Annika Lindholm

Transfusions of leukocyte-rich erythrocyte concentrates: A successful treatment in selected cases of habitual abortion☆☆☆

Abstract Forty-nine women who suffered recurrent spontaneous abortion of unknown etiology were studied for cellular reactivity and blocking antibody in one-way mixed lymphocyte culture before and after their receipt of three transfusion of leukocyte-rich erythrocyte concentrates from third-party donors. Those 38 of the 49 women who had no blocking antibody all developed significant blocking activity after the transfusion series. Twenty-five of them have become pregnant since, and only one aborted again. The blocking activity demonstrable in 11 of 49 women was increased after the transfusions. Subsequently five of them became pregnant, and all aborted again. We later found that these five women, who considered themselves to be in perfect health, all had serologic signs of autoimmune disease. We advise against transfusion treatment of women who habitually abort without preceding immunologic investigation, because a population of habitual aborters may contain women with yet undiagnosed autoimmune disease, who would be worse off after blood transfusion. We conclude from our results that a selected population of habitual aborters, that is, those without blocking antibody, benefits from transfusion treatment.

Subtypes of hepatitis B antigen in blood donors and post-transfusion hepatitis: clinical and epidemiological aspects.

Subtyping of hepatitis B antigen (HBA) in blood donors revealed subtype ad in 56% while patients with icteric post-transfusion hepatitis from the same centre showed subtype ay in the majority of the cases (75%). Donors with subtype ad in serum were mostly asymptomatic long-term carriers of the antigen with normal liver function (83%), while 70% of donors with subtype ay in serum had signs of acute or chronic liver disease. Healthy long-term carriers of HBA seem to present little risk of transmitting hepatitis irrespective of subtype. It is, however, possible that these differences in blood donors with subtype ad and patients with post-transfusion hepatitis with subtype ay might reflect epidemiological circumstances rather than biological differences in the two viral strains.

Trigger factors and HL-A antigens in chronic active hepatitis.

Forty-six patients with histologically verified chronic active hepatitis (CAH) were divided into three groups according to whether the CAH was virus-induced, drug-induced, or cryptogenic. The frequency of the HL-A antigens 1 and 8 was increased in the cryptogenic group while the other groups did not differ significantly from healthy controls. Autoantibodies were often found in high titres in the drug-induced and cryptogenic groups but were infrequent in the virus-induced group.

Persistent Alanine Aminotransferase Elevation in Healthy Swedish Blood Donors ‐ Mainly Caused by Obesity

Abstract. Five hundred consecutive healthy blood donors were tested for serum alanine aminotransferase (ALT) and 44 (8.8%) had increased levels. Donors with and without raised ALT were compared in several aspects but only weight (expressed as percentage of ideal body weight) and sex differed significantly (119.1 ± 14.5 and 106.3 ± 12.8%, respectively; p<0.001 and males 97.7 and 77.1%, respectively; p <0.01). The 44 donors with raised ALT were followed up and in 13 out of 15 donors with persistently raised ALT without obvious reason, a liver biopsy was performed. Ten donors had various degrees of liver steatosis, 2 had normal liver morphology and in 1 donor chronic hepatitis could not be ruled out. If ALT screening is introduced as a surrogate test for non‐A, non‐B hepatitis in Swedish blood donors, we suggest that a correction for overweight must be considered in order to minimize donor loss.

Hepatitis-associated antigen and antibody in Swedish blood donors. Relation to liver disease.

Abstract. Screening of sera from 11,100 blood donors with an immunodiffusion method showed the presence of hepatitis‐associated antigen (HAA) in 0.18% of the donors, and anti‐HAA antibodies likewise in 0.18% of the donors. The antigen was found more often in men, while antibodies were demonstrated at a higher frequency in women. HAA was not found in any of the oldest donors (48–60 years), but anti‐HAA antibodies were demonstrated in 0.31% of the oldest donors. The noted differences, however, were not statistically significant.

Blood transfusions generate/increase previously absent/weak blocking antibody in women with habitual abortion * †

Women who suffered recurrent spontaneous abortions of unknown cause were studied for cellular reactivity and blocking antibody in a one-way mixed lymphocyte culture. A defined group of 20 women whose serum displayed no blocking capacity was given three transfusions of leukocyte-rich erythrocyte concentrates. Serum from all women displayed significant blocking capacity 2 months after the third transfusion. Because blocking antibody seems to be one of the necessary prerequisites for successful pregnancy, leukocyte transfusions from third-party donors ought to be an effective cure for habitual abortion in selected cases.

Genetic factors in the development of chronic active hepatitis.

In 14 of 16 patients with chronic active hepatitis (C.A.H.) who did not have HLA antigens B8 and/or B12 an external triggering factor (drug or virus) could be demonstrated at onset of symptoms. In contrast external factors were involved in only 11 of 25 cases of C.A.H. in patients with HLA-B8 and/or B12. In the latter group antinuclear antibodies were less common in cases possible triggered by external agents compared with cases in which no such factor was demonstrated. The results suggest that there are at least two pathogenetically different types of C.A.H.---one genetically determined type in which no external factor is involved and in which autoimmune phenomena are common, and another type triggered by environmental agents and not involving predisposing genetic factors.

Hepatitis B and Non‐A, Non‐B in a Swedish Blood Center during 10 Years of HBsAg Screening

Abstract. In spite of routine screening for HBsAg by a sensitive radioimmunoassay, some cases of posttransfusion hepatitis B still occur. The frequency in the Gothenburg Blood Center is 1 clinical case per 10,000 bloods units transfused. About the same incidence has been noted for clinically overt cases of hepatitis non‐A, non‐B. In contrast to findings reported by others, the latter incidence has been rather stable over the last 5 years.

Hepatitis B Antigen and Prevention of Post‐Transfusion Hepatitis B

Abstract. Screening for hepatitis B antigen (HBsAg) in the serum of blood donors and exclusion of antigen‐positive blood units have reduced the frequency of post‐transfusion hepatitis but several cases of hepatitis B still occur in association with transfusions. One explanation for this is probably that HBsAg is not an indicator of infectivity. Thus healthy carriers of the antigen seem to have low infectivity while carriers with chronic liver disease as well as donors incubating hepatitis B probably present a great risk.

HBsAg-Positive Swedish Blood Donors: Natural History and Origin of Infection

99 HBsAg-positive blood donors (BDs) were discovered in Göteborg during 1970-84. Of the 82 patients where the outcome is known 46 had transient and 36 persistent antigenemia. Chronic hepatitis was found in 6 patients while 30 were asymptomatic carriers. Three BDs had died, 1 of them from cholangiocellular cancer. An obvious mode of transmission was demonstrated for 19 BDs, i.v. drug abuse being the most frequent one. Five BDs originated from countries with a known high prevalence of hepatitis B virus (HBV). Family contacts of the remaining carriers had serological markers for HBV in the following frequencies: mothers 46%, siblings 39%, fathers 25%, children 13%, spouses 10%. Only children of female carriers had markers for HBV infection. Intrafamiliar transmission during childhood is an important route of transmission even in a country with low HBV endemicity and amongst people without connection with endemic regions. This population may be susceptible to the consequences of a long-term carriership of HBV.