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Biomedical subjects

J Gillon

Publications and source records attributed to J Gillon.

At least 37 records · Page 2Linked to original sources
PubMed1996

Consensus conference on autologous transfusion. Acute normovolaemic haemodilution.

ANH is a relatively cheap and logistically straightforward method of autologous transfusion which is attractive in that it may be applied to a wide cross-section of patients, many of whom will not be suitable for pre-deposit. There are, however, concerns about the safety of the procedure, and doubts have been expressed about its efficacy in reducing allogeneic transfusion requirements and, therefore, its cost-effectiveness. Assessment of the value of the procedure is hampered by the lack of large scale prospective, controlled trials. In the present state of knowledge it seems that ANH is most likely to be safe, efficacious and cost-effective when undertaken aggressively (target haematocrit < 0.20) in otherwise healthy, young patients undergoing elective surgery with large expected blood losses.

Adult↗
PubMed1994

Prevalence and epidemiological characteristics of hepatitis C in Scottish blood donors.

All blood donors in Scotland who were found to be infected with hepatitis C virus (HCV) in the first 6 months of routine testing of all donations for anti-HCV were contacted. Those who attended were counselled, a history of exposure to risk was sought, and blood was taken for alanine aminotransferase (ALT) level as a measure of liver function. The epidemiological features were then correlated with the virological findings and ALT. In the period under study between September 1991 and February 1992, 180,658 blood donors attended. The prevalence of HCV infection was 0.088%. Of the 151 donors who attended for counselling, 101 (68%) were male. Intravenous drug use was the most common risk activity (39%), followed by previous blood transfusion (15.2%), other parenteral exposure (11.2%) and heterosexual contact with a parenterally infected partner (8.6%); 29.1% of donors gave no history of possible exposure. Elevated ALT levels were found in 59%. ALT levels were higher in donors with HCV types 1 and 3 than in HCV type 2 or non-viraemic donors. The prevalence of HCV in Scottish blood donors is thus relatively low. This may relate to the effectiveness of donor selection procedures, but donors with risk activities which should debar them continue to donate. The combination of ALT and PCR appears to be useful in counselling and assessing infected donors.

Alanine Transaminase↗
PubMed1994

Risk of hepatitis C in patients who received blood from donors subsequently shown to be carriers of hepatitis C virus.

A retrospective study was undertaken to identify recipients of blood from donors subsequently shown to be positive for hepatitis C virus using second-generation tests and polymerase chain reaction. The main aims were to determine the numbers of such recipients who were still alive and traceable, and to determine the risk of infection in this group. The feasibility and workload of this procedure, which is currently not practised in the U.K. or U.S.A., was also assessed. In the first six months of routine testing 42,697 donors were tested. Of 20 confirmed to be HCV-positive, 15 were regular donors. Eighty-three components were prepared from 63 anti-HCV positive previous donations from these donors. In all, nine recipients were found to be alive. All were positive for anti-HCV. We conclude that although this retrospective procedure is time-consuming and difficult, substantial numbers of infected recipients can be identified. The availability of treatment for chronic hepatitis C for such patients should encourage transfusion services to reassess current policies on the hepatitis C retrospective.

Blood Donors↗
PubMed1993

Detection of three types of hepatitis C virus in blood donors: investigation of type-specific differences in serologic reactivity and rate of alanine aminotransferase abnormalities.

