Blood Born Disease

Is there a risk of blood born disease in blood transfusions? The question should not be if, rather how many blood born diseases are you at risk if you get a transfusion?

Transfusion of blood and blood disease will always be connected to each other. The inherent blood related disease risks are many. What if there were an option to avoid blood transfusions all together?

What if there were hospitals and health care teams that did surgeries as serious as liver transplants, which could take as much as 50 units of blood, only with out one drop of transfused blood.

Well, there are. There are doctors, nurses, health care teams that will do just that. Shorter hospital stays. Decreased risk of disease.Decreased risk of death.

Glutathione plays a part. First, become an educated consumer. Here are the transfusion related blood born diseases you could possibly be exposed to, or not, if you opt for bloodless medicine and surgery.

Cytomegalovirus

Cytomegalovirus (CMV) infection lasts for a lifetime. The CMV antibodies prevalence increases with age. It is estimated that approximately 50% to 80% of the adult population are infected with the virus.

In otherwise healthy people, it does not pose a risk. However, in people with compromised immune systems are at severe risk. Those with bone marrow transplants, solid organ transplant, HIV, cancer, premature infants and pregnant women are at greatest risk.

CMV is transmitted through blood transfusion, organ and bone marrow transplantation.

Blood donors have been found to have the antibodies in ranges between 35 percent and 50 percent in this blood born disease.

Since every unit of blood exposes the recipient to lifetime immunomodulation, every additional unit of blood received in a life time increases the risk of CMV negative outcomes.

Epstein-Barr Virus

Epstein-Barr (EBV) infection (infectious mononucleosisis) common with an estimated half of all children five years old in the US having been infected.

In the general population it is usually experienced with out symptoms in children. In adults the infection can display symptoms such as fever and sore throat. EBV increases the risk of developing Burkitt's lymphoma, nasopharyngeal carcinoma, and B-cell lymphoma in those who are immunosuppressed.

EBV is transmitted by person-to-person contact via saliva and can be transmitted by airborne transmission. EBV can be transmitted via blood transfusion.

Human Parvovirus B19

Human parvovirus B19 (HPV-B19) is the causative agent for fifth disease. HPV-B19 infection is common, especially in children. Symptoms are mild, usually a fever, sometimes a round rash appears on the cheek the size of an old fashioned silver dollar.

Exposure in high risk groups can result in serious complications. Pregnancy exposure can result in fetal anemia and/or fetal death. The infection may cause transient aplastic crisis (TAC) in immunocompromised patients with hemolytic anemia and chronic bone marrow failure.

HPV-B19 has been transmitted to hemophilia patients via infusion of clotting factors (factor VIII and factor IX).

Blood is not routinely screened for HPV-B19 infection and the viral inactivation methods are ineffective against the virus.

Human Herpesvirus 6

Human herpesvirus 6 (HHV-6), the cause of sixth disease or Roseola (roseola infantum) is a mild illness resulting form this blood born disease. It will typically resolve in 3-5 days with out medication.

The most notable feature is a sudden rash appearing all over the body once the fever breaks.

Those with compromised immune systems such as HIV infected patients and transplant recipients may experience severe outcomes. Transmission happens via person-to-person contact with body fluids of infected individuals.

HHV-6 is considered a potential threat to transfusion safety because due to risks of persistent infection and the high presence of antibodies to HHV-6 among blood donors. There is little evidence based research about its clinical significance in blood recipients. Currently, blood is not routinely screened for HHV-6.

Human Herpesvirus 8

Human herpesvirus 8 (HHV-8), a more recently discovered virus, is associated with Kaposi's sarcoma. The virus has been transmitted through organ/bone marrow transplantation but it is not known if it can be transmitted through blood transfusion.

It is not screened due to limited prevalence in donors.

CJD and vCJD

Creutzfeldt-Jakob Disease (CJD), the human form of transmissible spongiform encephalopathie (TSE) is characterized by mental deterioration and dysfunction, involuntary movements. CJD is rare, only occurring in approximately 1 per million population annually.

The blood born risk of CJD through blood transfusion has not been established.

Variant Creutzfeldt-Jakob Disease (vCJD) is the human form of bovine spongiform encephalopathy (BSE). Unlike CJD, vCJD usually affects people under the age of 50. It is most likely transmitted by eating contaminated meats from BSE-infected cattle. It has been speculated that the risk that vCJD is transmissible through blood may be greater than that of classic CJD.

