[Immuno-hemolytic transfusion reactions. III. Report of 61 cases]. / Les accidents immuno-hémolytiques transfusionnels. III. Etude de 61 cas.

Blood transfusion is mainly bound to immunological and infectious risks. The immunological risk originates from an incompatibility between the blood of the donor and that of the recipient; this risk remains insufficiently assessed. A multicentre study has been carried out by the French Blood Transfusion Society and the National Institute for Blood Transfusion. Sixty-one accidents due to an erythrocyte incompatibility were found: 26 cases with ABO incompatibility, and 35 cases with alloantibodies of other blood group systems. For the former category of accidents, the most frequent cause was due to a failure in the realization of the bedside ABO check. For the latter, the main problem was the achievement and the interpretation of antibody screening. The long term follow-up shows no chronic after-effects of immunological accidents. For each accident, errors have been identified and analysed. It was proven that they all originate from health care establishments.

[Follow-up of blood donors with positive serology for hepatitis C virus and their recipients is insufficient]. / Le suivi des donneurs de sang ayant une sérologie du virus de i'hépatite C positive et de leurs receveurs est insuffisant.

OBJECTIVES: Our aim was to study the characteristics of blood donors with serum anti-HCV antibodies, their medical follow-up based on a questionnaire, and the follow-up of their recipients who were transfused before systematic screening of anti-HCV antibodies had begun. METHODS: From March 1990 to January 1992, 25,255 blood donors were tested by ELISA 1 or ELISA 2 serum tests and confirmed by RIBA 2 test in case of positivity: 126 (0.5%) were ELISA positive of whom 40 (0.16%) were RIBA 2 positive (n = 18) or indeterminate (n = 22); among the latter, 13 were retested by RIBA 3 which was positive in 2 cases. Thus, the prevalence of blood donors with truly positive HCV antibodies testing was shown to be between 0.08 and 0.12%. Among the 126 ELISA positive blood donors, 90 had given blood before systematic screening had begun, involving 232 patients and 50 non nominative products. RESULTS: In donors with positive ELISA test, the prevalence of serum ALT activity > 2N was 17% if the RIBA test was positive vs 1% if the test was negative or indeterminate (P = 0.0007). The rate of donors with serum ALT activity > N before March 1990 was 62.5% if the RIBA test was positive vs 17.5% if it was negative (P = 0.01). The follow-up at 2 years of 34 out of 40 donors with a positive or indeterminate RIBA test showed that 88% had had at least two serum ALT activity tests, that 12% had had a serologic test, that 6% had sought the advice of a specialist, and that a liver biopsy was performed in 3%. The follow-up of recipients showed that the response rate of physicians or recipients was 37% (47% at public hospital and 12% in private hospital, P < 0.01). The rate of recipients positive for HCV was 25%, that is 2% of the entire group, yielding an estimated 8% efficiency of the survey. Lack of screening was due to the lack of responses from physicians or recipients in 64% of cases and to the death of the recipient in 36% of cases. CONCLUSION: HCV seroprevalence among blood donors in France is closed to that observed in Northern Europe. In this population, there is a great discrepancy between the ELISA and RIBA tests. During the survey period, the follow-up of HCV positive blood donors seemed to be very insufficient. The screening of their recipients was poorly effective, thus emphasizing the importance of the systematic and prospective follow-up of blood donors.

[Programmed autologous blood transfusion in children. Results of a national survey]. / Transfusion autologue programmée chez l'enfant. Résultats d'une enquête nationale.

OBJECTIVE: To assess the development and the current practice of predeposit autologous blood transfusion (PABT) in children in France. STUDY DESIGN: Nationwide survey with a questionnaire. METHOD: Survey conducted in January 1995, including 121 blood transfusion centres (BTC) out of which 101 replied. RESULTS: Initiated in 1979, PABT is practiced at present in 66% of BTC. This figure increased by 12% from 1993 to 1994. Orthopaedic surgery was the main indication. Other indications included bone marrow harvesting for allogenic transplantation. Concerning the inclusion criteria, the lower limit of age was 9 +/- 4 years and weight 26 +/- 10 kg. The youngest child was one-year-old and his body weight was 8 kg. CONCLUSION: The production of codified protocols would probably favour the development of PABT in children and increase its safety and its efficiency.

