Hepatitis B vaccinees may be mistaken for confirmed hepatitis B surface antigen-positive blood donors

BACKGROUND AND OBJECTIVES

Hepatitis B surface antigen (HBsAg) test sensitivities have gradually increased, and neutralizable weak HBsAg-positive donations, with no other hepatitis B virus (HBV) markers, have occasionally been found in our donor population. On investigation, these donors have admitted to receiving hepatitis B vaccine up to 5 days previously. A study was therefore initiated to monitor HBsAg reactivity amongst volunteers after receiving their first dose of hepatitis B vaccine.

MATERIALS AND METHODS

Eight volunteers were tested using three HBsAg assays (Abbott Auszyme, Ortho HBsAg-3 and Abbott/Murex GE34/36) on days 0, 3, 5, 7 and 10 after administration of hepatitis B vaccine.

RESULTS

Two HBsAg tests (Abbott Auszyme and Ortho HBsAg-3) did not detect HBsAg reactivity amongst the volunteers, although the Abbott Auszyme test results reached 70-80% of the manufacturer's cut-off at day 3 in two volunteers. The most recently launched assay (Abbott/Murex GE 34/36) detected seven (87%) of the eight volunteers as HBsAg reactive on day 3, and two (25%) volunteers were still reactive on day 5.

CONCLUSION

The Abbott/Murex GE 34/36 assay demonstrated HBsAg reactivity in most volunteers on day 3 and in some on day 5 after vaccination. It is therefore recommended that individuals who have recently been vaccinated with hepatitis B be deferred from blood donation for at least 7 days.

Utilisation of bone allograft by orthopaedic surgeons in Scotland

The use of bone allograft in orthopaedic surgery has been predicted to increase, particularly in joint revision surgery. This has led to a potential problem with supply. Questionnaires were distributed to all 146 Consultant Orthopaedic surgeons working in Scotland in 2000. They were asked to indicate their current usage of bone and tissue allograft, any problems encountered with supply and if alternatives to allograft, such as processed bone, might be used. The questions asked were very similar to those asked in a previous study in 1995 to enable comparisons to be made. Replies were received from 125 Consultants (87%) of whom 93 reported using bone allograft. Forty-one consultants (46%) predicted an increase in their requirement for bone allograft, and 23 (26%) felt they could currently use more bone if this was available. Sixty percent of surgeons would consider using processed bone as an alternative. In comparison with figures from 1995, an increasing number of surgeons are prepared to use processed bone as an alternative to fresh frozen allograft.

The impact of the new tick-box questionnaire, and the personal donor interview, on donor deferrals in the East of Scotland

The impact of a new tick-box questionnaire (TBQ) and personal donor interview (PDI) on donor and recipient safety was assessed over an 18-month and a 13-month period, respectively, by prospectively studying individual donors prior to and after the introduction of the new methodology. A 'hit' was defined as an instance where the TBQ or PDI prompted a donor to divulge information which they would not otherwise have divulged, with the new information having an impact on donor eligibility. There was a 'hit' rate of 0.19% for TBQ and 0.65% for PDI. Of these donors, 33% in the TBQ category and 14% of PDIs were reinstated, 24% and 32%, respectively, were deferred because of a malaria/chagas risk, and 16% of the 'hits' related to donor safety issues. When assessing recipient safety, particularly risk of a window period viral transmission, PDI is very significantly superior at identifying such donors (14 times better). Such information establishes the important safety aspects of these interventions and requires that further work be done to see whether PDIs, in particular, may be better targeted to specific groups of donors.

From policy to action: access to essential drugs for the treatment of hypertension in the Small Island States (SIS) of the South Pacific

The existing acquisition cost for essential drugs in the Cook Islands, Kiribati, Marshall Islands, Nauru, Niue, Tuvalu, is sufficiently high to compromise equitable access to quality drug therapy. The difficulty of access is further compounded by problems of distance from drug manufacturers and suppliers, associated with inadequate transport and communication links. In some of the Small Island States of the Pacific, internal distribution challenges further reduce access to drugs for those people who live on the outer islands. Two management processes to address these problems which have successfully been used in the past, are the establishment of an essential drug list to guarantee consistent appropriate treatment, and the introduction of pooled or bulk purchasing in order to achieve economies of scale. The major non-communicable diseases (NCDs) in the South Pacific include diabetes, hypertension and cardiovascular disease. These diseases, in association with life-style factors of obesity and smoking result in significant morbidity and mortality. This paper demonstrates that collaboration in drug purchasing of a defined list of essential drugs for hypertension would be beneficial in the South Pacific, and that the process is a model for achievement of rational drug treatment for NCDs in isolated small economies.

