In the past two decades, major improvements in blood safety have been achieved, particularly for ... more In the past two decades, major improvements in blood safety have been achieved, particularly for HIV and hepatitis C virus (HCV). A prospective study was carried out between 1996 and 1999 in Brazil to determine the incidence of post-transfusion infection in surgery patients caused by HCV. One hundred sixty-four patients who received a blood transfusion during cardiac surgery were followed for six months and blood samples collected before and after surgery were assessed to investigate HCV infection. Alanine aminotransferase levels were serially determined, as well as clinical data related to hepatitis. Prior to surgery, HCV infection was detected by anti-HCV ELISA III in 6 patients. Any post-surgical samples which were positive by a third generation ELISA test were confirmed by immunoblot and reverse-transcription polymerase chain reaction (RT-PCR), as were the pre-transfusion samples to exclude pre-transfusion HCV infection not detected by ELISA screening. Results indicated that one patient who was previously considered negative for HCV antibody in the pre-surgical sample was later found to be positive for HCV by RT-PCR in that sample. Seroconversion for HCV antibody after surgery was observed in two patients, one of them with clinical hepatitis; their genotypes were 1a and 1b. The overall prevalence of HCV infection was 4.26% (7/164) and the incidence rate of HCV infection after surgery was 1.27% (2/157). This study shows a high rate of HCV infection acquired post-transfusion in a cohort of surgery patients in Brazil and suggests that better screening methods such as viral RNA assessment may be effective in lowering this rate.
The clinical meaning of viremia, especially at low levels, in chronic hepatitis B virus (HBV)-inf... more The clinical meaning of viremia, especially at low levels, in chronic hepatitis B virus (HBV)-infected patients remains unknown. The objective of the present study was to determine serum HBV-DNA levels and its relationship with liver histology in HBsAg-positive blood donors. A cross-sectional study was conducted on 78 blood donors, with alanine aminotransferase (ALT) and HBeAg evaluation and quantitative determination of HBV-DNA by polymerase chain reaction (Amplicor, HBV Monitor, Roche; lower limit of sensitivity 1,000 copies/mL). Liver biopsy was obtained from all patients with detectable viremia irrespective of ALT and HBV-DNA levels. Among 78 blood donors, serum HBV-DNA was detected in 47 (60%) patients; 39 (83%) were males; mean age 37.6+/-10.4 years; 31 (66%) were HBeAg-negative, and ALT was elevated in 26 (55%). The median of HBV-DNA levels was 24,000 copies/mL and 31 (40%) subjects had no detectable serum HBV-DNA. Although the histologic lesions were mild in the majority of patients, HBV-DNA levels were significantly higher in patients with chronic hepatitis or cirrhosis when compared with patients without histologic liver disease (25,260,000 vs. 9480 copies/mL; P<0.001). There was a significant correlation between HBV-DNA levels and necroinflammatory score (r=0.59) and fibrosis (r=0.50); however, in the subset of HBeAg-negative patients with HBV-DNA levels below 30,000 copies/mL, 25% presented histologic disease related to HBV. Most HBsAg-positive blood donors show low viral load. There is a significant association between viral replication and liver damage; however, low HBV-DNA levels do not exclude the presence of histologic disease.
In the past two decades, major improvements in blood safety have been achieved, particularly for ... more In the past two decades, major improvements in blood safety have been achieved, particularly for HIV and hepatitis C virus (HCV). A prospective study was carried out between 1996 and 1999 in Brazil to determine the incidence of post-transfusion infection in surgery patients caused by HCV. One hundred sixty-four patients who received a blood transfusion during cardiac surgery were followed for six months and blood samples collected before and after surgery were assessed to investigate HCV infection. Alanine aminotransferase levels were serially determined, as well as clinical data related to hepatitis. Prior to surgery, HCV infection was detected by anti-HCV ELISA III in 6 patients. Any post-surgical samples which were positive by a third generation ELISA test were confirmed by immunoblot and reverse-transcription polymerase chain reaction (RT-PCR), as were the pre-transfusion samples to exclude pre-transfusion HCV infection not detected by ELISA screening. Results indicated that one patient who was previously considered negative for HCV antibody in the pre-surgical sample was later found to be positive for HCV by RT-PCR in that sample. Seroconversion for HCV antibody after surgery was observed in two patients, one of them with clinical hepatitis; their genotypes were 1a and 1b. The overall prevalence of HCV infection was 4.26% (7/164) and the incidence rate of HCV infection after surgery was 1.27% (2/157). This study shows a high rate of HCV infection acquired post-transfusion in a cohort of surgery patients in Brazil and suggests that better screening methods such as viral RNA assessment may be effective in lowering this rate.
