Letters to the Editor Continued monitoring for human immunodeflclency virus type 2 Infections In Callfornla To the Editor: Early in 1990, we described’ an approach for monitoring blood donors for human immunodeficiency virus type 2 (HIV2) infection by testing anti-HIV type 1 (anti-HIV-1) enzyme immunoassay (E1A)-reactive donor sera for anti-HIV-2. This approach capitalized on the n o w well-documented crossreactivity (approx. 50-90%) of anti-HIV-2 on HIV-1 viral lysatebased EIAs’J and allowed surveillance for HIV-2-infected donors by testing less than 0.2 percent of all donations. The approach was subsequently implemented on a larger scale by the American Red Cross (ARC) in cqoperation with the Centers for Disease Control (CDC).3m4 In mid-1990, we expanded the HIV-2 surveillance program to include HIV-2 testing of antiHIV-1 repeatably reactive donor sera from most non-ARC blood centers in California (ARC centers were already participating in the national ARC surveillance program). With recent licensure and widespread implementation of anti-HIV-1/2 combination assays for routine donor screening, we felt it appropriate to summarize and report our findings to date. ’helve collection facilities located throughout the state chose to participate. Between July 1, 1990, and December 31, 1992, these centers collected and screened 869,545 blood donations, of which 578 (0.066%) were repeatably reactive in anti-HIV-1 EIA. Sera from 479 of these donations (83%) were submitted for anti-HIV-2 testing, and 35 (7.3%) were reactive in the licensed HIV-2 EIA from Genetic Systems Corporation (Redmond, WA). These 35 samples were submitted to the CDC for confirmatory testing using HIV-1- and HIV-2-specific synthetic peptide-based assays and Western blots.s No HIV-2 infections were identified. Our experience indicates that HIV-2-infected individuals are exceedingly rare in California, and, in particular, that HIV-2 currently poses a negligible risk to the blood supply. Combining these findings with the negative results of blood d0n0+~ and high:risk surveillances programs elsewhere in the country, we believe that the paced implementation of EIAs incorporating HIV-2 antigen was sound policy. MICHAELP. BUSCH,MD, PHD DRPH LESLIE TOBLER, Irwin Memorial Blood Centers 270 Masonic Avenue San Francisco, CA 94118 CHARLESSCHABLE,MS LYLEPETERSEN,MD Centers for Disease Control Atlanta, GA and participating California Blood Banks: San Diego Blood Bank, San Diego Blood Bank of San BernardinolRiverside Counties, San Bemardino Blood Bank of the Alameda-Contra Costa Medical Association, Oakland Houchin Blood Bank, Bakersfield Northern California Community Blood Bank, Eureka Blood Bank, University of California, LQS Angeles Blood Bank, Memorial Medical Center, Long Beach Blood Bank, Community Hospital of the Monterey Peninsula, Monterey Irwin Memorial Blood Centers, San Francisco Sacramento Medical Foundation Blood Center, Sacramento Stanford University Blood Bank, Palo Alto Tri-Counties Blood Bank, Ventura

References 1. Busch MP. Petenen L, Schablc C, Perkins H. Monitoring blood donors for HIV-2 infection by testing anti-HIV-1 reactive sera.

Transfusion 1990;30:184-7. 2. George JR. Rayfield MA, Phillips S, et al. Efficacies of US Food and Drug Administration-licensedHIV-1-saeening enzymc immunoassays for detecting a n h i i w to HIV-2. AIDS 1990;4:321-6. 3. Suweillance for HIV-2 infection in blood donors - United States. 1987-1989. Morbid Mortal Weekly Rep 1990;39:829-31. 4. Ha B, Miller H, Hyslop A, ct sl. Detection of HIV-2 antibody in HIV-1 EIA reactive donor samples (abstract). Transfusion 1991;31(Suppl):49S. 5. O’Brien TR, George JR, Holmbcrg SD. Human immunodeficiency virus typc 2 infection in the United States: epidemiology,diagnosis. and public health implications. JAMA (In press).

Transfusion practice should be audited for both undertransfusion and overtransfision To the Editor: The March-April issue of TRANSFUSION included two articles’J describing prospective audits of transfusion practice. Both articles showed a reduction in the inappropriate use of red cell components as the medical staff became more aware of modern criteria for transfusion. Both, however, directed attention only to the issue of overuse of red cell transfusion. There is evidence that transfusion is being underutilized in some sit~ations,’.~and there is concern that transfusion medicine educational efforts coupled with apprehension about the transmission of infectious diseases have swung the pendulum too far in the direction opposite to overtransfusion. Instructions from the Joint Commission on Accreditation of Healthcare Organizations for performing transfusion audits point out that “[flailure to administer [blood or blood components] when needed may substantially decrease the likelihood of a positive outcome for the patient.”’ Auditing for undertransfusion as well as for overtransfusion was recommended. Nevertheless, I have been unable to find any information that speaks to the order of magnitude of undertransfusion practice. The purposes of this letter are to call attention to undertransfusion as a problem and to encourage transfusion medicine specialists to devise audits to detect it. The National Heart, Lung, and Blood Institute (NHLBI) is interested in the magnitude of this problem in the context of a need to modify professional education materials that are part of the NHLBI’s National Blood Resource Education Program. I continue to believe that good clinical judgment is better than any single measure as the basis for decisions regarding perioperative transfusion, although laboratory data such as arterial oxygenation, mixed venous oxygen tension, cardiac output, the oxygen extraction ratio, and blood volume, when indicated, are often useful. CLAUDELENFANT, MD National Heart, Lung, and Blood Institute Building 131 National Institutes of Health Bethesda, M D 20892

References 1. Lepage EF, Gardner RM, h u b RM, Golubjatnikor OK. Improving blood transfusion practice: role of a computerized hospital infor-

mation system. Transfusion 1992;32:253-9.

873

Transfusion practice should be audited for both undertransfusion and overtransfusion.

Letters to the Editor Continued monitoring for human immunodeflclency virus type 2 Infections In Callfornla To the Editor: Early in 1990, we described...
122KB Sizes 0 Downloads 0 Views