Impact of nursing intervention on improving HIV, hepatitis knowledge and mental health among homeless young adults.

In a prospective two-group pilot study of a convenient sample of 156 young adults, we assessed improvement in HIV cognitive and transmission knowledge, hepatitis knowledge, and mental health at six-month follow-up. Multiple linear regression analysis revealed higher six-month scores in total HIV/AIDS knowledge, HIV/AIDS cognitive knowledge, HIV transmission knowledge and HBV and HCV knowledge at 6 months in the Hepatitis Health Promotion (HHP) group compared to the Art Messaging (AM) group. Moreover, homeless young participants who reported having significant others in their lives, and excellent or very good health did better than their counterparts. Youth who were attempting to get their lives together had higher scores for all types of knowledge except HBV. Hallucinogen users had significantly worse scores on all knowledge measures than non-users. Lastly, the HHP group revealed an improvement in psychological well-being compared to the AM group.

Benefits and complications of regular blood transfusion in patients with beta-thalassaemia major.

Early and regular blood transfusion therapy in patients with homozygous beta-thalassaemia decreases the complications of severe anaemia and prolongs survival. In the long term, however, the beneficial effects of transfusions are limited by the organ damage resulting from iron overload, a consequence of the body's limited capacity to excrete iron, and by the complications of infection with blood-borne agents. Transfusion regimens for beta-thalassaemia have changed substantially during the past four decades. In current protocols, pre-transfusion haemoglobin concentration should not exceed 95 g/l. This allows adequate control of anaemia, with a relatively low rate of iron accumulation. Although iron chelation therapy has successfully improved survival free from cardiac disease, thalassaemic patients continuously present new clinical challenges. In fact, the vast majority of them suffer from post-transfusion chronic hepatitis C, which is expected to significantly contribute to morbidity in the forthcoming years. Furthermore, recent studies demonstrated that thalassaemics are at high risk of acquiring several blood-borne viruses. The potential role of these multiple infections in inducing clinical disease is still uncertain, and needs to be thoroughly clarified in future surveys.

Preoperative autologous blood donation in orthognathic surgery: a follow-up study of 179 patients.

Although there have been recent advances in maxillofacial surgery and anaesthetic techniques, blood replacement is still common in orthognathic surgery. 179 patients underwent elective orthognathic surgery and donated autologous blood preoperatively. Standardized questionnaires about the preoperative blood donation were distributed to the patients. Haemoglobin, haematocrit, red blood cells and platelets were measured before blood donation, presurgically and postsurgically, as well as one year after surgery. Nearly all patients (98%) would recommend preoperative autologous blood donation. 97% of the patients saw the benefits of autologous blood donation in avoiding transfusion-transmitted infectious diseases such as acquired immune deficiency syndrome (AIDS) and hepatitis. No serious side-effects have been observed after blood donation. In patients with bimaxillary osteotomies (65% of the predeposited autologous blood units) 41% were in cases having upper jaw osteotomies and only 22% of the preoperatively donated units were retransfused in patients having lower jaw osteotomies. After a postsurgical decrease, the mean haemoglobin and mean haematocrit levels regained the levels determined prior to the donation. Preoperative autologous blood donation of 2 to 3 units (900-1350 ml +/- 10%) of blood is recommended in bimaxillary osteotomies and 1 to 2 units (450-900 ml +/- 10%) of blood for upper jaw osteotomies. In lower jaw surgery, the acute isovolaemic haemodilution should be considered.

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.

GB virus C infection by blood transfusion during and following liver surgery.

BACKGROUND/AIMS: GB virus C has been associated with some cases of fulminant hepatitis and post-transfusion hepatitis. We examined transfusion-related infection with this virus. METHODOLOGY: Of 150 patients undergoing liver resection, 108 received a homologous blood transfusion. Serum samples before and after surgery were examined for GB virus C RNA by a nested polymerase chain reaction with reverse transcription. We also studied the post-operative course of patients infected with GB virus C by blood transfusion. RESULTS: Viral RNA was detected in sera taken after transfusion in 4 (4%) patients receiving homologous transfusions. Viral RNA was not detected after surgery in the 42 patients given autologous transfusions or not receiving homologous blood. Post-operative courses in the 4 infected patients were uneventful. CONCLUSIONS: As 4% of homologous transfusions resulted in GB virus C infection in our small surgical study, autologous transfusion is recommended when circumstances permit.

Prevalence and risk factor analysis of GBV-C/HGV infection in prostitutes.

GB virus-C (GBV-C) and Hepatitis G virus (HGV) are variants of a recently cloned virus transmitted parenterally. It is unclear if sexual contact also transmits this virus. In this study, we detected serum GBV-C/HGV RNA in 140 prostitutes by reverse transcription polymerase chain reaction (RT-PCR) using different primers. Thirty (21%) were found with GBV-C RNA by nested PCR although only 22 (73%) had HGV RNA by single round RT-PCR. Both assays had a nearly perfect agreement (kappa value, 0.812). The prevalence of GBV-C RNA in prostitutes was significantly higher than the control group (30/140 vs. 2/40, P < 0.02). Multivariate analysis revealed that a frequency of paid sex more than 120 times per month was the only factor significantly associated with positive GBV-C RNA in prostitutes (P < 0.003). In summary, prostitutes are a high risk group and reservoir of GBV-C/HGV infection due to high frequency of paid-sex.

Indication, incidence and management of blood transfusion during sinus surgery: a review over 12 years.

The number of reports about blood transfusion-related HIV and hepatitis virus infections is increasing, presently. Thus, it should seriously be considered to inform the patient of any anticipated blood loss necessitating a transfusion of blood products. This is especially necessary for surgical procedures with only a low risk for high blood loss, such as endonasal surgery as a common otorhinolaryngological procedure. However, reports about the incidence of blood transfusion during this kind of surgery are very rare. The medical histories of 6,296 patients who underwent sinus surgery between 1982-1993 in the Department of Otorhinolaryngology at the University of Kiel were analyzed. Twenty-nine of these patients received a transfusion. Risk factors for required blood, the necessity of pre-operative information and the recommendation policy for pre-operative donation of autologous blood are discussed. The intra-operative blood losses of 120 patients who did not require a transfusion and who underwent sinus surgery in 1986 and 1989, were analyzed. The transfusion rate was 0.46% on average during the 12-year period. The incidence of blood transfusion and the amount of intra-operative blood loss decreased after combination of endonasal surgery with controlled intra-operative hypotension (0.07%; p < 0.01). Risk factors for the necessity of a transfusion in these cases were extensive polyposis and purulent exacerbation of the disease. There are risks for a blood transfusion in endonasal surgery. Every transfusion carries a certain risk for the infection with HIV or hepatitis, therefore every patient should be informed about the possibility of a blood transfusion prior to the operation. Endonasal microscopic sinus surgery performed by well-trained surgeons, combined with controlled intra-operative hypotension lowered the risk for a transfusion significantly (p < 0.01).

[Autologous blood donation--good clinical practice and good recuperation practice]. / Eigenblutspenden--gute klinische Praxis und gute Herstellungspraxis.

Since October 1987, autologous blood donations have been performed in Bern and in 1994 reached a total of 946, representing 3% of all blood donations. This value is lower than the 4.9% for Switzerland as a whole. We report on the motivation and reasons of patients in favour of autologous blood donations and compare the results of 1989 with 1995. In the 6 years' period, the median patient's age increased from 54 to 63 years. The motivation for autologous blood donations changed from "routine surgical office" to "doctors". More than 50% of the patients mentioned the risk of acquiring an infectious disease, especially HIV, as the main reason for autologous blood donations. Labeling, testing or storage of autologous blood products of 37 out of 100 patients was incorrect, and in a another 20% an enquiry at the donation centres was needed to confirm the required quality of the autologous blood products. In 7 cases only one out of several blood bags was screened for viral diseases, and in 5 cases, unfortunately, none of the autologous blood products were tested for HIV or hepatitis B and C. Considering the negative cost-effectiveness of autologous blood transfusion, it is strongly recommended that the intrinsically low clinical benefit of autologous blood product should not be compromised by lack of good clinical practice and good manufacturing practice.

Toward the elimination of homologous blood use in elective lumbar spine surgery.

Two hundred twenty-four consecutive patients underwent elective posterior lumbar spinal surgery over a 3 1/2-year span at the University of Miami/Jackson Memorial Medical Center. Patients ranged in age from 17 to 87 years, and 58% were male. Fifty-eight patients underwent revision surgery, and 65 patients required fusions, including 35 necessitating internal fixation. One hundred seventy-four patients (78%) were requested to participate in a preoperatively donated autologous blood (PDAB) program. Six of these patients were excluded from participation, and 168 patients banked 425 U of autologous blood. Eighty percent of the patients participating in the PDAB program received some or all of their donated blood. Intraoperative blood salvage was used in 37% of cases. Seven patients received homologous blood: four in addition to salvaged and donated blood, two that were unable to donate blood due to positive hepatitis B serology, and one erroneously. The combined use of PDAB and intraoperative salvage program allowed autologous blood replacement to meet the total transfusion requirements of 96% of the patients who predeposited blood, including 94% of those undergoing spinal fusions. Autologous blood comprised 99% of the total blood replacement used in this series, and 95% of the patients requiring blood transfusions received only autologous blood. Establishment of a protocol judiciously using PDAB in conjunction with intraoperative blood salvage can result in virtual elimination of the need for homologous blood transfusion in elective lumbar spine surgery.

[Transfusion risks and alternatives to transfusion]. / Rischi trasfusionali e alternative alla trasfusione.

The emergence of the acquired immunodeficiency syndrome (AIDS) has fueled concerns of both physicians and their patients about safety of blood transfusions. Although AIDS has generated the most fear, the risk today is extremely remote (1/60.000 units of blood). The risk of transmitting infectious disease by homologous transfusion is decreasing, as more donor screening and testing measures are implemented. The blood supply is safer that at any time, but small transfusion risks exist. The most common problems associated with transfusions are temporary: one in 100-300 recipients will experience fever or rash. The biggest problem is a mismatch of the well-known ABO blood groups and once in every 100-400.000 transfusions the hemolytic reaction is fatal. Viral hepatitis is another serious and important risk. At present hepatitis seems to strike between 1 and 3 percent of transfusion recipients. Most, if not all, of transfusion-associated hepatitis cases are caused by hepatitis C virus. Cytomegalovirus can cause primary infection, reactivation or reinfection by transfusion. Immunosuppressed patients are more likely to develop more severe disease. Epstein-Barr virus does not seem to cause significant post-transfusion disease. Bacterial or protozoal infections are an infrequently encountered adverse effect of transfusion. However, some clinical cases document the potential hazard of blood components as a vector for bacteria or protozoa. Homologous blood transfusion down-regulates some immune functions. Host defences against malignancy and infection may in some instances be severely compromised by transfusions of homologous blood.(ABSTRACT TRUNCATED AT 250 WORDS)

[Autologous blood transfusion and the problem of "safe" blood]. / Autogemotransfuzii i problema "bezopasnoi" krovi.

A conception of "safe" blood has been proposed based on autohemotransfusions with the use of the methods of preparation of autologous blood, preoperative isovolemic hemodilution and intraoperative blood salvage. For the latter method special apparatus are needed, while the two former methods are easily performable without complex equipment and high expenses. The wide use of autohemotransfusions is considered as the most reasonable alternative under conditions of diminution of donor number, increased hazard of transmission of some infections through homologous blood transfusions.