Autologous blood donor screening indicated a lower prevalence of viral hepatitis in East vs West Germany: epidemiological benefit from established health resources.

Prevalence data concerning viral hepatitis and human immunodeficiency virus (HIV) in the general population are usually scarce. We aimed for a large cohort representative of the general population that required little funding. Autologous blood donors are relatively representative of the general population, and are tested for viral hepatitis and HIV in many countries. However, frequently these data are not captured for epidemiologic purposes. We analysed data from well over 35,000 autologous blood donors as recorded in 21 different transfusion centres for anti-hepatitis C virus (HCV), HBsAg and anti-HIV, as well as TPHA if available. We found a lower prevalence of hepatitis B virus and HCV in East vs West Germany, 0.2%vs 0.32% and 0.16%vs 0.32% respectively, which confirms earlier data in smaller cohorts, thus supporting the value of our approach. HIV was too rare to disclose significant differences, 0.01%vs 0.02%. TPHA was higher in East (0.34%) vs West Germany (0.29%) without significant differences. HCV was more frequent in women vs men. Transfusion institutes managing autologous blood donations should be used as a resource for epidemiological data relating to viral hepatitis and HIV, if such testing is performed routinely. This approach generates data relating to the general population with special emphasis on undiagnosed cases.

New families with von Willebrand disease type 2M (Vicenza).

The variant von Willebrand disease (vWd) variant type 2M (Vicenza) was identified in 13 patients of 7 unrelated families. 11 patients were from different parts of germany and 2 patients from Turkey. Hitherto this variant of vWd has been described only in two families originating from the province of Vicenza in Northern Italy. Characteristically this type of vWd shows the supranormal multimers of von Willebrand factor (vWf) in plasma similar to those seen in normal plasma after desmopressin infusion. Clinically, the patients present with bleeding symptoms. Other laboratory abnormalities include reduced values for vWf antigen (vWf: Ag), factor VIII coagulant activity (VII:C), ristocetin cofactor activity (RiCof) and collagen binding activity (vWf: CBA). The hereditary transmission of this variant is consistent with an autosomal dominant mode of inheritance. The patients with vWd type 2M (Vicenza) could be allocated into two subgroups: type "platelet normal" with normal vWf properties in platelets and type "platelet low" with reduced vWf: Ag levels in platelets.

[Effect of desmopressin (DDAVP) on blood platelet parameters in vivo and in vitro]. / Untersuchungen zum Einfluss von Desmopressin (DDAVP) auf Blutplättchenparameter in vivo und in vitro.

Coagulation assays including DDAVP test were carried out in 15 patients preoperatively, evaluating several parameters of platelets during the assays. After DDAVP infusion we observed a decreased spontaneous aggregation in whole blood, an increased retention to glass beads, and in a number of cases a raised in vitro-formation of thromboxane. By application of DDAVP, a significant enhancement of spontaneous aggregation in whole blood and left shift to smaller volumes of the platelet volume distribution were demonstrated in vitro. It is concluded that DDAVP has an indirect inducing effect on aggregation, probably by release of ADP from red blood cells.

Ex vivo investigation of blood monocyte and platelet behaviour in pigs maintained on an atherogenic diet.

Domestic pigs aged 4 months were fed for 16 weeks an atherogenic diet rich in cholesterol and saturated fatty acid. The increase of plasma cholesterol and triacylglycerol levels was found to be accompanied by a significant increase in the number of blood monocytes and platelets when compared to control animals. Furthermore, the atherogenic diet produced a small but significant reduction in the blood monocyte phagocytic capacity and adhesion to plastic surface. No significant differences between both groups were found when spontaneous platelet aggregation in whole blood was studied. However, platelets from pigs fed the atherogenic diet had a smaller mean cell volume compared to controls. The results indicate than an atherogenic diet may affect blood monocytes and platelets in pigs.

[Kinetic fibrinogen determination with batroxobin (reptilase)]. / Kinetische Fibrinogenbestimmung mit Batroxobin (Reptilase).

A kinetic turbidity-producing method for fibrinogen determination on the basis of reptilase reagent (batroxobin) is described. The method, which is in good agreement with method by Clauss shows comparable precision, is marked out by the possibility of objective photometric measurement. Reagent stability, use of undiluted test plasma and single-point calibration are further advantages. The method is insensitive to heparin. With regards to FDP it is less disturbed than the method by Clauss. In case of adaptation to a modern photometer a clear rationalization effect can be achieved.

[The effect of combination epidural anesthesia techniques in upper abdominal surgery on the stress reaction, pain control and respiratory mechanics]. / Der Einfluss epiduraler Kombinationsanaesthesieverfahren bei Oberbaucheingriffen auf Stressreaktion, Schmerzverhalten und Atemmechanik.

