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Aim: Determine the risk factors in blood donors with anti hepatitis C antibodies (anti-HCV ab) possible liver involvement and evaluation of their infectious potential by a search for viral RNA in blood., Methods: Between July 1990 and October 1991, 19,632 blood donors were screened for hepatitis C. Antibodies to HCV were detected in 74 donors (2nd generation ELISA, Abbott). We evaluated the risk factors, determined ALAT levels and looked for circulating RNA virus by amplification of the non-coding region of the viral genome (RTPCR) in 68 of these 74 donors screened. A control was chosen arbitrarily from 103 donors with high ALAT levels, but with no antibodies to HCV nor detectable circulating viral DNA., Results: The prevalence of anti-HCV ab in blood donors in 0.37%. No risk factor was found in 29 donors (43%). Parenteral exposure (former i.v. drug addiction and history of transfusions) was found to be the mode of transmission of hepatitis C in 23 donors (34%). History of NANB jaundice (non-post transfusion) was reported in 1 donor (1%). The remaining 15 donors (22%) were found to have minor risk factors - either isolated or in combination (exposure, tatoos, multiple sexual partners). Former i.v. drug addiction (p = 0.0000006) as well as a history of transfusions (p = 0.0071) are significantly more frequent in the group of donors with antibodies to HCV. None of the 35 sexual partners of the tested donors proved to be positive. 21 donors (30%) had high ALAT (+2 SD). Viral RNA was detected in blood of 26 donors (38%). The proportion of cases with positive viral RNA was 61% if only those donors with high ALAT levels were taken into consideration (13 positive of 21)., Conclusions: Risk factors were found in 39 donors (57%) with antibodies to HCV. History of parenteral exposure was found to be significantly more frequent than in the control group (p = 0.0000054). Sexual transmission within couples was not demonstrated in the population tested. A positive PCR test is a probable indicator of a continuous viral replication and reflects a possible chronic hepatic involvement as well as a potential infectivity. This test is positive in at least 38% of donors with antibodies to HCV and in more than 60% of those who, in addition, have high ALAT levels.

In a prospective randomized study we investigated the potential of subcutaneous recombinant human erythropoietin (rhEpo) as adjuvant treatment for autologous blood transfusions (3 units) in elective surgery. Four and 2 weeks before surgery, 49 patients received 6 x 10,000 U of rhEpo. delta Hb values (days -28 and 0) of the rhEpo group were compared to delta Hb values of 52 controls (no rhEpo). Reticulocytes were measured at days -21, -14, -7 and 0. Peri- and postoperative supplementary homologous blood requirements were compared in the two randomized groups. delta Hb of rhEpo group was 0.96 g/dl (mean value) and 2.38 for controls. Reticulocyte count increased earlier and to higher levels in rhEpo-treated patients. Except in 1 case, Epo was well tolerated. These results indicate that autologous predonation (3 x 400 ml) does not create anemia if adjuvant Epo treatment is given. However, homologous blood requirements were not significantly different, which is probably due to the fact that 96 of the 101 treated patients underwent elective orthopedic surgery requiring limited blood replacement. Significant benefit of the Epo regimen can be expected in elective cardiovascular and hepatic surgery where larger amounts of blood (5-6 units) are needed.

The authors report on three cases of severe P. falciparum malaria successfully treated by iv quinine and exchange transfusion. Serum concentrations of Tumor Necrosis Factor (TNF) were determined before and during treatment. After an initial decrease, serum levels of TNF remained markedly elevated during the first 48 hours despite exchange transfusion. Though exchange transfusion accelerates the elimination of parasites from the blood, it seems to have no immediate effects on reducing serum levels of cytokines such as TNF.

A 30-year-old woman was treated with unrelated HLA-compatible bone marrow transplantation for acute myeloid leukemia. Examination of her bone marrow smears because of fever and pancytopenia revealed the presence of Toxoplasma cysts. Although Toxoplasma cysts are rarely found in the bone marrow, bone marrow examination in the immunocompromised patient offers rapid diagnosis of systemic toxoplasmosis.

In 1987, a 50-year-old patient presented with isolated thrombocytopenia (27,000/mm3) which proved to be refractory to steroid medication and high i.v. doses of immunoglobulin. Two years later he developed macrocytic anemia. Chromosomal analysis confirmed the diagnosis of myelodysplastic syndrome (MDS), refractory anemia type with blast excess. Cytogenetically, three cellular populations were observed: one normal (75% of metaphases) and two abnormal, clone A (2%) 46,XY, del(5q), del(11q), and clone B (23%) 46,XY, del(5q), del(11q) plus 2 other anomalies. Evolution was characterized by worsening of the bicytopenia with marked hypoplasia of the megakaryocytic and erythroid series while the percentage of blasts remained stable. Concerning the chromosomal markers, the normal population disappeared and clone A became predominant (clone A 97%, clone B 3%). This case shows that isolated thrombocytopenia can be the sole initial manifestation of MDS. We discuss the possibility that "refractory thrombocytopenia" constitutes a diagnostic category like refractory anemia or refractory anemia with ring sideroblasts. The proliferative advantage of clone A or the disadvantage of clone B may be due to the occurrence of new, cytogenetically non-detectable mutations.

In the early 1980s a new, although still empirical therapy was proposed for women undergoing recurrent spontaneous abortions of unknown origin, where an immunologic cause is suspected. The treatment consists in immunization of the women with human lymphocytes. We report here on our own first experience with this modality and discuss the results in light of the different immunologic tests which were performed before and after immunization with paternal lymphocytes. 11/13 treated women belong to the group with abortions of alloimmune origin, 6/11 patients were delivered of a normal baby in the 40th week of gestation (median), one patient is pregnant in the 36th week of gestation, 2 had abortions again and two women are not yet pregnant. Further investigations suggest that 2/13 women had abortions of autoimmune origin; one of these women had a normal baby in the 33rd week of gestation and the other is pregnant in the 18th week.