Epidemiological and clinical aspects of hepatitis G virus infection in blood donors and immunocompromised recipients of HGV-contaminated blood.

BACKGROUND AND OBJECTIVES: The infectiousness and clinical relevance of the newly discovered blood-borne Flaviviridae-like agent, termed hepatitis G virus (HGV), are not well understood. MATERIALS AND METHODS: Twenty-three transfusion recipients of two HGV-affected long-term blood donors were studied for HGV genome and antibodies to the putative envelope 2 glycoprotein (anti-E2) of HGV. Nine recipients had nonhematological disorders and 14 suffered from severe hematological diseases and 7 of them received allogeneic bone marrow or blood stem cell transplantation. The molecular epidemiology of the observed HGV infection was studied by direct sequencing of parts of the 5'-noncoding region, NS3, and NS5 region of HGV in the 2 long-term donors and in their 6 recipients who became HGV RNA positive. Additionally, 549 individuals-homologous (n = 254) and autologous blood donors (n = 202), and medical staff (n = 89)--were investigated for the presence of HGV RNA. RESULTS: HGV RNA in serum was found in 15 of the 23 (65%) transfusion recipients with known exposure of HGV-contaminated blood. Seven of the remaining 8 recipients showed only an anti-E2 response, indicating previous HGV infection with spontaneous clearance of the virus. In one recipient neither HGV RNA nor anti-E2 could be detected. Molecular evidence for HGV transmission by the 2 donors was found in 3 of the 6 recipients studied. The alanine aminotransferase levels were not significantly different in the HGV RNA positive and negative recipients, and none of the 23 recipients developed posttransfusion hepatitis. Persistent HGV infection was observed especially in recipients with severe hematological disorders or in those in whom intensive immunosuppressive treatment was necessary. Of the 549 individuals studied, 10 (1.8%) were healthy carriers of HGV RNA. CONCLUSION: The persistence of transfusion-acquired HGV infection is not associated with acute or chronic hepatitis, but may be influenced by the recipient's underlying disease.

[Screening for markers of transfusion-associated infections in autologous blood donation]. / Screening auf Marker für transfusionsassoziierte Infektionen bei autologen Blutspenden.

Autologous blood donation is increasingly used in preparing patients for elective surgical procedures. The aim is to diminish the transmission of transfusion-associated infections, to avoid transfusion-related immunosuppression and to relieve the general blood supply. However, autologous blood donation programs do not necessarily incorporate serologic donor screening. From June 1990 to January 1993 we examined 4,038 consecutive autologous donations from 1,708 patients. The median age was 61 years (range 10-88), the sex ratio was 1/1.5 male/female. We tested each unit for serum ALT, anti-HIV1 + 2, HBsAG, anti-HBc, anti-HCV, and Treponema pallidum antibodies (TPHA test). The overall rates of positive test results were: ALT > 45 U/l 0.64%, anti-HBc 15.9%, BHsAG 0.72% and TPHA test 0.32% of all units; anti-HCV (1st gen.) 4.26% of 1,948 and anti-HCV (2nd gen.) 2.34% of 2,090 donations. With respect to the sex-related normal range of the local laboratory, 332 (8.2%) of all components had an elevated serum ALT level. No donation was positive for anti-HIV1/2. The overall rate of components with pathological findings in tests for ALT, HCV antibodies, HBs antigen and/or Treponema antibodies was 11.7%. We conclude from these data that a substantial proportion of autologous blood is potentially harmful in cases of mistake solely with respect to serologic screening results. Procedures to minimize the risk of mistake of autologous blood should routinely include serologic screening and marking of units with pathological findings.

[Erythropoiesis and iron metabolism in autologous blood donation]. / Erythropoese und Eisenstoffwechsel bei der Eigenblutspende.

Autologous blood donation before elective surgery has been widely endorsed as good transfusion practice. Although only 6 percent of patients undergoing elective orthopedic surgery are unable to donate 3 autologous units, 40 percent cannot donate 4 units because they become anemic [1,2]. According to the results of our study this must be due to different problems in bone marrow dynamics, which cannot be overcome by unselected use of human recombinant erythropoietin alone [3].

[Autologous blood donation and erythropoiesis]. / Eigenblutspende und Erythropoese.

Autologous blood donation before elective surgery has been widely endorsed as good transfusion practice. Although only 6% of patients undergoing elective orthopedic surgery are unable to donate 3 autologous units, 40% cannot donate 4 units because they become anemic. According to the results of our study this must be due to different problems of bone marrow dynamics, which cannot be overcome by unselected use of human recombinant erythropoietin.

[Stem cell separation with different cell separators]. / Stammzellseparation mit unterschiedlichen Zellseparatoren.

For some years, there has been an increasing success in transplanting peripheral blood stem cells (PBSC) instead of autologous bone marrow in patients suffering from different malignancies. While collecting PBSC for autologous transplantation, we compared four different separation techniques and three different cell separators (COBE Spectra, Fresenius AS 104, Haemonetics V50) routinely used for platelet production. Our results suggest that continuous flow separators seem to have some advantage over discontinuous flow machines in harvesting PBSC.

[Clinical use of peripheral stem cells for autologous transplantation]. / Klinischer Einsatz peripherer Stammzellen zur autologen Transplantation.

Peripheral blood derived hematopoietic stem cells (PBSC) have been transplanted successfully to eight patients suffering from different malignancies. The separations were started during chemotherapy-induced cytopenia and large volumes of peripheral blood were processed. Using this separation concept, it was possible in all cases to obtain the stem cell amount necessary for hematopoietic reconstitution.

[Risks of autologous blood transfusion]. / Risiken der autologen Transfusion.

Underutilization of autologous blood for transfusion is widespread. Our results suggest that this problem could only gradually be corrected, as some patients show insufficient erythropoietic recovery after a predeposit autologous donation.