Collection, processing and testing of bone, corneas, umbilical cord blood and haematopoietic stem cells by European Blood Alliance members

BACKGROUND AND OBJECTIVES

A questionnaire study was carried out in collaboration with the European Blood Alliance (EBA) Tissues and Cells (T&C) working group. The aim was to assess the level of involvement and commonality of processes on the procurement, testing and storage of bone, corneas, umbilical cord blood (UCB) and haematopoietic stem cells (HSC) in order to identify different practices and to explore whether recommendations can be made for harmonization.

MATERIALS AND METHODS

An online questionnaire was used for data collection in 2011, and 43 replies were received covering 71 product answers from 13 countries.

RESULTS AND CONCLUSIONS

Estimated percentages of tissue and cell banking covered by EBA member blood banks as a proportion of all collections of each individual country varied markedly. There were also major differences in the amounts of products collected and discarded and in proportions tissues provided for grafting. However, discarding of certain collections also reflects the practice of increasing the likelihood of the very best units being used for transplantation. Harmonization of possible practices should focus on matching supply with demand and on identifying the most efficient operators. This could allow for the development of practices for minimizing unnecessary collections.

The organization of tissue banking in Scotland

Tissue banking in Scotland has developed significantly over the past 20 years or so. The range of issues procured has increased and so have their numbers. Initially, bone from live donors was the only tissue banked; later, tissues from multiorgan donors were procured; this was finally followed by the collection of tissues from donors following cardiac death. Bones, tendons, heart valves and skin are the main tissue types collected, stored and issued for clinical use. Much of our activity is based on identification of donors in two major accident and emergency departments followed by retrievals that take place in a dedicated mortuary by fully-trained staff. Tissues are released according to clinical need for Scottish patients and beyond. All of the tissue banking activity in Scotland takes place within the Scottish National Blood Transfusion Service, which is the preferred provider of tissues for Scottish patients. There is very close cooperation between our teams, the transplant teams and other clinical colleagues, including pathologists and anatomical technicians. The achievements in issue banking in Scotland are outlined along with the main clinical indications of the tissue procured. Diversification is now taking place into cellular therapy with the establishment of an islet processing programme and cell culturing techniques. The future is very exciting.

Estimating the potential of tissue donation in Scotland

The Scottish National Blood Transfusion Service became the preferred provider of tissues in 2000. At that time, the only tissues procured were heart valves and some tendons from multiorgan donors. These sources and the range of tissues were not enough to provide for the clinical needs of Scottish patients. A systematic review was undertaken using the International Classification of Disease codes to assess what the potential pool of tissue donors would be by region, hospital and hospital department. Such data would enable us to focus our limited resources to maximize the yield of tissues to meet clinical demand. The data from this study were validated by a case-note audit in one hospital in Edinburgh. It was shown that the maximum tissue donor potential of approximately 48.5 per million population was in the central belt of Scotland in hospitals with large emergency medicine departments.

Prevention and control of childhood asthma and allergy in the EU from the public health point of view: Polish Presidency of the European Union

The leading priority for the Polish Presidency of the Council of the European Union was to reduce health inequalities across European societies, and, within its framework, prevention and control of respiratory diseases in children. This very important paper contain proposal of international cooperation on the prevention, early detection and monitoring of asthma and allergic diseases in childhood which will be undertaken by the EU member countries as a result of EU conclusion developed during the Polish Presidency of the Council of the European Union. This will result in collaboration in the field of chronic diseases, particularly respiratory diseases, together with the activity of the network of national institutions and NGOs in this area. Paper also contains extensive analysis of the socio-economic, political, epidemiological, technological and medical factors affecting the prevention and control of childhood asthma and allergy presented during Experts presidential conference organized in Warsaw-Ossa 21–22 September 2011.

Estrogen receptors α and β have different gender-dependent effects on the adaptive responses to load bearing in cancellous and cortical bone

To determine the effect of estrogen receptors (ER) α and β on bones' adaptive response to loading, we subjected the right tibiae of mice lacking ERα or ERβ activity to either axial loading or to disuse. Adaptive changes in architecture were assessed by comparing differences between the right (treated) and left (control) tibiae in these genotypes as assessed by microcomputed tomography. In female ERα(-/-) mice, the net-osteogenic response to loading was lower in cortical bone compared with their wild-type littermates (11.2 vs. 20.9% in ERα(+/+)), but it was higher in both cortical and cancellous bone of male ERα(-/-) mice (cortical 20.0 vs. 4.6% in ERα(+/+); cancellous 30.0 vs. 5.3% in ERα(+/+), P < 0.05). In ERβ(-/-) male and female mice, the net-osteogenic response to loading was higher in cortical bone (males 10.9 vs. 3.9% in ERβ(+/+); females 18.5 vs. 15.8% in ERβ(+/+), P < 0.05) but no different from controls in cancellous bone. The bone loss in response to disuse was less in cancellous bone of ERα(-/-) mice than in controls (-15.9 vs. -21.3%, respectively, P < 0.05) but no different at any other site or between any other groups. Our conclusion is that functional ERα enhances the net-osteogenic response to loading in cortical but not cancellous bone in female mice but reduces it in males. ERβ decreases the response to loading in cortical bone of males and females but has no effect in cancellous bone. Bone loss due to disuse in cortical bone is unaffected by ER status, but in cancellous bone, functional ERα contributes to greater disuse-related bone loss.

