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  • Title: [Transfusion practice in isolated areas: prevention of HIV transmission].
    Author: Flachet L.
    Journal: Dev Sante; 1993; (103):15-9. PubMed ID: 12287304.
    Abstract:
    HIV transmission is the greatest single risk of blood transfusion today. The World Health Organization estimated in late 1900 that 8-10 million persons worldwide were HIV seropositive. In Africa, 10% of adult and 25% of early childhood HIV infections are believed to be caused by contaminated transfusions. 90% of patients transfused with contaminated blood will become infected. The other serious infectious risks of transfusion are hepatitis B, malaria, and syphilis. Accidents and complications of transfusion can be avoided if transfusions are limited to absolute indications, clinical examinations of donors are thorough, the blood group is reliably determined, and testing of blood for HIV is reliably conducted. Transfusions not formally indicated are now formally contraindicated. The vital risk if the patient is not transfused must be assessed before the transfusion is done, as should the risk of transmitting infection through the transfusion. When emergencies occur in isolated areas, the donor is often a family member or person accompanying the patient. The blood of the donor as well as of the patient must be typed. The medical history and clinical examination of the donor to exclude contraindications must be thorough. The physical contraindications to blood donation are infectious disorders and especially AIDS, a history of untreated syphilis or jaundice, and recent malaria. Blood should never be donated by persons with fever, jaundice, cutaneous lesions suggesting syphilis or AIDS, clinical anemia, or cardiac insufficiency. Pregnant women and children under 15 should not donate blood. Aseptic conditions must be maintained during all handling of the blood. ABO and rhesus grouping and testing for HIV infection must be done in all cases. ELISA tests are most often used for blood screening, but the rapid tests developed a few years ago are equally reliable and more suited to isolated medical facilities or those that perform few transfusions. Because the tests give false positive results in a significant proportion of cases, they should be repeated before a positive result is reported. The results of an HIV test, whether positive or negative, should only be reported to the donor if information on the consequences of a positive test has been provided and consent to the test has been obtained, the screening test results have been confirmed by a diagnostic test, and the seropositive individual can receive medical follow-up and counselling. Prevention of syphilis transmission can be achieved by limitation of indications for transfusion, selection of low risk donors, clinical examination of donors, use of blood stored for 72 hours at 4 degrees celsius or lower, use of screening tests, and prophylactic administration of antibiotics. Clinical examination and a careful medical history are the main tools for preventing hepatitis B transmission. Systematic prophylaxis against malaria following national protocols is recommended.
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