Blood Transfusion Transmitted Diseases
Blood Transfusion Transmitted Diseases
There are many Blood borne, transfusion transmitted and related diseases. In the United States, many are openly and commonly written about in the press, and spoken of on the news..... some are not. Following here is a partial and growing list of the most commonly known Blood transfusion transmitted diseases, but for which no routine cost-effective laboratory testing is available.
Clerical errors also contribute to transfusion transmission of harmful agents. These types of errors include, among others, the release of unsuitable units of Blood; accidental transfusion of autologous Blood to another recipient (autologous Blood may include infectious disease); and errors in testing.
Hepatitis B - Hepatitis B virus (HBV) is transmitted through parenteral and sexual exposure. The mean incubation time is 90 days with a range of 30 to 180 days. Donor Blood is routinely tested for HBsAg and HBcAb. There is no routine testing for hepatitis A, because it is said to be rarely transmitted by Blood products in the United States. Recipients of Blood products can also be infected with hepatitis delta, which is a defective RNA virus that needs an HBV superinfection to replicate. Persons who have received a hepatitis B vaccination (recommended for all health care workers with patient contact) will have hepatitis B surface antibody present, but not HBsAg or HBcAb. Risk of transmission in the Unites States is said to be 1 in 66,000.
Hepatitis C - The hepatitis C virus (HCV) currently affects over four million people in the United States. This disease has reached epidemic proportions. It is the primary reason for liver transplantation in the United States hepatitis C virus (HCV) infection is still the most common transfusion transmitted infection. Persons at highest risk for the virus are those who received blood transfusions prior to 1991 or people with a history of IV drug abuse using shared needles. One attribute of this disease that contributes to the high rate of infection, is that the time from infection with the virus until manifestation of liver disease can be decades. The hepatitis C virus subtype varies worldwide. In Europe, types 1, 2 and 3 are the predominant genotypes with types 1a and 3a in the north-western countries and 1b in Hungary, Germany, Russia and Turkey. In North America, types 1a and 1b have been found. In Japan and Taiwan, types 1b, 2a and 2b predominate; type 6a in Hong Kong and Macau. Type 4 is found in Zaire, Central and North Africa; 5a in South Africa. The hepatitis C virus is taken into the body other than through the digestive tract. It must be inherited, transfused or injected in some manner. The sexual transmission rate is lower than once thought. At present, only testing for hepatitis C antibody is available. The antibody to the hepatitis C virus appears 54 to 192 days in a person's Blood after infection. If an infected person donates Blood prior to the appearance of this antibody the chance of that Blood being used in a transfusion is said to be one out of 103,000 donations, There are an estimated 15-million Blood transfusions each year. Risk of transmission in the Unites States is said to be 1 in 121,000.
Human Immunodeficiency Virus (HIV) - In 1982 the first cases of AIDS transmitted from Blood or Blood components were reported, but little of the infection was known at that time, and even less was talked about publicly. By 1983 radical changes began to occur in the donor criteria to exclude those at high risk for transmission of HIV. The testing of Blood products for HIV started in 1985. It was a test to detect the presence of the antibody directed against HIV, rather than a direct test for HIV. Testing for HIV p24 antigen was mandated in 1996. Risk of transmission in the Unites States is said to be 1 in 563,000.
Human T-lymphocytotrophic Virus (HTLV-1) - This is a retrovirus that is endemic in Japan and the Caribbean. It is implicated as causing adult T-cell leukemia/lymphoma and a neurological disorder similar to multiple sclerosis. Blood is routinely screened for antibodies to HTLV-1 utilizing this relatively inexpensive test. Risk of transmission in the United States at this time is said to be 1 in 641,000.
HGV - The Hepatitis G Virus is an RNA virus of the Flaviviridae family. HGV infection was originally associated with fulminant hepatitis, but recent studies have failed to prove a connection between HGV and clinical illness. It is primarily Blood borne and accounts for 0.3% of acute viral hepatitis estimated at 900 to 2000 infections per year in the United States In many countries, 1% to 2% of Blood donors test positive for HGV RNA & the prevalence of HGV infection is up to 10% to 15% in West African children. How this high prevalence is maintained is unknown, but this does suggest that sub-clinical infection is common. Therefore, HGV infection is probably much more frequent than studies of the prevalence of HGV RNA suggest. The virus is transmitted by the same routes as HCV and co-infection is common, however, this may represent a common source of infection rather than any clinical similarity between the two viruses. The clinical significance of HGV infection and HGV-HCV co-infection remains to be fully elucidated, but at present does not seem to be a major disease-causing factor. The majority of patients infected with HGV by Blood transfusion do not develop serious chronic hepatitis.
Cryoglobulinemia - Cryoglobulinemia is a term given to a disorder of the Blood and refers to the presence of cryoglobulins in the blood. These are abnormal forms of protein molecules that precipitate (clump together) at cold temperatures and re-dissolve at normal body temperature. Therefore, when a person with cryoglobulinemia is exposed to cold, he or she may experience decreased circulation in the smaller blood vessels. This may lead to color changes in the skin, damage to the extremities, bleeding into the skin (purpura), hives and other problems. The underlying cause of this condition may include diseases of the immune system, such as Waldstrom's macroglobulinemia, or its malignant form, multiple myeloma, and some infectious diseases, such as the hepatitis C virus. There are treatments for Cryoglobulinemia, such as cryofiltration, which has proven extremely effective in easing complications of this disease such as organ damage and skin ulcers.