Intra-operative washing of morcellised bone allograft with pulse lavage: how effective is it in reducing blood and marrow content?

The use of unprocessed bone carries a risk of transmission of blood borne diseases. Although models of infectivity are unproven, a theoretical risk of transmission of variant Creutzfeld-Jakob Disease, a human prion disease, exists as probable blood borne transmission has been reported in three cases. The aim of our study was to determine the effectiveness of standard operating theatre pulse lavage in removing protein, fat and double stranded Deoxyribonucleic acid (dsDNA) from morcellised bone allograft. Twelve donated femoral heads were divided into halves and milled into bone chips. One half of the bone chips were washed with pulse lavage, whereas, the other half acted as control. In order to determine the amount of protein, fat and dsDNA present in the washed and unwashed samples, a validated multistep washing protocol was used. Using the validated technique, simple intra-operative washing of morcellised unprocessed bone allograft removed a significant amount of the protein (70.5%, range: 39.5-85%), fat (95.2%, range: 87.8-98.8%) and DNA (68.4%, range: 31.4-93.1%) content. Intra-operative washing of morcellised bone allograft with pulse lavage may thereby reduce the theoretical risk of prion and other blood borne disease transmission. Combined with the known improved mechanical characteristics of washed allograft, we would recommend pulse lavage as a routine part of bone allograft preparation.

Hygiene behaviour of adolescents in the Pacific: associations with socio-demographic, health behaviour and school environment

This study presents findings on health-related hygiene behaviours of 9,013 adolescents from Vanuatu, Tonga and Pohnpei in the Federal States of Micronesia as part of the Health Behaviour of Pacific Youth Life surveys. We examined the prevalence of and relationship between tooth brushing, hand washing before eating, hand washing after toileting and a range of psychosocial factors such as sociodemographic charac-teristics, health behaviour and school affiliation. The results showed that patterns of prevalence and relationships were consistent for all countries, with weaker associations observed in Pohnpei. In general, adolescents reported moderate levels of optimal hygiene practice. Girls reported significantly more frequent optimal hygiene practice than boys. Logistic regression analysis confirmed that frequent hygiene behaviours were significantly associated with gender, parental occupations and high levels of school affiliation. These findings suggest the need to consider psycho-social and economic factors when examining potential influences on hygiene behaviour to ensure effective interventions.

Comparison of prevalence rates of microbiological markers between bone/tissue donations and new blood donors in Scotland

BACKGROUND AND OBJECTIVES

Blood-borne virus prevalence rates of samples accompanying tissue donors are not widely available. This article compares the rates in Scottish bone/tissue donors with those of new blood donors for the 7-year period, 1998-2004.

MATERIALS AND METHODS

Data were collated from existing internal reports. Age distributions of the donor populations were obtained by extracting information from existing computer databases.

RESULTS

Scottish bone/tissue donors were found to have a fourfold higher prevalence for hepatitis B virus (HBV), a 1.6-fold higher prevalence for hepatitis C virus (HCV), an 11-fold higher prevalence for human T-cell lymphotropic virus (HTLV) and a 34-fold higher prevalence for syphilis compared with new blood donors. Excluding confirmed positives, the repeat-reactive rates for bone/tissue donors were similar to those of new blood donors.

CONCLUSIONS

The data demonstrated that the prevalence of blood-borne viruses in Scottish bone/tissue donors is higher than in new blood donors. We believe that the different age profiles of the two donor populations plays a significant role.

