The overall absence of an association of NIDDM with pulmonary function in these older adults may reflect survival bias and the small number of subjects with severe diabetes or diabetes of prolonged duration. The apparent relation of FPG levels to FEV1 and FVC suggests that any effect of glycemia precedes diabetes and contradicts any putative causal role for duration and severity of glycemia, however. More epidemiological studies are needed to provide further information about the relationship between NIDDM and lung function.

Discordant results have been observed regarding the associations of chronic obstructive pulmonary diseases with secretor, Lewis, and ABO histo-blood groups, which are defined by glycosyltransferases. These enzymes build up oligosaccharide structures that play a role in the adhesion of environmental factors to epithelial cells. The objectives of the present study were to assess the role of all three systems, Lewis (Le), salivary ABH secretor (Se), and red cell blood group ABO, on lung function, wheezing, and asthma in a cohort of 228 coal miners studied cross-sectionally, considering the potential modifying effect of environmental factors on these associations. Asthma was significantly related to nonsecretor phenotype. Significantly lower lung function and higher prevalences of wheezing and asthma were observed in Lewis-negative or nonsecretor subjects of blood group O. Very low lung function values were observed in the small group of Lewis-negative nonsecretors who lack both Le and Se controlled fucoses (1% of Caucasians). Lewis-positive, salivary ABH secretors who have these two fucoses represent 70% of Caucasians. Among these subjects, lower lung function was observed in blood group A, and in a lesser extent in blood group B, i.e., with terminal alpha GaINAc or alpha Gal respectively, than in blood group O subjects. ABO, Lewis, and secretor phenotypes did not account for the potential genetic heterogeneity of subjects toward smoking, but alcohol consumption appeared to exert a protective effect on lung function in Lewis-negative subjects (10% of Caucasians). If confirmed in other populations, the magnitude of the effects observed regarding low lung function in Lewis-negative ABH nonsecretors, and the protective effect of Lewis negative on the deleterious effect of alcohol, may be of clinical importance. Further studies of the combined effects of various histo-blood group genetic systems seem worthwhile, particularly for airflow limitation, wheezing, and asthma, possibly with reference to susceptibility to infectious agents.

Haemovigilance was part of the reform of the French transfusion system. The haemovigilance network is now operational with approximately 4600 transfusion incidents reported annually. Immediate incidents observed within 8 days after transfusion account for 85% of the reports. A cause cannot be identified in 41% of these, usually concerning minor clinical incidents with transient fever and/or shivers. An allergic reaction is described in 31% of transfusion reactions. Immunological conflicts account for 18% and bacteria associated transfusion reactions for 6%. The importance of bacteria associated transfusion reactions, the first identified cause of death associated with transfusion is one of the findings of haemovigilance. Improvement in the haemovigilance systems aims at obtaining better descriptions of transfusion incidents, standardisation of severity and imputability assessment and definitions of denominators such as the actual number of recipients. Delayed incidents will ultimately provide a true vision of post transfusion immunisation and infection The improvement of haemovigilance now considered as part of transfusion medicine practice is a continuous process.

Haemovigilance is a national system of surveillance and alarm, from blood collection to the follow-up of the recipients, gathering and analysing all untoward effects of blood transfusion in order to correct their cause and prevent recurrence. In France haemovigilance was created by law and notification of transfusion incidents is a legal obligation. The haemovigilance network associates local correspondents in each hospital and blood centre with regional co-ordinators and is centralised by the Agence Française du Sang. After 4 years the incident reporting rate is 2.3 per 1,000 allogeneic blood components transfused, justifying for example increased efforts in the prevention of bacteria-associated transfusion reactions, haemolytic transfusion reactions or vascular overload. However, haemovigilance still has to be strenghtened by improved information management or further progress in standardisation from one region to the other. The most important factor of success is collaboration between blood centres and hospitals. Haemovigilance clearly is the ultimate quality indicator of a transfusion service.

The relationships of haptoglobin level to respiratory and allergic parameters have been assessed in an epidemiological study conducted in a working population surveyed twice 5 years apart. At the first survey conducted in 892 working men, haptoglobin level was significantly related to FEV1 (r = -0.18; P less than 0.001) and smoking habits. After adjustment for smoking, a history of wheezing was significantly related to lower haptoglobin level. A second survey conducted in 304 men of the original sample 5 years later confirmed that haptoglobin was related to FEV1 (r = -0.21; P less than 0.001) and that wheezing was significantly related to hypohaptoglobinaemia (lower decile; P = 0.04). Men who exhibited bronchial hyper-responsiveness to methacholine had haptoglobin levels 0.35 g/l higher than those who did not (P = 0.01). Haptoglobin level was unrelated to IgE level and skin prick tests. These results support the hypothesis of the role of inflammation in both lower lung function and bronchial hyper-responsiveness. They suggest that some heterogeneity exists within subjects with a history of wheezing.