Side Bar One day in the mid 1990's, a patient in the hospital where I worked appeared despondent. On asking why, he showed me a letter. It was from the CDC. He was informed that a transfusion he received came from a woman who had died and during her autopsy was found to have one of the TSE's. Specifically it said that she died of Creutzfeldt-Jakob Disease.

At the time, the CDC was saying to the public that there was no known infections in the United States. Was it an error or just propaganda?

This is not the current procedure for handling such an incident but illustrates what in one form or another will happen should you be exposed to a blood born disease. The number of those affected is clinically insignificant, unless you are the one. More importantly, there are hospitals and health care teams that can treat and preform surgeries with out blood transfusions, eliminating these risks.

Chronic Wasting Disease

CWD is a variant of CJD passing to man from deer meat in the US West.

Bacterial Contamination

Transfusion Transmitted bacterial reaction is one of the most common and severe infectious complication that falls under blood born disease coming from blood transfusions.

It has been estimate that over half of all Transfusion Transmitted Infections and 16% of transfusion-related deaths are caused in some way with bacterial contamination.

By one estimate, 1 in 38,500 units of red cells, 1 in 3,300 units of platelets, and 1 in 2,000 units of apheresis platelets are contaminated with bacteria.

Red cell infections are often gram-negative bacilli such as yersinia enterocolitica and pseudomonas fluorescens. Storage over 21 days is associated with increased risk.

Platelet infections are most often gram-positive species such as Staphylococcus and Streptococcus species. Storage over three days is associated with increased risk although the reactions are minor.

Syphilis

Treponema pallidum - the cause of syphilis - results in three stages of the disease. Starting as a sexual disease, it becomes a blood born disease when in transfused blood.

The third stage may result in cardiovascular, mental disorders and blindness.

Syphilis transference is rare due to current screening methods.

Malaria

Transfusion Transmitted malaria (TTM) is a rare blood born disease. The primary method of screening is donor deferral policy. This however makes it a serious blood born disease risk in the current economy when people can get paid for blood donation.

Chagas' Disease

Trypanosoma cruzi - the cause of Chagas' is notable in Central and South America. T. cruzi is transmitted from an infected fling insect to a humans through fecal contamination at the time of being bit. The agent can also be transmitted by blood transfusion and organ transplantation.

Several cases of Transfusion Transmitted Chagas' disease have also been reported in the US and Canada.

Most patients diagnosed with TT Chagas in North America were all ready immunosuppressed. There is not an effective screen in place.

Toxoplasmosis

Toxoplasmosis caused by the parasite toxoplasma gondii, a parasite that is hosted in cats and dogs, is transmitted through several routes. Symptoms are minor and are only sever in those with compromised immune systems.

Transmission has been reported thorough organ transplant and blood transfusion.

Leishmaniasis

Leishmaniasis, the result of infection by leishmania donovani, is a tropical and subtropical infection that starts with the bite of an infected fly. The symptoms of infection are often subclinical, although chronic infection may result in anemia and lymphadenopathy.

Leishmaniasis can be transmitted by transfusions. it is not currently tested due to low risk.

Lyme Disease

Lyme disease is caused by borrelia burgdorferi which comes from a tic bite. The most notable characterization is the bulls eye rash in the early stages.

Late stages of the untreated disease result involve major organ systems such as musculoskeletal, nervous, and cardiovascular systems.

Although lime disease may be a risk in blood transfusions, it is considered low. Some blood banks will not allow donation by those previously infected and others will after one year. Of course this requires the honesty of the person donating blood. When there is a monetary motivation in donating blood, honesty often gets left out.

Babesiosis

Babesiosis is usually caused by babesia microti (there are several different species or types of Babesia parasites) also transmitted by deer tics in the coastal areas of the lower New England States and now (2011) in the upper Midwest. The greatest risk is during the warmer months of May to August. Up to the year 2000, research indicates there were about 300 cases. Now, the number is growing rapidly but there is little info on how widespread it is.

Symptoms are minor for most but can become life threatening. With a compromised immunity, elderly, infants, and those who have had their spleen removed the outcomes can be more serious.

According to the CDC, it can be transmitted by blood transfusions. Humans most often get it from Ixodes scapularis ticks (also called black-legged ticks or deer ticks).

Diagnosing babesiosis is difficult and may be confused with malaria. It should be included in the differential diagnosis of post-transplant hemolytic-uremic syndrome in organ transplant patients when ruling out blood born disease. Also, the antibiotics that will kill Lyme will not help babesiosis.