The serologic reactivity and epidemiology associated with different hepatitis C virus (HCV) variants were investigated in a cohort of 113 anti-HCV-positive donors. In Scotland, HCV type 1 accounted for one-half of all infections; 40 percent of subjects were infected with HCV type 3, and the remainder were infected with type 2. Reactivity with the NS-4-encoded antigens in the first-generation anti-c100 assay was absent in 68 percent of donors infected with types 2 and 3, as compared with 10 percent for those infected with type 1. Even when combined with surrogate marker testing, first-generation tests would have failed to detect 12 percent of HCV-infected blood donors. The age distribution, incidence of past infection with hepatitis B virus, and reported risk factors were similar in donors infected with types 1 and 3 (mean ages were 31.9 and 29.9; 18 and 17.5% were positive for antibody to hepatitis B core antigen; and 47 and 48% had past intravenous drug abuse). However, the distributions of alanine aminotransferase levels were significantly different in those infected with type 3 (abnormally raised in 83%) and those infected with type 1 (55% abnormal alanine aminotransferase; p < 0.05) or type 2 (60%; p < 0.01) and those who were nonviremic (8%; p < 0.0001). These data suggest that HCV type 1 is the most common HCV infection in blood donors and that infection with HCV type 3 may be associated with more severe liver disease, because of more recent infection or because of a greater inherent pathogenicity of type 3 variants.

Alanine Transaminase↗
PubMed1993

Peripheral blood stem cell mobilization using high-dose cyclophosphamide and G-CSF in pretreated patients with lymphoma.

Peripheral blood stem cell (PBSC) mobilization for autologous transplantation is more difficult in treated patients and those with bone marrow involvement. In 17 pretreated lymphoma patients, cyclophosphamide (4 g/m2) and G-CSF mobilized a median circulating peak of 1959 CFU-GM/ml on day 12.5. PBSC harvesting commenced when WBC was 1 x 10(9)/l at day 10.5 collected a median of 21.2 x 10(4)/CFU-GM/kg. 13/17 (76%) patients exceeded the 10 x 10(4) CFU-GM/kg threshold for engraftment. The CFU-GM yield was significantly higher in patients whose WBC recovered from 1-5 x 10(9)/l in less than 3 days and correlated with the maximum WBC pre and post the cyclophosphamide induced nadir. This regime safely mobilized adequate PBSC in the majority of pretreated lymphoma patients.

Adult↗
PubMed1993

Prevalence and consistency of ALT elevation in plasmapheresis donors: implications for the assessment of blood product infectivity.

Alanine aminotransferase (ALT) levels were determined in 8,420 plasmapheresis donations obtained from 431 donors over a period of 18 months. Using sex-differentiated normal ranges 2.5% of donations but 23% of donors exhibited elevated ALT levels on at least 1 occasion. Amongst the donors with elevated ALT this was only seen on 1 occasion in one third, while a quarter had elevations in consecutive donations. No donors with consecutive elevations above 100 IU/l were detected. The results are discussed in terms of the guidelines currently recommended for assessing post-transfusion hepatitis infectivity of blood products, such as factor VIII. It is concluded that the current allowance for infection acquired from sources other than blood products under consideration may be over-generous, leading to a potential underestimate of the true rate of infection.

Adult↗
PubMed1992

A controlled trial of intra-operative autologous transfusion in cardiothoracic surgery measuring effect on transfusion requirements and clinical outcome.

We carried out a prospective, controlled trial of intra-operative autologous transfusion (IOAT) in cardiac surgery using the Haemonetics Cellsaver 4, to determine the effects on transfusion requirements and early clinical outcome. Intra-operative autologous transfusion in unselected patients resulted in a reduction in the use of red cells in patients undergoing first-time operations (IOAT median 3 units, controls median 4 units, P = 0.0023), with no difference in the use of other blood products. Post-operative haemoglobin was higher in IOAT patients (IOAT 11.6 g/dl +/- 1.1 versus controls 11.2 g/dl +/- 0.98, P < 0.001). There is therefore the potential for a further reduction in homologous blood use in the IOAT group. There was no difference in early clinical outcome in the two groups; in particular the incidence of coagulopathies was not influenced by IOAT. The routine use of IOAT would add substantially to the cost of these operations. The decision to use it must therefore be based on an assessment of the value of the reduction in risk to the patient achieved by a small reduction in homologous donor exposures.

