HBc positive persons; one late immunization-like response for anti-HBs and two serological hepatitis B infections without transaminase elevation. Five of the nine cases were also associated with the administration of pooled clotting factors.
We have investigated 8 cases of clinically manifest hepatitis type B said to be posttransfusion hepatitis that have become known in the years 1978-1981. Paired samples of serum from all 54 blood donors implicated have been drawn at the time of the donation in question as well as a few months later. Only 1 donor, negative for HBsAg but positive with high titer for anti-HBc, could have been a possible source of infection. There is strong evidence that this person is a chronic low level carrier. In the case of 2 other patients transmission of hepatitis by clotting factors from pooled plasma cannot be denied. Regarding the remaining 5 cases, there is no hint whatsoever for a causal connection between blood transfusion and hepatitis type B.
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HBsAg was determined quantitatively by radioimmunoassay and by Laurell electrophoresis in sera of 90 patients with acute hepatitis B, 57 patients with chronic hepatitis B, and 154 HBsAg positive blood donors. Of 55 patients with clearance of HBsAg from the circulation within six months, 54 (98%) showed an at least 50% reduction in concentration within 16 days. All 55 patients had such a decrease within 20 days. No such decrease was found in seven patients with acute hepatitis B who became HBsAg carriers. Therefore, quantitative HBsAg concentration in paired sera seems to be a reliable and early prognostic marker in acute hepatitis B. In patients with clearance of HBsAg most of the antigen is already present in the circulation at hospitalization and is eliminated with a mean half-life of 8.8 days. Patients with chronic hepatitis exhibit on average nearly the same HBsAg concentration (about 40,000 ng/ml) as patients with acute hepatitis B at hospitalization (about 39,000 ng/ml) and HBsAg positive blood donors on average a lower HBsAg concentration (about 8,000 ng/ml).
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Using ultracentrifugation, gel filtration, and ion exchange, an attempt was made to completely separate immunoglobulin IgM and IgG present in pooled human serum of blood group O. The quality of separation was studied by testing IgG fractions for the presence of IgM by a sensitive detection method. It is demonstrated by rheophoresis that small amounts of IgM always remain detectable in the IgG fraction. This is of clinical importance because conclusions on the presence of specific antibody of different Ig classes are usually drawn under the assumption of complete separation. The control of the efficacy of the separation process using a sensitive detection method for Ig of different classes is recommended.
A solid-phase radioimmunoassay using anti-HBe-coated polysterence beads and iodine-125-labeled anti-HBe of human origin was developed for the detection of HBeAg. Anti-HBe could be determined by a blocking test. Both assays were about 500-fold more sensitive than immunodiffusion. Few nonspecific positive results for HBeAg could be recognized in the anti-HBe test by increase in cpm over that of the negative control. HBeAg was not found in acute hepatitis A and non A-non B hepatitis or in a control group of accident patients. On admission to the hospital 12 of 48 (25%) acute hepatitis B patients from Greece and 17 of 20 (85%) acute hepatitis B patients from Germany were HBeAg-positive. All 39 initially HBeAg negative sera were already anti-HBe positive. Tests of the acute stage and follow-up sera of the 20 German patients indicated that HBeAg is regularly present in the incubation period and early acute phase of hepatitis B. After onset of disease the antigen is cleared from the serum very rapidly in uncomplicated cases and is usually followed by the appearance of anti-HBe. Like anti-HBc, anti-HBe can serve as a tool for the diagnosis of hepatitis B after the disappearance of HBsAg.
Using a solid phase radioimmunoassay, prevalence of anti-HA was determined in sera of 661 German patients treated following accidents, 70 persons born in Mediterranean countries and 175 persons from Lillehammer, Norway. In Germany (55% positive) an increase in prevalence of anti-HA from 13% in the group below 20 years of age to 92% in persons over 49 was noted. This and further data suggest that after infection anti-HA is detectable for life. Persons from Norway (17% positive) aged below 40 years had a low prevalence of anti-HA (4-10%), whereas even young persons from Mediterranean countries (81% positive) hat antibody in about 80% of cases. Prevalence rates in different age groups suggest a remarkable decrease in incidence of hepatitis A infection over the last three decades in Germany. This results in a rise in the mean age at which hepatitis A infection is acquired and high morbidity during travel abroad. Only one of 10 hepatitis A infections appears to produce clinical disease. Young anti-HA positive individuals exhibit higher titers on average than older ones.
In a prospective study in posttransfusion hepatitis 54 patients with open heart surgery received 220 blood units which were negative for HBS Ag by radioimmunoassay. 15 of these units contained anti-HBS and were given to 13 antibody negative patients. In a half year follow up period neither clinical nor biochemical (SGOT, SGPT, gamma-GT) signs of hepatitis could be found in these patients and neither HBS Ag nor anti-HBS developed. At the same time a screening for HBS Ag of hospital staff in contact with these patients revealed no carrier of the antigen. Therefore, the lack of any hepatitis in our relatively small study group may be attributable to two facts: the relative safety of blood screened by highly sensitive methods for the detection of HBS Ag and the noninfectious environment of these patients in the hospital during the observation period.
Hepatitis B antibody could be demonstrated in 101 (8,7 percent) of 1157 sera of blood donors from the Tübingen area by passive hemagglutination. The prevalence of antibody in this population is similar to the prevalence in volunteer blood donors of New York and Chicago and 4-5 times as high as in blood donors from Lillehammer/Norway. The percentage of antibody-positive donors is very dependent on age and increased from 5 per cent in donors less than 20 years of age to 17 per cent in donors 50-59 years of age. No significant difference in the prevalence of antibody was noted between male and female donors and donors of different occupations. However, persons working in the medical field exhibited an increased percentage of antibody carriers (17 per cent).
During a prospective study in post transfusion hepatitis 222 blood units were given to 55 patients who underwent open heart surgery. Eleven of these blood units contained anti-HBs titered higher than 1:128 by passive hemagglutination and were given to 10 patients previously negative for anti-HBs. Eight of these 10 patients showed anti-HBs in the first serum sample obtained usually one to three days after surgery and a continuous decline in titre was noted at later bleedings until antibodies were no longer detectable 2 to 20 weeks after transfusion. In four patients from whom regular blood samples were available the half life of passively acquired anti-HBs was determined to be between 23 and 28 days. In two patients with serum anti-HBs before blood transfusion no change in antibody titre was noted over a period of six months.
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