10th Anniversary Commemorative Album Working Team FFFFFrrrrrooooommmmm llllleeeeefffffttttt tttttooooo rrrrriiiiiggggghhhhhttttt::::: Dr. Edmond Ma Ms. Paule Tang (Hon. Treasurer) Mr. NK Chan (Hon. Secretary) Dr. Gregory Cheng Dr. CK Lee (Chairman) Dr. Raymond Chu Dr. Jason So Contents Preface 3 Review of Contribution of Hong Kong to Literature on 4 Transfusion Medicine Articles by Past and Present Chairpersons Dr. Susan Leong Hong Kong Red Cross Blood 17 Transfusion Service Blood Programme Blood: Free and Safe Dr. C. S. Feng 25 Hospital Transfusion Practices Dr. Gregory Cheng 28 Innovations in Blood Transfusion Practice Dr. Edmond Ma Hong Kong Association of Blood Transfusion and 33 Haematology: History and Milestones Dr. Raymond Chu 40 How safe is Blood Transfusion in Hong Kong? Dr. C.K. Lee 45 New Developments in Blood Transfusion 4 Preface Dr. CK Lin Hospital Chief Executive Hong Kong Red Cross Blood Transfusion Service Itgives me great pleasure to provide the Preface for this 10th Anniversary Commemorative Album of the Hong Kong Association of Blood Transfusion and Haematology (HKABTH). The establishment of the HKABTH ten years ago was a symbol of the drive, foresight and energy of a band of like-minded doctors and transfusion specialists who recognized the future importance of their area of interest and study. The science and its practical applications have developed and progressed dramatically over the last ten years, and often in directions that may not have been readily foreseen. Nevertheless, the very presence of the HKABTH has provided a healthy and lively forum for considered debate and discussion and a fertile ground for developing ideas and adding to the wide range of research on our subject. It is perhaps significant that this anniversary also coincides with the 50th Anniversary of the establishment of a formal Blood Collection Service in Hong Kong started by the Hong Kong Red Cross. Both anniversaries serve to demonstrate just how seriously the subjects of blood transfusion and haematology have been taken in Hong Kong, in terms of both practice and theory, and how, from virtually nothing, Hong Kong has become a regional leader and example of best practice in such a short period of time. This Commemorative Album contains a comprehensive bibliography of the research material that has emanated from Hong Kong on the subject of transfusion medicine. It is an impressive list and, we must hope, one that will be joined by many more learned papers and contributions in the years to come. We are also most grateful to our six esteemed colleagues, past and present HKABTH chairpersons, who have contributed their own thoughts in a series of papers that both look back over a momentous period of development in transfusion and haematology, but also look forward to future directions for development and highlight some of the significant issues relating to our subject. This Commemorative Album is a fitting tribute to an important institution and a commendable effort to its production team. I offer my warmest congratulations to all who have made the past ten years of such success for the HKABTH. 5 Review of Contribution of Hong Kong to Literature on Transfusion Medicine Compiled by Mr. NK Chan, Dr. Jason So and Ms. Paula Tang T he field of transfusion medicine has 2. Fok TF, So LY, Leung KW, Wong W, advanced significantly over the past 50 Feng CS, Tsang SS years. New scientific findings and innovative ideas are disseminated throughout the Use of peripheral vessels for exchange medical community largely by way of transfusion* publication in peer-reviewed journals. Arch Dis Child 1990;65:676-8 Transfusion workers in Hong Kong have been actively contributing to this advancement, The study demonstrates the practicability as evidenced by the many articles that and safety of using peripheral access for appear in international journals. Listed below exchange transfusion in infants. The are research papers and review articles problem of excessive cather-induced published by local authors in the medical haemolysis was not seen. literature. A brief abstract accompanies each article that serves to introduce to 3. Poole J, King MJ, Mak KH, Liew YW, readers the main ideas and findings Leong S, Chua KM presented by the authors. Interested readers are strongly recommended to peruse the The MiIII phenotype among Chinese original articles for complete information. We donors in Hong Kong: immunochemical apologize to authors of articles omitted here and serological studies# due to incomplete literature search. Transfus Med 1991;1:169-75 * Paper published by author(s) in an insti- Immunochemical and serological studies tution in Hong Kong among Chinese donors in Hong Kong # Paper by local author(s) and with study illustrated (1) the advantage of using subjects from Hong Kong immunoblotting to identify the Mi sub- class of large numbers of red cell 1. Feng CS, Tsang SS samples when specific typing serum was not available. (2) the detection of A survey of fresh frozen plasma use in a homozygous MiIII cells which was not teaching hospital in Hong Kong* previously possible by conventional Pathology 1989;21:85-7 serological techniques (3) the dominant inheritance of the MiIII gene. A survey on the appropriate use of FFP was conducted in Prince of Wales Hospital in Hong Kong, based on the consensus statement of the United State National Institute of Health (NIH). Among the 746 units of FFP used in a 30 days period, only 8.7% could be considered inappropriate. 