NoBlood

Jan B. Wade · #1 (**permalink**) 01-15-2004, 11:36 PM

Blood recipients may be barred from donating

Transfusion may have given vCJD victim the disease

James Meikle, health correspondent
Thursday December 18, 2003
The Guardian

People who have received blood transfusions may be barred from donating blood themselves following the revelation that the most recent confirmed victim of the human form of BSE may have been infected by a transfusion six and a half years earlier.

The health secretary, John Reid, told MPs yesterday that there was a possibility that the incurable deadly disease had been spread by a common hospital procedure.

He revealed that a patient who died this autumn of variant CJD - although the condition was not confirmed until a few days ago - had received blood during an operation for a serious illness in spring 1996 from someone who went on to die of vCJD in 1999.

Dr Reid said it was therefore possible that the disease had been transmitted from donor to recipient before the donor was even known to be infectious."This is a possibility, not a proven causal connection," he said.

"However, it is also possible that both individuals separately acquired vCJD by eating BSE-infected meat or meat products.

"This is a single incident, so it is impossible to be sure which was the route of infection. However, the possibility of this being transfusion-related cannot be discounted."

The identity, gender and age of the person who received the blood is being withheld at the family's request, and senior health officials urged the media to act responsibly in reporting the event, to avoid blood supplies being disrupted by a panic reaction.

There is only ever a five- to seven-day bank of blood available nationally, and the shelf-life of red cells - most commonly used in operations - is no longer than six weeks.

Government advisers decided as recently as October not to ban recipients of transfusions from donating blood, a drastic measure which might reduce donations by up to 15%, but they are urgently reconsidering the decision.

The risk of accidental infection by blood transfusions has for years been described as theoretical, even though the possibility was demonstrated in laboratory tests on sheep.

In Britain 138 people have died from vCJD since 1995 and another six are still alive with the disease. The number of deaths this year, 17 so far, will be at least the same as last.

There have been six cases in France, one in Italy, one in Ireland, one in the United States and one in Canada. Not all have any obvious connection with Britain.

There is no test, no cure, and no proved treatment for the disease, although families have forced the government to allow doctors to use unproved therapy.

Most are assumed to have got the disease through eating contaminated beef products years ago. The last seven years have seen a range of precautions to protect blood supplies and reduce the risk of accidental infection by contaminated surgical instruments.

If blood transfusion was the culprit in this case, the incubation period was obviously far shorter than the double-figure span assumed in most other vCJD cases.

The government is concerned that vCJD could be transferred through organ and tissue transplantation too.

In all, 14 people who later went on to develop vCJD are confirmed as having given blood, although the families of other victims have reported they did. Fifteen people have received identifiable donations.

The 14 surviving people are all being told and offered counselling and support. Checks are being made to see if people such as haemophiliacs who might have received pooled plasma from such donations can be traced.

Five people received blood after precautionary measures to filter out the potentially most dangerous white cells were phased in from 1998.

There are well over 2m blood donors in Britain, providing over 3m units of blood and blood products.

Graham Steel, of the Human BSE Foundation, made up of families of vCJD patients, said: "This only goes to show how carefully we must continue to scrutinise everything. But we do not want to see any problems for the blood supply."

Sir Liam Donaldson, the chief medical officer, said the "risks of a shortage of blood through any action have to be weighed up very carefully. You are then talking of a real life and death situation and not the margins of science."

What are the alternatives?

Am I at risk of catching variant CJD through a blood transfusion?

Possibly. But the risk, if any, is still likely to be extremely low, balanced against the immediate need for blood which might be life saving.

Are there alternatives which I might discuss with doctors?

Yes. Products using EPO, a hormone that stimulates production of red blood cells, can be used to treat anaemia suffered by patients with kidney failure.

Can I use my own blood when I have an operation?

Yes. But this is only a practical option for pre-arranged surgery. Patients can deposit their blood in the month before the operation. But this depends on a low risk of surgery being cancelled or anything going wrong during the operation.

Any other possibilities?

Doctors can use a technique which allows up to three pints of blood being taken from patients just before operations and being replaced with biological fluids so the same blood can be used in emergencies. There is also cell salvage, using machinery that gathers blood lost during surgery and delivers it for transfusion back to the patient. Equipment can be expensive but Jehovah's Witnesses are increasingly donating it to hospitals.

Which part of the blood donation is infective, if any?

Your blood is divided up into red blood cells, used for most operations, platelets used for clotting, and plasma, the fluid carrying the blood cells, used for coagulation. White cells are no longer used because they were thought potentially the biggest source of infectivity for vCJD. But plasma too might be infected and most used in transfusion is now imported. Red blood may still carry infectivity too.

What else might be done?

Blood services are considering banning anyone who has ever received a donation from giving blood themselves, a move that would cut donations by anything between 3% and 15%. This would not stop the possibility of infectivity being passed on through the blood of others.

Will I know if I have received blood from a donor who went on to develop vCJD?

Fourteen others have received blood from vCJD patients. They are being informed despite there being no test and no treatment.

Should I still donate blood?

Yes. A panic leading to shortages is the last thing patients need.

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Cartoon
Steve Bell on the BSE report

Useful links
Official BSE inquiry
Human BSE Foundation
British Medical Journal CJD page
Department of Health CJD/BSE page
Department for Environment, Food and Rural Affairs BSE page
The UK CJD disease surveillance unit
Food Standards Agency BSE page