疟疾感染与单采血浆还输血细胞关系的研究

本文探讨了永清县人群疟疾感染与供血的关系。在２４９例疟疾中，２４４例（９８．０％）为单采血浆还输血细胞（简称单采浆）供血者，５例（２．０％）为受血者。人群疟疾发病率与单采血浆率呈显著正相关，而与人群总供血率和供全血率无相关关系；不同年龄组人群疟疾发病率与该年龄组人群单采浆率呈显著正相关；病例对照调查结果表明，单采浆是疟疾发病的危险因素；单纯单采浆供血者疟疾发病率为３３．７％，既单采血浆又供全血者为１５．７６％，无供血史者为０．００１４％，单纯供全血者无人发病。对单采浆血站调查发现，在采血、离心分浆和血细胞还输过程中存在血液交叉污染环节，血站停业后疟疾疫情平息。认为永清县人群疟疾感染与单采浆有关。     

严格单采血浆干预措施控制疟疾的探讨

单采血浆还输血细胞术是一种成分采血技术,是将供血者的全血采出,通过离心,分离其血浆,将血细胞还输给供血者的过程。但由于在操作过程中存在血液交叉污染,如共用采血器材、剪刀、生理盐水及分浆员不佩戴一次性手套等,造成疟疾在供血者中流行[1,2]。对此,我们对单采血浆还输血细胞(简称单采浆)过程采取了严格的干预措施,以控制疟疾。方　法1　单采浆血站的选择及干预措施　河北省位于北纬36°以北,1986年该地区已达基本消灭疟疾。在本省境内分别选择甲、乙、丙3地为单采浆血站。这3地均为平原,交通便利,且处在同一条经线上,其中乙地位于甲地…     

单采血浆相关性疟疾合并艾滋病病毒感染的研究

目的了解单采血浆相关性疟疾病例中,艾滋病病毒(HIV)感染情况。方法对1993-2005年间单采血浆相关性疟疾病例和非疟疾既往单采血浆供血者进行调查和采集血标本,采用快速蛋白印迹试验或酶联免疫吸附试验检测HIV抗体,初筛阳性者再用蛋白印迹试验进行确认;对现症疟疾病例的血标本用吉氏液染色-光学显微镜(油镜)检查疟原虫。结果 220例单采血浆相关性疟疾病例的HIV感染率为30.0%(66/220),3 008例非疟疾单采血浆供血者的HIV感染率为2.4%(72/3 008)。1993年12月和1994年1月采集并检测的上述两人群,HIV抗体均为阴性;而1995年3月至2005年采集并检测的上述两人群,HIV阳性率则分别为43.4%(66/152)和2.4%(72/2 958)。单采血浆相关性疟疾为间日疟,感染的HIV为HIV-1型。结论单采血浆相关性疟疾病例的HIV感染率较高。     

中国某县既往有偿供血者HIV感染追踪监测

目的了解某县单采血浆供血者艾滋病病毒(HIV)感染状况。方法 (1)对某县全部人口进行逐户调查有偿供血者,采集血标本分离血清检测HIV抗体。(2)利用监测系统,开展动态监测,发现漏筛HIV感染者和AIDS病人;(3)采用快速蛋白印迹方法 (RWB)或酶联免疫吸附试验方法 (ELISA)初筛,阳性者用Western-blot确认。用套式聚合酶链反应(Nest-PCR)扩增产物并进行序列分析,对HIV型别和亚型进行鉴定。结果 1995-2009年,全县共发现有偿供血者HIV/AIDS病人226例,其中1995年3月有偿供血者中普查到HIV感染者111例,感染率为5.53%(111/2008),单采血浆供血者感染率为15.05%(79/525),既供全血又供血浆者感染率为8.06%(32/397),供全血者无感染者发现(0/1086)。1996-2009年追踪监测发现115例HIV感染者,发现的方式包括血液中心的HIV抗体筛查、VCT、医院就诊、孕妇筛查和术前检查等。结论在爆发初期,由于恐惧和歧视等原因,人们隐瞒了有偿供血史而被漏筛,经过15年的追踪监测,显现出了这起有偿供血者HIV/AIDS爆发的全貌。     

