Serological infectious disease markers in blood donated at Siriraj Hospital.

A retrospective study was done on blood donated at Department of Transfusion Medicine, Siriraj Hospital from 1987 to 1996. The total number of 274,288 units were donated from three types of blood donors : voluntary (61.31%), replacement (35.57%) and paid (3.12%) during 1987-1993. The serological infectious disease markers were found to be highest in replacement donors. The prevalence of anti-HIV, HIV antigen, HBsAg, anti-HCV and positive VDRL were 0.7%, 0.02%, 6.2%, 1.6% and 2.3% respectively. The prevalence of these markers in voluntary donors were 0.3%, 0.01%, 2.6%, 0.9% and 1.0% respectively. In conclusion, the serological infectious disease markers in blood donated at Siriraj Hospital during the 10 years period consisted of 0.44% anti-HIV, 0.01% HIV antigen, 3.7% HBsAg, 1.13% anti-HCV and 1.40% positive VDRL. It was also noted that the prevalence of these markers in new blood donors were higher than those found in repeat blood donors.

Angiotensin converting enzyme gene polymorphism in healthy Thais and patients with non-insulin dependent diabetes mellitus.

Insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene has been shown to be associated with various cardiovascular disorders in diabetic and non-diabetic patients. Its association with the development of non-insulin dependent diabetes mellitus (NIDDM) has been raised. This study was aimed to examine I/D polymorphism of ACE gene in healthy Thai subjects and patients with NIDDM. The I/D ACE genotypes were determined by polymerase chain reaction technique. Healthy unrelated subjects were 151 males and 147 females, 17-70 year old (mean +/- SD = 37.5 +/- 10.4). The unrelated diabetic patients were 42 males and 66 females, 20-79 years of age (mean +/- SD = 54.7 +/- 12.0). In healthy subjects, the ACE genotypes were DD 10.1 per cent, ID 39.2 per cent and II 50.7 per cent. Diabetic patients had similar distribution of ACE genotypes. The frequency of I and D alleles in diabetic patients was 0.69 and 0.31, similar to 0.70 and 0.30, respectively, in healthy subjects (p = 0.69). The frequency of I and D alleles in healthy Thai subjects was similar to the Japanese (I = 0.66 & D = 0.34) but different from Caucasians (I = 0.44-0.46 & D = 0.54-0.56). We conclude that I/D ACE gene polymorphisms may possess a racial difference. The similar frequency of both alleles in diabetic patients and healthy subjects suggests that there is no association between I/D polymorphism of ACE gene and diabetes mellitus in Thai individuals.

A comparative study of three techniques for eluting red cell antibodies.

Sixty-seven eluates obtained from the heat, ether and acid elution techniques were tested with the specific red blood cells (RBCs) and were compared according to their reactivities using the indirect antiglobulin test (IAT). It was found that the ether elution technique was superior in eluting Rh antibodies except for anti-e while the acid elution technique was superior in eluting Miltenberger (Mi(a)) antibodies (P < 0.05). The heat elution technique gave the lowest reactivity among the three techniques. In conclusion, the reactivities of the eluates obtained from the acid elution technique were overall comparable to those from the ether elution technique. The acid elution technique is practical for routine use in most blood banks because it is less time consuming and reduces the risk of exposing hazardous chemicals.

HLA class II allele frequencies in northern Thais (Kamphaeng Phet).

The polymorphism of HLA class II genes (HLA-DRB1, -DQA1, -DQB1 and -DPB1) was investigated in 97 normal Northern Thais (NT) from Kamphaeng Phet province using PCR-SSO typing. Allele frequencies (AF) have been determined. DRB1*1202 (17.5%), DRB1*1502 (16.5%), DQA1*0101 (25.8%), DQA1*0102 (21.7%), DQB1*0502 (22.7%), DPB1*0501 (23.2%) and DPB1*1301 (22.7%) showed the highest frequencies in each locus. These results were more similar to those observed in Present-day Thais (PDT) and Central Thais (CT) than Northern Thais from Chiang Mai (CM) and Dai Lue (DL). However, the data presented in this population study should be useful in many fields, such as anthropology, organ transplantation, disease susceptibility and evolutionary genetics.

