Revival of the Ugandan Blood Transfusion System 1989: an example of international cooperation.

10 yr of civil war in Uganda had destroyed the Blood Transfusion Service when the government came to power in 1986. AIDS had become recognized as a problem of severe proportion. In 1987, the E.E.C. pledged to rehabilitate the central blood bank. This paper describes the first year of operation from December 1988. Over 5000 units of blood, largely from volunteer donors, were delivered to 19 hospitals. The overall incidence of HIV-1 seropositivity was 14.6% and Hepatitis B surface antigen was 5.5%. The cost was 21.5 ECU (US $25) for each unit of HIV negative, H.B.s.Ag. negative, blood.

Solid phase red cell adherence immunoassay for anti-HIV 1: a simple, rapid, and accurate method for donor screening.

In technically developed countries in which acquired immunodeficiency syndrome is a risk to the recipients of blood or tissue, it is mandatory to screen the donor for evidence of HIV (human immunodeficiency virus) infection. Current tests, based on enzyme-linked immunoassay, are time-consuming and expensive and as such are unsuitable for developing countries. We describe a second generation test using anti-human IgG coupled to red cells as the indicator of antibody having reacted with test antigen (1). The test is complete within ten minutes, simple to perform and to read and has 100% sensitivity and 99% specificity compared with Western blot. It is ideal for the rapid screening of organ donors and for the screening of blood donors where cost is a major consideration.

Rapid, easy, and economical screening test for antibodies to human immunodeficiency virus.

A new dot enzyme immunoassay (EIA) with a conserved portion of the envelope protein of the human immunodeficiency virus (HIV) as antigen has been designed for use in areas with few laboratory facilities and by personnel with little laboratory experience. Sera were tested in 263 subjects who had AIDS or AIDS-related complex or were at-risk or not-at-risk of AIDS from the USA, Africa, and Asia/Oceania. The dot EIA was 100% sensitive in the American subjects, and there were only 2 false negatives in the others, both of which were negative by commercial EIA. The test is simple to perform, economical, rapid (30 min), and stable.

Respiratory pharmacology. Antithrombotic and fibrinolytic therapy.

Antithrombotic therapy with heparin is effective in reducing the incidence of thromboembolic disease when given prophylactically to high-risk patients. Heparin followed by oral antithrombotic therapy is accepted practice for the management of established thromboembolism. Fibrinolytic therapy has been demonstrated to be effective in recanalization of vessels occluded by thrombus, but is contraindicated if the effect of peripheral embolization from the occlusion is likely to result in severe morbidity. The use of heparin and oral antithrombotic drugs is associated with an increased frequency of bleeding, and requires careful clinical and laboratory control, for which the best methods have not yet been determined. Low-molecular-weight preparations of heparin have been shown to have effectiveness when administered once or twice a day, but not to have less risk for hemorrhage than regular heparin. Fibrinolytic therapy is entering a new phase with the conclusion of clinical trials of the newer agents that are associated with a reduced risk of systemic anticoagulation.

Alcohol and the blood.

Pathologic effects of ethanol on hematopoietic tissue can result directly from alcohol ingestion or from secondary nutritional deficiencies or hepatic disease. The clinician will often confront an array of overlapping syndromes in the alcoholic patient which involve abnormalities of erythrocytes, leukocytes, and platelets.

Chronic myelogenous leukemia and genetic events at 9q34.

Assessment of cytogenetic patterns associated with chronic myelogenous leukemia (CML) suggests that genetic events at band q34 of chromosome nine are critical in the conversion of benign to malignant hematopoiesis. A break at this band is identified in almost all cases of Philadelphia chromosome (Ph1) positive CML, is also noted in some cases of Ph1 negative CML and cannot be excluded in the remaining cases. The human cellular homolog of the Abelson retrovirus oncogene (c-abl) is situated at band 9q34 and is translocated with the genetic sequences distal to the break point at this site in Ph1 positive disease. This oncogene has been shown experimentally to transform pre-B cells and it is expressed in primitive cells of the granulocytic series which are involved in CML. Although the break in CML chromosomes at 9q34 and the location of c-abl at 9q34 could be unrelated, it seems more likely that the two genetic events are associated with evolution of malignant hematopoiesis of man.

Pseudoleukemia due to infection. A case report.

