Homologous serum jaundice

Post-transfusion hepatitis in a London hospital: results of a two-year prospective study

Seven hundred and sixty-eight patients were seen and tested at frequent intervals after transfusion of whole blood. Eight patients were judged to have developed icteric or anicteric post-transfusion viral hepatitis, an incidence of 1%. Five were icteric and four of these were hepatitis B antigen (HB Ag) positive; two of these four died. One of the fatal cases and one non-fatal HB Ag positive case had received HB Ag positive blood. Two other antigen-positive patients had received blood or plasma or both which had not been tested for antigen.

Thirty-five patients showed conspicuous or sustained elevations of alanine transaminase without clinical features of hepatitis.

Four were positive for HB Ag but had not received antigen positive blood.

Two who had received antigen positive blood remained antigen negative, but one developed hepatitis B antibody (HB Ab).

Two other patients were also transfused with plasma.

Five had serological evidence of cytomegalovirus (CMV) infection accompanying the enzyme changes.

One patient who had received HB Ag positive blood remained antigen-negative and showed no abnormalities.

Five patients who became HB Ag positive, although they had been given antigen-negative blood, remained clinically and biochemically well.

Cytomegalovirus primary infection or reactivation occurred in another 32 patients; five had isolated, transient enzyme rises, one other was associated with a drug-induced focal liver necrosis and 26 showed no enzyme changes. Epstein–Barr virus infections, one of which was associated with a transient upset of enzyme activity, were detected in five patients. There were no cases of post-perfusion syndrome.

Post-transfusion hepatitis in a London hospital: results of a two-year prospective study. A report to the M.R.C. Blood Transfusion Research Committee by the Medical Research Council Working Party on Post-Transfusion Hepatitis

Seven hundred and sixty-eight patients were seen and tested at frequent intervals after transfusion of whole blood. Eight patients were judged to have developed icteric or anicteric post-transfusion viral hepatitis, an incidence of 1%. Five were icteric and four of these were hepatitis B antigen (HB Ag) positive; two of these four died. One of the fatal cases and one non-fatal HB Ag positive case had received HB Ag positive blood. Two other antigen-positive patients had received blood or plasma or both which had not been tested for antigen.Thirty-five patients showed conspicuous or sustained elevations of alanine transaminase without clinical features of hepatitis.Four were positive for HB Ag but had not received antigen positive blood.Two who had received antigen positive blood remained antigen negative, but one developed hepatitis B antibody (HB Ab).Two other patients were also transfused with plasma.Five had serological evidence of cytomegalovirus (CMV) infection accompanying the enzyme changes.One patient who had received HB Ag positive blood remained antigen-negative and showed no abnormalities.Five patients who became HB Ag positive, although they had been given antigen-negative blood, remained clinically and biochemically well.Cytomegalovirus primary infection or reactivation occurred in another 32 patients; five had isolated, transient enzyme rises, one other was associated with a drug-induced focal liver necrosis and 26 showed no enzyme changes. Epstein-Barr virus infections, one of which was associated with a transient upset of enzyme activity, were detected in five patients. There were no cases of post-perfusion syndrome.

Experience with a hepatitis-free plasma protein solution

Clinical experience with a 4.3% solution of plasma protein treated to render it free of the agent of serum hepatitis is satisfactory. Sixty-seven transfusions of 400 ml. of the commercial preparation were given to 33 patients (25 with acute blood loss, 4 with severe burns, and 4 with hypoproteinaemia secondary to hepatic or renal disease).The solution was clinically as effective as reconstituted dried plasma in expanding plasma volume and in replacing serum protein lost in burns. Adverse effects were mild pyrexial reactions in one case and facial flushing in another. No cases of serum hepatitis occurred.The solution is available for immediate use, it can be kept at room temperature, and, as it does not cause rouleaux formation, it can be given before blood is taken for grouping and cross-matching.

Safety of stored liquid plasma; a clinical study

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