Preoperative autologous blood collection and haemodilution with gelatin solution (gelifundol).

Autologous blood collection and haemodilution with gelatin solution had an effect on the decrease in red blood cells, haemoglobin, haemotocrit, fibrinogen and platelets; however, this technique had no effect on coagulograms, platelet function and haemostasis. In conclusion, this technique is suitable and possibly practical in obtaining sufficient blood for elective surgical patients and is without any undesirable side effects.

Factor VIII, factor IX and fibrinogen content in cryoprecipitate, fresh plasma and cryoprecipitate-removed plasma.

In order to provide accurate information for physicians, factor VIII, factor IX and fibrinogen content were determined in 40 bags of cryoprecipitate, fresh plasma and cryoprecipitate-removed plasma. A cryoprecipitate bag with a volume of 21.8 +/- 5.3 ml contained 139.5 +/- 42.9 units of factor VIII and 200.0 +/- 80.0 mg of fibrinogen. Fresh plasma with a volume of 208.0 +/- 22.5 ml contained 180.9 +/- 45.3 of factor IX, significantly higher than in cryoprecipitate-removed plasma. It was also found in this study that group O blood showed a significantly lower level of factor VIII.

Autologous blood and platelet-rich plasma reinfusion reduce post-operative blood and blood component therapy after cardiopulmonary bypass.

To study blood and blood component transfusion following reinfusion of platelet-rich plasma (PRP)/and autologous blood, 33 patients undergoing open-heart surgery were randomly divided into three groups. Group I comprised 13 patients as controls; group II, eight patients from whom were collected PRP 15-20 percent of plasma volume with Haemonetics; and group III, 12 patients from whom were collected PRP and whole blood (400-800 ml) before initiating standardized cardiopulmonary bypass. All of them had balanced anesthesia with thiopental, fentanyl, midazolam, atracurium and nitrous oxide in oxygen. After heparin reversal, PRP/PRP and autologous blood were reinfused in groups II and III, respectively. Recording of hematocrit, blood loss as well as the total number of transfusion was performed. In three groups, significant low levels of hematocrit were seen after cardiopulmonary bypass. Groups II and III has less blood loss after the operation as well as less banked blood and blood products transfusion (p<0.05). In conclusion, the reinfusion of PRP/PRP and autologous blood may serve as an effective method for reducing the amount of banked blood and blood products given in transfusion following cardiac operation.

Unexpected red cell antibodies in donors and patients at Siriraj Hospital.

The incidence of unexpected red cell antibodies in patients and donors at Siriraj Hospital were found to be 4.91% and 4.33% respectively. Anti Lewis, anti P1 and anti Mia were the most common antibodies detected. Antibodies of Rh system were the next, in which anti E was more common than anti D. Anti Jka, Jkb, Fyb, Dia, S and rare antibodies such as anti K, Ge1, Mta and H were also detected in this study.

Further study of Rh, Kell, Duffy, P, MN, Lewis and Gerbiech blood groups of the Thais.

Blood and saliva from unselected blood donors at the Blood Bank, Siriraj Hospital were studied. Two Kell positive, two Rh negative and one Gerbiech negative were found, which could be considered as rare blood type in Thailand. The commonest Rh gene complex was CDe (R11 and the presence of CDE (Rz) in this study are the usual pattern of people in Southeast Asia. Fya is very common as in other people of Asia. In the Lewis system, the incidence of Le (a + b -) was 28.48% which agree well with our previous report 30.9%. There were 410 out of 1,668, (23.17%) who were found to be Lea non-secretor and 95 of them have Lewis antibodies in their sera. Aberrant secretion patterns were also found in this study, 5 people were found to secrete A or B substances according to their blood groups but no H substance was detectable. Further investigation of Lewis groups and secretion in Thailand are needed.