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In order to study the asymptomatic hepatitis C virus (HCV)-positive blood donors in Israel we analyzed their sera for HCV-RNA using the polymerase chain reaction technique. We found that 0.44% of blood donors were anti-HCV positive. Of those who had repeatedly positive anti-HCV, 82% had evidence of HCV-RNA. One-third of them had elevated liver enzymes, but no detectable cryoglobulins were found in their sera. Although HCV-RNA was detected in the majority of the patients, we were unable to demonstrate vertical or horizontal transmission among the family members of our carrier population.

We studied 24 HIV-positive Palestinians who presented for medical care in the West Bank, Jerusalem and the Gaza Strip between 1987 and 1992. Three individuals, all males, were detected by blood bank screening. An additional 21 individuals (12 males, 7 females, 2 infants) were diagnosed as having HIV infection. Fifteen of 24 had full-blown AIDS--11/24 (46%) were expatriates; there were 4 heterosexuals, 5 transfusion recipients and 6 homosexuals, together comprising 79% of the individuals whose risk group was known. As compared with Israelis, Palestinians presented for medical treatment at a later stage of HIV infection. We also studied the incidence of HIV infection among Palestinian blood donors between 1987 and 1992. The incidence analysis was based on HIV screening at seven blood banks of major hospitals in the West Bank, at the Makassed Hospital in East Jerusalem, at Hadassah University Hospital (Palestinian blood donors only) and at two blood banks in the Gaza Strip. Demographic features were derived from the health department of the West Bank and from the AIDS clinic at Hadassah Hospital. Approximately 50,000 Palestinians were screened at the blood banks. Only three, all males, were detected as HIV seropositive, giving an HIV overall cumulative incidence of 0.006%. This figure was similar to the incidence among 500,000 Israeli donors (0.008%; NS) during that period. Although the low HIV incidence at the blood banks is encouraging, the negligible number of HIV seropositives and the presentation at a late clinical stage points to a deficiency in AIDS tracing and in access to specialized AIDS care in the West Bank and the Gaza Strip. The small overall number of cases precludes any definite conclusion as to trends in the epidemiology of AIDS in the West Bank and Gaza. However, the receipt of contaminated transfusions and the return of infected expatriates seem to be important features of AIDS in the West Bank and Gaza.

Leukocyte antibodies are the major cause of nonhemolytic transfusion reactions. One of the less frequent but severe forms of this reaction is the adult respiratory distress syndrome, or transfusion-related acute lung injury. This rare phenomenon is the result of leukocyte antibodies forming immune complexes with granulocytes, complement activation, sequestration of activated granulocytes in the pulmonary capillary bed, and their degranulation associated with release of proteolytic and cytotoxic substances. This cascade causes endothelial damage with increased capillary permeability. Plasma fluids and proteins accumulate in the interstitial and intra-alveolar spaces, leading to respiratory insufficiency. We present two patients with transfusion-related adult respiratory distress syndrome associated with leukocyte HLA antibodies, who were successfully treated in our hospital. The pathogenesis, diagnostic measures and treatment of this uncommon yet critical condition is discussed.

The prevalance of traumatic intravascular hemolysis was estimated in 25 patients following aortofemoral bypass. Stigmata of mild red cell fragmentation were noted in approximately one third of the patients, but in only one of them was hemolysis of sufficient severity to be of clinical significance. The case history and laboratory findings in this patient are described in detail. This study indicates that traumatic hemolysis should be considered as a possible cause of anemia developing after aortofemoral bypass.

An analysis of the etiology of acute viral hepatitis in 172 hospitalized patients showed that 70.9% suffered from hepatitis A (HA), 12.2% from hepatitis B (HB), 1.7% from infectious mononucleosis and 15.1% (26 cases) from non-A, non-B hepatitis. Patients who had received blood transfusions during the 6 mo preceding the onset of the disease were not included in the present survey. The male:female ratio in the patients with non-A, non-B hepatitis was 1:88; 73% were Ashkenazic and 27% non-Ashkenazic Jews. The ethnic distribution of patients with non-A, non-B hepatitis was similar to that of patients with HA but differed from that of HB patients (only 41% Ashkenazic). Thirty-eight percent of the non-A, non-B group had had contact with jaundiced patients during the 6 mo preceding the onset of the disease, and 46% were students or soldiers. The clinical course of the disease was, on the whole, milder than that of HB and similar to that of HA. Since many cases of non-A, non-B hepatitis are anicteric, it is concluded that the disease is a significant problem in Israel.

Several blood constituents were used to evaluate the nutritional status of a random, consecutive group of 655 blood donors. The population included 503 men and 152 women, with a mean age of 35.1 years; 26.8% of the women and 26.5% of the men had deficient levels of ascorbic acid; 18.0% of the women an 11.9% of the men had hemoglobin levels below normal. Plasma iron was inadequate in 29.3% of the women and 18.6% of the men. A very small number of donors were found to be deficient in carotene, retinol, thiamine, riboflavin and pyridoxine. These findings call attention to an unexpected aspect of nutrition in an apparently healthy, not undernourished population.