6 REVIEW OF CONTRIBUTION OF HONG KONG TO LITERATURE ON TRANSFUSION MEDICINE 4. Feng CS, Wan CP, Lau J, Lam TK, 6. Lin CK, Chu R, Li KB, Leong S Fok TF. A study of hepatitis C virus antibodies Incidence of ABO haemolytic disease of and serum alanine amino transferase in the newborn in a group of Hong Kong blood donors in Hong Kong Chinese* babies with severe neonatal jaundice* Vox Sang 1992;62:98-101 J Paediatr Child Health 1990;26:155-7 The relationship between serum ALT and This study conveys two pieces of impor- anti-HCV tests was studied and con- tant information. First, the amount of cluded that: (1) there is a direct relation- maternal ABO antibodies bound on ship between serum ALT level and anti- neonatal red cells does not correlate HCV positively by EIA; (2) there is a direct with the degree of hyperbilirubinaemia. correlation between serum ALT level and Second, ABO haemolytic disease of the anti-HCV ELISA ratio, and (3) both Abbott newborn occurs predominantly in the and Ortho anti-HCV kits perform similarly settings of group O mother and group A in the identification of positive serum or B newborns. samples. 5. Feng CS, Ng AK 7. Mak KH, Voak D, Chu RW, Leong S, Chua KM An analysis of donor blood wastage due to outdating in a large teaching Bv: a distinct category of B sub-group hospital* among Chinese blood donors in Hong Pathology 1991;23:195-7 Kong* Transfus Med 1992;2:129-33 The authors reported their analysis of the pattern and rate of donor blood The authors presented a detailed study outdating in Prince of Wales Hospital of this special blood subgroup, with from 1986 to 1990. They found that the emphasis on the laboratory techniques rate of blood outdating was significantly for its differentiation from other B reduced after implementation of the subgroups. Type and Screen crossmatch protocol. 77 REVIEW OF CONTRIBUTION OF HONG KONG TO LITERATURE ON TRANSFUSION MEDICINE 8. Mak KH, Yan KF, Cheng SS, Yuen MY 10. Lau YL, Chow CB, Lee AC, Ng KW, Lim WL, Chan CF, Lam SY, Li CK Rh phenotypes of Chinese blood donors in Hong Kong, with special reference to Hepatitis C virus antibody in multiply weak D antigens* transfused Chinese with thalassaemia Transfusion 1993;33:348-51 major* Bone Marrow Transplant 1993;12 Suppl 1: The authors reported the Rh phenotypes 26-8 of Chinese blood donors in Hong Kong with special reference to the weak D The authors detected a percentage antigens. Of 0.27 percent apparently D (34%) of hepatitis C virus carriage in this negative, 0.19 percent were "true D group of patients. They also showed that negative" and 0.079 Del phenotypes as seropositivity was associated with age defined by the reactivity of eluate and the number of units transfused. obtained by an adsorption and elution procedure using anti-D. 56.77 percent of 11. Mak KH, Banks JA, Lubenko A, the "apparent D negative" and 80.24 Chua KM, Torres de Jardine AL, Yan KF percent of the "true D negative" were ccdee phenotype. A survey of the incidence of Miltenberger antibodies among Hong 9. Simmonds P, McOmish F, Yap PL, Kong Chinese blood donors* Chan SW, Lin CK, Dusheiko G, Transfusion 1994;34:238-41 Saeed AA, Holmes EC The authors reported that the incidence Sequence variability in the 5' non-coding of Miltenberger antibodies among Hong region of hepatitis C virus identification Kong Chinese blood donors was 0.057% of a new virus type and restrictions on and most of them were naturally sequence diversity# occurring. J Gen Virol 1993 ;74:661-8 12. Chiu EK, Yuen KY, Lie AK, Liang R, Lau Using molecular techniques the authors YL, Lee AC, Kwong YL, Wong S, Ng MH, discovered a new type of hepatitis C Chan TK virus (type 4) which was not usually found in the Far East. They also showed that the A prospective study of symptomatic sequence variability in the genome bacteremia following platelet transfusion among different types was less than and of its management* expected due to covariability. This Transfusion 1994;34:950-4 phenomenon resulted in preservation of an important secondary loop structure in This is one of the few prospective studies all different types on the topic and is often quoted. The authors found that significant febrile reactions (> 2 degree Celcius rise) occurring within 24 hours of platelet transfusion were highly likely to be indica- tive of bacteraemia. They also proposed routine retention of the transfused plate- let bags for 24 hours to facilitate micro- biological investigations if needed. 