A simplified pharmacologic erection program for patients with spinal cord injury

INTRODUCTION AND OBJECTIVES

Intracavernosal injection (ICI) of vasoactive agents has been successfully used in the treatment of erectile dysfunction (ED). The authors' pharmacologic erection program, using a fixed combination of prostaglandin E1 (PGE1) and papaverine, is notable for its simplicity and acceptance by patients who have suffered spinal cord injuries (SCIs).

METHODS

Patients undergo baseline questionnaire, physical examination, and hormone profile followed by instruction and injection of a fixed combination of PGE1 and papaverine. On successive visits, the patient injects himself and the dosage is titrated until a satisfactory erection is obtained. Patients who do not respond to injection of 1.0 cc are considered treatment failures. Patients return periodically for routine follow-up.

RESULTS

From May 1994 to March 1997, 37 patients with SCI underwent initial evaluation and 28 (76%) responded to injection therapy and were successfully using self-injection therapy at 3-month follow-up. Twenty-three patients are still on injection therapy. Five patients have dropped out for several reasons including a lack of a current sexual partner (60%) and pain with injection (40%). Patient age ranges from 24 to 72. The dosage range was 0.10 to 0.50 cc (mean = 0.29 cc). The average duration of erection was 43 minutes. At 3-month follow-up, 85% of the patients rated their erections as good or excellent. Forty-three percent of patients are using ICI 1 or more times per week. Seventy-seven percent of patients are moderately or extremely satisfied with their treatment and 89% said that they would recommend this program to a friend.

CONCLUSIONS

This simplified pharmacologic erection program offers safe, well accepted, and effective therapy for ED to a SCI population with very high patient satisfaction.

The efficient organization of blood donation: what determines the number of donors and donations?

This study investigates the influence of socio-economic characteristics on the number of donors in geographical areas in the North of Scotland as well as the influence of panel-specific characteristics on the number of donations obtained from each panel in the North of Scotland. Econometric models are applied to establish the relationship between these variables. The main findings were that there was no scope for identifying new areas in which to locate new panels or extend the activities of existing panels because the number of donors in an area was closely correlated with population. There was therefore little scope for recruitment of donors by focusing on any particular area. It was found that annual donations per panel are significantly influenced by the number of donors invited, the number of opportunities to donate and the average length of sessions. Combined with cost information, increasing the length of the session appears to be the most cost-effective means of collecting higher volumes.

Supply and demand of bone allograft for revision hip surgery in Scotland

The Scottish National Blood Transfusion Service is the main provider of bone for grafting in Scotland. Bone is procured only from live donors, following very strict selection criteria, and we have investigated whether the amount being collected was adequate.

Our current harvest of approximately 1700 femoral heads per year is shown not to be enough to meet the future demand for revision surgery of the hip. Many more of these operations are being undertaken, and impaction grafting is being used increasingly.

We have calculated the predicted rates of collection and usage for the next four to five years so that we can expand our service in a controlled fashion.

Supply and demand of bone allograft for revision hip surgery in Scotland

The Scottish National Blood Transfusion Service is the main provider of bone for grafting in Scotland. Bone is procured only from live donors, following very strict selection criteria, and we have investigated whether the amount being collected was adequate. Our current harvest of approximately 1700 femoral heads per year is shown not to be enough to meet the future demand for revision surgery of the hip. Many more of these operations are being undertaken, and impaction grafting is being used increasingly. We have calculated the predicted rates of collection and usage for the next four to five years so that we can expand our service in a controlled fashion.

Study on medical donor deferrals at sessions

A 10-month audit of reasons for donor medical deferral at sessions was carried out in two Scottish regions of the SNBTS. Six thousand deferred donors were assessed. Although the deferred donor population mirrored the attending donor population in both regions, significantly more donors, both new and regular, were deferred in the Edinburgh and South East region, compared with the North East. The main differences in deferral were attributable to three clinical conditions (cervical carcinoma in situ, other gynaecological conditions and hypertension) and to donors admitting to high-risk behaviour. Although the staff in the deferral process - doctors, nurses and clerks - were involved in roughly equal proportions in both regions, the spectrum of medical conditions seen by each staff grouping appeared to be different in each region. The staff in the South East appeared to have made more correct decisions. Further analysis and audits are being undertaken in areas highlighted by this study.