Twenty-eight patients undergoing upper abdominal operations (mainly selective proximal vagotomy [SPV]) were referred for assessment of the hormonal metabolic reaction (adrenocorticotropic hormone [ACTH], arginine vasopressin [AVP], cortisol, and glucose), the postoperative pain reaction, and respiration according to the method of anesthesia (group 1: neuroleptanesthesia [NLA], group 2: NLA in combination with epidural opiate analgesia, group 3: NLA in combination with local anesthesia). To alleviate postoperative pain piritramide was systematically administered in group 1, whereas in groups 2 and 3 a thoracic epidural catheter was injected with morphine or bupivacaine. Postoperative analgesia was better in patients with epidural administration than in those with systemic application. On the 1st and 2nd postoperative days the vital capacity was statistically significantly higher by 10%-15% in groups 2 and 3 than in group 1. As expected, the neurohormonal and metabolic stress response was highest in all patients in the intraoperative and immediate postoperative phases: ACTH, AVP, and glucose levels were in most cases significantly higher compared with the initial values. However, cortisol levels decreased intraoperatively, probably as a result of the generally used induction agent etomidate. Comparison of the three methods of anesthesia revealed that all mean hormone levels analyzed in group 2 patients were lower both intraoperatively and 2 h postoperatively, which implies that epidurally administered morphine reduces the stress reaction, probably indirectly through additional selective alleviation of pain at the spinal cord level. The various differences in hormonal reactions of patients in groups 1 and 3 gave no clear evidence, however, of possible mitigation of the stress reaction by epidural local anesthetics in upper abdominal operations.

[Measurement of spontaneous platelet aggregation in citrated whole blood by application of the hematologic automatic Coulter S plus VI]. / Zur Messung der spontanen Thrombozytenaggregation im Citratvollblut (SPAV) unter Verwendung des hämatologischen Automaten Coulter S plus VI.

A method for measurement of the spontaneous platelet aggregation in citrated whole blood (SPAV) was tested using the Coulter Counter S plus VI and a simple mechanism for sample rotation. The underlying principle of the procedure consists in the sequential measurement of the decrease of free platelets in a specimen of citrated whole blood which ist rotated at 37 degrees C for 20 minutes. SPAV offers advantages compared to other methods for spontaneous aggregation in platelet rich plasma. First experiences about application of the SPAV-procedure are presented.

[Behavior of plasminogen in prostatic carcinoma treated with cytonal]. / Das Verhalten des Plasminogens beim Prostatakarzinom unter dem Einfluss der Cytonaltherapie.

With the help of the lysis time method after Blix as well as of the radial immune diffusion after Mancini in blood donors and in patients with histologically ascertained carcinoma of the prostate estimations of plasminogen were performed. In the group of patients the controls were repeated after having finished the initial therapy. While with the help of the two methods plasminogen values were established before therapy which essentially were within the normal, after the initial therapy with cytonal a significant increase of plasminogen developed. The importance of these findings is discussed in connection with a possible increased rate of fibrinolysis in carcinoma of the prostate.

[Results of in vivo analysis of injected fibrinogen degradation products and factor VIII in patients with hemophilia A]. / Ergebnisse der In-vivo-Wiederauffindung von Fibrinogenspaltprodukten und Fakto VIII bei Patienten mit Hämophilie A.

Seven patients with haemophilia A CP were injected in a dosage of 1 to 3 double units, which were stored for 127 days partly deep-frozen, partly lyophilized and after this time contained fibrinogen fission products (16--256 microgram/ml). Though in two patients after the transfusion positive WA of the injected fibrinogen fission products were established, a relevant influence on the fibrinogen fission product levels of the patients is to be expected only after administration of larger quantities of such preparations. The therapeutic efficacy of the stored CP was insufficient, since despite good in-vitro-activities of factor VIII the increase of factor VIII in four patients was slight and retarding and did not take place in three patients.

[Occurrence and behavior of fibrin fibrinogen degradation products in concentrates of factor VIII, cryoprecipitate and dextran precipitate during long-term preservation]. / Vorkommen und Verhalten von Fibrinogenspaltprodukten in den Faktor-VIII-konzentraten Kryopräzipitat und Dextranpräzipitat bei Langzeitlagerung.

In deep-frozen and lyophilized cryoprecipitates and dextran precipitates it was analyzed by the TRCHII and the SCT, whether these factor VIII concentrates contain fibrinogen fission products effecting as inhibitors of the coagulation of blood and how they act during storage for 200 days. Simultaneously the parameters total protein, fibrinogen, fibrin monomers, plasminogen and factor VIII activity were always determined. In all preparations being tested fibrinogen fission products could be detected. Lyophilized cryoprecipitates showed the highest average values with 7.97 microgram/ml (TRCHII) resp. 18.31 microgram/ml (SCT). They were followed by deep-frozen cryoprecipitates with 6.93 microgram/ml (TRCHII) resp. 7.54 microgram/ml (SCT). Deep-frozen dextran precipitates free of heparin contained the fewest fission products (TRCHII: 0.36 microgram/ml; SCT: 3.13 microgram/ml). At the beginning of the storage only few fission products were found in all groups of preparates. A predominantly clear rise with forming a peak after about 115 to 145 days and a drop following happened with extended storage period. This course of storage of the quantities of fission products shows that the fibrinogen fission products arise during storage.

[The use of anti-AHP as a test reagent on blood group documentation cards]. / Uber den Einsatz von Anti-AHP als Testreagenz auf Blutgruppendokumentationskarten

In principle it is possible to use anti-AHP upon bedside test cards for the purpose of blood group documentation. In accordance with the individual quality of the anti-AHP substance an optimal concentration has to be determined and retained. With regard to the rapidity of responses and their strength the anti-AHP involves advantages towards the human anti-A test serum. However, the reliability of reading the results will be slightly limited by the appearance of very fine pseudoagglutinates towards O and B blood corpuscles.