8 REVIEW OF CONTRIBUTION OF HONG KONG TO LITERATURE ON TRANSFUSION MEDICINE 13. Mak KH, Lin CK, Ford DS, Cheng G and 15. Bhattacherjee V, Prescott LE, Pike I, Yuen C. Rodgers B, Bell H, El-Zayadi AR, Kew MC, Conradie J, Lin CK, Marsden H, The first example of anti-Gya detected in et al Hong Kong* Immunohematology, 1995; 11:20-21. Use of NS-4 peptides to identify type- specific antibody to hepatitis C virus The authors reported the first example of genotypes 1, 2, 3, 4, 5 and 6# potent anti-Gya in a Hong Kong Chinese J Gen Virol 1995;76:1737-48 old male patient when his blood was found incompatible with all units of The authors used the 5' end of the NS-4 blood tested by a saline indirect anti- peptides of hepatitis C virus (HCV) to globulin test. The patient was transfused identify the type-specific antibody to six with 10 units of Gy(a+) blood without any major genotypes (1 to 6). They found adverse effect. that 87% samples from blood donors and patients infected with chronic HCV 14. Mellor J, Holmes EC, Jarvis LM, genotypes 1 to 6 showed detectable Yap PL, Simmonds P. The International type-specific antibody to NS-4 peptides HCV Collaborative Study Group that in almost all cases (>97%) (Dr. CK Lin is a member of the study corresponded to the genotype group) detected by a PCR method. These results show that there are major antigenic Investigation of the pattern of hepatitis C differences between genotypes of HCV, virus sequence diversity in different and explain why detection of infection geographical regions: implications for with different variants of HCV by a virus classification# serological test is possible. J Gen Virol 1995;76:2493-507 16. Lin CK, Wong KF, Mak KH, Yuen CM, This extensive and detailed study shows Lee AW that the genetic information in a small part of the hepatitis C virus genome Hemolytic transfusion reaction due to Rh (NS-5) provided adequate information antibodies detectable only by manual for classification of most genotypes, polybrene and polyethylene glycol subtypes and isolates. New types of this technique* virus were detected from the specimens Am J Clin Pathol 1995;104:660-2 collected from different areas in the Eastern Hemisphere. Study on the The authors reported two cases of severe phylogenetic relationship of these strains hemolytic transfusion reaction gave hints for the mechanism of attributable to Rh antibodies, which transmission of this virus. were readily detectable by manual polybrene technique, manual polybrene indirect antiglobulin test and polyethylene glycol indirect antiglobulin test, but not detectable by conventional methods such as saline indirect antiglobulin test, low ionic strength saline solution technique, or two-stage enzyme indirect antiglobulin test. 9 REVIEW OF CONTRIBUTION OF HONG KONG TO LITERATURE ON TRANSFUSION MEDICINE 19. Lin CK, Mak KH, Yuen CMY, Chan NK, Liu HW, Cheng G. A case of hydrops fetalis, probably due to antibodies directed against antigenic determinants of GP.Mur (Miltenberger Class III) cells* 17. Yip SP, Yow CM, Lewis WH Immunohaematology 1996; 12:115-118. DNA polymorphism at the ABO locus in The authors reported a case of hydrops the Chinese population of Hong Kong* fetalis due to maternal anti-Mi. The Hum Hered 1995;45:266-71 maternal anti-Mi was a mixture of IgG1 and potent IgG3 and fixed DNA polymorphism at the ABO locus was complement. It gave strongly positive investigated using denaturing gradient results in the monocyte monolayer assay gel electrophoresis of polymerase-chain- and chemiluminescence test. reaction-amplified DNA products from 315 healthy individuals of the Chinese 20. Prescott LE, Simmonds P, Lai CL, population of Hong Kong. Five different Chan NK, Pike I, Yap PL, Lin CK alleles were identified. The genotyping method identifies many more alleles in Detection and clinical features of hepa- the ABO locus and thus makes it a more titis C virus type 6 infections in blood useful genetic marker in linkage analysis, donors from Hong Kong# paternity testing and individualization in J Med Virol 1996;50:168-75 forensic work. This study employs serological as well as 18. Davidson F, Simmonds P, genotyping techniques to determine the Ferguson JC, Jarvis LM, Dow BC, genotype distribution of hepatitis C virus Follett EA, Seed CR, Krusius T, Lin CK, in 212 viraemic blood donors from Hong Medgyesi GA, et al Kong. The most frequent genotypes were 1b and 6a, at percentages of 58.8 Survey of major genotypes and subtypes and 27.0 respectively. Previous blood of hepatitis C virus using RFLP of se- transfusion, intravenous drug abuse and quences amplified from the 5' non- tattooing were identified as the major coding region# risk factors for infection. A history of drug J Gen Virol 1995;76:1197-204 abuse was found in 66% of donors infected with the 6a genotype. This paper describes a molecular method for genotyping hepatitis C virus. 21. Yip SP, Choy WL, Chan CW, Choi CH The prevalence of the various geno- types in the world was studied using this The absence of a B allele in acquired B technique in an international collabora- blood group phenotype confirmed by a tion (15 countries/regions including DNA based genotyping method* Hong Kong). Important geographical J Clin Pathol 1996;49:180-1 differences in genotype distribution was found, which provides important infor- The authors confirmed the absence of a mation for further epidemiological B allele in a group A patient with ac- studies. quired B blood group phenotype by DNA based genotyping methods. 10