We undertook a prospective study to estimate the risk in Montreal of developing hepatitis following transfusion of blood with an elevated alanine aminotransferase (ALT) level. Two thousand consecutive donor units were screened for ALT activity; 133 (6.7%) had values greater than or equal to 51 IU 1(-1). Twenty-four patients received one or more units with elevated ALT levels and completed follow-up; two (8%) developed hepatitis (one of these was type B hepatitis). One of the 10 'control' patients who received only units with normal ALT levels also developed hepatitis. In this study, the risk of transfusion-transmitted hepatitis was the same in recipients of blood units with abnormal ALT levels as in those who received only blood with normal ALT, and very similar to the risk reported in other studies for recipients of volunteer donor blood with normal ALT. These findings require confirmation by a larger study, but suggest that the hepatitis risk associated with transfusion of high-ALT blood may be lower in Montreal than has been reported in several centers in the U.S.
OBJECTIVE--To assess the effects of perioperative blood transfusion on cancer related survival and infective complications after radical operations for colorectal cancer. DESIGN--Retrospective study. SETTING--District hospital in Sweden. SUBJECTS--217 patients who fulfilled the criteria for inclusion, out of 392 consecutive patients operated on for colorectal cancer between 1975 and 1979. MAIN OUTCOME MEASURES--Morbidity and cancer related mortality depending on whether blood was transfused and, if so, how much. RESULTS--Dukes' stage (p
OBJECTIVE: To describe trends and patterns in the AIDS epidemic among Scandinavian women with AIDS. SUBJECTS AND METHODS: All women with AIDS reported to national surveillance units in Denmark, Norway and Sweden in 1980-1990 were included for analyses. RESULTS: The number of heterosexually infected female AIDS cases increased over time. AIDS-defining diseases varied with transmission categories, a variation similar to that found among heterosexual Danish male AIDS cases. Heterosexually infected women were more frequently diagnosed with Pneumocystis carinii pneumonia than with oesophagus candidiasis compared with intravenous drug using women. Twenty-five out of 56 heterosexually infected women reported having a male partner who was bisexual or from a Pattern II country, while one in four did not recognize any risk in their sex partner(s). Survival time increased between 1980 and 1990 and did not differ from survival in male AIDS cases. In a proportional hazards model, age, year of diagnosis and the duration of known HIV-positivity before development of AIDS had an independent impact on survival. The number of women known to be HIV-positive for more than 1 year before diagnosis of AIDS increased over time, although the number of women tested for HIV close to the development of AIDS was especially high among heterosexually infected women. CONCLUSION: Increasing numbers of heterosexually infected women are being diagnosed with AIDS in Scandinavia.
To examine the distribution of AIDS-defining illnesses among Danish AIDS patients, data on 687 AIDS patients diagnosed in the period from 1980 to 1990 (93% of all reported cases in the period) were collected. The most frequent AIDS-defining illness was Pneumocystis carinii pneumonia followed by candida oesophagitis and Kaposis sarcoma. The proportion of homo/bisexual men presenting with Kaposis sarcoma as the initial AIDS-defining illness declined over time. Patients with extrapulmonary tuberculosis had higher CD4 cell counts than patients presenting with other illnesses. Cytomegalovirus chorioretinitis and atypical mycobacteriosis were seen more frequently after the time of the AIDS diagnosis, and a low CD4 cell count at time of the AIDS diagnosis was a significant predictor for the development of these opportunistic infections during follow-up. Danish AIDS patients present with a wide spectrum of HIV-related illnesses, reflecting their exposure to opportunistic microorganisms and the degree of immune deficiency. The pattern of HIV-related illnesses is changing over time, and therefore continuous surveillance is needed to optimize therapeutic and prophylactic regimens.
BACKGROUND: Allogeneic red blood cell transfusion is frequently used in total hip replacement surgery (THR). However, data on the prognosis of transfused patients are sparse. In this study we compared the risk of complications following THR in transfused and non-transfused patients. METHODS: A population-based follow-up study was performed using data from medical databases in Denmark. We identified 28,087 primary THR procedures performed from 1999 to 2007, from which we computed a propensity score for red blood cell transfusion based on detailed data on patient-, procedure-, and hospital-related characteristics. We were able to match 2,254 transfused with 2,254 non-transfused THR patients using the propensity score. RESULTS: Of the 28,087 THR patients, 9,063 (32.3%) received at least one red blood cell transfusion within 8 days of surgery. Transfused patients had higher 90-day mortality compared with matched non-transfused patients: the adjusted OR was 2.2 (95% confidence interval (CI): 1.2-3.8). Blood transfusion was also associated with increased odds of pneumonia (OR 2.1; CI: 1.2-3.8), whereas the associations with cardiovascular or cerebrovascular events (OR 1.4; CI: 0.9-2.2) and venous thromboembolism (OR 1.2; CI: 0.7-2.1) did not reach statistical significance. The adjusted OR of reoperation due to infection was 0.6 (CI: 0.1-2.9). CONCLUSIONS: Red blood cell transfusion was associated with an adverse prognosis following primary THR, in particular with increased odds of death and pneumonia. Although the odds estimates may partly reflect unmeasured bias due to blood loss, they indicate the need for careful assessment of the risk versus benefit of transfusion even in relation to routine THR procedures.
Also with a restrictive transfusion policy, screening with second-generation anti-hepatitis C virus enzyme-linked immunosorbent assay would have reduced post-transfusion hepatitis C after open-heart surgery.
The incidence of post-transfusion hepatitis non-A, non-B (PTH-NANB) was prospectively assessed among open-heart surgery patients from the southeast region of Sweden before the introduction of antihepatitis C virus (HCV) blood donor screening. Blood samples for alanine aminotransferase analysis were drawn before and 2, 3, and 4 months after transfusion. Surgery was performed in four centres. Of 190 transfused and followed-up patients 2 (1.1%) contracted PTH-NANB, both operated on at the centre with significantly fewer transfusions than the other centres. One patient had antibodies to HCV detected by first-generation (C100-3) and later by second-generation anti-HCV enzyme-linked immunosorbent assay (ELISA-2) and by positive second-generation recombinant immunoblot assay (4-RIBA). The other patient, although negative by first-generation anti-HCV ELISA, was positive by second-generation ELISA and by 4-RIBA. Both patients were hepatitis C-viremic by polymerase chain reaction (PCR). All the six donors implicated in the two hepatitis cases were first-generation anti-HCV-negative, but two, one for each patient, were positive by second-generation anti-HCV ELISA. This finding was confirmed by positive 4-RIBA in only 1 donor, the other being 'indeterminate'. However, in both donors hepatitis C viremia was found by PCR. This study shows that the second-generation anti-HCV ELISA will further reduce the risk for PTH-NANB/C and draws attention to the problem of evaluation of confirmatory tests.