In order to investigate the sexual transmission of the Hepatitis C Virus (HCV), the prevalence of... more In order to investigate the sexual transmission of the Hepatitis C Virus (HCV), the prevalence of specific antibodies in populations at high and low risk for sexually transmitted diseases (STDs) was evaluated. The population at low risk for STDs was composed of persons who voluntarily donated blood at the Hospital Universitário Clementino Fraga Filho (HUCFF) between July and November, 1990 (n = 2494). The population at high risk for STDs was drawn from an ongoing study on the natural history of Human Immunodeficiency Virus (HIV) infection (n = 210, 187 with sexual risk factors for HIV infection). All samples were screened using a first generation ELISA. Repeat reactive samples were then tested in a second generation RIBA. For all ELISA positive samples, two sex and age-matched ELISA negative controls were selected. Data pertaining to the presence of antibodies to the Hepatitis B core antigen (anti-HBC antibodies) and to Treponema pallidum were abstracted from the medical records. Th...
Revista da Sociedade Brasileira de Medicina Tropical
Hepatitis C virus is the main agent responsible for post-transfusion hepatitis. Progression to ch... more Hepatitis C virus is the main agent responsible for post-transfusion hepatitis. Progression to chronic hepatitis, cirrhosis and hepatocellular carcinoma is very common. The aim of this study was to evaluate the frequency, timing and factors related to progression of hepatitis C. One hundred seventy five patients with chronic post-transfusion hepatitis C were grouped in a cirrhosis group (n = 92) and a non-cirrhosis group (n = 83). The medium time of development to cirrhosis was 11 +/- 6 years. Patients with cirrhosis were older at the time they received transfusion, used more alcohol and had longer times of evolution. The prognosis was worse in the cirrhosis group with a mortality rate of 28.4% and 9.1% of evolution towards hepatocellular carcinoma, comparing with 5.5% and 0% in the non-cirrhosis group respectively. It is shown that post-transfusion hepatitis C is slowly developing progressive disease which progress is much more rapidly in elderly patients and patients with others f...
Revista da Sociedade Brasileira de Medicina Tropical
The authors studied the prevalence of HBV markers among health care personnel of the University H... more The authors studied the prevalence of HBV markers among health care personnel of the University Hospital of the Federal University of Rio de Janeiro. The aim of study was to identify the high risk groups, in order to counsel vaccination of those groups, in order to counsel vaccination of those groups at risk as a routine. As a control group, a group of office workers of the hospital were chosen. A significant difference of incidence of HBV markers, mainly in surgeons (40%) and hemodialysis unit personnel (36.4%) when compared to the control group, was observed (p less than 0.05). The incidence increased with age and the time spent in the profession. The authors concluded that vaccination is indicated in surgeons hemodialysis personnel, dentists and laboratory personnel.
We have studied 933 volunteer blood donors from May to July, 1990. After a interview and screenin... more We have studied 933 volunteer blood donors from May to July, 1990. After a interview and screening tests for syphilis, Chagas disease, malaria and HIV, they underwent an enzyme immunoassay for HBsAg, anti HBc and anti HCV antibodies. Alanine aminotransferase (ALT) serum levels were determined by auto analyser. Most blood donors were male with mean age of 33 years (19-65). Anti HCV prevalence was 3.1% (29 from 933 blood donors). Among anti HCV+, blood donors, 44.8% (13/29) had ALT 40 UI/L, 31% (9/29) were anti HBc+ and 17.2% (5/29) had both surrogate markers simultaneously. From 109 donors with ALT 40 UI/L, 13 (11.9%) were anti HCV+, while among 153 anti HBc+ donors, the anti HCV was 5.8%. 1) we found a higher anti HCV prevalence among our blood donors than previous published reports from other countries; 2) our data show that surrogate assays do not adequately identify anti HCV blood donors, 41.4% of them would not have been excluded by anti HBc and ALT tests alone; 3) there were a ...
