2008-2012年太原市无偿献血者梅毒及HIV感染状况分析

目的分析太原市无偿献血者梅毒及HIV感染状况,为招募低危献血者提供科学依据。方法采用酶联免疫吸附试验（E1．ISA）检测太原市2008-2012年无偿献血者血浆标本梅毒抗体和HIV抗体,分析梅毒及HIV感染年度、性别、年龄、文化程度及职业分布。结果太原市2008～2012年无偿献血者血液标本共389796份,梅毒抗体阳性2277例,阳性率为0．584％,年度阳性率差异有统计学意义（χ2=22．63,P〈0．01）,但变化无规律;女性阳性率为0．661％,男性阳性率为0．549％,差异有统计学意义（χ2=18．28,P〈0．01）,男性41～50岁和女性31～40岁抗体阳性率最高;职业分布以农民和工人阳性率较高,分别为1．028％和0．645％,不同职业人群差异有统计学意义（χ2=248．84,P〈0．01）;初中及其以下学历者梅毒阳性率最高,为0．877％,不同文化程度人群阳性率差异有统计学意义（χ2=213．57,P〈0．01）。2008～2012年无偿献血者HIV抗体阳性80例,阳性率为0．021％,呈逐年上升趋势;男性阳性率为0．029％,女性为0．015％,差异有统计学意义（χ2=28．82,P％0．01）,且男性阳性率随年龄增长而降低;不同职业及文化程度人群HIV阳性率差异无统计学意义（P〉O．05）。无偿献血者5年平均梅毒一HIV合并阳性率为0．005％,全部为男性,占男性梅毒抗体阳性者的1．29％。结论太原市无偿献血者HIV抗体阳性率较低但有增高趋势,梅毒5年阳性率较高但无变化规律。梅毒、HIV对血液安全仍造成威胁,应加强对农民、工人及文化程度较低等高危人群献血前的征询。     

Prevention of transfusion-transmitted hepatitis E by donor-initiated self exclusion

Safety in blood transfusion has all along been focused on blood borne viruses like HIV, hepatitis B and C. However, infective agents that are not usually transmitted through blood may also pose risk to transfusion if the donor gives blood in the early-viraemic phase. A case report of potential transfusion-transmitted hepatitis E (HEV) is described. It shows the virus can be transmissible via blood because of the presence of HEV RNA in the blood donated. Pre-donation health screening was unable to exclude this asymptomatic donor. But donor-initiated call back system which acts as an additional safety net prevented the release of the potential infective blood products.     

Evaluation of awareness and utilization of an autologous blood transfusion programme

Autologous blood transfusion (ABT) has an important role in transfusion practice in the developing world due to increasing incidence of HIV and hepatitis C virus infection. Our study was done to evaluate the level of awareness and utilization of an autologous blood transfusion programme in a teaching hospital in Delhi. We assessed the level of awareness of preoperative ABT amongst treating physicians from different specialties in a teaching hospital through an anonymous questionnaire. The utilization of this methodology in transfusion practice was estimated from records of the Blood Transfusion Service.
Of the 150 doctors contacted 96 (64%) responded. Although 67.7% of them were aware of the technique and its advantages, only 21.8% used it for the patients under their care. In the preceding 24 months 133 (1.1%) of 12 090 blood collections in the transfusion service were from autologous donor-patients. Only one unit of blood was collected from each patient, although 41.8% of them received  2 units of blood. Of the 11 123 patients transfused, 55 (0.49%) received the ABT. Thus only 55 (41.3%) of 133 total ABT collections were utilized. The study highlights that there is a general lack of awareness about ABT amongst physicians. This transfusion practice is rarely and inadequately used. The study was repeated the following year after an intensive intervention strategy was adopted. The results show a trend towards improvement in the practice of ABT. This study emphasizes the need for proper organization, planning and communication between clinicians and blood transfusion personnel for effective implementation of an ABT programme, especially in countries with a high incidence of transfusion-transmitted infections and acute shortages of blood for transfusion.     

Role of transfusion-transmitted virus in acute viral hepatitis and fulminant hepatic failure of unknown etiology

BACKGROUND AND AIM: The role of the newly described transfusion-transmitted virus (TTV), a circular single-stranded DNA virus, has been investigated in acute liver disease, comprising 36 patients with acute viral hepatitis (AVH) and 25 with fulminant hepatic failure (FHF), including 50 volunteer blood donors as controls. METHODS: Detection of TTV DNA sequences was carried out by polymerase chain reaction (PCR) using primers derived from the UTR(A) region of the TTV genome. The clinical course and biochemical profile when infected with TTV alone or coinfected with other classical hepatotropic viruses were analyzed. All patients were first evaluated for liver function profile and for the presence of various hepatotropic viruses using serological tests and PCR in serologically negative patients. RESULTS: Transfusion-transmitted virus DNA was detected in 80.6% (29/36) of the AVH cases and in 76% (19/25) of the FHF cases, which were significantly higher levels (P < 0.05) than the 52% (26/50) observed in volunteer blood donors. No significant difference in symptoms, clinical course, liver function and risk factor profile between TTV-positive and TTV-negative patients could be observed in both AVH and FHF patients. TTV was found to coexist with both parenterally and non-parenterally transmitted hepatotropic viruses in similar frequency in both AVH and FHF patients. Further, there was no significant difference in the mortality rates between TTV-positive and TTV-negative FHF patients. Also, there was no difference between patients coinfected by TTV and other hepatotropic viruses and those with TTV infection alone. CONCLUSION: Thus, it appears that TTV, although it exists in a very high frequency in the Indian population, appears to have no significant etiological role in AVH and FHF.     

