[Anti-hepatitis C prevalence and incidence in 2.8 million blood donors in Lower Saxony--residual transfusion-associated HCV risk]. / Anti-HCV-Prävalenz und -Inzidenz bei 2,8 Millionen niedersächsischen Blutspenden--transfusionsassoziiertes HCV-Restrisiko.

561 out of 2,777,021 blood donations from 582,655 donors tested confirmed positive for anti-HCV (RIBA II or Matrix Dot), 549 of them at their first donation, in their first HCV test ever, or in the first HCV test with a new, more sensitive test generation. Thus, our anti-HCV prevalence is 0.037% or 1 in 2,679 donations; among first-time donations it is five times higher than among repeat donations. Twelve repeat donors seroconverted, yielding an anti-HCV incidence of 0.0008% or 1 in 122,570 repeat donations and a seroconversion rate of 2.32 per 10(5) repeat donor person-years. The residual risk associated with transfusion of blood for repeat donors amounts to 5.2 per 10(6) repeat donations. We estimate a risk reduction from introduction of direct virus genome testing after PCR to be at 3.7 per 10(6) repeat donations. Look-backs among recipients of the last seronegative blood products from 12 donors with subsequent seroconversion revealed no recipient infection. Thus, today the residual risk for HCV transmission through transfusion of blood components obtained from Lower Saxony blood donors is quite low. The added safety from direct virus genome testing after PCR is considered extremely low, which casts doubt on the cost-effectiveness of such a measure.

[Donor exclusions, discarded blood and transfusion unsuited blood conserves of 2,13 million potential blood donors 1991 to 1994]. / Spenderausschlüsse, -rückstellungen und nichttransfusionsgeeignete Konserven von 2,13 Mio. Spendewilligen der Jahre 1991 bis 1994.

UNLABELLED: German authorities plan to legislate transfusion safety. We report on the efficacy of donor selection, unit pre-release testing, quality assurance and look-back efforts (LBE): Among 2,127,102 visits by 503,971 donors are 8.7% first-time donors. 96% of repeaters present our donor ID-card. We defer 5.6% repeat and 18.2% first-time donors, mostly for their own safety. 0.5% of the donors suffer a reaction. 94,000 units (4.7%) are not released due to confidential self-exclusion (1.1%), quality and safety concerns (1.7%), and positive screening tests (1.9%). Only 5.2% positive infectious disease screening tests were confirmed. HIV-prevalence of first-time donors is 0.002%; the HIV seroconversion rate for second-time donors is 0.003%. All other seroconversion rates for HBV, HCV, HIV and lues at subsequent donations are 0.001%. 23 donor-related LBE did not reveal a single HIV-infected recipient. In 106 recipient-related LBE involving 868 donors, we found 5 seroconverted donors (1 HBV, 3 HCV, 1 HIV). CONCLUSIONS: Our repeat donors present proper ID. Strict donor selection criteria result in many rejections. Donor reactions are rare. High demands on blood safety and quality result in many discards. In our hands, confidential unit exclusion does not add safety. The HIV prevalence of first-time and repeat donors is equally low. Donor seroconversions are rare. LBE rarely identify infected donors or recipients. Our current high transfusion safety is unlikely to be improved through legislative measures.

[Exceptional production of leukocyte-free erythrocyte concentrates using filtration with the BPF 4 BBS leukocyte filter]. / Das Herstellen weitgehend leukozytenfreier Erythrozytenkonzentrate durch Filtern mit dem Leukozytenfilter BPF 4 BBS.

Leukocyte depletion prevents some undesirable effects of red cell transfusions. We evaluated the blood filter system BPF 4 BBS (PALL) by filtering 26 units of buffy coat-free red cell concentrates, prepared from 500 ml of whole blood and suspended in SAG-M-additive solution, over 8 min within 48 h after donation at room temperature. Filtration reduced the leukocyte content by more than 99.99% in 25 of the 26 units examined. In 20 instances, no leukocyte was found in the Nageotte counting chamber (2 x 50 microliters) corresponding to a total leukocyte count below 2.38 x 10(4). In 5 instances a single leukocyte was seen, corresponding to a total leukocyte count of (2.35 +/- 0.01) x 10(4). One unit contained 2.93 x 10(5) leukocytes after filtration, corresponding to a 99.98% leukocyte reduction. Red cell recovery was 92.5 +/- 3.8%. This system is well suited for routine use.

[Comparison of production costs of allogenic and autologous blood preservation]. / Herstellungskostenvergleich allogener und autogener Blutkonserven.

Comparing direct, indirect and capital costs for preparing allogeneic versus autogenous blood reveals: If one applies modern blood banking (component preparation, routine safety tests prior to blood release for transfusion), supplies and reagent costs for allogeneic and autogenous units are identical, if patient needs no postphlebotomy volume replacement. Personnel costs are higher for preparing autogenous units, because patients require extra care compared to experienced blood donors and because autogenous blood inventory control takes more time. Indirect and capital costs are the same. At our blood bank, the costs for preparing a 3-unit autogenous blood depot are DM 710,42 as compared to DM 663,15 for 3 allogeneic units.

[Personnel need for preoperative establishment of autologous blood preservation compared with allogenic blood preservation]. / Personalbedarf für präoperative Herstellung autogener Blutkonserven verglichen mit allogenen Blutkonserven.

Based on the CAP-Laboratory Workload Recording Method, we compare staffing needs for our preoperative autogenous blood deposit program (PAB) with those for routine allogeneic blood donation (ABD) in our hospital-based community blood center. For the preparation of 1,000 ABD-units, we need 0.17 clerical, 0.34 nursing, 0.47 technologist and 0.27 medical staff full time equivalents (FTE) compared to 0.17/0.71/1.23 and 0.36 FTE, respectively, for 1,000 PAB containing one unit from each donor-patient. For 1,000 PAB containing 4 units from each donor-patient, we require 0.68/2.84/3.96 and 1.38 clerical/nursing/technologist and medical staff, respectively.