[Post-transfusion purpura: and cause of severe postoperative thrombopenia]. / Purpura post-transfusionnel: une cause de thrombopénie postopératoire grave.

A 59-year-old woman developed an acute and severe thrombocytopenia (platelet count below 10.10(9).L-1) with active bleeding, 6 days after a massive transfusion for intraoperative haemorrhagic shock. The diagnosis of post-transfusion purpura (PTP) was confirmed by the presence of an allo-antibody directed against HPA-1a platelet antigen. The patient and her daughter had a rare HPA-1b platelet phenotype, but also belonged to the HLA DR3 phenotype, frequently associated with PTP. This case shows the therapeutic difficulties of postoperative PTP. Despite active bleeding, this syndrome requires the discontinuation of transfusions of incompatible platelets. Transfusion of phenotyped platelets is often inefficient. Red cell concentrates must be platelet and plasma free. Immunomodulating therapy can shorten the time course. Preventive measures, particularly autologous transfusions, are necessary for subsequent haemorrhagic surgery or parturition.

A multicenter study on the efficiency of white cell reduction by filtration of red cells.

To evaluate accurately the current performance of filtration, the French Produits Sanguins Labiles study group, composed of 21 transfusion teams, conducted a large-scale 6-month study involving over 1400 filtrations and 3000 controls. Some 745 standard red cell concentrates (RBC concentrates) and 690 concentrates previously white cell (WBC)-reduced by removal of buffy coat (BC-poor RBC concentrates) were filtered using six commercially available filters: at least 170 results were collected per filter, spread among a minimum of three teams. Prefiltration controls show that the removal (manual and automated) of the buffy coat results in an initial WBC reduction of approximately 63 percent, along with a hemoglobin loss of 4 g (7%). After filtration, residual WBCs were counted in the Nageotte manual counting chamber. The reliability of this counting method, which is simple and adapted to low WBC concentrations, was characterized in this study by a 25-percent coefficient of variation (CV) for a concentration of 2.5 WBCs per microL (i.e, 0.6 x 10(6) WBCs/filtered unit). The analysis of the results shows that, for five of six filters (1 filter was excluded), the postfiltration median value of residual WBCs was 1.1 x 10(6) in filtered RBC concentrates (n = 590), whereas it was 0.34 x 10(6) in filtered BC-poor RBC concentrates (n = 581). The difference is significant (p less than 10(-8), Wilcoxon test). Hemoglobin loss due to filtration varies according to the filter, from 5.7 +/- 2.2 to 17.3 +/- 2.5 g.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention of HLA immunization with leukocyte-poor packed red cells and platelet concentrates obtained by filtration.

HLA immunization is a common complication of transfusion therapy in 30% to 60% of oncohematologic patients. Evidence shows that leukocytes present in cellular blood products are the main component involved in the occurrence of HLA immunization, and several studies showed that leukocyte-poor blood products are less able to induce it. However, leukocyte-poor platelet concentrates obtained by conventional techniques, ie, centrifugation, frequently have a high level of remaining leukocytes. Cotton wool filter Imugard IG 500 can be used to obtain leukocyte-poor cellular blood products. The technique is easy to perform, even in an emergency, and can be used with either packed RBCs or platelet concentrates. Means of 97%, 92%, and 76% elimination of leukocytes are obtained for packed RBCs, pooled standard platelet concentrates, and single-donor platelet concentrates, respectively. Patients were randomized to receive either standard (control group) or filtered (leukocyte-poor group) blood products. Of 112 randomized patients, 69 were evaluable, 35 in the control group and 34 in the leukocyte-poor group. Both groups are comparable according to age, diagnosis, sex ratio, previous transfusions, and pregnancies. There is a significant difference in regard to the HLA immunization rate (31.4% in the control v 11.7% in the leukocyte-poor group, P less than .05) and frequency of refractoriness to platelet transfusions (46.6% v 11.7%, P less than .05). We conclude that this filtration technique can be an efficient means to reduce the HLA immunization rate in polytransfused oncohematologic patients.