Processing of Whole Femoral Head Allografts: Validation Methodology for the Reliable Removal of Nucleated Cells, Lipid and Soluble Proteins Using a Multi-step Washing Procedure

Following the major outbreak of BSE in the United Kingdom in the mid 1980's and the first reported cases of the human disease equivalent, vCJD, in 1996 a number of measures were taken to reduce the risk of secondary transmission of vCJD by blood or surgical instruments. Two cases of probable transmission of vCJD by blood components have now been reported. The Department of Health has recently undertaken a vCJD risk analysis for bone. Although significant uncertainties still exist in the assumptions on which the assessment is based, a few important recommendations were made. These include a recommendation that bone should be processed to remove blood and marrow and that pooling of donations is never advantageous. This study aimed to establish a method of processing whole femoral heads using disposable equipment, with the purpose of removing as much of the marrow components as possible. We are able to remove 98.2% (range 94.5-99.9%) of the nucleated cells and 98.7% (range 97.8-99.4%) of the soluble protein content from within an intact femoral head. This work confirms that the majority of blood and marrow components can be removed without the need for morselising the bone prior to washing.

Clinical effectiveness of processed and unprocessed bone

Bone allografts have been used clinically for a number of years. Understanding the biology of bone healing and the impact that bone banking has on this helps to improve the methodologies used in increasing the quality and safety of banked bone. Banked bone in its various forms has been used in a variety of surgical procedures, and although there is no doubt that it is clinically effective, most of the studies have been retrospective and non-randomized. The review attempts to summarize some of the data in this area and highlights some of the difficulties encountered in such work. Although there is no doubt that bone banking is nowadays better controlled, there are ever-increasing pressures to produce bone that is as safe as possible with the least impact on its effectiveness. This can only be achieved if the requirements of the providers and users of bone are better understood.

Global priority setting for Cochrane systematic reviews of health promotion and public health research

BACKGROUND

Systematic reviews of health promotion and public health interventions are increasingly being conducted to assist public policy decision making. Many intra-country initiatives have been established to conduct systematic reviews in their relevant public health areas. The Cochrane Collaboration, an international organisation established to conduct and publish systematic reviews of healthcare interventions, is committed to high quality reviews that are regularly updated, published electronically, and meeting the needs of the consumers.

AIMS

To identify global priorities for Cochrane systematic reviews of public health topics.

METHODS

Systematic reviews of public health interventions were identified and mapped against global health risks. Global health organisations were engaged and nominated policy-urgent titles, evidence based selection criteria were applied to set priorities.

RESULTS

26 priority systematic review titles were identified, addressing interventions such as community building activities, pre-natal and early infancy psychosocial outcomes, and improving the nutrition status of refugee and displaced populations.

DISCUSSION

The 26 priority titles provide an opportunity for potential reviewers and indeed, the Cochrane Collaboration as a whole, to address the previously unmet needs of global health policy and research agencies.

Environmental influences on helminthiasis and nutritional status among Pacific schoolchildren

This paper describes a study undertaken to: (1) determine the prevalence of Ascaris lumbricoides, Trichuris trichiura and hookworm infections and nutritional status among Pacific Island school children; (2) identify factors influencing helminthiasis; (3) identify interventions to improve school health. A total of 3,683 children aged 5-12 years attending 27 primary schools in 13 Pacific Island countries were surveyed along with school environmental data. Stool samples were collected from 1996 children (54.2%) and analysed for ova and helminths. Total prevalence of helminthiasis was 32.8%. Anaemia prevalence was 12.4%. Children with helminthiasis and anaemia were found to be 8.7 times more likely to be stunted and 4.3 times more likely to be underweight than non-anaemic and non-infected children. Four significant environmental influences on helminthiasis were identified: (1) an inadequate water supply; (2); availability of a school canteen; (3) regular water/sanitation maintenance regimes; and (4) overcrowded classrooms. Helminthiasis was found to be strongly associated with anaemia, stunting and underweight and environmental influences identified. Although mass anti-helminthic drug administrations (MDA) have been taking place, reinfection is common as drug therapy alone is not enough. Programme effectiveness depends upon upgrading school environments to include an adequate water supply, controlled food preparation/provision, well-maintained water/sanitation facilities and class sizes of 30 students or less.

Efficacy and safety of oral sildenafil in men with erectile dysfunction and spinal cord injury

OBJECTIVE

To assess the efficacy of sildenafil in men with spinal cord injury (SCI) and erectile dysfunction (ED).

METHODS

Seventeen men with SCI were selected from February to September 1998 for sildenafil treatment of ED. The initial dose of 25 mg was increased by 25-mg increments as needed. Patients underwent baseline physical examination and answered questions from the abridged International Index of Erectile Function before and during therapy.

RESULTS

Sixteen patients tolerated therapy; 1 developed hypotension and discontinued therapy. There was significant improvement in erectile function (P < .05) after 5.3 +/- 2.2 months when compared with baseline or previous therapies (P < .05). Of the 17 patients, 94% recommended sildenafil to others. Six of these 16 patients were available for long-term follow-up. There was further significant improvement in quality of erection (P < .05), but no change in satisfaction.

CONCLUSION

Sildenafil is effective and well tolerated in men with SCI and ED.

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.