Identification of risk factors in blood donors found to have HIV infection.

To ascertain whether current screening procedures for human immunodeficiency virus (HIV) infected blood can be improved, a study of blood donors found by Mersey and North Wales Blood Centre to be HIV positive was made. In total 22 donors were identified, of which 16 were referred to the Department of Genito-Urinary Medicine (GUM) in Liverpool. Most (9/16) should have been excluded from donating because of recognized risk factors. However, in 7 cases no such identifiable factors were found. Although the risk of transfusion transmitted infection is small, there is an argument for testing donated blood for HIV RNA by nucleic acid technology.

Post-transfusion HIV infection despite donor screening: a report of three cases.

In August 1996, a blood donation was collected which subsequently infected three patients post-transfusion with HIV 1. The donation itself was originally screened as negative for anti-HIV 1/2 using a sensitive EIA method, but subsequently was shown to contain p24 Ag and HIV RNA by an amplification technique. The proposed introduction of nucleic acid testing of all blood donations in the UK for hepatitis C, hepatitis B and HIV may further reduce the remote risk of further episodes of post-transfusion infection. The infection in the index recipient was detected on routine pre-transplant virological screening but proved difficult to confirm, at a time when she had recently received myeloablative treatment for a haematological malignancy which impaired the immune response. There is a need for continued vigilance in such patients to exclude post-transfusion infection, at a time when natural immunological responses have been impaired by their disease or treatment.

Preventing Rhesus D haemolytic disease of the newborn by giving anti-D immunoglobulin: are the guidelines being adequately followed?

OBJECTIVE: To ascertain whether anti-D immunoglobulin is being administered to Rhesus D negative women in accordance with the 1991 recommendations for its use to cover all events which may result in fetomaternal haemorrhage. DESIGN: The notes of women delivered in 1994 were examined for compliance with the 1991 recommendations. SETTING: Seven maternity units using a central antenatal screening service. PARTICIPANTS: Nine hundred and twenty-two Rhesus D negative women delivered in these seven hospitals. MAIN OUTCOME MEASURES: The prescription, dosage and indications for administration of anti-D immunoglobulin to women during pregnancy and in the puerperium. RESULTS: Postnatal anti-D immunoglobulin was given in appropriate doses to more than 95% of women who required it. Omissions mainly arose from confusion among women who recently had received antenatal treatment with anti-D immunoglobulin. The 1991 recommendations for antenatal administration were less closely followed. Abdominal trauma was covered in only 20% of cases. An inadequate dosage of 250 i.u. was given to 25 women for antepartum haemorrhage after 20 weeks of gestation. The purpose of the Kleihauer test was sometimes poorly understood, with a 'negative' result interpreted as a reason not to give anti-D immunoglobulin. CONCLUSION: Closer adherence to the 1991 recommendations might further reduce the incidence of Rhesus D immunisation below the current 1%. It is suggested that more careful application of the recommendations should be evaluated before considering either routine antenatal prophylaxis, or the European recommendation of a larger dose (1000-1500 i.u.), both of which would increase the requirements for this limited resource.

Immune haemolytic anaemia and nomifensine treatment in north west England 1984-85: report of six cases.

Nomifensine, an antidepressant used for eight years in Britain, was particularly popular in the north west of England. Haemolytic anaemia was recognised as a rare side effect, but in 1984 a cluster of six cases was referred to the North West Regional Transfusion Centre, reflecting an incidence of 0.006%. These were collected within 18 months and showed variable serological features, indicating that antibodies associated with nomifensine treatment are neither rare nor of one particular type. The accumulation of this and similar data contributed to its withdrawal from the British market in January, 1986.