The sustained impact of a group and screen and maximum surgical blood ordering schedule policy on the transfusion practice in gynaecology and obstetrics

A retrospective study was carried out to examine the durability of the impact of Group and Screen (GS) and Maximum Surgical Blood Ordering Schedule (MSBOS) policy on transfusion practices. The study involved the Gynaecology and Obstetrics wards of the three Aberdeen teaching hospitals, all of which are supplied with blood and services by the transfusion laboratory of Aberdeen and North East of Scotland Blood Transfusion Service. The transfusion laboratory and hospital records were examined and analysed for all transfusion events in Gynaecology and Obstetrics during the three periods of 6 months immediately before, immediately after and 2 1/2-3 years following the introduction of a GS and MSBOS policy in November 1986. The number of units of blood crossmatched and units transfused decreased consistently and progressively to half the pre-GS and MSBOS level in both Gynaecology wards and Obstetrics wards during the study periods. This reduction was not associated with a decrease in the clinical workload. However, the crossmatched/transfused ratio (CTR) showed an immediate but transient improvement (3.6 to 2.2 to 3.4) and only partial and delayed improvement (10.1 to 9.6 to 7.7) with regard to blood use in the Gynaecology wards and the Obstetrics wards (respectively) during the three periods of 6 months indicated above. We conclude that the introduction of a GS and MSBOS policy can have a significant and sustained impact in reducing unnecessary blood ordering. The CTR may not be as sensitive an indicator of the effect of the introduction of GS and MSBOS as the total blood usage and a more detailed examination of blood use is necessary to assess performance and long-term impact.

A predictive score index for the outcome of associated biofeedback and vaginal electrical stimulation in the treatment of female incontinence

A group of 64 women with stress incontinence alone (20), urgency incontinence (7) and mixed incontinence (37) were treated during 12 sessions, each 20 minutes long, during 6 weeks with combined alternating biofeedback and intravaginal electrical stimulation. Of the patients 21 had a complete recovery, 20 recovered sufficiently to avoid other forms of treatment and 23 failed to respond to the treatment. Thus, the overall success rate for this treatment was 64%. Various physiological parameters were collected from each patient before the start of the treatment sessions. Patient age, estrogen status, detrusor hyperreflexia, intravaginal pressure, percent transmission of the abdominal pressure to the urethra, degree of intrinsic sphincter deficiency and compliance with therapy were significant factors affecting the success of treatment. A statistical analysis was performed on these measurements to generate a score index model capable of predicting the outcome of a treatment consisting of associated biofeedback and electrical stimulation. We present a reliable method for distinguishing between patients who will and will not respond to this form of treatment. The most significant variables predictive of a good reduction outcome are patient age, presence of estrogen, absence of detrusor instability and intrinsic sphincter deficiency, low urethral hypermobility and, most of all, compliance with treatment.

Cytomegalovirus studies on blood donors in north-east Scotland and a review of UK data

The epidemiology of cytomegalovirus (CMV) infection as assessed by CMV antibody testing varies significantly in different parts of the world and also in different regions of a country. A study was therefore carried out to assess the prevalence of CMV antibody in our blood donors, looking in particular at different subgroups of donors as divided by age, sex and social class, to see how we could maximise the yield of CMV-negative blood from our testing. It was shown that patterns of CMV infection in the North East of Scotland followed well-established norms. Data from other Regional Transfusion Centres within the UK were also collected for comparison.

The incidence and consequences of cytomegalovirus transmission via blood transfusion to low birth weight, premature infants in north east Scotland

In a 2-year study involving 133 premature low birth weight (less than 1,500 g) infants, the impact of CMV infection via blood transfusion was assessed. 8.4% (7 out of 83) of transfused infants and 10% (7 out of 70) of those exposed to seropositive blood acquired CMV. In those less than 1,250 g the infection rate rose to 13.2% (7 out of 46). Seropositive infants were at a higher risk of acquiring CMV infection than seronegative ones. CMV infection did not give rise to specific immediate morbidity, and no deaths were attributed to CMV. The only source of nosocomial CMV infection was the transfused seropositive blood. Based on these findings, it was possible to formulate a CMV transfusion policy to premature infants in our region.

Discoid lupus erythematosus in an X-linked cytochrome-positive carrier of chronic granulomatous disease

A 13-year-old female presented with photosensitivity, recurrent aphthous ulcers and discoid lupus erythematosus (DLE)-like skin lesions. These symptoms have been linked to the carrier status of chronic granulomatous disease (CGD). Neutrophil (PMN) function was investigated by nitroblue tetrazolium reduction test and chemiluminescence. A severe impairment of PMN oxidative burst activity was revealed in spite of supranormal levels of cytochrome b245. Glucose-6-phosphate dehydrogenase activity was deficient. Her mother and two sisters also showed reduced PMN function. These findings are consistent with a cytochrome positive X-linked form of CGD with variable lyonization. DLE in association with the carrier status of this CGD variant has not been reported previously.