Adult↗
PubMed1991

Efficiency of blood use and prospects for autologous transfusion in general surgery.

A 6-month retrospective audit of crossmatch and transfusion practice in a general surgical unit has been performed. Inefficiencies in blood ordering practices have been demonstrated and the value of performing a local audit to allow estimation of blood needs has been proven. Using criteria based on the suggested tariff for operations derived from this audit, only a small number of general surgical patients would be considered as potential autologous blood donors.

Blood Donors↗
PubMed1989

Scottish attitudes to blood donation and AIDS.

OBJECTIVE: To see whether the issue of AIDS has influenced the observed decline in blood donation in Scotland. DESIGN: Two methods: a quantitative survey using personal interviews based on a questionnaire and a qualitative survey based on group discussions. SETTING: Interviews based on the questionnaire were conducted in the respondents' homes. The group discussions were held in the homes of professional market research interviewers. PARTICIPANTS: For the quantitative survey a representative sample of 976 Scottish adults was selected by multistage sampling. In the qualitative survey 16 groups of five to eight respondents assigned according to donating experience and sociodemographic criteria took part. MAIN RESULTS: AIDS was not mentioned as a discouraging factor in donation, and off putting aspects identified before AIDS became a public issue remained salient--for example, fear of needles. Many (75%) thought it unlikely that donation entailed a risk of developing AIDS. Nevertheless, respondents were reluctant to consider the AIDS issue personally. Being asked to do so, as in the routine screening of donors, aroused fears and resentment. CONCLUSIONS: The issue of AIDS, including fear of infection, has not directly influenced the declining numbers of donors, but the unpleasant associations of AIDS have had an indirect effect, particularly in undermining the emotional benefits of giving blood. For example, the screening process, which requires potential donors to consider their personal risk from AIDS, had had the effect of discouraging donors in general. Redressing the balance is difficult as screening must be universally applied. Rather than minimising the issue of AIDS, publicity needs urgently to reassert the positive benefits of and rewards from giving blood.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Respiratory impairment in inflammatory bowel disease: does it vary with disease activity?

Serial assessments of respiratory function were made in 44 patients with inflammatory bowel disease. Pulmonary function tests were performed at the initial assessment and after three months to see if abnormality was associated with alteration in disease activity, drug therapy or with evidence of immunological disturbance. Fourteen patients (32%) had some abnormality of respiratory function when first investigated. Seven (16%) had a reduced gas transfer factor but these abnormalities were not related to disease activity, drug therapy or any immunological variable. Elevation of both functional residual capacity and residual volume was found in nine (20%) patients at the initial assessment. These abnormalities appeared to be associated with active inflammatory bowel disease and in four of these patients lung volumes returned to normal at 3 months when the bowel disease was in remission.

Adolescent↗
PubMed1989

Transmission of non-A, non-B hepatitis by pH4-treated intravenous immunoglobulin.

Four patients (2 with X-linked, one with common variable hypogammaglobulinaemia, and 1 with ulcerative colitis) developed non-A, non-B hepatitis (NANBH) following administration of a specific batch of intravenous immunoglobulin (IV IgG) manufactured by the Scottish National Blood Transfusion Service using the pH4/mild pepsin method. Each patient had normal serum ALT levels over a preceding period of 12-67 months, with raised values developing within 4-18 weeks of first administration of the implicated batch. Two patients had very mild symptoms of hepatitis, the other 2 being asymptomatic. Over a follow-up period of 8-12 months, ALT levels returned to normal in 3 patients, but biopsy-proven chronic NANBH developed in the fourth. The level of NANBH virus in the starting plasma used to manufacture this batch may have exceeded the capacity of the process to inactivate the virus. The transmission of NANBH by one of approximately 110 batches administered demonstrates the importance of continued close surveillance of recipients of IV IgG, even if asymptomatic, by regular monitoring of liver function tests and recording of all batches received.

Adolescent↗