采血致献血者血红蛋白尿1例

李某 ,女 ,36岁 ,体重 6 0 kg,有 5年采血采浆史 ,查体符合《供血者健康检查标准》,查体后次日来我站采集成分血。采血过程 :采用美国血液技术公司产 pcs- 2采浆机采集成分血。机器运行参数设置为 :Cuff Pressure 5 0 ,Draw Pumpspeed 80 ,Return Pump Speed 80 ,Ac/Blood Ratio 1:12 ,Cen-trifuge Speed 75 0 0。当机器采集到第二个循环时 ,血浆分离钵发出刺耳的鸣声 ,采血人员按 Return键回输 ,机器发生故障 ,自动回输没有成功。手工回输分离钵内血液于献血者体内 ,更换分离钵后继续工作 ,发现采集出的成分血已溶血 ,立即停止采血 ,…     

快速单采新鲜血浆在儿科的应用

快速单采血浆系用最快速度从供血者身上取出血液,立即分离血浆,同时把血细胞还输给供血者,而把新鲜血浆用于病人的新方法。我科临床应用10例,颇感迅速方便,经济实用。一、设备与方法:把采血设备与还输设备联合组装(如图一)。采血前先用生理盐水充盈采血针以上部分,并将空气排空,把     

提高浓缩白细胞中粒细胞含量的初步探讨

为了提高浓缩白细胞中的粒细胞含量,我们对全血离心后提取浓缩白细胞的部位进行了初步探讨,现报告如下。1.材料与方法:本试验所用塑料血袋由上海市血液中心生产,每袋含ACD—B液100ml,可采全血400ml。离心机为西德产Heracus 800型。采血后立即离心,速度为2200r/min,时间为8.5分钟,温度为13℃。离心后,在净化台内按分浆常规分离血     

常州市输血感染疟疾回顾分析

目的对常州市输血感染疟疾的发现与控制作回顾报告,为疟疾防控提供参考。方法 1986年以1家医院为监测哨点,发现输血性疟疾并实施防控措施。结果在1月余时间内确诊输血性疟疾3例,对供血者的追踪调查提示与输血性疟疾具有一定关系。随即实施输血性疟疾的防控措施,4年后未再发生新的病例。结论常州市输血性疟疾防控措施切实有效。     

1例由输入性疟疾感染者引起输血疟疾的调查

目的　对泰州市1例因输血感染恶性疟的病例进行分析,为疟疾防控提供科学依据。方法　对1例恶性疟患者开展流行病学追踪调查,通过实验室方法对供血者血样进行检测,以明确感染来源。结果　1名64岁肾病住院患者的血液标本镜检查见疟原虫,确诊为恶性疟。经流行病学调查,患者除接受过输血外,无非洲和东南亚等恶性疟流行区旅行史;住院期间曾接受14次输血治疗,对23份供血者血样进行检测,发现1名印度尼西亚籍留学生留存血样PCR检测呈恶性疟原虫阳性,流行病学调查发现该供血者曾有疟疾感染史。结论　该患者为输血感染恶性疟病例,应加强对献血者的疟疾筛查,以预防输血传播疟疾的发生。     

辐照与去白细胞过滤单采血小板对血小板诸参数与部分细胞因子含量影响

目的：了解应用去白细胞过滤器制备去白细胞单采血小板以及经γ射线辐照单采血小板血小板参数与血浆部分细胞因子含量变化情况。方法：应用SysmexF-800血液分析仪检测血小板参数与应用ELISA法检测血浆IL-2、IL-6、INF-γ与TNF-α细胞因子。结果：去白细胞单采血小板与经γ射线辐照单采血小板悬液血小板包括：血小板数、血小板平均体积、血小板平均宽度、血小板压积以及血浆IL-2、IL-6、INF-γ与TNF-α含量与对照组相互比较差异均无统计学意义（P〉0．05）。结论：单采血小板经去白细胞或经γ射线辐照后，不会影响血小板参数与血浆部分细胞因子含量。     

江苏省献血员疟疾防治的效果观察

目的观察对献血员疟疾防治的效果,控制献血员疟疾的传播.方法对80年代末期献血员疟疾发病率较高的茅山地区4县(市)和扬州市的邗江县实施传染源管理、主动侦查病例、献血员服药、血站规范管理等一系列针对性抗疟措施,进行防治效果观察.结果1996年至今无献血员疟疾病例报告.门诊发热病人血检阳性率、流行季节走访发病率、IFA阳性率等指标也显示献血员疟疾流行程度已下降到较低水平.结论所应用措施效果良好,在当地献血员不再是疟疾高发人群.     