Multicenter evaluation of PCR methods for detecting CMV DNA in blood donors

BACKGROUND: CMV DNA screening may be a useful adjunct to serologic tests in distinguishing potentially infectious blood donations from those that are "CMV-safe." However, there is currently no consensus on the optimal assay method for accurate detection of CMV DNA in donors. STUDY DESIGN AND METHODS: A blinded multicenter evaluation of seven CMV PCR assays was performed by five laboratories by using coded sets of analytical controls and donor blood samples. RESULTS: Five assays displayed sufficient sensitivity for donor screening, as judged by consistent detection of a minimum of 25 CMV genome equivalents (geq) in analytical controls constructed to contain from 1 to 100 CMV geq in background DNA from 250,000 cells, while the other two assays displayed inadequate sensitivity. Three sensitive assays, two based on nested PCR directed at the UL93 and UL32 regions of the CMV genome and another test (Monitor Assay, Roche), did not detect CMV DNA in samples from any of 20 pedigreed CMV-seronegative, Western blot-negative (S-/WB-) donors. Two other assays based on nested PCR occasionally detected CMV DNA in S-WB- samples, and one sensitive nested PCR assay directed at UL123 detected CMV DNA in a large proportion (85%) of S-WB- samples. CONCLUSION: Seven CMV PCR assays currently used for research and/or diagnostic applications displayed marked variations in sensitivity, specificity, and reproducibility when applied to coded analytical and clinical control samples containing cellular DNA from the equivalent of 250,000 WBCs. These results will be useful in the selection of assays with performance characteristics appropriate to donor screening objectives. They may also help explain discrepant findings from previous studies that used PCR to determine CMV DNA prevalence in seronegative and seropositive blood donors.     

Evaluation of the de-selection of men who have had sex with men from blood donation in England

BACKGROUND AND OBJECTIVES: The Blood Services of the UK permanently de-select men who have had sex with men (MSM) from donating blood. The rationale for this has been questioned. This article attempts to evaluate whether this selection criterion does contribute to blood safety. MATERIALS AND METHODS: Data about transfusion-transmissible infections, in particular about human immunodeficiency virus (HIV) infection, were used to evaluate whether de-selection of MSM meets the aims of donor selection. Models were constructed to estimate the risk of HIV-infectious donations entering the blood supply should this criterion be changed. RESULTS: Many assumptions were required to generate estimates of the risk of HIV infection entering the blood supply. The accuracy of the estimates is therefore uncertain and the probable ranges around the estimates were wide. However, by using the most probable assumptions, our models suggested that de-selection of MSM for 12 months since the last sexual contact, or complete removal of this selection criterion, would be expected to increase the risk of HIV-infectious donations entering the blood supply in England by approximately 60% (from the current risk of 0.45 per year to 0.75 per year) and 500% (to 2.5 per year), respectively. The increase in numbers of non-infected donations would be relatively small--less than 2% of donations. The probability of a relatively high frequency of other sexually transmissible blood-borne infections also currently favours maintaining permanent de-selection of MSM, irrespective of the risk of HIV-infectious donations. Current compliance with this selection criteria was estimated to be 95%. CONCLUSIONS: Based on current knowledge, accepting blood donations from MSM would probably increase the risk of transfusion-transmission of HIV and of other blood-borne infections. Good compliance with this criterion has contributed greatly to the safety of blood transfusions in England. Better communication about donor selection, to maintain and improve compliance with this and other selection criteria, is recommended. Other risk groups are gaining in relative importance for the risk of transfusion-transmitted HIV infection, and ongoing evaluation of all donor-selection criteria is also recommended.     

TT Virus Infection in Patients on Peritoneal Dialysis in Taiwan

Many studies have reported the prevalence of transfusion-transmitted virus (TTV) infection in hemodialysis patients, but few reports studied the prevalence of TTV infection in peritoneal dialysis patients. In this study, we determined the prevalence of TTV in a peritoneal dialysis population in Taiwan and related its prevalence with history of blood transfusion, serum hepatitis B surface antigen (HBsAg), antibody to hepatitis C virus (anti-HCV), and serum aminotransferases (AST and ALT) levels. Serum samples from 47 peritoneal dialysis patients and a control group of 43 patients at health examination were studied for TTV viremia by using polymerase chain reaction. The rate of blood transfusion exposure (p < 0.0001), female gender (p = 0.001), younger age (p?=?0.0014), and serum AST level (p?=?0.012) were significantly higher in peritoneal dialysis patients. The prevalence of TTV viremia was not significantly different between peritoneal dialysis patients and the control group (23.4% vs. 37.2%). TTV infection was not associated with evident liver diseases in peritoneal dialysis patients, and the infection rate was not different between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) patients. There was no statistically significant association between TTV infection and age, gender, transfusion history, duration of peritoneal dialysis, AST level, ALT level, HBsAg, or anti-HCV seropositivity in peritoneal dialysis patients. Our results suggest that TTV infection is not associated with evident liver diseases, and there is no difference between TTV infection in healthy individuals and peritoneal dialysis patients. TTV transmission probably occurs via routes unrelated to peritoneal dialysis.