Page 2048 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 120 Transfusion-Transmitted Diseases 1819

no clinical signs or symptoms of vCJD at death from unrelated Berg MG, Lee D, Coller K, et al: Discovery of a novel human pegivirus
causes, but had abnormal prion protein aggregates in lymphoid (but in blood associated with hepatitis C virus co-infection. PLoS Pathog
not neural) tissues at autopsy and was considered to have preclinical 11:e1005325, 2015.
infection. Five years before death the recipient received nonleukocyte Brennan CA, Yamaguchi J, Devare SG, et al: Expanded evaluation of blood
reduced RBCs from a donor who developed clinical vCJD 18 months donors in the United States for human immunodeficiency virus type 1
after donating. These four cases represent 6% of the 67 UK recipients non-B subtypes and antiretroviral drug-resistant strains: 2005 through
who received blood components from 18 different donors subse- 2007. Transfusion 50:2707, 2010.
quently diagnosed with vCJD (and an estimated 23% of exposed Busch MP: Cooley Award Lecture. Transfusion-transmitted viral infections:
methionine homozygotes). In light of these cases and animal transfu- building bridges to transfusion medicine to reduce risks and understand
sion experiments, TSE transmission and disease from transfusion is epidemiology and pathogenesis. Transfusion 46:1624, 2006.
22
no longer regarded as a theoretical event. A single case reports a Centers for Disease Control and Prevention and Association of Public Health
potential epidemiologic link between exposure to plasma derivatives Laboratories: Laboratory Testing for the Diagnosis of HIV Infection: Updated
and transmission of the agent to a recipient. Recommendations. Available at http://dx.doi.org/10.15620/cdc.23447.
Prion-removal strategies (e.g., affinity filters) remain under evalu- Published June 27, 2014. Accessed 31.01.16.
ation, especially in the United Kingdom, but none is expected to be Centers for Disease Control and Prevention: HIV transmission through
suitable for consideration for use in the United States in the immedi- transfusion—Missouri and Colorado, 2008. MMWR 59:1335, 2010.
ate future. There are currently no blood donor–screening tests for Custer B, Kessler D, Vahidnia F, et al: For the NHLBI Retrovirus Epidemiol-
vCJD, leaving risk mitigation dependent on removal of donors that ogy Donor Study-II (REDS-II) Risk factors for retrovirus and hepatitis
could have asymptomatic infection. Initially, primarily on the basis virus infections in accepted blood donors. Transfusion 55:1098–1107,
of the prominent distribution of vCJD prion in reticuloendothelial 2014.
C
tissue compared with classic prion protein (PrP ,), on subsequent FDA Final Rule: Docket No FDA-2006N-0040. Fed Regist 80(99):29842–
reports of animal and human infection by transfusion, and then on 29906, 2015.
the early observation that nearly all cases of vCJD were associated Hewitt PE, Ijaz S, Brailsford SR, et al: Hepatitis E virus in blood compo-
with potential exposure in the United Kingdom or to UK bovine nents: a prevalence and transmission study in southeast England. Lancet
products, the FDA adopted and has modified donor-deferral policies 384:1766–1773, 2014.
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sequentially since 1999. The first called for indefinite deferral of Jackson BR, Busch MP, Stramer SL, et al: The cost-effectiveness of NAT for
donors who had spent more than 6 months in the United Kingdom HIV, HCV, and HBV in whole-blood donations. Transfusion 43:721,
from 1980 to 1996, before control of the food chain and of recipients 2003.
of bovine insulin from the UK. Models predicted that this would Kleinman SH, Lelie N, Busch MP: Infectivity of human immunodeficiency
remove approximately 90% of the risk at a “cost” of deferring virus-1, hepatitis C virus, and hepatitis B virus and risk of transmission
approximately 5% of otherwise eligible donors. These were subse- by transfusion. Transfusion 49:2454–2489, 2009.
quently expanded to include US military personnel and their Kleinman Steven, Cameron C, Custer B, et al: Modeling the risk of an
dependents who spent certain durations on bases in the European emerging pathogen entering the Canadian blood supply. Transfusion
Union where UK beef was imported during the BSE epidemic and 50:2592, 2010.