Sickle cell anemia (SCA) is characterized by chronic hemolytic anemia. Worsening of anemia after ... more Sickle cell anemia (SCA) is characterized by chronic hemolytic anemia. Worsening of anemia after red blood cell (RBC) transfusion has been reported and is often referred to as hyperhemolysis syndrome (HS). HS is a severe transfusion reaction characterized by destruction of both donor and host RBCs. In this study we report the clinical findings and treatment of three adolescent patients with SCA who presented with HS. HS occurred after exchange transfusion in two cases and after RBC transfusion during vasoocclusive crises in one. A decrease of serum hemoglobin (Hb) levels was observed 5 to 7 days after transfusions and ranged from 2.5 to 5.7 g/dL. The direct antiglobulin test was positive in two patients who also presented with alloantibodies. Patient 3 received 2 additional RBC units after the onset of HS and experienced the lowest Hb values (2.5 g/dL) shortly after. Patients received intravenous steroids as the main specific treatment and also immunoglobulin and erythropoietin. Resolution of hemolysis was observed in all cases. Of note, spleen lesions were detected in two patients, one had a normal spleen size, and the other presented with enlarged spleen. Pathophysiologic implications of these findings were discussed. HS must be a well-recognized complication of SCA after RBC transfusion. Prompt initiation of treatment and avoiding further transfusions may contribute to reduce the mortality associated with HS. The presence of functional spleen on the pathophysiology of HS deserves further evaluation.
BACKGROUND: The optimal cryopreservation cell con-centration during the peripheral blood stem cel... more BACKGROUND: The optimal cryopreservation cell con-centration during the peripheral blood stem cell (PBSC) collection is a controversial topic. We evaluated the influence of cryopreservation concentration on the recovery of hematopoietic progenitor cells and the kinetics of hematopoietic recovery of autologous stem cell transplant patients. STUDY DESIGN AND METHODS: In this retrospective study, we compared two different cryopreservation protocols: 1 ¥ 10 8 cells/mL (Protocol A) and 2 ¥ 10 8 cells/mL (Protocol B). A total of 419 PBSCs were ana-lyzed with regard to the number of viable cells and colony-forming units–granulocytes-monocytes (CFU-GM) progenitors. The hematopoietic recovery of 275 patients who received PBSCs cryopreserved at a dose of 1 ¥ 10 8 cells/mL (Group A) and 2 ¥ 10 8 cells/mL (Group B) were compared. RESULTS: There were no significant differences in recovery of viable cells between Protocol A and Proto-col B. The median of recovery of CFU-GM progenitors was signifi...
In the past two decades, major improvements in blood safety have been achieved, particularly for ... more In the past two decades, major improvements in blood safety have been achieved, particularly for HIV and hepatitis C virus (HCV). A prospective study was carried out between 1996 and 1999 in Brazil to determine the incidence of post-transfusion infection in surgery patients caused by HCV. One hundred sixty-four patients who received a blood transfusion during cardiac surgery were followed for six months and blood samples collected before and after surgery were assessed to investigate HCV infection. Alanine aminotransferase levels were serially determined, as well as clinical data related to hepatitis. Prior to surgery, HCV infection was detected by anti-HCV ELISA III in 6 patients. Any post-surgical samples which were positive by a third generation ELISA test were confirmed by immunoblot and reverse-transcription polymerase chain reaction (RT-PCR), as were the pre-transfusion samples to exclude pre-transfusion HCV infection not detected by ELISA screening. Results indicated that one patient who was previously considered negative for HCV antibody in the pre-surgical sample was later found to be positive for HCV by RT-PCR in that sample. Seroconversion for HCV antibody after surgery was observed in two patients, one of them with clinical hepatitis; their genotypes were 1a and 1b. The overall prevalence of HCV infection was 4.26% (7/164) and the incidence rate of HCV infection after surgery was 1.27% (2/157). This study shows a high rate of HCV infection acquired post-transfusion in a cohort of surgery patients in Brazil and suggests that better screening methods such as viral RNA assessment may be effective in lowering this rate.
