Prospective investigation of transfusion transmitted infection in recipients of over 20 000 units of blood. TTI Study Group.

OBJECTIVES: To follow up recipients of 20 000 units of blood to identify any transmissions of infections through blood transfusion. DESIGN: Follow up study of recipients of transfusion. SETTING: 22 hospitals in north London. PARTICIPANT: Adult patients who had recently been transfused. MAIN OUTCOME MEASURES: Patients had further blood samples taken at 9 months that were tested for markers of hepatitis B and C and HIV and human T cell leukaemia/lymphoma virus type I or II (HTLV) infections. Recent infections were distinguished from pre-existing infections by comparison with blood samples taken before transfusion. RESULTS: 9220 patients were recruited, and 5579 recipients of 21 923 units of blood were followed up. No transfusion transmitted infections were identified. The incidence of transfusion transmitted infections was 0 in 21 043 units (95% confidence interval for risk 0 to 1 in 5706 recipients) for hepatitis B; 0 in 21 800 units (0 to 1 in 5911 recipients) for hepatitis C; 0 in 21 923 units (0 to 1 in 5944 recipients) for HIV; and 0 in 21 902 units (0 to 1 in 5939 recipients) for human T cell leukaemia/lymphoma virus. Three patients acquired hepatitis B during or after hospital admission but not through transfusion; 176 (3%) had pre-existing hepatitis B infection. Sixteen (0.29%) patients had hepatitis C, and five (0.09%) had human T cell leukaemia/lymphoma virus. CONCLUSIONS: The current risk of transfusion transmitted infections in the United Kingdom is very small, though hospital acquired infections may arise from sources other than transfusion. A considerable proportion of patients have pre-existing infections.

Organisation of blood transfusion services.

Worldwide, the availability of blood product support for patients varies considerably, not only in quantity and in standards but also with regard to safety from infections, and specifications for components. Similarly, the organisation responsible for providing blood varies from one country to another. This article discusses the organisation of transfusion services in the UK, describing how the blood supply is provided and looks briefly at the structure of the organisations involved.

A case-control study of cocaine use in pregnancy.

OBJECTIVE: This study analyzed the relationships between cocaine use, various other parameters, and perinatal outcomes. STUDY DESIGN: A case-control study of cocaine use was conducted among pregnant women delivered at a large urban hospital in New Orleans, Louisiana. Two control patients for each case, matched for age, race, parity, and month of delivery, were selected. RESULTS: Between April and September 1990, there were 2332 admissions to the obstetric service; urine toxicology screens were obtained on 2225 patients. Cocaine metabolites were identified in 166 patients; 138 of these women had data that could be evaluated. These data were compared with those of 276 control patients, and the findings were analyzed. Complications that occurred significantly more often in study patients included vaginal bleeding, abruptio placentae, premature rupture of the membranes, meconium staining of the amniotic fluid, and low birth weight. Study patients were found to use prenatal care less often (45.0% vs 86.4%) and to smoke cigarettes more often (67.4% vs 35.1%). Regression analysis identified lack of prenatal care and smoking as important variables in birth weight. When these two variables were excluded, identifiable differences in bith weight between cocaine and control mothers were no longer present. CONCLUSION: The reduction in birth weight experienced by patients who used cocaine may be explained by lack of prenatal care and by smoking. Other identified differences observed between study and control patients were not significantly altered by smoking or prenatal care.