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The epidemiology of cytomegalovirus (CMV) infection as assessed by CMV antibody testing varies significantly in different parts of the world and also in different regions of a country. A study was therefore carried out to assess the prevalence of CMV antibody in our blood donors, looking in particular at different subgroups of donors as divided by age, sex and social class, to see how we could maximise the yield of CMV-negative blood from our testing. It was shown that patterns of CMV infection in the North East of Scotland followed well-established norms. Data from other Regional Transfusion Centres within the UK were also collected for comparison.

In a 2-year study involving 133 premature low birth weight (less than 1,500 g) infants, the impact of CMV infection via blood transfusion was assessed. 8.4% (7 out of 83) of transfused infants and 10% (7 out of 70) of those exposed to seropositive blood acquired CMV. In those less than 1,250 g the infection rate rose to 13.2% (7 out of 46). Seropositive infants were at a higher risk of acquiring CMV infection than seronegative ones. CMV infection did not give rise to specific immediate morbidity, and no deaths were attributed to CMV. The only source of nosocomial CMV infection was the transfused seropositive blood. Based on these findings, it was possible to formulate a CMV transfusion policy to premature infants in our region.

An in vitro test system is described which measures the ability of anti-D sera to lyse Rh(D)-positive red cells. This test was applied to anti-D sera from 11 cases of HDN selected in Glasgow and tested 'blind' in Edinburgh. Evidence is presented to support the view that the ADCC (antibody-dependent cell-mediated cytotoxicity ) assay can correctly identify those cases where there is a satisfactory clinical outcome despite a high level of anti-D suggesting otherwise. Amniocentesis might therefore be avoided in this group.

Four patients (2 with X-linked, one with common variable hypogammaglobulinaemia, and 1 with ulcerative colitis) developed non-A, non-B hepatitis (NANBH) following administration of a specific batch of intravenous immunoglobulin (IV IgG) manufactured by the Scottish National Blood Transfusion Service using the pH4/mild pepsin method. Each patient had normal serum ALT levels over a preceding period of 12-67 months, with raised values developing within 4-18 weeks of first administration of the implicated batch. Two patients had very mild symptoms of hepatitis, the other 2 being asymptomatic. Over a follow-up period of 8-12 months, ALT levels returned to normal in 3 patients, but biopsy-proven chronic NANBH developed in the fourth. The level of NANBH virus in the starting plasma used to manufacture this batch may have exceeded the capacity of the process to inactivate the virus. The transmission of NANBH by one of approximately 110 batches administered demonstrates the importance of continued close surveillance of recipients of IV IgG, even if asymptomatic, by regular monitoring of liver function tests and recording of all batches received.