Impact of HIV-associated immunosuppression on malaria infection and disease in Malawi

BACKGROUND: Human immunodeficiency virus (HIV) infection and malaria coexist in much of Africa. Previous studies differ in their findings on the interactions between the 2 infections. METHODS: Adults living with HIV infection in Blantyre, Malawi, were enrolled in a longitudinal observational study from September 2002 to August 2004. Malaria blood smears were obtained monthly and for any illness suggestive of malaria. Complete evaluations of all illness episodes were conducted, regardless of malaria smear results. RESULTS: The incidence of clinical malaria episodes was higher in participants with CD4 cell counts <200 cells/mm3 than in those with CD4 cell counts >500 cells/mm3. The trend was preserved when increasingly specific definitions of malaria disease were used. The prevalence of malaria infection was not associated with CD4 cell count. In per-visit analysis, lower CD4 cell counts were associated with higher incidences of pneumonia, sepsis, and tuberculosis but not of malaria. Severe malaria was rare, with only 3 cases in 591 person-years of observation. Parasite density and CD4 cell count were independent risk factors for fever. CONCLUSIONS: Profoundly immunosuppressed adults with HIV infection require more-frequent treatment for uncomplicated malaria, but malaria infection and disease are less strongly associated with HIV-associated immunosuppression than are other opportunistic infections. Where malaria is common, the high incidence of fever found among immunosuppressed adults may lead to misclassification of illness episodes as malaria.     

Factors associated with acute renal failure in falciparum malaria infected patients

To identify factors associated with acute renal failure among patients with severe falciparum malaria (MARF), we studied 189 severe malaria patients admitted to the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, in Bangkok, Thailand. Among these, 63 had MARF, and 126 did not. Baseline clinical demographics and laboratory variables were evaluated with univariate analysis. Logistic regression was used to ascertain adjusted odds ratios. By univariate analysis, factors associated with MARF included male gender, fever duration > 4 days, patients who lived in a non-endemic area prior to malaria infection, body mass index > 18.5 kg/m(2), oliguria, abdominal pain, impaired consciousness, jaundice, anemia, liver enlargement, total white blood cell count > 10x10(9)/1, total bilirubin > 3 mg/dl, aspartate aminotransferase > 120 U/l, alanine aminotransferase > 120 U/l, albumin < 3 g/dl, fever clearance time >72 hours, and parasite clearance time > 72 hours. A hemoglobin > 10 g/dl, patients living in a malaria endemic area, non-oliguria on the day of admission, and splenomegaly were negatively associated with MARF. After multivariate logistic regression, oliguria during the first 24 hours of admission and a history of living in a nonendemic area prior to malarial infection were factors associated with MARF. We conclude the most significant factors associated with MARF were oliguria on the day of admission and living in a non-endemic area prior to malaria infection.     

Storage related haematological and biochemical changes in <Emphasis Type="Italic">Plasmodium falciparum</Emphasis> infected and sickle cell trait donor blood

Background

In sub-Saharan Africa where sickle cell trait (SCT) and malaria is prevalent, significant proportions of blood donors may be affected by one or more of these abnormalities. The haemato-biochemical properties of SCT and asymptomatic malaria in donor blood have not been evaluated. This study evaluated the haemato-biochemical impact of SCT and asymptomatic malaria infections in citrate-phosphate-dextrose-adenine (CPDA-1) stored donor blood units.