TTV - Transfusion Transmitted Virus is a relatively new virus becoming widely known in 1997 in patients with fulminant hepatitis and chronic liver disease of unknown etiology. TTV is an unenveloped, single stranded DNA virus. Two genetic groups have been identified, differing by 30% in nucleotide sequences. TTV DNA was detected in 47% of patients with fulminant non-A-G hepatitis and 46% of patients with chronic liver diseases of unknown etiology. The result suggests that TTV may be the cause of some cryptogenic liver diseases. In testing, the presence of TTV, was found in approximately 10% of U. S. volunteer Blood donors, 13% of commercial Blood donors, and 17% of intravenous drug abusers. The rate of TTV infection among U. S. non-A, non-B, non-C, non-D, non-E hepatitis patients was only 2%.
Cytomegalovirus (CMV) - The prevalence of the CMV antibody ranges from 50% to 80% of the population. Blood contaminated with CMV can cause problems in neonates or immunocompromised patients. Potential problems in selected patient populations can be prevented by transfusing CMV negative Blood or frozen, deglycerolized RBC's. Donor Blood is not routinely tested for CMV.
Creutzfeldt-Jakob Disease (CJD) - A degenerative and fatal nervous system disorder. Affected individuals can remain asymptomatic for decades after infection and then progress rapidly to dementia, severe loss of coordination and death. We are told by the Blood establishment that the risk of CJD being transmitted through Blood products is 'theoretical.' The infectious agent has (yes, has) been found in Blood products.
KS and HHV-8 - While there appears to be association between Kaposi’s sarcoma (KS) and human herpes virus-8 (HHV-8) and), it is said to be unproven whether or not the virus is transfusion transmitted. Also, if it is transfusion transmitted, is it associated with development of KS. Again we see here at this time, in our opinion, another case of under-researching, under-investigating and extremely under-reporting.
Leishmaniasis - Cases of transfusion-associated Leishmaniasis are growing each year world wide. This increase is increasingly associated with patients who are positive for HIV. Transfusion-associated Leishmaniasis requires that the parasites be present in the peripheral Blood of the donor, survive processing and storage in the Blood bank, and infect the recipient. In endemic areas where the population of potentially infected individuals may be much higher and the screening process for donors less rigorous, transfusion-associated Leishmaniasis is more common. Leishmaniasis is now found in over 90 countries. Again here we see the fact of world travel by a diverse population, and the 'honor system' Blood donor screening process, and too expensive testing, all contribute to the increase of transfusion transmitted Leishmaniasis.
Lyme Disease - Lyme disease is associated with the bite of the eastern deer tick, and can cause an illness that affects many systems within the body. Donors with a history of Lyme disease can not donate Blood unless they no longer have symptoms whatever, have undergone a full course of antibiotic treatment, and are cleared by a physician. Public health and Blood agencies are closely monitoring this disease.
Malaria - The popular statement, routinely given is that "malaria is rarely transmitted by Blood products." The number of transfusion associated cases of malaria, however, is at an all-time high. There are no practical laboratory tests available to test donor Blood, so donors travelling to high risk malaria areas are often deferred from donating Blood for six months. This policy, however, is not evenly applied in all areas and, believe it or not, depends on the honor system to work.
Chagas Disease - Discovered a century ago by Brazilian doctor Carlos Chagas, this disease, properly named Chagas' Disease, is caused by a parasite that infects an estimated 18 million people worldwide, causing death from heart and digestive problems. Up to 20% of infected people never exhibit symptoms. Because of recent shifts in population, individuals from countries where this disease is common (South and Central America) are migrating in large numbers to the United States and other countries.
Babesiosis - An intraerythrocytic parasitic infection caused from the bite of the infected Ixodes tick. The disease closely resembles in some ways Lyme Disease, and in other ways, malaria. This significantly affects the hematological system, causing among other things, hemolytic anemia, thrombocytopenia, and atypical lymphocyte formation. The transmitted parasite only infects red Blood cells by altering the cell membranes that causes decreased conformability and increased red cell adherence, which, in turn, can lead to development of acute respiratory distress syndrome (ARDS) among those severely affected. Babesia parasites invade and survive within erythrocytes. These Blood-borne parasites remain viable under Blood bank conditions. In Europe, Babesiosis is a life-threatening disease and is a significant public health problem in regions of the northeastern United States. Of patients with Babesiosis, 84% are asplenic, and 53% become comatose and die. Those individuals with a history of the disease are to be permanently deferred from donating Blood, if they know and admit before Blood donation that they have carried the malady
Toxoplasmosis - A systemic protozoan infection that causes symptoms similar to infectious mononucleosis. In immunocompromised individuals this infection can have serious neurological symptoms and can cause fetal death in pregnant women. Toxoplasmosis is also transmitted by common house cats.
Syphilis
Bacterial Contamination of Blood Products - This is another less often observed risk disorder directly associated with Blood transfusion. It is increasingly rare but a very serious complication of Blood transfusion. Most commonly associated with contamination during Blood collection or during handling of Blood products, such as preparation of platelet pools, and on occasion, associated with bacterial infection of the donor, it is sometimes recognizable by obvious changes in the appearance of the Blood product. Studies indicate that the rate of contamination of Blood products by bacterial pathogens may be significant. Since Blood recipient death continues to occur, in 1997, the CDC entered into an agreement with national Blood collection and distribution agencies to determine the frequency of transfusion reactions associated with bacterial contamination of Blood products. The new study will be a critical step in addressing this issue and will increase clinicians' awareness of bacterial contamination as a cause of transfusion reactions. Currently, the nation's Blood supply is not screened for bacterial contamination. Amazingly, when this contamination issue is raised, Blood donor deferral is merely recommended, and not mandatory.
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Originally Posted by binita
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