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Background and Objective: Evidence-based guidelines on platelet transfusion therapy assist clinicians to optimize patient care, but currently do not take into account costs associated with different methods used during the preparation, storage, selection and dosing of platelets for transfusion. This systematic review aimed to summarize the available literature regarding the cost effectiveness (CE) of these methods. Methods: Eight databases and registries, as well as 58 grey literature sources, were searched up to 29 October 2021 for full economic evaluations comparing the CE of methods for preparation, storage, selection and dosing of allogeneic platelets intended for transfusion in adults. Incremental CE ratios, expressed as standardized cost (in 2022 EUR) per quality-adjusted life-year (QALY) or per health outcome, were synthesized narratively. Studies were critically appraised using the Philips checklist. Results: Fifteen full economic evaluations were identified. Eight investigated the costs and health consequences (transfusion-related events, bacterial and viral infections or illnesses) of pathogen reduction. The estimated incremental cost per QALY varied widely from EUR 259,614 to EUR 36,688,323. For other methods, such as pathogen testing/culturing, use of apheresis instead of whole blood-derived platelets, and storage in platelet additive solution, evidence was sparse. Overall, the quality and applicability of the included studies was limited. Conclusions: Our findings are of interest to decision makers who consider implementing pathogen reduction. For other preparation, storage, selection and dosing methods in platelet transfusion, CE remains unclear due to insufficient and outdated evaluations. Future high-quality research is needed to expand the evidence base and increase our confidence in the findings.

AbstractObjectives: The objective of this retrospective study was to evaluate the added value of communicating post-transfusion hemoglobin values to clinicians as a strategy to improve RBC utilization in a 500-bed hospital.Methods: The total number of RBC transfusions, the mean number of RBC units transfused per patient, the mean pre- and post-transfusion hemoglobin values, the ratio of patients transfused and the ratio of patients with a post-transfusion hemoglobin > 10.5 g/dL were calculated per service and per department for six months. The data were reported to each service and compared with the data of the department as peer group. The impact of this communication strategy was evaluated in the following six months.Results: In the six months pre-intervention, the mean post-transfusion hemoglobin value was 9.2 g/dL. Post-transfusion hemoglobin was > 10.5 g/dL in 13.4% of patients (112/835). Following communication of these data, RBC consumption decreased 21.0% (p < 0.01) and 21% (p < 0.01) fewer patients received transfusions despite an increase in mean post-transfusion hemoglobin value to 9.4 g/dL (p < 0.01).Conclusion: Providing feedback on post-transfusion hemoglobin data and the global consumption of RBC units to prescribing physicians can be an additional, feasible and effective strategy to encourage self-assessment and to improve blood utilization.

To determine the prevalence of antibodies against HIV, hepatitis B (HBV) and hepatitis C (HCV) in postmortem samples from drug related deaths (DRDs) in Denmark.Prospective cohort study. Postmortem samples tested for anti-HIV, anti-HCV anti-HBc and anti-HBs. Comparison to pre-mortem testing when possible. DRDs were searched for in the national register of drug treatment, national prison registers, and the national infectious disease register.National level.Drug related deaths admitted to Danish Institutes of Forensic Medicine during 2004.Prevalence of antibodies, injection drug use, drug treatment experience and prevalence of cirrhosis.Samples for analysis were obtained from 78% (233/299) of DRDs. The prevalences of anti-HIV, anti-HCV and anti-HBc were 4% (9/214), 51% (110/215), and 35% (74/209), indicating a persisting low prevalence of HIV and a declining prevalence of HCV and HBV. Injecting ever was detected among 45% of DRDs and this was associated with a significantly higher prevalence of hepatitis B and C. Among the DRDs 56% received drug treatment and 12% had cirrhosis at autopsy. Evidence of vaccination against HBV was found among 16% (21/128).Monitoring of viral hepatitis and HIV among DRDs is feasible, and our survey indicates a falling prevalence among Danish drug users. Surveillance based on drug users in treatment may overestimate the true prevalence.

Denmark is a country with low prevalence and incidence of blood borne viral infections. Among health care workers (HCWs) vaccination for hepatitis B is only offered to high-risk groups. The aims of this cross sectional survey were to determine the prevalence of hepatitis B, -C, and human immunodeficiency virus (HIV) among the staff at a Danish University hospital and to correlate this with risk factors for transmission. Additionally, we wanted to examine the current frequency of blood exposure, reporting habits and hepatitis B vaccination status in the staff. Of 1439 eligible hospital staffs included, 960 (67%) were HCWs. The overall human immunodeficiency virus (HIV)-, hepatitis C Virus (HCV)- and hepatitis B Virus (HBV)-prevalence was 0% (0/1439), 0.14% (2/1439) and 1.6% (23/1439), respectively. Twenty-three percent of HCWs were vaccinated against HBV. Age, blood transfusion and stay in endemic areas were associated independently to HBV infection as opposed to job-category, duration of employment, HBV vaccination status and blood exposure. Based on a 4-week recall period, the incidence of percutaneous blood exposure was 1.5/person-year. In conclusion the HIV and hepatitis prevalence was low despite frequent blood exposure and the principal risk factors were unrelated to work. Danish HCWs do not seem to be at increased risk of hepatitis B even though universal HBV vaccination has not been implemented.

