ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36396182133.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36396182134.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:There currently is debate on whether to include new assays for viral antigens and nucleic acids in the battery of screening tests applied to all blood donations. Proposals call for implementation of p24 antigen screening tests to help identify donors who are infected with human immunodeficiency virus type 1 (HIV‐1) but have not yet seroconverted (window‐period donors). There is concern, however, that people at higher risk for HIV infection will be attracted to blood centers in order to obtain the results of an HIV assay that is not routinely available elsewhere. Therefore, the benefit of antigen testing may be offset by an increase in the HIV incidence rate among blood donors.Study Design and Methods:Estimates were obtained from previous reports for the HIV incidence rate among blood donors, the percentage of donations from test‐seeking donors, the duration of the HIV‐infectious window period, and the performance of p24 antigen screening assays. Sensitivity analyses were performed by using various percentages of test‐seeking donors following implementation of antigen testing and various HIV incidence rate ratios of test‐seekers to nonseekers. Hypothetical residual HIV risks were calculated for multiple scenarios and compared to the current estimate of HIV risk without antigen screening of blood donations.Results:If antigen testing reduces the window period by 27 percent (e.g., from 22 days to 16 days), and the HIV incidence rate among test‐seekers is 30 times that among nonseekers, then the benefit of antigen testing will be eliminated if the percentage of test‐seekers (currently estimated at 3.2%) increases to 5.7 percent. If antigen testing reduces the window period by approximately 45 percent (e.g., from 22 days to 10 days or from 13 days to 6 days) and the HIV incidence rate ratio (test‐seekers vs. nonseekers) is assumed to be equal to the HIV prevalence ratio (5.3), then the percentage of donations from test‐seeking donors would have to increase to 25 percent of all donations to offset the benefit of antigen screening.Conclusion:This model helps identify the key measures for assessing the potential adverse effect of increased test seeking as a consequence of the addition of p24 antigen (or other direct virus) assays to blood donor screening programs. In most scenarios, the beneficial effect of antigen screening exceeded the potential detrimental effect of attracting higher‐risk, test‐seeking donors. The possibility cannot be ruled out, however, that a subgroup of high‐risk, test‐seeking donors attracted to the blood centers by a new HIV test will offset the reduction in the residual risk of HIV infection associ

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36396182135.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:In southeastern Michigan, the group O, Rh‐negative (O‐) red cell supply was below emergency levels during one‐sixth of 1994, despite 43‐percent overcollection of O‐ red cell units relative to the size of the O‐ patient population. O‐ red cell units are overutilized because of their universal ABO and Rh compatibility. This study evaluated how hospitals in a large metropolitan area utilized O‐ red cell units, so that strategies could be devised to reduce O‐ usage.Study Design and Methods:Through an O‐ red cell utilization survey, 56 hospitals were encouraged to collect three months' worth of transfusion data, either prospectively or retrospectively. O‐ usage was compared to total red cell usage and categorized into transfusions to O‐ patients, those to non‐O‐ patients, and the number of O‐ units that outdated.Results:Of 40,616 units transfused in 38 hospitals, 3,535 (8.7%) were O‐; 71 percent of the O‐ units were transfused to O‐ patients, 28 percent were transfused to non‐O‐ patients, and 1 percent outdated. Hospital transfusions to O‐ patients appeared to correlate with the racial makeup of the patient population, while hospital transfusions to non‐O‐ patients appeared to correlate with hospital size and the hospital's transfusion practices.Conclusion:O‐ red cell usage in a hospital is dependent on the racial and ethnic mix of the hospital's patient population, the amount of transfusion activity, and the hospital's transfusion practices. An understanding of the dynamics of O‐ usage allowed the dev

