Verification of the drug history given by potential blood donors: results of drug screening that combines hair and urine analysis.

BACKGROUND: Besides modern virus-screening methods, the avoidance of transfusion transmission of viral diseases is based on the best possible selection of healthy donors. Unfortunately, most of the relevant behavior-related risk factors are not accessible to objective verification. Drug screening can be used to validate a defined section of donor statements. It may be assumed that donors who conceal drug consumption may also conceal other relevant risk factors. STUDY DESIGN AND METHODS: Hair and urine samples from 186 young potential donors who denied having consumed drugs were investigated by gas chromatography with mass selective detection and a urine fluorescence polarization immunoassay for cannabinoids, amphetamine and amphetamine derivatives, cocaine, and opiates. RESULTS: Ten potential donors with 14 positive results on hair and urine analyses (6x cannabinoids, 4x cocaine, 1x opiates, 3x dihydrocodeine) could be identified in the population investigated. CONCLUSIONS: The donor history is not adequate for identifying potential donors with risk factors. Deliberately false statements concerning risk factors are a clear breach of trust between the blood bank and potential donors. These unreliable donors represent an incalculable risk for the transfusion recipient. Therefore, it is appropriate to validate donor statements about drug consumption by random hair and urine analyses and to exclude from the donor pool all persons revealed as drug users.

[Hepatitis after blood transfusion in inpatients. Post-transfusion hepatitis, or infection of other etiology?]. / Hepatitis nach stationärer Bluttransfusion. Posttransfusionshepatitis oder Infektion anderer Atiologie?

BACKGROUND AND OBJECTIVE: Hepatitis after a transfusion of blood products is often uncritically called post-transfusion hepatitis (PTH). It was the aim of this study to ascertain in how many reported cases of suspected PTH a causal relationship between transfusion and the infection in the recipient can be proven. PATIENTS AND METHODS: Full investigations (look-back method) were made of 23 cases of PTH reported in the 10-year period of 1987-1997 (11 cases of PTH B and 12 of PTH non-A-non-B or C). The recipients had been given a mean of 7.7 blood components (range 1-57). The clinical diagnosis had been made a mean of 5.2 (range 1-27) months after transfusion. RESULTS: One case each of hepatitis B and C had been caused by transfusion of blood products. In 5 of 12 suspected cases of PTH non-A-non-B hepatitis C, PTH could not be definitively excluded (despite absent seroconversion for anti-hepatitis C virus [HCV]), because HCV-RNA findings were not available. In 16 of 23 investigated cases serological and molecular-biological tests firmly excluded PTH B or C. CONCLUSIONS: The small number of confirmed cases of PTH indicates that hepatitis that has occurred post-transfusion is frequently due to a cause not related to the transfusion. The number of transfusion-associated cases will be further reduced with the introduction (standard since 1.4.1999) of VCH-RNA screening of donors. This will raise the importance of hepatitis cases not associated with transfusion.

[Hemolytic anemia as cause of a marked bilirubin increase in primary biliary cirrhosis]. / Hämolytische Anämie als Ursache eines auffälligen Bilirubinanstieges bei primärer biliärer Zirrhose.

HISTORY AND CLINICAL FINDINGS: 16 years ago a now 53-year-old woman was found to have primary biliary cirrhosis. 5 years later, after bleeding from oesophageal varices, she had a portacaval shunt. For several years she had been taking ursodeoxycholic acid (750 mg daily). Because of steadily increasing jaundice over the past few years she presented for possible liver transplantation. INVESTIGATIONS: There was a discrepancy between the markedly raised serum bilirubin concentration (7.8 mg/dl) and the only slightly raised or normal activities of alkaline phosphatase (247 U/l) and gamma-GT (21 U/l). Further tests confirmed that the patients had not only PBC but also Coombs-negative haemolytic anaemia (haemoglobin 10.7 g/dl, reticulocyte count 122/1000, indirect bilirubin 6.4 mg/dl, haptoglobin not demonstrated, lactate dehydrogenase 316 U/l). She had splenomegaly despite the portacaval shunt. Blood smear revealed spherocytes, but hereditary spherocytosis was not confirmed. TREATMENT AND COURSE: A six-week interruption of taking ursodeoxycholic acid led, as expected, to a rise in the activities of serum alkaline phosphatase and gamma-GT, while haemolysis parameters were not affected. CONCLUSION: Serum bilirubin concentration is a decisive prognostic factor in the course of primary biliary cirrhosis and is therefore of particular relevance for the indication of liver transplantation. The reported case demonstrates the importance of considering other causes of hyperbilirubinaemia.