With the demonstration of an effect of GBV‐C infection on the outcome of HIV infection, it has become important to understand the epidemiology of GBV‐C. The purpose of this study was to determine the prevalence in high‐ and low‐risk populations. The following populations were tested: school children, 9 and 15 years of age (n = 901), blood donors (n = 5,203), hospital employees (n = 1,432), and prisoners and injecting drug users (n = 447). In‐house RT‐PCR for GBV‐CRNA was used together with a commercial ELISA for anti‐E2 (Boehringer, Germany). In addition, questionnaires for risk factors for transmission and serological tests for HIV and hepatitis were applied. The overall prevalence of GBV‐CRNA was 1.4% among children, 2.2% among blood donors, 2.2% among hospital employees, 12.5% among non‐injecting prisoners, and 34.9% among drug injectors. Correspondingly anti‐E2 was found in 0.3%, 12.3%, 25.0%, and 42.7%. Among hospital employees, independent risk factors for GBV‐C were professions with blood exposure and sexual risk partners. Among prisoners and drug users, injecting and a sexual risk index were associated independently with GBV‐C. Based on these results, the following hypothesis is suggested: GBV‐C is transmitted frequently at birth or early childhood and this leads to chronic infection in most cases. Sexual transmission is the most important route of transmission in the adult population but this infection is usually transient. Blood borne transmission plays a role among health care workers and injecting drug users and GBV‐C should be further evaluated as a surrogate marker for professional blood exposure. J. Med. Virol. 70:156–162, 2003. © 2003 Wiley‐Liss, Inc.

Although Denmark has a low hepatitis B virus (HBV) prevalence, HBV transmission has been reported in Danish day‐care centres. The aim of this study was to validate saliva anti‐HBc testing as a method for HBV screening, the applicability of saliva sampling to pre‐school children, and to determine the HBV prevalence in Danish day‐care centres with a high proportion of immigrants. For validation, paired saliva and plasma samples were obtained from blood donors and injecting drug users. Employees and children in day‐care centres with a high proportion of immigrant children were offered saliva screening followed by blood test if positive. The specificity and sensitivity of anti‐HBc tests on saliva was 100% (102 blood donors and four injecting drug users) and 85.9% (61 of 71 anti‐HBc‐positive injecting drug users), respectively. In all samples from HBsAg (n = 7) or anti‐HBc IgM‐positives (n = 9), anti‐HBc was detected in saliva. Adequate saliva samples were obtained from 93% (588/634) of children and 100% (166/166) of employees participating in the day‐care centre survey. Among children 55% were of non‐Scandinavian origin and only one (0.2%, 95% CI [0.0; 1.0]) was HBV positive. Among employees the corresponding values were 22% and 7 (4.2%). The positive predictive value of the saliva test was 25% (1/4) among children and 88% (7/8) among adults. In conclusion, saliva testing is feasible for HBV screening among children in low prevalence populations, but any anti‐HBc reactivity should be confirmed by plasma analysis. The HBV prevalence in pre‐school children in Denmark is low even among immigrants from endemic areas. J. Med. Virol. 68:500–504, 2002. © 2002 Wiley‐Liss, Inc.

Injecting drug users and prisoners have high prevalences of antibodies to hepatitis A–C. The aim of this study was to determine the prevalence of antibodies to hepatitis E virus (anti‐HEV) in two Danish high‐risk populations and correlate anti‐HEV with risk factors for transmission. Three hundred thirty male prisoners and 137 patients at a drug treatment center were tested for anti‐HEV with an in‐house enzyme‐linked immunoassay (EIA) utilizing antigens derived from open reading frame 2 (ORF2). This was compared with a commercial test with antigens derived from ORF2 and ORF3 (Abbott HEV EIA). In addition the samples were tested for antibodies against hepatitis A–C viruses, human immunodeficiency virus (HIV) 1 and 2, human T lymphotropic virus (HTLV) I and II and herpes simplex virus type 2 (HSV2). The participants were interviewed about risk factors for transmission. The anti‐HEV prevalence was 16.9% (95% CI 14–21) for the in‐house assay compared to 4.1% (95% CI 2.5–6.3) with the commercial assay. The correlation between the two assays was low (87% overall agreement; κ value 0.32). One sample was strongly anti‐HEV IgM positive, suggesting recent HEV infection inside Denmark. The presence of anti‐HEV was associated significantly with anti‐HAV among prisoners and increased with age in both groups. In contrast, associations were not found with injecting drug use or sexual risk factors. With the commercial assay an increased prevalence of anti‐HEV was found among participants who had spent more than 5 years outside Northern Europe. In conclusion, anti‐HEV was highly prevalent among Danish prisoners and drug users but not related to risk factors for blood‐borne or sexual transmission. J. Med. Virol. 66:49–55, 2002. © 2002 Wiley‐Liss, Inc.