Methods

Fifty-milliliters of sterile CPDA-1 anti-coagulated blood were drained into the sample pouch attached to the main blood bag. Ten units each of sickle cell/malaria negative, sickle cell and malaria positive blood were analyzed. Baseline and weekly haematological profiling and week 1, 3 and 5 concentrations of plasma haemoglobin, % haemolysis, sodium, potassium and chloride and lactate dehydrogenase (LDH) were assayed. Differences between baseline and weekly data were determined using one-way analysis of variance (ANOVA) and Kruskal-Wallis test, whereas differences between baseline parameters and week 1–3 data pairs were determined using paired t-test. P-value <?0.05 was considered statistically significant.

Results

Storage of SCT and malaria infected blood affected all haematological cell lines. In the SCT donors, red blood cells (RBC) (4.75?×?10¹²/L?±?1.43^baseline to 3.49?×?10¹²/L?±?1.09^week-5), haemoglobin (14.45 g/dl?±?1.63^baseline to 11.43 g/dl?±?1.69^week-5) and haematocrit (39.96%?±?3.18^baseline to 33.22%?±?4.12^week-5) were reduced. In the asymptomatic malaria group, reductions were observed in RBC (5.00?×?10¹²/L?±?0.75^baseline to 3.72?×?10¹²/L?±?0.71^week-5), haemoglobin (14.73 g/dl?±?1.67^baseline to 11.53 g/dl?±?1.62^week-5), haematocrit (42.72%?±?5.16^baseline to 33.38%?±?5.80^week-5), mean cell haemoglobin concentration (35.48 g/dl?±?1.84^baseline to 35.01 g/dl?±?0.64^week-5) and red cell distribution width coefficient of variation (14.81%?±?1.54^baseline to 16.26%?±?1.37^week-5). Biochemically, whereas plasma LDH levels significantly increased in asymptomatic malaria blood donors (319% increase at week 5 compared to baseline), SCT blood donors had the most significant increase in plasma potassium levels at week 5 (382% increase). Sodium ions significantly reduced in SCT/malaria negative and sickle cell trait blood at an average rate of 0.21 mmol/L per day. Moreover, elevations in lymphocytes-to-eosinophils and lymphocytes-to-neutrophils ratios were associated with SCT and malaria positive blood whilst elevation lymphocytes-to-basophils ratio was exclusive to malaria positive blood.

Conclusion

Severe storage lesions were significant in SCT or malaria positive donor blood units. Proper clinical evaluation must be done in prospective blood donors to ensure deferral of such donors.

     

Acute myelogenous leukemia (M2) simultaneously associated with multiple myeloma with special reference to chromosome abnormality of t(6; 14) (p21.1; q32.3)

A 73-year-old male was admitted to our hospital in October 1987 because of severe anemia, anorexia, and loss of weight. The hemoglobin level was 5.7 g/dl, the white blood cell count 2,500/microliters with 5% myeloblasts positive for peroxidase, and the platelet count 8.6 x 10(4)/microliters. The LDH was 656 mU/ml, the total protein in the serum 7.4 g/dl, IgG 419 mg/dl, IgA 104 mg/dl, IgM 10 mg/dl, and urine Bence Jones (BJ) protein 8.8 g/day. The X-ray survey of the bones showed multiple osteolytic lesions. A bone marrow aspirate was hypercellular with 91.4% plasma cells, and was cultured a whole day for chromosome study. It revealed an abnormal karyotype of 46, XY, -15, t(6; 14) (p21.1; q32.3), +der(15)t(1; 15) (q23; q24). Immunoelectrophoresis demonstrated lambda type BJ protein. He was treated with melphalan and prednisolone. Proteinuria and marrow plasma cells decreased in amount. In December a white cell count was 6,030/microliters with 80% myeloblasts. A bone marrow aspirate revealed an increase of 82.6% myeloblasts or promyelocytes. The patient was refractory to chemotherapy and died of sepsis in April 1988. An unrelated abnormal karyotype; 48, XY, +8, +13 appeared concomitant with an increase of the leukemic cells, but no cells showed the t(6; 14). We cytogenetically discussed the simultaneous presence of multiple myeloma with acute myelogenous leukemia.     

