ARTICLE
‘The first great breakthrough in the treatment of syphilis involved the use of arsenic compounds in the 20th century’
treatment for primary, secondary and tertiary syphilis was monitored by the WR. Two deaths occurred due to Neo-Salvarsan and one following a second injection of Salvarsan, which was complicated also with diphtheria.
SYPHILIS AND BLOOD TRANSFUSION The early practice of blood transfusion usually involved connecting the donor directly to the patient, creating a serious problem through the potential transmission of syphilis from donor to recipient. The introduction of effective anticoagulation and storage of blood during the 1914-18 War resulted in the transmission of syphilis by transfusion being virtually eliminated. In two reports, published in 1941, Bloch
and Turner and then Diseker showed that Treponema pallidum (the causative organism of syphilis) did not survive in blood stored at 50˚C. It is of interest that, despite this knowledge, routine testing of donor blood for
WR Day
From the 1930s until the end of the 1960s in most routine bacteriology laboratories there was one day a week known as ‘WR Day’. This was the day on which the WRs – the Wasserman reaction, a complement fixation test for syphilis, and Khans, a flocculation test for syphilis – were done. It was often a tense day until it was known that the tests had worked. This was particularly so when a junior technician was allowed to do the tests on their own for the first time. This was a significant ‘rite of passage’ in a bacteriology technician’s life. If all went well it would mean that they were ready to sit their Institute Final examination and, if successful, become a qualified technician – with a pay rise!
syphilis is still carried out in the United Kingdom. The continuation of this practice is based on the increasing use of blood components (rather than red cells), especially platelets, which are stored at 22˚C prior to transfusion.
The initial techniques for screening blood for syphilis were the Kahn test and, later, the Price precipitation test (PPR), which were not wholly satisfactory as false-negative results
occurred due to the prozone phenomenon. The Berger-Kahn slide test was also used, which although not affected by the prozone effect, unfortunately gave rise to frequent false-positive results. A review of techniques was undertaken by King and Wilkinson in 1960 and 1969, respectively, which resulted in recommendations to blood transfusion centre directors to employ the Treponema pallidum immobilisation test (TPI) and the WR using refined cardiolipin antigen for improved specificity and accuracy.
A simple slide test devised at the Venereal Disease Reference Laboratory (VDRL) became widely used for screening blood donations. This test remained popular until fully automated screening of blood was introduced. The manual VDRL test did not transfer to automation and the Treponema pallidum haemagglutination test (TPHA) became the method of choice, following the publication of a paper by Barbara and colleagues in 1982. Subsequently, enzyme-linked immunosorbent assay (ELISA) automated methods, which give increased specificity and sensitivity, were introduced and remain in use for blood screening to the present day.
The article is based on the IBMS History Committee’s Congress 2007 presentation entitled ‘The Great Pox. A History of Syphilis and its Laboratory Diagnosis’.
A selection of articles due to appear in the next issue
Volume 70, Number 4, 2013 • Vitamin D in health and disease: a literature review
• Matrix-assisted laser desorption/ionisation-time of flight mass spectrometry: rapid identification of bacteria isolated from patients with cystic fibrosis
• Rapid identification of bacteria from bioMérieux BacT/Alert blood culture bottles by MALDI-TOF
• Molecular cloning and characterisation of the methionine sulphoxide reductase A (msrA) gene locus in Campylobacter lari organisms
• Blood sample contamination by glucose-containing solutions: effects and identification
www.
bjbs-online.org DECEMBER 2013 THE BIOMEDICAL SCIENTIST 721
BJBS
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