Armed Services Blood Program Office and the United States Army Blood Program, Falls Church, Virginia, USA.
Transfusion. 2011 Mar;51(3):473-85. doi: 10.1111/j.1537-2995.2010.02906.x. Epub 2010 Oct 7.
Current US military clinical practice guidelines permit emergency transfusions of non-Food and Drug Administration (FDA)-compliant freshly collected blood products in theaters of war. This investigation aimed to characterize the risks of transfusion-transmitted infections (TTIs) associated with battlefield transfusions of non-FDA-compliant blood products.
US Service members who received emergency transfusion products in Iraq and Afghanistan (March 1, 2002-September 30, 2007) were tested for hepatitis C virus (HCV), human immunodeficiency virus (HIV), and hepatitis B virus (HBV) infections using reposed pre- and posttransfusion sera. Selected regions of viral genomes from epidemiologically linked infected recipients and their donors were sequenced and compared.
Of 761 US Service members who received emergency transfusion products, 475 were tested for HCV, 472 for HIV, and 469 for HBV. One transfusion-transmitted HCV infection (incidence rate of 2.1/1000 persons) was identified. The pretransfusion numbers (prevalence per 1000 persons) were HCV-four (8/1000), HIV-zero (0/1000), chronic HBV-two (4 /1000), and naturally immune (antibody to HBV core antigen)-nine (19/1000).
One HCV TTI was determined to be associated with emergency blood product use. The pretransfusion HCV and HBV prevalence in transfusion recipients, themselves members of the potential donor population, indicates better characterization of the deployed force's actual donor population, and further investigations of the TTI prevalence in these donors are needed. These data will inform countermeasure development and clinical decision making.
目前，美国军事临床实践指南允许在战区紧急输注未经食品和药物管理局（FDA）批准的新鲜采集的血液制品。本研究旨在描述与战场输注未经 FDA 批准的血液制品相关的输血传播感染（TTI）的风险。
2002 年 3 月 1 日至 2007 年 9 月 30 日期间，在伊拉克和阿富汗接受紧急输血产品的美国军人使用重新采集的输血前和输血后血清检测丙型肝炎病毒（HCV）、人类免疫缺陷病毒（HIV）和乙型肝炎病毒（HBV）感染情况。对来自具有流行病学关联的感染受者及其供者的病毒基因组的选定区域进行测序并进行比较。
在 761 名接受紧急输血产品的美国军人中，475 名接受 HCV 检测，472 名接受 HIV 检测，469 名接受 HBV 检测。确定了 1 例输血传播 HCV 感染（发病率为 2.1/1000 人）。输血前人数（每 1000 人患病率）为 HCV4 例（8/1000），HIV0 例（0/1000），慢性 HBV2 例（4/1000），自然免疫（抗乙型肝炎核心抗原抗体）9 例（19/1000）。
确定了 1 例与紧急血液制品使用相关的 HCV TTI。输血受者的输血前 HCV 和 HBV 患病率，他们本身就是潜在供者人群的一部分，表明需要更好地描述部署部队的实际供者人群，并进一步调查这些供者中的 TTI 患病率。这些数据将为对策制定和临床决策提供信息。