Prognostic implication of hypocalcemia and QTc interval in malaria

Hundred confirmed cases of malaria were included in the present study to determine the clinical and prognostic implications of hypocalcemia and corrected QT interval (QTc) prolongation in malaria. Peripheral blood smear examination was done to determine the parasite species and the parasite load. Serum calcium level and QTc measurements in electrocardiogram were done for each patient. Fifty patients were of P. falciparum malaria (38 complicated and 12 uncomplicated), 40 of vivax malaria and 10 patients were having mixed (P. falciparum and P. vivax) infection. Hypocalcemia was found in 26 cases in which QTc was prolonged. Ten patients who had convulsions, all of them were having QTc prolongation and eight had hypocalcemia. A total number of eight patients had muscle spasm, of which six had QTc prolongation and four had hypocalcemia. There were 34 cases of cerebral malaria, of which 18 had hypocalcemia as well as QTc prolongation, 12 of them developed renal failure and 14 had high parasitaemia. Four patients died who had hypocalcemia and QTc prolongation due to hepatorenal syndrome. The mean parasite load, QTc interval and serum calcium were 2.69 +/- 1.0, 0.468 +/- 0.055 sec and 8.16 +/- 0.86 mg/dl respectively in complicated falciparum malaria; 1.6 +/- 0.55, 0.442 +/- 0.043 sec and 8.72 +/- 0.97 mg/dl in complicated mixed (Pf + Pv) infection. 1.33 +/- 0.52, 0.435 +/- 0.035 sec and 9.77 +/- 1.34 mg/dl in uncomplicated falciparum malaria and 1.35 +/- 0.58, 0.403 +/- 0.019 sec and 9.68 +/- 0.99 mg/dl in vivax malaria. The difference was significant between complicated falciparum and mixed (Pf + Pv) infection when compared to uncomplicated falciparum and vivax malaria (p < 0.05).     

Post-transfusion malaria in thalassaemia patients

Summary A total of 125 -thalassaemia patients receiving repeated blood transfusions were screened by Giemsa stain, Acridine-orange stain and antigen detection for evidence of malaria infection on each visit. A total of 8 (6.4%) of the patients developed post-transfusion malaria (PMT) as confirmed by tracing the infected blood donors. A high incidence of PTM in thalassaemia patients appears to be due to the use of fresh blood and the high frequency of blood transfusions required by these patients. Antigen detection using monoclonal antibody was found to be more sensitive for diagnosis of PTM and for screening suspected donors than the conventional blood smear examination methods and is therefore recommended for routine blood donor screening to rule out malaria infection.     

Pre-dialysis application of the glucose infusion test for recirculation detection

Vascular access recirculation (R) is a well-known cause of decreased dialysis dose. In this paper a new easy protocol for R detection in pre-dialysis derived from the classic Glucose Infusion Test (GIT) is introduced. The pre-dialysis GIT (GIT-pre) is based on the glucose (5%, 10 ml) bolus injection directly into the venous needle and on a simultaneous withdrawal from the arterial needle. If the glucose value increases during the glucose bolus, R is present. This new protocol was validated on 29 chronic haemodialysis patients (20 AVFs, 7 CVCs, 2 PTFE grafts), comparing the glucose increase with the classic GIT during dialysis. Only one CVC had R with the blood lines in the normal position (deltaglu = 465 mg/dl with GIT-pre and a deltaglu = 186 mg/dl, R = 9.3% with classic GIT) while in the reverse blood line position, all CVCs showed a significant glucose increase (mean GIT-pre deltaglu = 195 mg/dl; mean GIT deltaglu = 140 mg/dl corresponding to a R = 8%). There were 5 AVFs with true R (correct blood lines position) clearly identified by both methods (mean values deltaglu = 316 mg/dl with GIT-pre and a deltaglu = 390 mg/dl, R = 19.5% with classic GIT). Preliminary results show good reliability of the new protocol in identifying VA R caused either by failing VA with stenosis or by reverse blood lines position. The GIT-pre is a simpler application of the classic GIT useful for testing new VA, new needle positions or CVC performance before starting dialysis. A simpler R test could increase the frequency of the measurements and consequently the power of R in early detection of VA problems.