Transmission of Human Immunodeficiency Virus (HIV) by Blood Transfusions Screened as Negative for HIV Antibody

Jw, Ward; Sd, Holmberg; Allen, Matthew R.; Dl, Cohn; Se, Critchley; Sh, Kleinman; Ba, Lenes; Ravenholt, Otto; Davis, Sharon G.; Mg, Quinn

doi:10.1056/nejm198802253180803

Cited by 450 publications

(93 citation statements)

References 14 publications

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“…One patient (no. 6) undergoing haemodialysis, maintained a haematocrit of 25%, unchanged from donations for HIV, there remains a small risk of HIV infection for recipients of screened blood [12]. the pre-operative value.…”

Section: Discussion Resultsmentioning

confidence: 99%

Intra‐operative autotransfusion in radical cystectomy

Park¹,

Kojima²,

Tomoyoshi³

1997

British Journal of Urology

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Objective To assess the feasibility of intra‐operative autotransfusion (IAT) as a method of decreasing or avoiding homologous blood transfusion during radical cystectomy. Patients and methods IAT was performed in 10 patients with bladder cancer who underwent radical cystectomy. The patients were divided into two groups: group 1 consisted of six patients without and group 2 of four patients with pre‐deposited blood. Blood shed in the operative field was collected and processed with an IAT device. Results In group 1, the intra‐operative blood loss ranged from 1.08 to 2.67 L (mean 1.82) and homologous blood transfusion ranged from 0 to 1 L (mean 0.47). The amount of autologous blood processed and transfused by the IAT device ranged from 0.38 to 0.98 L (mean 0.64). Two patients did not require homologous blood transfusion. In group 2, the volume of pre‐deposited blood ranged from 0.8 to 1.2 L (mean 0.9). The intra‐operative blood loss ranged from 1.03 to 3.24 L (mean 1.8). The amount of processed autologous blood transfused ranged from 0.4 to 0.6 L (mean 0.45). None of the patients in group 2 required homologous blood transfusion. Conclusion Although there are theoretical risks with IAT, they were not substantiated by the clinical data. IAT seems to be a feasible method of reducing or avoiding homologous blood transfusion in radical cystectomy. These results suggest that IAT in combination with pre‐deposited blood will abolish the need for homologous blood transfusion during radical cystectomy.

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Section: Discussion Resultsmentioning

confidence: 99%

Intra‐operative autotransfusion in radical cystectomy

Park¹,

Kojima²,

Tomoyoshi³

1997

British Journal of Urology

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“…Even if screened, this status cannot usually be known with certainty, specifically due to laboratory error, limits in test sensitivity, or window period (time between infection and detection of antibodies to HIV). 15 Surviving patients may acquire HIV infection and develop AIDS. Treatment outcomes considered in this analysis were survival, death, or survival with AIDS.…”

Section: Methodsmentioning

confidence: 99%

“…[11][12][13][14] Even screened blood can be infectious, with a risk that depends on the background seroprevalence among the blood donors and on the quality of the screening. 12,15 The mortality from severe anemia is known to be higher with more intense P. falciparum transmission patterns and patient characteristics such as younger age, lower hemoglobin level, and presence of respiratory distress or impaired consciousness. 7,[16][17][18][19][20][21][22] A survival benefit of transfusion was found in an observational study in western Kenya, 7 but the effectiveness of transfusions has unfortunately not been studied in randomized controlled trials.…”

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confidence: 99%

Blood transfusions for severe malaria-related anemia in Africa: a decision analysis.

Obonyo

Oloo²,

Habbema³

1998

The American Journal of Tropical Medicine and Hygiene

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Abstract. Severe childhood malarial anemia is commonly treated using blood transfusion. Although transfusion may decrease short-term mortality, the risk of human immunodeficiency virus (HIV) transmission is considerable in Africa. We constructed a decision tree to weigh the short-term mortality benefit of transfusion against HIV infection risk. Probability estimates were derived from published studies. The base-case was a two-year-old child with a 13.5% mortality risk to be transfused with screened or unscreened blood (1% or 13% HIV contamination risk, respectively), with reduction of mortality to 5.5% by transfusion (odds ratio ϭ 2.7), and a 2.4% risk of fatal transfusion complications. A sensitivity analysis was performed to assess the influence of variation in these estimates. If a child developed acquired immunodeficiency syndrome, survival was weighed as one-tenth of normal survival. For the base-case, we found that transfusion with screened blood provided a survival benefit of 5%. In contrast, transfusion with unscreened blood decreased survival by 2%. Patients with a mortality risk Ͻ 5% derived no benefit from a transfusion with screened blood. Other important factors for the benefit of transfusion were the effectiveness of transfusion in reducing mortality and the risk of blood contamination. A blood transfusion was clearly beneficial if the mortality risk was high and the risk of contamination was low. Our findings can be used as a basis for a clinical transfusion policy that limits transfusions to situations in which they are likely to be beneficial. This will in turn optimize child survival and prevent unnecessary exposure of low risk children to the transfusion risks.With the risk of transmission of the human immunodeficiency virus type-1 (HIV-1), the use of blood transfusion in the management of severe pediatric anemia has become an important clinical decision problem in Africa.

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“…However, a small number of cases of transmission still occur when a newly infected donor has not yet developed a detectable Ievel of HIV antibody (Ward et al, 1988). ln a number of deve10ping countries, the bIood supply is not yet universally screened.…”

Section: (A) Sexual Contactmentioning

confidence: 99%

Monographs on the Evaluation of Carcinogenic Risks to Humans

1991

Analytica Chimica Acta

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Transmission of Human Immunodeficiency Virus (HIV) by Blood Transfusions Screened as Negative for HIV Antibody

Cited by 450 publications

References 14 publications

Intra‐operative autotransfusion in radical cystectomy

Intra‐operative autotransfusion in radical cystectomy

Blood transfusions for severe malaria-related anemia in Africa: a decision analysis.

Monographs on the Evaluation of Carcinogenic Risks to Humans

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