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ABSTRACTS OF PAPERS PRESENTED AT THE 92ND RESEARCH MEETING OF THE MEDICAL RESEARCH CENTRE OF BOMBAY HOSPITAL ON MONDAY, 10TH DECEMBER 2001, 2.30 PM SP JAIN CAFETERIA (CONVENOR DR. HL DHAR)
1. DONOR VDRL TESTING –RELEVANCE
Praveen Singh, Maya Parihar–Malhotra
Syphilis is a veneral (sexually transmitted) disease caused by spirochaetes, Treponema pallidum. There are 3 stages of the disease – Primary, Secondary, Tertiary.
Treatment - Penicillin is uniformly effective in syphilis.
Routes of Transmission
1. Sexual intercourse.
2. Intimate person to person contact with lesion on lips, tongue, or fingers.
3. Materno-foetal transmission.
4. Transfusion of infected blood or blood products.
Serological Test
After infection, the host forms Treponemal antibodies to Treponema pallidum, in addition the host also forms Non- Treponemal antilipoidal antibodies in response to the lipoidal material released from the damaged host cell. These antibodies are traditionally referred as 'Reagins' . There are two types of tests-
1. Non-treponemal based tests.
2. Treponemal based tests.
Percentage positivity of tests during various stages
Stage VDRL FTA-ABS TPHA Primary 70 85 55 Secondary 100 100 100 Latent/Late 70 98 98
Donor testing for syphilis is mandatory by FDA (also HIV/HbsAg/HCV/MP). At our blood bank we have been using the Redgen test for syphilis. REDGEN detects antilipoidal antibodies in serum or plasma.
Principle
During the test procedure, the specimen, serum or plasma is mixed with REDGEN reagent and allowed to react for eight minutes. If antilipoidal antibodies are present in the specimen, they will react with REDGEN reagent forming visible red floccules against the white background of the reaction card. If antilipoloidal antibodies are not present in the specimen, there will be no flocculation, resulting in an even matt on the reaction cicle.
Note/CautionInterpretation of test results
- In the absence of supporting clinical, historical or epidemiological evidence, reactive results must be confirmed with more specific treponemal tests.
- False positive reactions occur frequently and have been attributed to a variety of acute and chronic conditions.
1. Reactive
2. Weakly reactive
3. Non–reactive
DISCUSSION
Disadvantages
1. Cost - Added cost of a disputed test.
2. Many biologicaol false positive (BFP) test results-
BFP test results are positive results found in uninfected individuals, the cause of which may be unknown.
-Safe blood wasted.
-Donors frightened, embarrassed.
Causes of BFP - diabetes, rheumatoid arthritis, lupus, pregnancy.
3. Syphilis very rarely transmitted by blood transfusion.
4. Incomplete detection: Window period cases missed.
AdvantagesToday donor screening test is done not because there is a concern with transfusion transmitted syphilis but rather because syphilis like hepatitis B, hepatitis C and HIV, is a sexually transmitted disease. A donor who proves to be syphilis positive is probably at a higher risk for exposure to hepatitis and HIV because it implies that "safe" sexual practices have not been followed.
- Historical success eliminating transfusion transmitted syphilis.
- Active syphilis cases sometimes detected, treated, contacts found (Public Health benefit).
- Surrogate test for HIV/hepatitis (disputed)-
However, there is still no consensus whether the test helps to account for the rarity of transfusion-transmitted syphilis.
2. SIGNIFICANCE OF ALPHA FOETO PROTEIN AS A TUMOUR MARKER IN LIVER DISORDERS
Rashmi Deshpande, SR Kankonkar
Tumour markers have been attracting growing interest in experimental and clinical medicine. A tumour marker is suitable for clinical use as it can provide clinically relevant information about a tumour in the area of diagnostic, differential diagnosis and/or after-care and therapy or as a prognostic parameter.