The direct in vitro effect of radiographic contrast media (RCM) on granulocyte locomotion was assayed using an under agarose technique. All RCM tested inhibited the chemotactic response to N-fmlp, a synthetic chemotactic N-formylated tripeptide, which is an analogue of natural bacterial products. The inhibition was most pronounced for diatrizoate, the most hyperosmolar of the RCM, but hyperosmolality per se was not the only inhibitive factor, since 0.5 M NaCl, which has an osmolality comparable to the RCM used, did not inhibit chemotaxis significantly. Furthermore, the inhibition was not caused by a nonspecific sticky effect of RCM on granulocytes, since spontaneous migration was normal. We propose that the inhibition might be caused by competitive binding of RCM to the N-fmlp receptor sited on leukocytes because the third amino acid in N-fmlp is phenylalanine, which, like the RCM, contains a benzene ring.

We investigated the DNA restriction fragment length polymorphism of the major histocompatibility complex class II genes: HLA-DRB,-DQA,-DQB, DPA,-DPB, the serologically defined HLA-A, B, C, DR antigens, and the primed lymphocyte typing defined HLA-DP antigens in 23 Danish patients with primary biliary cirrhosis (PBC) and in healthy Danes. The following genetic markers were found with increased frequencies in PBC: HLA-B8 (relative risk, RR=2.4, P<0.05, ‘corrected’ P>0.05), HLA-DR3 (RR=3.4, P<0.01, ‘corrected’ P<0.05), the DRB3*01/02/03 (DRw52) associated DRB Bgl II 9.1 kilobase (kb) fragment (RR= 2.9; P<0.05, ‘corrected’ P>0.05), the DQA1*0501 associated DQA Taq I4.8 kb fragment (RR=3.1; P<0.05, ‘corrected’ P>0.05), the DQB1*0201 (DQw2) associated DQB Hin dIII 11.5 kb fragment (RR=3.1; P<0.05, ‘corrected’ P>0.05). No DNA fragments specific for DRB1*0301 (DR3) could be identified. The frequencies in PBC of other genetic markers including DRw8, DRB1*08, HLA-DP antigens, DPA, and DPB genes did not differ significantly from those in controls. The associations between PBC and B8, DR3, DQA1*0501, and DQB*0201, which are frequently found together on the same haplotype, are at variance with recent reports on associations between PBC and Drw8. The discrepancy suggests that PBC is genetically heterogenous.

Background and objectives: The purpose of this study was to evaluate more than 3 years of experience with a gel technique in combination with pooled screening cells for the detection of irregular red cell antibodies. Materials and methods: Conventional serologic methods were used for blood typing, antibody screening and cross-matching until the end of 1992. We introduced the gel technique as a routine assay for antibody detection and identification in 1993. Results: After the tube technique had been abandoned, the number of false-positive antibody screening tests was reduced by 71%, positive antibody screening tests by 33%, enzyme agglutination by 100% and rouleaux reactions and cold-reacting antibodies by more than 50%. There was a 40% increase in first-time detection of clinically relevant antibodies. We saw no increase in delayed haemolytic transfusion reactions. Conclusions: For the detection of irregular red cell antibodies, pooled screening cells in combination with a gel technique are at least as efficient and safe as a conventional tube technique with unpooled test cells.

TO THE EDITOR.— Our studies of the effect of the histamine2 (H2) receptor antagonist, ranitidine, in patients with trauma- and blood transfusion-induced immunosuppression, in patients with multiple myeloma, and in patients with human immunodeficiency virus infection,1 have included a few patients with psoriatic lesions. Some of these patients who were treated with the active drug showed improvement in psoriatic disease, but with recurrence within a few weeks after the therapy was discontinued. Based on these observations, and despite previous randomized, placebo-controlled studies of short-term treatment (28 days) with another H2 receptor antagonist, cimetidine, which had shown no beneficial effect,2 an open pilot study of the effect of long-term (4 months) treatment with ranitidine in patients with different forms of psoriasis was initiated. SUBJECTS AND METHODS.— Six patients were studied in the autumn of 1989 (September 1 through December 31, 1989). All of the patients had