[Secondary costs of the disposition of preoperatively withdrawn autologous blood preserves]. / Sekundäre Kosten der Bereitstellung präoperativ entnommener autogener Blutkonserven.

Preoperative autogenous blood (PAB) deposit programs are expensive. Aside from primary costs of preparing PAB, the user incurs major secondary costs from additional preadmission visits with the surgeon and from excess production, utilization and outdating of PAB (transfer into the allogeneic blood supply is not permitted here). These costs will exceed 200 Mio DM annually, increasing with better acceptance of PAB programs. However, PAB deposits are only indicated if transfusion incidence for the intended elective procedure exceeds 30%. Below that, preoperative, isovolemic hemodilution is considered the method of choice for limiting exposure to allogeneic blood.

[Personnel need and production costs of preparative thrombocytapheresis: an appropriate cost-benefit analysis?]. / Personalbedarf und Herstellungskosten präparativer Thrombozytapherese: Stimmt das Preis-Leistungs-Verhältnis?

During their economic assessment of our medical center, the accountants Ernst & Young recommended staffing levels for our blood bank. Based on this and while applying the effective annual working time of each professional group (donor room personnel: operator/physician/medical technologist), we developed a staffing key for complete preparation and testing of apheresis-platelet concentrates (TAPH): with scheduled complete physical examinations (first-time donor, then annually) 1,500/1,450/2,300 procedures a year are considered an adequate output for the professional groups involved. With routine donor screening, the key is 1,800/1,900/2,300 procedures. This does not include any HLA-related activities. Based on this staffing key, our average personnel costs for TAPH are DM 124.67, or 18.3% of the total costs of such product (DM 681.40).

[Population genetics of HLA polymorphism in blood donors of Bremen and Hannover]. / Untersuchungen zur Populationsgenetik des HLA-Polymorphismus bei Blutspendern aus Bremen und Hannover.

501 blood donors from Bremen have been typed for HLA-ABC and -DR. The results are compared with HLA data obtained on 474 blood donors from Hannover. The gene frequencies do not differ significantly between these two population samples. Comparisons with population samples from Kiel, Hamburg, Essen, Frankfurt/M., Mainz, Mannheim, Freiburg/Br., Munich and Vienna did also not reveal any remarkable differences concerning the gene frequencies. Analysis of linkage disequilibrium of two-factor and three-factor haplotypes could show that the typical Caucasoid allele combination A1/B8 is not a constituent part of three-factor haplotype combinations. Between the population samples from Bremen and Hannover no marked differences in the distribution of two-factor and three-factor haplotype frequencies could be found.

[Organization of a bone marrow donor database]. / Aufbau einer Knochenmarkspender-Datei.

We report on the organisation of developing a bone marrow donor file. Emphasis was placed on adequate information for and informed consent and on adherence to legal requirements for maintaining confidentiality. Nearly 7500 blood donors received a three part information, including the possibility of registration as a potential bone marrow donor. About 430 donors are now registered in this bone marrow donor file.

[Preoperative autologous blood bank: communication, documentation, informed consent, iron supplement, testing, blood bank reports, cost control, transfusion]. / Das präoperative autologe Blutkonservendepot: ein K.R.A.F.T.A.K.T.

Preoperative deposition auf autologous blood requires a strenuous effort for its initiation and operation. K.R.A.F.T.A.K.T. (literal translation: strenuous effort) became therefore the acronym for the program realized at this institution; it stands for: K = communication between patient and his physicians (primary care, surgeon, blood banker) R = direction of the program through the primary care physician (who does what, when, where, how and how much of it) A = informed consent of the patient prior to the first donation F = iron supplement (100mg Fe++ daily beginning 2 weeks prior) T = collection, processing, labelling, storage, pretransfusion testing, and release in accordance with GMP and legal requirements A = blood bank reports on the available units to all concerned K = cost control (limited to operations in need of transfusion) T = transfusion of autologous prior to any homologous unit. We report initial experiences and a cost assessment.

[Results of treatment of habitual abortion by immune stimulation with partner and/or foreign donor lymphocytes]. / Ergebnisse der Behandlung von habituellem Abort durch Immunstimulation mit Partner- und/oder Fremdspenderlymphozyten.

47 couples with repeated spontaneous first trimester abortions were referred for immunotherapy with lymphocytes from spouse and/or unrelated donor towards stimulation of blocking antibody, protecting the next pregnancy. 40 couples were treated, 38% did not yet conceive again. 69% of the 29 observed pregnancies were successful, as were 3 among the 7 untreated women. A prospective, controlled trial is necessary to determine the value of active immunotherapy recurrent spontaneous first trimester abortion.

[Limits of routine blood group serology in perinatal diagnosis]. / Grenzen der Routine-Blutgruppenserologie in der perinatalen Diagnostik.

We report on a multigravida with high-titer Rh-incompatibility who was admitted for delivery at term. Multiple intrauterine transfusions had resulted in nearly total replacement of fetal cells with donor cells. Routine serologic methods were unable to determine the blood group of the newborn and resulted in a falsely negative direct antiglobulin test. Four weeks later the newborn developed severe anemia in need of transfusion. The anemia was explained by a) suppression of erythropoesis because of early optimization of tissue oxygenization with the prenatally transfused HbA-containing donor cells, b) their limited survival in the infant and c) the accelerated elimination of the baby's own red cells by the maternal antibody.