Seroprevalence and epidemiological correlates of HTLV-I infection in U.S. blood donors.

Screening for human T-lymphotropic virus type I (HTLV-I) antibodies was performed on sera from 39,898 blood donors at eight blood centers in geographically distinct areas of the United States. Ten donors (0.025 percent) showed evidence of HTLV-I seropositivity by enzyme immunoassays; this was confirmed by protein immunoblot and radioimmunoprecipitation. Seroprevalence rates ranged from 0 to 0.10 percent at the locations sampled, with HTLV-I antibodies found predominantly in donors from the southeastern and southwestern United States. Matched case-control interviews and laboratory studies were performed on five seropositive women and two seropositive men who participated in an identity-linked collection of sera from a subset of 33,893 donors at six of the eight blood centers. Four of the women and both men are black; one woman is Caucasian. Four of the seven seropositive individuals admitted to prior intravenous drug abuse or sexual contact with an intravenous drug user. Sexual contact with native inhabitants of an HTLV-I endemic area was the only identified risk factor for one male. The distribution of HTLV-I antibodies in this U.S. blood donor sample corroborates the previously reported epidemiology of this agent and suggests that additional donor screening measures, including the testing of donated blood for HTLV-I markers, may be necessary to prevent the spread of HTLV-I to transfusion recipients.

The preparation of leukocyte-poor red cells from AS-1 red cells by the spin-cool-filter method.

Ninety-eight units of AS-1 red cells (RBC) were studied to determine the optimal unit age for the preparation of leukocyte-poor red cells by the spin-cool-filter method. After 1 week of storage, the residual leukocyte counts of AS-1 units prepared by this method averaged 0.5 x 10(9) or fewer white cells, which indicated removal of more than 79 percent of the total white cells. The spin-cool-filter method, in conjunction with the rapid degeneration of the white cells in the AS-1 RBC, yielded leukocyte-poor units comparable to those prepared from citrate-phosphate-dextrose-adenine (CPDA-1) RBC.

Febrile transfusion reaction following initial transfusion in a man with immunoblastic lymphadenopathy and granulocyte autoantibodies.

A 69-year-old man with immunoblastic lymphadenopathy and autoimmune hemolytic anemia who had no previous exposure to blood products developed a severe febrile nonhemolytic transfusion reaction following the initial infusion of packed red blood cells. The reaction recurred with transfusion of packed red blood cells, but not when freeze-thawed red blood cells were used. Immunofluorescence techniques demonstrated granulocyte antibodies in his serum and on the surface of his granulocytes. Circulating immune complex, HLA, and platelet antibodies were not present. The granulocyte antibodies fluctuated in titers with disease activities, and could be completely removed from the serum by autologous granulocyte absorption. We conclude that our patient had granulocyte autoantibodies which probably produced febrile transfusion reactions.

Plasma exchange in idiopathic thrombocytopenic purpura.

Two cases of adult-onset idiopathic thrombocytopenic purpura (ITP), refractory to conventional therapy, were treated. Because of recent successful reports of plasma exchange in ITP, this technique was performed on each patient. In both cases, the therapy was unsuccessful in controlling their disease, suggesting that in refractory adult-onset ITP, plasma exchange may not be an effective mode of therapy.