The clinical meaning of viremia, especially at low levels, in chronic hepatitis B virus (HBV)-inf... more The clinical meaning of viremia, especially at low levels, in chronic hepatitis B virus (HBV)-infected patients remains unknown. The objective of the present study was to determine serum HBV-DNA levels and its relationship with liver histology in HBsAg-positive blood donors. A cross-sectional study was conducted on 78 blood donors, with alanine aminotransferase (ALT) and HBeAg evaluation and quantitative determination of HBV-DNA by polymerase chain reaction (Amplicor, HBV Monitor, Roche; lower limit of sensitivity 1,000 copies/mL). Liver biopsy was obtained from all patients with detectable viremia irrespective of ALT and HBV-DNA levels. Among 78 blood donors, serum HBV-DNA was detected in 47 (60%) patients; 39 (83%) were males; mean age 37.6+/-10.4 years; 31 (66%) were HBeAg-negative, and ALT was elevated in 26 (55%). The median of HBV-DNA levels was 24,000 copies/mL and 31 (40%) subjects had no detectable serum HBV-DNA. Although the histologic lesions were mild in the majority of patients, HBV-DNA levels were significantly higher in patients with chronic hepatitis or cirrhosis when compared with patients without histologic liver disease (25,260,000 vs. 9480 copies/mL; P<0.001). There was a significant correlation between HBV-DNA levels and necroinflammatory score (r=0.59) and fibrosis (r=0.50); however, in the subset of HBeAg-negative patients with HBV-DNA levels below 30,000 copies/mL, 25% presented histologic disease related to HBV. Most HBsAg-positive blood donors show low viral load. There is a significant association between viral replication and liver damage; however, low HBV-DNA levels do not exclude the presence of histologic disease.
In the past two decades, major improvements in blood safety have been achieved, particularly for ... more In the past two decades, major improvements in blood safety have been achieved, particularly for HIV and hepatitis C virus (HCV). A prospective study was carried out between 1996 and 1999 in Brazil to determine the incidence of post-transfusion infection in surgery patients caused by HCV. One hundred sixty-four patients who received a blood transfusion during cardiac surgery were followed for six months and blood samples collected before and after surgery were assessed to investigate HCV infection. Alanine aminotransferase levels were serially determined, as well as clinical data related to hepatitis. Prior to surgery, HCV infection was detected by anti-HCV ELISA III in 6 patients. Any post-surgical samples which were positive by a third generation ELISA test were confirmed by immunoblot and reverse-transcription polymerase chain reaction (RT-PCR), as were the pre-transfusion samples to exclude pre-transfusion HCV infection not detected by ELISA screening. Results indicated that one patient who was previously considered negative for HCV antibody in the pre-surgical sample was later found to be positive for HCV by RT-PCR in that sample. Seroconversion for HCV antibody after surgery was observed in two patients, one of them with clinical hepatitis; their genotypes were 1a and 1b. The overall prevalence of HCV infection was 4.26% (7/164) and the incidence rate of HCV infection after surgery was 1.27% (2/157). This study shows a high rate of HCV infection acquired post-transfusion in a cohort of surgery patients in Brazil and suggests that better screening methods such as viral RNA assessment may be effective in lowering this rate.
In order to investigate the sexual transmission of the Hepatitis C Virus (HCV), the prevalence of... more In order to investigate the sexual transmission of the Hepatitis C Virus (HCV), the prevalence of specific antibodies in populations at high and low risk for sexually transmitted diseases (STDs) was evaluated. The population at low risk for STDs was composed of persons who voluntarily donated blood at the Hospital Universitário Clementino Fraga Filho (HUCFF) between July and November, 1990 (n = 2494). The population at high risk for STDs was drawn from an ongoing study on the natural history of Human Immunodeficiency Virus (HIV) infection (n = 210, 187 with sexual risk factors for HIV infection). All samples were screened using a first generation ELISA. Repeat reactive samples were then tested in a second generation RIBA. For all ELISA positive samples, two sex and age-matched ELISA negative controls were selected. Data pertaining to the presence of antibodies to the Hepatitis B core antigen (anti-HBC antibodies) and to Treponema pallidum were abstracted from the medical records. Th...
Revista da Sociedade Brasileira de Medicina Tropical
Hepatitis C virus is the main agent responsible for post-transfusion hepatitis. Progression to ch... more Hepatitis C virus is the main agent responsible for post-transfusion hepatitis. Progression to chronic hepatitis, cirrhosis and hepatocellular carcinoma is very common. The aim of this study was to evaluate the frequency, timing and factors related to progression of hepatitis C. One hundred seventy five patients with chronic post-transfusion hepatitis C were grouped in a cirrhosis group (n = 92) and a non-cirrhosis group (n = 83). The medium time of development to cirrhosis was 11 +/- 6 years. Patients with cirrhosis were older at the time they received transfusion, used more alcohol and had longer times of evolution. The prognosis was worse in the cirrhosis group with a mortality rate of 28.4% and 9.1% of evolution towards hepatocellular carcinoma, comparing with 5.5% and 0% in the non-cirrhosis group respectively. It is shown that post-transfusion hepatitis C is slowly developing progressive disease which progress is much more rapidly in elderly patients and patients with others f...
