Post-transfusion hepatitis. Sudden drop of its incidence associated with hyperbilirubinemic donors disqualification.

The lacking impact of various precautions on the incidence of post-transfusion hepatitis (PTH) in the last 15 years is presented. In 1984, however, PTH dropped from 0.12 to 0.04%. This PTH drop did not coincide with the disqualification of HBsAg carriers, nor with that of high ALT, nor with the introduction of complete voluntary donorship in 1982, but with the systematic exclusion of hyperbilirubinemic donors. Circulating immune complexes (CIC) were found in 28.9% of PTH compromised donors, and CIC are therefore supposed to be a marker of PTH risk even if HBsAg was not demonstrable. Re-examining donors compromised in 120 PTH found 12.4% HBsAg carriers who had not been detected by CIEP prior to the transfusions. Accumulation of more than one HBsAg positive transfusion in 56.5% of the PTH patients suggests a cumulative effect. The inability of specific tests to identify sources of infection in 50% of PTH suggests that doubts must be raised as to their post-transfusional origin. This thesis is also supported by the relative increase of this group after the considerable drop of PTH. The importance of viral sources non-B and B undetectable by sensitive specific methods must be emphasized. The latter is in accordance with the observed PTH drop due to a non-specific marker effect. The bilirubin level screening in each donor before stored blood collection is recommended by means of the described extended AST screening test and, besides HBsAg screening, this is supposed to be the most effective precaution for preventing PTH.

The Hp, Gc, Gm, Km and beta 2-glycoprotein I genetic variants in hairy cell leukemia: no apparent association.

No significant differences could be observed when Hp, Gc, Gm, Km and beta 2-glycoprotein I phenotypes of 50 patients with hairy cell leukemia were compared with healthy unrelated adults.

High-titered anti-HBs plasma donors--another form of post-hepatitic immunopathy syndrome.

In the population of 55 high-titered anti-HBs donors only 23 tolerated plasmapheretic collections without intermittent elevations or ALT activity. In 4 persons a RIA-detected HBsAg circulated along with high-titered anti-HBs. In 73.8% of donors anti-HBs was accompanied by an anti-HBe antibody which also appeared in the HBIG preparation HEPAGA and can perhaps participate on its protective influence. Circulating immune complexes (CIC) were detected in 89.1%. No HBsAg, HBeAg, or albumin were detected in CIC isolated from anti-HBs sera in spite of their content in CIC isolated from HBsAg carriers. Thus, CIC carriers found in normal population with a prevalence of 1.0% can be divided into 0.6% of HHsAg-containing CIC and 0.4% of HBsAg-lacking CIC carriers with anti-HBs attesting the hepatitic origin in a considerable part of them. The continuing production of alienated CIC-forming antigens and a common origin combine these two forms of post-hepatitic development to a syndrome of post-hepatitic immunopathy which seems to be the most frequent source of CIC in a normal population. All the donors and HEPAGA were anti-HBc positive, as well, but this antibody possessed the IgM character only in 4.3% of the donors. Mean serum ferritin levels in the anti-HBs donors were distinctly higher than those found in normal populations of both men and women but the differences were statistically not significant due to high variability.