Risk of transfusion associated AIDS by seronegative blood in Thailand: a multicenter report.

Prevention of transfusion associated AIDS (TAA) in Thailand began in 1986 when the HIV infection started to be sharply increased among the general population. The retrospective anti-HIV screening in various blood donor populations by The National Blood Center (NBC) revealed a seroconverted prisoner. Then the use of prisoners, prisoners' blood was not recommended from 1986. In April 1987, the first case of TAA was disclosed. Five months later, anti-HIV screening in all units of blood was firstly introduced at Ramathibodi Hospital (RH) and NBC. From 1989, anti-HIV screening in all units of blood is mandatory nationwide by Ministry of Public Health. Despite the anti-HIV screening, TAA cases transmitted by seronegative blood were gradually reported. Among many Medical Centers, there were 9 and 18 cases of TAA recorded from Chiang Mai and Bangkok areas respectively, since 1985. In addition, several new seroconverters were observed among voluntary blood donors. All of this evidence indicates the existence of blood donation during the early stage of infection, the so-called "window period". At present, HIV-P24 antigen ELISA seems to be the only available technique for mass screening. In 1990, NBC successfully performed a retrospective study on HIV-Ag ELISA screening by obtaining the prevalence of 1/10,000 units of blood. At the same period of time, in RH prospective study, a unit of blood with HIV-Ag only was detected when 3432 units of blood were screened. The HIV-Ag ELISA screening was then performed on every unit of blood routinely since Aug 12, 1991 at RH.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiological assessment of anti-HIV 1 antibodies in Thailand.

Anti-HIV 1 antibodies were detected in 4 groups of subjects (peoples attending hospitals or medical clinics for anti-HIV investigation, blood donors, women in massage parlours and thalassemia patients) in the north, northeast and central Thailand. A total number of 1,726 blood samples were initially tested with ELISA. The ELISA reactive samples were confirmed by the Western blot analysis. Using ELISA as a screening test, the highest incidence (9.09%) of anti-HIV 1 antibodies was found in thalassemic children (4 of 44). Six (0.72%) and 4 (1.02%) samples in the first, second and third groups had a repeatedly reactive ELISA respectively. The Western blot analysis confirmed that 7 cases (3 thalassemia and 4 subjects in the first group) had antibodies to HIV 1. Two cases with reactive Western blot test were Westerners while the rest were symptomatic and asymptomatic Thais. The HIV infection has spread to thalassemia patients probably via blood transfusion.

Endotoxemia in protein-energy malnutrition.

The plasma endotoxin levels of 16 severely malnourished Thai children were determined by the Limulus amebocyte lysate assay. Endotoxemia was present in seven children (44%) on admission to the hospital and was associated with the coexistence of vitamin A deficiency. Protein-energy malnutrition is associated with the presence of endotoxemia.

Activities of liver cell-producing coagulation factors in thalassemic children.

Coagulation studies were carried out in 20 beta-thal children (five splenectomized) and 16 control children. It was found that the activities of factors II, VII, IX, and X (prothrombin complex group), V, and possibly I that are produced by hepatic parenchymal cells were uniformly depressed. Factor VIII activity was normal. There was no statistically significant difference in the prothrombin complex activity between the splenectomized and nonsplenectomized group, or those with and without parenteral vitamin K administration. The absence of "cold-activation" of factor VII in thal plasma, probably secondary to depressed activities of plasma kallikrein and HMW kininogen, further implicates liver involvement in these children.

Unexpected red cell antibodies in thalassemic children.

Nineteen of the 632 (3%) children with homozygous beta-thal and beta thal/Hb E developed alloantibodies to red cell antigens, primarily as a result of repeated transfusion. There were eight cases of anti-E, four cases of anti-E+, and two cases of anti-Le(a + b) antibodies. The low incidence rate in these patients is probably due to acquired tolerance.

Iron status and the effect of iron supplementation in Thai male blood donors in northern Thailand.

The iron status of voluntary and professional male donor groups was investigated. The study indicated that serum ferritin level was lower significantly in those who donated three times per year compared to the first time donors (p less than 0.05) in voluntary donor group. Similar results were observed among the professional donors. Whereas haemoglobin, haematocrit and transferrin saturation were not altered by donating blood in both groups. It also showed that, in general, the body iron stores of professional donors were lower to those of voluntary donors. Supplementation with iron over a period of three months produced a rise in serum ferritin levels and the percentage prevalence of iron depleted subjects decreased from 23.6% to 6.4%. Haemoglobin, haematocrit and transferrin saturation levels also improved.

Changes in the red blood cell membrane in protein-calorie malnutrition.

Ten children with protein-calorie malnutrition (five with kwashiorkor, three with marasmus, and two with marasmic-kwashiorkor) were studied at hospital admission and during recovery for evidence of changes in red blood cell lipids, osmotic fragility, and chromium survival. On admission, the children had significantly higher-than-normal red blood cell membrane cholesterol and phospholipid, and an elevated cholesterol:phospholipid ratio. Both red blood cell osmotic fragility and red cell survivals were depressed. These measurements returned to normal limits with recovery.

HLA antigen, gene, and haplotype frequencies in Thailand.

Antigen, gene, and haplotype frequencies as well as phenotype distribution of the HLA system were studied in a series of 213 individuals in northern Thailand. The series consisted of 160 northern Thais, 23 Thai individuals from various other regions of Thailand, and 25 persons of Chinese origin. Most frequently found were the alleles HLA-A11 and HLA-Bw40 and the haplotype HLA-A2,B-. Phenotype distribution followed a Hardy-Weinberg expectation. Significant differences were found especially between our results for the alleles of locus B and the results of a series from Bangkok reported by Chiewsilp and Chanarat (1976).

Defective local leukocyte mobilization in children with kwashiorkor.

The Rebuck window technique was used to determine the functional integrity of the inflammatory response in nine children with kwashiorkor. The total numbers of leukocytes mobilized into skin abrasions were similar between kwashiorkor and control patients. However, children with kwashiorkor showed significantly delayed and decreased macrophage migration and increased polymorphonuclear leukocyte migration. These defects of leukocyte mobilization were corrected with nutritional repair.

Complement activity in children with protein-calorie malnutrition.

Using the hemolytic complement (CH50) assay, we evaluated the complement system of 28 children with severe protein calorie malnutrition (PCM) during their hospital admission and recovery. The mean CH50 activity in children with kwashiorkor was significantly less on hospital days 1 and 4 than in 17 healthy control subjects. On day 8 it rose to normal, and by day 50 it was significantly higher than the controls. The mean CH50 titer of 16 well-nourished febrile children was, in contrast to that of untreated PCM, significantly greater than the healthy controls. Of the children with PCM, 11 (40%) evidenced anticomplementary (AC) activity in their serum on either day or 1 or 4, but only two (7%) had detectable serum AC activity during later convalescence. Significantly, the CH50 titer in a PCM serum correlated inversely to the amount of AC activity in that serum (P less than 0.01). These results indicate that, in children with PCM, the complement system is compromised functionally, and that its repair coincides with intake of adequate diet. The presence of AC activity provides a possible mechanism for depressed complement activity in some untreated PCM children.

Can the growth of a neuroblastoma be influenced by a child's nutritional state? Observations in a patient treated for kwashiorkor and later given a restricted diet.

A 17-month-old Thai female with neuroblastoma presented with an abdominal mass and the classical findings of kwashiorkor. Concomitant with effective repair of the child's protein deficit, the mass enlarged dramatically and metastases were noted. This is the first known report of such an occurrence.