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36396182136.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:There is little information in the medical literature on t he clinical spectrum of blood donation‐related neurologic needle injury and on its frequency in a blood donor population.Study Design and Methods:Sixty‐six cases of blood donation‐related neurologic needle injury were identified from nursing reports made during a 2‐year collection period involving 419,000 whole blood donations. Telephone follow‐up was completed on 56 of the 66 cases to better define clinical symptoms, the donor's desire for physician consultation, recovery times, and residual effects.Results:Symptoms in 66 donors included numbness or tingling (n = 54), excessive or radiating pain (n = 43), and loss of arm or hand strength (n = 8). Of the 56 donors with complete follow‐up, 17 (30%) consulted a physician one or more times. Recovery times in these 56 donors were6 months (n = 2). Fifty‐two of 56 donors achieved a full recovery, and 4 other donors had only a mild, localized, residual numbness. The incidence of blood donation‐related neurologic needle injury was 1 of every 6300 donations.Conclusion:While donor recovery may in some cases require a great deal of time and/or physician consultation(s), total recovery appears to be the rule. The incidence of blood donation‐related neurologic needle injury

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36396182137.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:The administration of blood to the wrong patient remains the leading cause of acute hemolytic transfusion reactions and subsequent death. A process control system for blood administration was developed that verifies, at the bedside, the match between barcoded patient identification and blood unit identification.Study Design and Methods:The system is composed of 1) a portable bedside scanner that reads barcoded patient identification and blood unit identification, 2) a host computer system capable of accepting transfusion data from the bedside scanner, 3) printed documentation of the transfusion episode, and 4) audit trail monitoring of whether all steps in the automated patient and blood unit identification process have been performed. Software design, development, and validation protocols followed industry standards.Results:A pilot study was performed over a 2‐month period evaluating the blood administration process using the computerized bedside transfusion identification system prototype for transfusions in 39 oncology patients.Conclusion:This system controls the blood administration process and includes bedside verification of the match between patient identification and blood unit identificatio

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36396182138.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:A blood component is transfused to a patient other than the intended recipient because of patient and sample identification problems once in about every 24,000 transfusions. An investigation was performed of the cost‐effectiveness of a barrier system to prevent mistransfusion of a unit of red cells through this kind of error.Study Design and Methods:A decision analysis model was constructed that took into account nonfatal and fatal events, costs of patient care, and legal costs. The model was used to determine the cost‐effectiveness of the barrier system in terms of cost per year of life saved and lives saved per million transfusions.Results:The barrier system is predicted to save 1.5 lives per million transfusions when used as intended. If the cost‐effectiveness calculations are based on an average damage award for a fatality of more than $725,000 and a chance of mistransfusion exceeding 1 in 16,700, use of the system results in reduced healthcare expenditures. If no legal costs are included in the cost‐effectiveness calculations, use of the system costs $197,000 per year of life saved. Routine use of the system extends patient life by 1 year per 60,000 units transfused.Conclusion:The application of a barrier system to prevent mistransfusion and related morbidity and mortality can be cost‐effective. If legal costs are included in the calculations, the use of a barrier system reduces to

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36396182139.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:Trypanosoma cruzi, the protozoan parasite that causes Chagas'disease, is endemic in Central and South America and in Mexico. Risk of infection is related to exposure to insects harboringT. cruzior to the transfusion of blood from an infected donor. Large numbers of immigrants from endemic areas reside in California, but the frequency with which persons at risk forT. cruzicontribute to the blood supply there is not known.Study Design and Methods:A questionnaire was used to survey donors in 18 California donor centers for risk factors forT. cruziinfection.Results:Otherwise eligible allogeneic blood donors (n = 17,521) completed questionnaires. Of this group, 427 (2.4%) had lived in endemic areas for more than 1 year, and 39 of these donors had lived in dwellings with mud walls or thatched roofs. Sixteen donors had received transfusions in endemic areas. Six donors gave a history of Chagas' disease. Fifty‐seven donors (0.33% of total) had at least one risk factor forT. cruziinfection. Donors at risk forT. cruziwere found in all 18 centers studied, at a median prevalence of 1 per 340 donors.Conclusion:Donors at risk forT. cruziare contributing to the blood supply throughout California. Further consideration should be given to donor screening for this transfusion‐transmissible infect