From 1979 to 2009, there have been over 159 cases of transfusion transmitted Babesia (called TTB ) and 12 have died from 2005-2008 according to Clinical Microbiology Reviews.
Also see...https://www.ncbi.nlm.nih.gov/pubmed/21893613

In August of 2015, former New Jersey First Lady Jean Byrne died from and infection of Babesiosis.

In a July 2015 commentary entitled Time to Become Familiar with Babesiosis? the article indicated that "Babesiosis is the single most common transfusion-related infection."

First confirmed case of human Babesia microti infection from blood transfusion in Europe (2007)

There are no effective screens in place as of 2016.

It should be noted that there are over 20 different spirochete bacteria that can infect our blood but not be easily detected. Six are related to our teeth.

Rocky Mountain Spotted Fever

Rocky Mountain Spotted Fever (RMSF), a tick-borne disease resulting from rickettsia rickettsii, is endemic to most of the US.

Fatalities are as high as 30% in untreated patients.

It is transmitted through blood transfusions. There are no screens.

Cat Scratch Fever

Also known as Bartonella, can, according to the NIH be transmitted by blood transfusions.

"Bartonella henselae is the agent of cat scratch disease and bacillary angiomatosis. Blood donors can be asymptomatic carriers of B. henselae and the risk for transmission by transfusion should be considered," according to an October 2008 article in Transfusion Med.

Symptoms include swollen painful lymph nodes. Muscle along with joint pain, nausea, vomiting,ice pick headache, shin pain, rapid mood shifts, anxiety, insomnia, chills and red rashes that look like stretch marks.

Ehrlichiosis

Human ehrlichiosis is a tick born infection that invades and infects the white blood cells. There are three forms and they primarily found in the United States in the southern, central and northeastern areas.

Symptoms include fever, malaise, sweating, elevated liver enzymes, right upper quadrant abdominal pain, nausea, dry cough, headache, anemia, muscle aches and pain.

Complications can be mild to severe with fatality ratios can be as high as 5% to 10%.

Currently, there are no effective screening questions or serologic tests available to identify infected blood donors.

West Nile Virus

West Nile Virus (WNV) is transmitted with mosquito bite is of greatest risk to the immune compromised, elderly, and organ transplant recipients.

West Nile Virus produces almost no symptoms in 80% of those infected.

WNV can be transmitted through transfusion however incidence is reduced due to testing. Even with testing, JAMA in 2007 reported a kidney transplant recipient who contracted the disease after receiving screened blood. Two patients contracted the disease from the same donor.

Human T-lymphocytotrophic Virus (HTLV-1) A retrovirus that endemic in Japan and the Caribbean, is believed to be the cause of adult T-cell leukemia/lymphoma and a neurological disorder similar to multiple sclerosis.

Blood banks screen for this yet the risk of transmission in the United States is around 1 in 640,000 for this blood born disease.

Lineage II Powassan (POW) or Deer Tick Virus

Like its cousins, while there are no studies showing it is transmissible by blood transfusion, given the fact there is no screen and the other blood borne bacteria's are transmissible by transfusion, this most likely can be transmitted by transfusion.

Powassan (POW) virus is a tick-transmitted flavivirus. It can be a strain called lineage II or “deer tick virus”. The virus is transmitted by the Ixodes scapularis tick. The POW virus may cause encephalitis or meningitis, and many long-term health issues in one out of every two people who get exposed. Approximately 10-15% of those exposed die from complications.

Literature indicates that Linage I POW, as of 2016 has also been found to have infected humans.

Signs and symptoms of POW / Deer Tick Virus include...

encephalitis or meningitis
fever
headache
vomiting
weakness
confusion
loss of coordination
speech difficulties
memory loss
fatality rate between 10 to 15%

Cryoglobulinemia

Cryoglobulinemia, a blood disorder, refers to the presence of cryoglobulins in the blood. These abnormal protein molecules cause the blood to clump together at cold temperatures and then re-dissolve when the body temperature returns to normal.

When one afflicted with cryoglobulinemia is exposed to cold, they may experience decreased circulation in the smaller blood vessels. Color changes in the skin, damage to the extremities, bleeding into the skin (purpura), hives and other problems may be noted.

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.

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.

This is the comprehensive list of blood born diseases. If there is a blood born disease we missed, please let us know of it.

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