PubMed · 4716709
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P J Schmidt. Regulating transfusion therapy.. https://pubmed.ncbi.nlm.nih.gov/4716709/
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BACKGROUND: Despite sensitive antibody-based blood-donor screening, a residual risk of transfusion-transmitted viral infections exists. Only direct monitoring by sensitive nucleic-acid tests would provide data accurately to measure the risk and to assess risk-reduction procedures. We investigated the feasibility and efficacy of routine screening of donors for hepatitis C virus (HCV), hepatitis B virus (HBV), and HIV-1 by PCR. METHODS: For PCR testing, individual donor plasma samples were pooled (96x100 microL) overnight by two automatic pipetting machines. Viruses were concentrated by centrifugation and nucleic acids were extracted. HCV PCR was done on the Cobas Amplicor system (Hoffmann-La Roche, Mannheim, Germany). HBV and HIV-1 sequences were amplified by single (non-nested) in-house PCRs and detected by agarose-gel electrophoresis. Detection limits were 1000-5000 genome equivalents/mL in the donor blood. FINDINGS: PCR testing was done in parallel to antibody screening with a maximum throughput of 3000 samples in 7-8 h. Positive samples were identified 1-2 days later. 111 of 373,423 donations (107 of 4500 pools) were PCR and antibody/antigen-confirmed positive. We found one HCV PCR-positive antibody-negative donation with normal alanine aminotransferase and one HCV PCR-positive donation with an elevated alanine aminotransferase (100 IU), which was negative in the AxSYM 2.0 and Matrix 1.0, but positive after control in the Abbott Prism test (Abbott GmbH, Wiesbaden, Germany). INTERPRETATION: PCR is a suitable and fast blood-donor screening procedure and contributes to a reduction in viral transmission by transfusion of blood components. In our selected donor population, the yield of detected contaminated donations from donors in the time window in which they are highly infectious but do not have any symptoms or detectable antigen and antibody concentrations (diagnostic window), confirms theoretical estimates.
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Pre-operative blood donation gives ready availability of large volumes of patient compatible blood, up to four units and five when erythropoietin is used. It is recommended that autologous pre-donated blood is leucocyte depleted immediately after the donation. During normovolaemic haemodilution it is mandatory to monitor haemodynamics during the donation. Usually 1-2 units are removed pre-operatively and returned during or after the operation. Intra and postoperative salvage and recycling is performed either with washing and haemoconcentration of the blood or with salvage and immediate retransfusion. When salvaged blood is retransfused unwashed there are high levels of free haemoglobin, degradation products of fibrin/fibrinogen, interleukin-6 and activated complement. Clinically, this has not been shown to be of importance. Taking the patient's health status into account, we suggest that a level of B-haemoglobin should be determined pre-operatively to indicate use of transfusions both with autologous and allogeneic blood.