[An a priori risk analysis study. Securisation of transfusion of blood product in a hospital: from the reception in the medical unit to its administration]. / Cartographie des risques a priori. Sécurisation de la transfusion d'un produit sanguin labile, dans un établissement de santé : de sa réception à son administration.

Following an ABO accident after transfusion of red blood cells, an a priori risk analysis study is being performed in a hospital. The scope of this analysis covers from the reception of the blood product in the medical unit to its administration. The risk analysis enables to identify the potentially dangerous situations and the evaluation of the risks in order to propose corrective measures (precautionary or protective) and bring the system back to an acceptable risk level. The innovative concept of an a priori risk analysis in the medical field allows the extension of the analysis of this transfusion risk to other hospitals. In addition, it allows the extension of the use of this approach to other medical fields.

[Klebsiella oxytoca septicemia following platelet transfusion]. / Septicémies a Klebsiella oxytoca après transfusions de plaquettes.

Two fractions of a three-day-old apheresis platelet collection from a known habitual donor were transfused to two children with thrombocytopenia and bleeding. Both patients developed evidence of severe infection during the transfusion. One died despite intensive care and antimicrobial therapy. The other, whose transfusion was cut short, recovered. A Klebsiella oxytoca strain was recovered from the two transfusion bags, from a third unused bag, and from blood samples from the patient who died. Genotyping results established that all these isolates were identical. Tests for K. oxytoca were negative on the batches of blood donation material, the bottle of antiseptic used, and throat and stool specimens from the donor and phlebotomists. The most likely hypothesis is that the donor developed transient asymptomatic bacteremia during the 136-minute-long collection procedure and that the organism subsequently grew in the platelet collections, which were kept at 20-24 degrees C with agitation for three days before being used.

Products for the treatment of hemophilia A and B prepared by ion exchange chromatography.

In France, since 1988, factor VIII concentrate are prepared by ion exchanged chromatography from plasma cryoprecipitate. The final product is a very high purity factor VIII with a specific activity (SA) between 150 and 250 IU/mg of proteins. Viral inactivation is obtained after solvent detergent method with TNBP and Tween 80. Since 1989 hemophilia B patients are treated with a factor IX preparation purified from a prothrombin complex concentrate and after solvent detergent inactivation. Factor IX concentrate is a high purity product with a SA of 50 to 100 U/mg of protein.

Autoimmunity after allogeneic bone marrow transplantation. A study of 53 long-term-surviving patients.

Various autoantibodies were screened in 53 long-term survivors after allogeneic bone marrow transplantation. Among them, 40 displayed chronic graft-versus-host disease, with clinical features reminiscent of collagen diseases, especially scleroderma, Sjögren's syndrome, and autoimmune hepatitis. Antinuclear, anti-smooth muscle, antimitochondria, anti-liver kidney microsome, and antiepidermal antibodies were found at a frequency of 62.2%, 49.0%, 11.3%, 5.6%, and 11.3%, respectively. The screening for native anti-DNA, anti-extractable nuclear antigen, anticentromere, and anti-salivary gland duct antibodies was negative. The presence or absence of acute GVHD made no difference in the frequency of autoantibodies. No correlation between cutaneous hepatic involvement, sicca syndrome, scleroderma status, and autoantibodies could be established. Despite clinical features mimicking collagen vascular diseases, the biological autoimmune profile of GVHD was different. The precise role of autoimmunity in chronic GVHD remains to be defined.

Autoimmunity in 28 patients after allogeneic bone marrow transplantation: comparison with Sjögren syndrome and scleroderma.

The occurrence of autoantibodies in 28 long-term survivors of allogeneic bone marrow transplantation (BMT) (21 with chronic graft-versus-host disease) was compared with 48 cases of idiopathic Sjögren syndrome and 82 cases of scleroderma. Antinuclear, anti-smooth muscle, and anti-mitochondria antibodies occurred respectively in 80%, 82% and 14% of the post BMT cases. Anti-native DNA, anti-soluble nuclear antigen and anticentromere antibodies were not found. Antiepidermal antibodies were present in 14% of the cases but their pathological role is unclear. Although the clinical manifestations of chronic graft-versus-host disease are similar to Sjögren syndrome and scleroderma the autoantibody profile is significantly different.