Revista da Sociedade Brasileira de Medicina Tropical
The authors studied the prevalence of HBV markers among health care personnel of the University H... more The authors studied the prevalence of HBV markers among health care personnel of the University Hospital of the Federal University of Rio de Janeiro. The aim of study was to identify the high risk groups, in order to counsel vaccination of those groups, in order to counsel vaccination of those groups at risk as a routine. As a control group, a group of office workers of the hospital were chosen. A significant difference of incidence of HBV markers, mainly in surgeons (40%) and hemodialysis unit personnel (36.4%) when compared to the control group, was observed (p less than 0.05). The incidence increased with age and the time spent in the profession. The authors concluded that vaccination is indicated in surgeons hemodialysis personnel, dentists and laboratory personnel.
We have studied 933 volunteer blood donors from May to July, 1990. After a interview and screenin... more We have studied 933 volunteer blood donors from May to July, 1990. After a interview and screening tests for syphilis, Chagas disease, malaria and HIV, they underwent an enzyme immunoassay for HBsAg, anti HBc and anti HCV antibodies. Alanine aminotransferase (ALT) serum levels were determined by auto analyser. Most blood donors were male with mean age of 33 years (19-65). Anti HCV prevalence was 3.1% (29 from 933 blood donors). Among anti HCV+, blood donors, 44.8% (13/29) had ALT 40 UI/L, 31% (9/29) were anti HBc+ and 17.2% (5/29) had both surrogate markers simultaneously. From 109 donors with ALT 40 UI/L, 13 (11.9%) were anti HCV+, while among 153 anti HBc+ donors, the anti HCV was 5.8%. 1) we found a higher anti HCV prevalence among our blood donors than previous published reports from other countries; 2) our data show that surrogate assays do not adequately identify anti HCV blood donors, 41.4% of them would not have been excluded by anti HBc and ALT tests alone; 3) there were a ...
Sickle cell anemia (SCA) is characterized by chronic hemolytic anemia. Worsening of anemia after ... more Sickle cell anemia (SCA) is characterized by chronic hemolytic anemia. Worsening of anemia after red blood cell (RBC) transfusion has been reported and is often referred to as hyperhemolysis syndrome (HS). HS is a severe transfusion reaction characterized by destruction of both donor and host RBCs. In this study we report the clinical findings and treatment of three adolescent patients with SCA who presented with HS. HS occurred after exchange transfusion in two cases and after RBC transfusion during vasoocclusive crises in one. A decrease of serum hemoglobin (Hb) levels was observed 5 to 7 days after transfusions and ranged from 2.5 to 5.7 g/dL. The direct antiglobulin test was positive in two patients who also presented with alloantibodies. Patient 3 received 2 additional RBC units after the onset of HS and experienced the lowest Hb values (2.5 g/dL) shortly after. Patients received intravenous steroids as the main specific treatment and also immunoglobulin and erythropoietin. Resolution of hemolysis was observed in all cases. Of note, spleen lesions were detected in two patients, one had a normal spleen size, and the other presented with enlarged spleen. Pathophysiologic implications of these findings were discussed. HS must be a well-recognized complication of SCA after RBC transfusion. Prompt initiation of treatment and avoiding further transfusions may contribute to reduce the mortality associated with HS. The presence of functional spleen on the pathophysiology of HS deserves further evaluation.
BACKGROUND: The optimal cryopreservation cell con-centration during the peripheral blood stem cel... more BACKGROUND: The optimal cryopreservation cell con-centration during the peripheral blood stem cell (PBSC) collection is a controversial topic. We evaluated the influence of cryopreservation concentration on the recovery of hematopoietic progenitor cells and the kinetics of hematopoietic recovery of autologous stem cell transplant patients. STUDY DESIGN AND METHODS: In this retrospective study, we compared two different cryopreservation protocols: 1 ¥ 10 8 cells/mL (Protocol A) and 2 ¥ 10 8 cells/mL (Protocol B). A total of 419 PBSCs were ana-lyzed with regard to the number of viable cells and colony-forming units–granulocytes-monocytes (CFU-GM) progenitors. The hematopoietic recovery of 275 patients who received PBSCs cryopreserved at a dose of 1 ¥ 10 8 cells/mL (Group A) and 2 ¥ 10 8 cells/mL (Group B) were compared. RESULTS: There were no significant differences in recovery of viable cells between Protocol A and Proto-col B. The median of recovery of CFU-GM progenitors was signifi...
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