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36396182140.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:The value of the test for antibody to hepatitis B core antigen (anti‐HBc) as a surrogate screening assay in the time before sensitive, virus‐specific screening tests were available has been well established. There is significant debate, however about the residual value of anti‐HBc screening after the implementation of human immunodeficiency virus (HIV)‐, human T‐lymphotrophic virus (HTLV)‐, and hepatitis C virus (HCV)‐specific assays and, in particular, about its utility as a lifestyle marker to identify persons at risk for retrovirus infections.Study Design and Methods:Screening tests for antibodies to HIV, HTLV, and HBc, as well as confirmatory or supplemental test results for anti‐HIV and anti‐HTLV, were obtained from approximately 2.8 million donations collected from 1991 through 1993 by five blood centers within the United States. The sensitivity, positive predictive value, and relative prevalence of anti‐HBc for each retrovirus were calculated and compared among demographic subgroups.Results:The overall relationship between anti‐HBc and anti‐HIV was similar to that between anti‐HBc and anti‐HTLV. When calculated from the measured endpoint of the prevalence of anti‐HIV‐positive and anti‐ HTLV‐positive donations, the sensitivities were 31.1 and 26.2 percent, the positive predictive values were 0.18 and 0.21 percent, and the relative prevalences were 30.1 and 23.8, respectively. Among 27 anti‐ HIV‐seroconverting donors and 9 anti‐HTLV‐seroconverting donors, the sensitivities were 7.4 percent (95% CI: 0.9–24.3%) and 0 percent (95% CI: 0.0–28.3%), respectively. It was estimated that for each HIV‐ infected window‐period donation detected by anti‐HBc, from 19,000 to 81,000 HIV‐noninfected donations are discarded. Similarly, more than 33,000 HTLV‐noninfected donations are likely to be discarded for each HTLV‐infected donation detected by anti‐HBc.Conclusion:Although anti‐ HBc‐reactive donations are more likely to be seropositive for a retrovirus than are anti‐HBc‐nonreactive donations, the low positive predictive value limits the test's effectiveness. If the anti‐HBc test is retained in the blood donor setting, eff

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36396182141.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Background:The long‐term consequences of parvovirus B19 infection in transfusion recipients are not known, and thus the value of B19 screening of blood donors remains unresolved. Hemophiliacs, at risk for B19 through their chronic exposure to clotting factor concentrates, have frequent, close medical follow‐up and thereby constitute an ideal group in which to study the hematologic sequelae of B19 infection.Study Design and Methods:An enzyme‐linked immunosorbent assay was used to detect B19 IgG and IgM and the polymerase chain reaction was used to detect B19 DNA in frozen, stored plasma samples, obtained between 1987 and 1994, from 136 subjects with hemophilia, including 71 who were human immunodeficiency virus (HIV)‐positive and 65 who were HIV‐ negative. Then the results of the tests were compared with clinical hematological data and blood product usage data.Results:B19 seroprevalence in the hemophilic cohort was 81.6 percent (111/136), including 74.6 percent (53/71) of HIV‐positive and 89.2 percent (58/65) of HIV‐negative hemophiliacs. It was not affected by age, type or severity of hemophilia, HIV status, CD4 number, or yearly blood product usage. Only 1 (0.7%) of the 136 samples was positive for B19 IgM and none was positive in polymerase chain reaction for B19 DNA. After adjusting for HIV status, there were no differences between B19‐ positive and B19‐negative hemophiliacs in hematologic values, CD4 counts, or blood product use.Conclusion:Although B19 IgG seroprevalence in this hemophilic cohort is high and indicative of past B19 infection, there is no detectable B19 viral activity or any associated long‐term clinical or h

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1996.36396182142.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY