Severe Acute Hemolytic Transfusion Reaction Treated with Ruxolitinib and Plasma Exchange.

INTRODUCTION: Acute hemolytic transfusion reaction is a rare but extremely mortal condition. Even small quantities of ABO-incompatible erythrocytes, as much as 50 mL, can lead to fatality. Since there is no successful standard therapy, preventive measures are very important. In this case report, we presented a 29-year-old woman who was transfused with 2 units of AB Rh-positive instead of 0 Rh-positive red blood cells following a cesarean section. As far as we know, this is the first patient in the literature for whom ruxolitinib was used as a part of therapy. CASE REPORT: The patient was referred to our center 22 h after the ABO-mismatched transfusion. On admission, she had severe hemolysis, acute renal failure, and disseminated intravascular coagulation. Massive plasma exchange, hemodialysis, and pulse steroid therapy were commenced. The patient was refractory to first-line therapies. She was intubated on day 2 due to hypoxia, respiratory failure and changes in consciousness. Ruxolitinib, 2 × 10 mg/day, was started on day 3. The patient's clinical status improved on day 6. Ruxolitinib was withdrawn on day 15, and the patient was discharged without any complications or sequels on day 26. CONCLUSION: Ruxolitinib may be life-saving in patients with ABO-incompatible transfusion reaction which follows a severe and catastrophic course.

Are isolated anti-HBc blood donors in high risk group? The detection of HBV DNA in isolated anti-HBc cases with nucleic acid amplification test (NAT) based on transcription-mediated amplification (TMA) and HBV discrimination.

AIM: Hepatitis B virus (HBV) can be transmitted by blood transfusions even so using serological tests having high sensitivity and specificity. We aimed to detect HBV DNA in isolated Anti-HBc donors and show if they have transfusion risk or not. METHOD: We investigated Anti-Hbc and Anti-HBs in serum samples of 12858 HBs-Ag negative blood donors who were applied to the Turkish Redcrescent between June 2007 and October 2008 by the Micro ELISA kit (Hepanostica ultra HBsAg, Bio Meriux, France). Anti-HBc and Anti-Hbs positive cases were omitted. We used Procleix ultrio (Chiro, USA) test kit (Chiron Tigris automated instrument was used) based TMA (Transcription-Mediated Amplification) for NAT study in Anti-HBc positive and Anti-HBs negative plasma samples. The discrimination of HBV in NAT positive samples were performed by Procleix Discrimination (Chiro, USA) test. RESULTS: 2748 (21.4%) Anti-HBc seropositivity were detected in 12852 HBsAg(-) serum samples. 23.5% Anti-HBs negativity was detected in 2748 Anti-HBc positive serum samples. On the other hand, 5.1% isolated Anti-Hbc positivity [HBsAg(-), Anti-HBc(+), Anti-HBs(-)] were detected in 12852 HBsAg(-) serum samples. 0.091% and 0.047% HBV-DNA positivity were detected in isolated Anti-HBc positive plasma samples and HBsAg(-) plasma samples, respectively. CONCLUSION: As a result, even we have detected one HBV transmission in every 2142 blood transfusion by HBsAg screening tests; we suggest that it is not necessary to add additional tests to detect isolated Anti-HBc for routine purposes in Blood Banking. The reasons are higher negativity rates (99%) of isolated Anti-HBc serum samples and the rejection of blood donors with Anti-HBc positivity.

Can the nucleic acid amplification test (NAT) be an alternative to the serologic tests? A prospective study, the results of 18,200 blood donors from the Turkish Red Crescent.

AIM: Serologic tests having high sensitivity and specificity are used in order to prevent contamination with infectious agents from blood and blood products for transfusion safety. The present serologic tests have problems such as low sensitivity and weak detection capacity of infectious agents in the "window period". We aimed to test the use of NAT (Nucleic Acid Amplification Test) in routine blood screening in the Blood Bank. METHOD: We used the Procleix Ultrio (Chiron Ltd., USA) test kit based TMA (Transcription Mediated Amplification) for the NAT study of serum samples from 18,200 donors who came to the Turkish Red Crescent between February 2007 and September 2008. The NAT positive samples were studied twice. The discrimination of HIV, HCV and HBV NAT positive samples was performed by the Procleix Discrimination (Chiron Ltd., USA) test. Otherwise, Micro ELISA were used in parallel for routine serological screening of Anti-HIV, Anti-HCV, and HBsAg with Vironoste HIV Uni-form, AG/Ab innotest HCV Ab and Hepanostika Ultra HBsAg test kits. RESULTS: The results of serum samples with serology (+) and NAT (+) (13/18,200 and 0.05%) for anti-HIV, anti-HCV and HBsAg were higher than in other NAT studies; we also detected that a transfusion risk can occur in every 1400 transfusions.

HBV, HCV and HIV seroprevalence among blood donors in Istanbul, Turkey: how effective are the changes in the national blood transfusion policies?

The national blood transfusion policies have been changed significantly in recent years in Turkey. The purpose of this study was to determine the prevalence of HBV, HCV, and HIV in blood donors at the Red Crescent Center in Istanbul and to evaluate the effect of changes in the national blood transfusion policies on the prevalence of these infections. The screening results of 72695 blood donations at the Red Crescent Center in Istanbul between January and December 2007 were evaluated retrospectively. HBsAg, anti-HCV, and anti-HIV-1/2 were screened by microparticle enzyme immunoassay (MEIA) method. Samples found to be positive for anti-HIV 1/2 and anti-HCV were confirmed by Inno-Lia HCV Ab III and Inno-Lia HIV I/II Score, respectively. The seropositivity rates for HBsAg, anti-HCV, and anti-HIV-1/2 were determined as 1.76%, 0.07%, and 0.008%, respectively. Compared to the previously published data from Red Crescent Centers in Turkey, it was found that HBV and HCV seroprevalances decreased and HIV seroprevalance increased in recent years. In conclusion, we believe that the drop in HBV and HCV prevalence rates are likely multifactorial and may have resulted from more diligent donor questioning upon screening, a higher level of public awareness on viral hepatitis as well as the expansion of HBV vaccination coverage in Turkey. Another factor to contribute to the decreased prevalence of HCV stems from the use of more sensitive confirmation testing on all reactive results, thereby eliminating a fair amount of false positive cases. Despite similar transmission routes, the increase in HIV prevalence in contrast to HBV and HCV may be linked to the increase in AIDS cases in Turkey in recent years.

HBV, HCV and HIV seroprevalence among blood donors in Istanbul, Turkey: how effective are the changes in the national blood transfusion policies?

The national blood transfusion policies have been changed significantly in recent years in Turkey. The purpose of this study was to determine the prevalence of HBV, HCV, and HIV in blood donors at the Red Crescent Center in Istanbul and to evaluate the effect of changes in the national blood transfusion policies on the prevalence of these infections. The screening results of 72695 blood donations at the Red Crescent Center in Istanbul between January and December 2007 were evaluated retrospectively. HBsAg, anti-HCV, and anti-HIV-1/2 were screened by microparticle enzyme immunoassay (MEIA) method. Samples found to be positive for anti-HIV 1/2 and anti-HCV were confirmed by Inno-Lia HCV Ab III and Inno-Lia HIV I/II Score, respectively. The seropositivity rates for HBsAg, anti-HCV, and anti-HIV-1/2 were determined as 1.76 percent, 0.07 percent, and 0.008 percent, respectively. Compared to the previously published data from Red Crescent Centers in Turkey, it was found that HBV and HCV seroprevalances decreased and HIV seroprevalance increased in recent years. In conclusion, we believe that the drop in HBV and HCV prevalence rates are likely multifactorial and may have resulted from more diligent donor questioning upon screening, a higher level of public awareness on viral hepatitis as well as the expansion of HBV vaccination coverage in Turkey. Another factor to contribute to the decreased prevalence of HCV stems from the use of more sensitive confirmation testing on all reactive results, thereby eliminating a fair amount of false positive cases. Despite similar transmission routes, the increase in HIV prevalence in contrast to HBV and HCV may be linked to the increase in AIDS cases in Turkey in recent years.

The significance of repeat testing in Turkish blood donors screened with HBV, HCV and HIV immunoassays and the importance of S/CO ratios in the interpretation of HCV/HIV screening test results and as a determinant for further confirmatory testing.

The purpose of this study was to investigate the intra-assay correlations amongst initial reactive and repeat screening results used in enzyme immunoassays (EIAs) for hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV in blood donors. This study evaluated the value of using the power of the signal to cut-off (S/CO) ratio index for confirming anti-HCV/HIV reactive screening results, thereby touching upon the utility of S/CO indices in determining whether further confirmatory testing was necessary. Screening test results of the 72,695 blood donors were evaluated over a 1-year period. Correlation analysis among each initial test and retests was done by Pearson r test. Appropriate S/CO values to determine the need of the confirmation testing was investigated by ROC analyses. EIA intra-assay correlations were of statistical significance and were determined as follows: 0.948 for anti-HCV, 0.827 for anti-HIV and 0.948 for HBsAg. The threshold S/CO ratio values which predicted more than 95% of the confirmation test result were 3.8 for HCV and 5.6 for HIV. We were able to demonstrate a strong level of intra-assay correlation amongst EIAs, thereby eliminating the need for repetition of the screening test. Hence, we suggest that repeat screening should only be limited to HBV and HIV tests with low EIA S/CO ratios. Thus, using the power of the S/CO ratio in determining the need for HCV confirmation testing can be a cost-effective measure, especially if the S/CO value is >or=3.8.

The evaluation of nosocomial infection during 1-year-period in the burn unit of a training hospital in Istanbul, Turkey.

An analysis of the burned patients, admitted to our eight bed burn unit and treated between 1 January and 31 December 2000, was performed. Prevalence, etiologic agents, length of hospitalization, cost of treatment and mortality rates caused by nosocomial infections (NIs) were studied. The study included 63 patients. Eighteen of these (Group-A) had 24 NI episodes. The most common NI observed was burn-wound infection (58.3%), followed by bacteraemia-sepsis (16.7%). NIs were not detected in the rest at all (Group B). The mean length of hospitalization was 38.5+/-19.7 days in Group A, and 20.3+/-7.6 days in Group B. The mean total burned surface area (TBSA) was 43+/-21 in Group A and 29+/-18 in Group B, while the most important independent risk factor for NI was TBSA in burned patients (OR, 1.08; CI(95), 0.93-1.24). NI prolonged the mean hospital stay to 18 days and increased the cost of treatment by 502 US dollars. The most common bacteria isolated was Pseudomonas aeruginosa (41.7%) and the second was methicillin resistant Staphylococcus aureus (MRSA-25.0%). All of the NI-free patients survived, while, five (28.5%) patients with NI died (P<0.01). These findings emphasized the need for careful disinfection and conscientious contact control procedures in areas that serve immunosupressed individuals, such as burned patients.