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Aim: To determine the prevalence of antibodies to hepatitis C (anti-HCV) in patients who have undergone bone marrow transplantation in Wellington, prior to the introduction of hepatitis C screening, and to contrast these results with the prevalence of anti-HCV in the Wellington haemophiliac population., Method: Serum specimens were obtained from 30 patients who had undergone bone marrow transplantation for the treatment of haematological disorders, and from 29 haemophiliacs. Specimens were analysed using a second generation HCV immunoassay., Results: Exposure to blood products was high in bone marrow transplant recipients with subjects receiving red cells or platelets from an average of 53 donors (range 15-100, SD 23.2) during their transplant procedure. Despite the high usage of blood products, only one of the 30 patients tested was positive for hepatitis C on the basis of second-generation antibody testing. Confirmatory testing in this patient, (anti-HCV immunoblot assay) was negative. In contrast, 26 of 29 (89%) haemophiliac patients tested were positive for anti-HCV., Conclusion: Although the infective risk of blood products cannot be underestimated, the risk of patients contracting hepatitis C from multiple single-unit transfusions, prior to the introduction of screening for hepatitis C was low. This contrasts with the high risk of hepatitis C seroconversion in patients exposed to pooled plasma products.

A case of transfusion-related AIDS is described which is believed to be the first published case to occur in New Zealand in a nonhaemophiliac patient. The human immunodeficiency virus (HIV) positive donor was shown to be the source of infection in five further HIV positive recipients.

Pulmonary complications are common in patients with acute leukaemia. Infection is the usual cause of these. A case of acute leukaemia is described in which diffuse interstitial pneumonitis developed during remission induction therapy. This occurred during a very rapid fall in the leukaemic blast population following the start of chemotherapy. Open lung biopsy showed necrotic leukaemic cells filling the lung interstitium. The patient made an uneventful recovery from this complication.

From 1982 to 1987, 22 patients with proven Pneumocystis carinii pneumonia were diagnosed at Wellington Hospital. Patients comprised 15 males and 7 females aged 15-76 years and included seven with AIDS, eight with haematological malignancy and seven with renal disease. Two distinct clinical prodromes occurred. In renal patients a classic fulminating pneumonitis developed over 24 to 72 hours. In patients with AIDS a more indolent illness occurred lasting 3 or more weeks and was characterised by fever, dry cough and breathlessness. Haematology patients showed no specific duration of prodrome. At the time of diagnosis all had an abnormal chest radiograph and the arterial PO2 was reduced in all but one case. An invasive diagnostic procedure was performed in all except one case where the diagnosis was made at post mortem. Two patients required a second procedure to establish the diagnosis. Procedures performed included bronchoalveolar lavage [14], open lung biopsy [7] and transbronchial lung biopsy [2]. All patients were treated with high dose cotrimoxazole and 18 survived to leave hospital. A review of the approach to the diagnosis and treatment of Pneumocystis carinii pneumonia is presented.

Eleven patients with progressive hairy cell leukaemia (three nonsplenectomised) were treated with recombinant alpha-2 interferon (Intron-A or Roferon-A) subcutaneously three times per week at a dosage of 3 x 10(6) units. Ten patients completed at least ten weeks of therapy and could be evaluated; one patient died of haemorrhage from severe thrombocytopenia after only three weeks treatment. Nine of the ten patients responded and all of these are regarded as good partial remissions (normalisation of all blood parameters but still discernible hairy cells in the marrow). Responding patients have all been followed for a median of two years and in one case 3 1/2 years since commencement of therapy. The patients are all transfusion independent and free of infection. We conclude that alpha-2 interferon therapy for progressive hairy cell leukaemia is effective therapy in both splenectomised and nonsplenectomised patients.

The deoxyuridine suppression test (DUST), performed on bone marrow cells, or peripheral blood lymphocytes, provides a rapid, dynamic assessment of vitamin B12 and folate status. The principles of this test are described and the use of the DUST in haematological practice at Wellington Hospital is reviewed. The advantages of the test are the speed of obtaining results, and an accurate assessment of the patient's condition when other haematological tests may be misleading.

Healthy Maori males were found to have higher platelet counts (mean 295 x 10(9)/L: SD 46) compared to healthy nonMaori males (mean 253 x 10(9)/L; SD 50). Maori males had higher weights (mean 88.4 kg; SD 12.5) than nonMaori males (mean 81.0 kg; SD 9.0); and the platelet count was significantly correlated with weight (r = 0.30; p = 0.003). After weight adjustment significant differences between Maori and nonMaori males for platelet counts remained. These findings have implications for laboratory reference ranges, and may be of epidemiological significance in cardiovascular disease.