A 29-year-old white female developed fever, vomiting, diarrhea, and hypovolemic shock. Twenty-four hours after resection of intraperitoneal adhesions she had granulocytopenia and leukopenia with a marked "left shift"; a bone marrow aspirate was interpreted as showing acute non-lymphocytic leukemia. The clinical presentation made this diagnosis unlikely and the subsequent course indicated that this was a reaction to bacterial infection.

Thrombotic thrombocytopenic purpura: report of fourteen cases--occurrence during pregnancy and response to plasma exchange.

Thrombotic thrombocytopenic purpura (TTP), a syndrome of diverse etiology probably related to factors regulating platelet-vessel wall interaction, is predominantly a disorder of women. We report our experience with 14 patients in an 11-year period. Thirteen were female and aged between 25-69 years. Four were postmenopausal, and of the nine premenopausal women three were pregnant, one was immediately postpartum, and three were taking estrogen-containing oral contraceptives. A review of the literature confirms the two to one female/male preponderance and that TTP is reported in 56 women who are pregnant or recently postpartum. While this association with possible hormonal events has been noted, it has previously received little comment. We stress the similarity between TTP and some occurrences of preeclamptic toxemia, and that this may suggest not only a common etiology but that therapeutic attempts should be similar. While no single therapeutic modality is universally successful, our experience is that plasma exchange is the most effective, with five of seven patients so-treated obtaining prolonged remission; four of five patients responded to splenectomy and corticosteroids, but one died of infection postoperatively. Five patients, including two treated exclusively with antiplatelet aggregating agents, died without achieving remission. The frequency of successful therapy is not changed by the concurrent pregnancy, but the fetal loss is high. There does seem to be an increased risk of recurrence of TTP in a subsequent pregnancy, and this might be considered when counseling premenopausal patients who have achieved remission of TTP.

Platelet activation during steady state sickle cell disease.

Previous reports have given conflicting conclusions of the role platelets may play in initiating vaso-occlusive sickle cell crisis. Seven patients homozygous for sickle cell hemoglobin, and seven age, race and sex matched controls were each studied on at least two occasions in a six week period of normal health. The number of platelets circulating as aggregates, the plasma concentration of beta-thromboglobulin (beta-TG) and platelet factor 4 (PF-4) were significantly elevated compared with controls. These findings were confirmed with a second series of fourteen patients and nine controls. Patient's platelets in plasma adjusted for both platelet number and citrate concentration aggregated more in response to low concentrations (0.4 and 1 microM) but less to higher concentrations (4 and 20 microM) of ADP and needed significantly more prostacyclin (PGI2) to inhibit ADP induced aggregation than did platelets from control subjects. There was no significant difference in plasma concentration of fibrinopeptide A and thromboxane (Tx)B2, nor in the platelet generation of TxB2 and release of serotonin and beta TG induced by aggregating agents. Thus, the platelets of patients with sickle cell anemia in the steady state are readily activated and respond in vivo by increased formation of aggregates and release of beta TG and PF-4.

Anti-inhibitor Coagulant Complex (Autoplex) for treatment of factor VIII inhibitors in hemophilia.

Fourteen individuals with severe hemophilia complicated by factor VIII inhibitors (1 to 132 Bethesda Units) were treated for 33 bleeding episodes with a new activated prothrombin complex concentrate, Anti-Inhibitor Coagulant Complex (Autoplex, Hyland, Glendale, Calif.). Excellent or good results were observed in 21 of 25 minor bleeding episodes treated, which included joint, soft tissue, and mucous membrane hemorrhages. Eight major bleeding problems (an epidural bleed, a puncture wound, 2 serious soft tissue hemorrhages, 2 lacerations, and 2 major surgical procedures) were treated with excellent (6) or good (2) results. No serious complications were encountered, but two children developed transient hypofibrinogenemia following Autoplex infusion. Although some shortening of the prothrombin time and activated partial thromboplastin time was noted after infusion of Autoplex, there is no useful laboratory test for monitoring therapy. Despite the unknown mechanism of action for bypassing factor VIII, Autoplex appears to be a useful and needed interim product and is safe and effective. In view of the possible potentiation of thrombosis concurrent use of fibrinolytic inhibitors should be avoided.

Successful control of life-threatening thrombocytosis with a blood processor.

A patient with polycythemia rubra vera developed marked thrombocytosis and hemorrhage after splenectomy. Plateletpheresis with a blood processor proved to be a safe, efficient, and rapid method for the mechanical removal of large quantities of platelets prior to adequate control with chemotherapy.