Alpha foeto protein (AFP), a single polypeptide chain of glycoproteins with molecular weight 70,000 Dalton is synthesized primarily in the liver and yolk sac of foetus. AFP is the most important circulating tumour marker for detection of hepatocellular carcinoma (HCC). Serum AFP levels are found elevated in HCC as well as in benign hepatic conditions such as acute viral hepatitis, chronic active hepatitis and cirrhosis.
Thirty patients and 15 normal subjects were studied for detection of AFP by Microparticle Enzyme Immunoassay (MEIA). The male:female ratio was 4:1. The age range was 18 to 78 years. 50% of the patients were from the age group 41-60 years. The serum AFP concentrations were found elevated with increasing age.
The patients showed symptoms like abdominal pain, abdominal distention, ascites, gastritis, icterus, weight loss, etc. SGOT and SGPT values and also creatinine, bilirubin, alkaline phosphatase and lactate dehydrogenase values were found to be high.
Seven cases of HCC, 13 cases of liver cirrhosis and 5 cases of other benign liver diseases showed high serum AFP concentrations. All the 4 patients with secondary liver metastasis and 1 patient with operated HCC showed normal serum AFP concentration. Seven patients with HBV infection, 5 patients with HCV infection and 5 alcoholic patients showed elevated serum AFP concentrations.
AFP helps in primary diagnosis, differential diagnosis and prognosis of disease progression. Hence AFP determination is recommended for screening of HCC for monitoring high risk groups (HBs antigen positive chronic active hepatitis, cirrhosis, hepatitis B acquired in childhood).
3. ROLE OF MSW IN THE BLOOD BANK
Charulata Murudkar, Maya Parihar-Malhotra
The Blood Bank of Bombay Hospital mainly caters to the blood requirement of the hospital. Ours is a blood bank attached to a tertiary care hospital and due to the high consumption of blood in the OTs and the ICUs, there is a continuous struggle between the demand and supply of blood. Blood can not be manufactured and our blood stock is maintained by donations made by the relatives of the patients admitted in the hospital and voluntary donors. Our voluntary donors programme is being further developed so that we can tap this essential and reliable source of blood.
The Medical Social Worker (MSW) functions as a common link between the patients, doctors and the blood bank staff. The MSW is the person who looks into the blood requirement of the patient, motivates and counsels the relatives of the patient, who come to the blood bank with queries and regarding their patient’s blood requirement. In this way MSW strikes a balance between the donation and the issue functions of the blood bank.
Ideally for any planned surgery the patient’s relatives should be informed by the treating doctor and the requisition slip should be filled at least two days before the blood requirement whether it is for some medical disorder or for an operation. Thus the patient’s relatives as well as the blood bank has sufficient time to make the required arrangement. But most often this requisition slip is given on the same day of the blood requirement. The result is that the relatives as well as the blood bank is put through unwarranted pressure to arrange blood for the patient and a routine situation presents as an emergency. During the blood bank working hours these are the crucial times where the MSW comes in between and tries to sort out the problem.
Inspite of having a regularized system of meeting the day to day blood requirement of the hospital, many a times things are not as simple as they sound because there are many more factors that contribute to the shortage of blood. Basically, people believe that once they have made a payment to the hospital, just like any other medical assistance provided to them, blood is also something that would be taken care of by the hospital. More and above the relatives feel that blood is a commodity that could be bought by the mere payment of cash.
A major hindrance to blood donation is the misconceptions people have (1) blood donation causes weakness, (2) it may expose them to HIV infection, (3) blood donation is a lengthy procedure, (4) common blood groups are easily available but it is an irony that the common groups are the ones which are most commonly needed. This is when we face the major problem of convincing the relatives themselves to donate blood and discouraging any sort of help taken from professional blood sellers.
Let me sum up by saying that the MSW in the blood bank has the non-stop challenge of meeting the day to day blood requirements of the patients. As and when it is required every staff of the blood bank also puts in their effort to help a patient and motivate the relatives to come forward for the donation. I must surely say that though this all sounds like a struggle, but the fact that we are part of the team that has helped in the patient’s successful recovery is reward enough.
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