recipients of transfusions in the United Kingdom and France during Laperche S, Nübling CM, Stramer SL, et al: Sensitivity of hepatitis C virus
the peak risk periods of their BSE epidemics. Experience at US blood core antigen and antibody combination assays in a global panel of window
centers has largely confirmed the donor loss predictions of the FDA period samples. Transfusion 55:2489–2498, 2015.
models. Murphy EL, Glynn SA, Fridey J, et al: Increased prevalence of infectious
Chronic wasting disease (CWD) of deer and elk is prevalent at diseases and other adverse outcomes in human T lymphotropic virus types
rates as high as 15% in cervid populations in multiple areas of the I- and II-infected blood donors. Retrovirus Epidemiology Donor Study
United States and Canada. Concern has been expressed that, given (REDS) Study Group. J Infect Dis 176:1468, 1997.
the popularity of hunting, there may be risk for exposure to and Orton SL, Stramer SL, Dodd RY, et al: Risk factors for HCV infection among
infection with the CWD prion during handling or consumption blood donors confirmed to be positive for the presence of HCV RNA
of infected animals. Apparent clusters of classic CJD in hunters and not reactive for the presence of anti-HCV. Transfusion 44:275–281,
have been alleged, but on full evaluation have not been shown to 2004.
have a relationship to the CWD agent. There is currently no plan Petrik J, Lozano M, Seed CR, et al: Hepatitis E. Vox Sang 110:93–103, 2016.
to intervene for this theoretical risk in hunters who donate blood Seed CR, Kiely P, Law M, et al: No evidence of a significantly increased risk
beyond hygienic measures when handling cervids or their tissues. of transfusion-transmitted human immunodeficiency virus infection in
Australia subsequent to implementing a 12-month deferral for men who
have had sex with men. Transfusion 50:2722, 2010.
FUTURE DIRECTIONS Seghatchian J, Hervig T, Putter JS: Effect of pathogen inactivation on the
storage lesion in red cells and platelet concentrates. Transfus Apher Sci
The residual risk for transmitting HIV, HBV, and HCV is less than 45:75, 2011.
1 per million units transfused, an extremely low rate. In contrast, Snyder EL, Stramer SL, Benjamin RJ: The safety of the blood supply – time
platelet septic events are reported at a frequency of 1 per 100,000 to raise the bar. N Engl J Med 372:1882–1885, 2015.
units. Transmission of known, emerging infectious agents such as Stramer SL, Dodd RY, Brodsky JP: The value of screening signal-to-
dengue, Zika virus, B. microti, and those currently unrecognized cutoff ratios for hepatitis C virus antibody confirmation. Transfusion
remain problematic. Continued safety of the blood supply requires 53:1497–1500, 2013.
constant vigilance, early detection, reporting of untoward events, and Stramer SL, Moritz ED, Foster GA, et al: Hepatitis E virus: seroprevalence
excellent communication and cooperation between those providing and frequency of viral RNA detection among U.S. blood donors. Transfu-
blood components and those prescribing them. sion 56:481–488, 2016.
Stramer SL, Notari EP, Krysztof DE, et al: Hepatitis B virus testing by
minipool nucleic acid testing: does it improve blood safety? Transfusion
SUGGESTED READINGS 53:2449–2458, 2013.
Stramer SL, Wend U, Candotti D, et al: Nucleic acid testing to detect HBV
Aubuchon JP, Prowse CV, editors: Pathogen inactivation: the penultimate infection in blood donors. N Engl J Med 364:236–247, 2011.
paradigm shift, Bethesda MD, 2010, AABB Press. Taira R, Satake M, Momose S, et al: Residual risk of transfusion-transmitted
Bennett JL, Blajchman MA, Delage G, et al: Proceedings of a consensus hepatitis B virus (HBV) infection caused by blood components derived
conference: risk-based decision making for blood safety. Transfus Med from donors with occult HBV infection in Japan. Transfusion 1393–1404,
Rev 25:267, 2011. 2013.