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What is the Risk of New-variant Creutzfeldt-Jakob Disease on Blood Transfusion

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Introduction

What is the Risk of New-variant Creutzfeldt-Jakob Disease on Blood Transfusion Part 1: Variant Creutzfeldt-Jakob Disease (vCJD) is the human form of Bovine Spongiform Encephalopathy (BSE). It is a transmissible spongiform encephalopathy (TSE), which are a group of fatal neurodegenerative disorders , also including scrapie in sheep, BSE in cattle and CJD in humans, (Baker et al, 1998). The New-variant Creutzfeldt Jakob disease (nvCJD) is a new form of TSE in humans, first identified in 1996 in the UK, (Will et al, 1996). nvCJD differs from the classical form of CJD and develops clinical symptoms that are markedly different than those from other forms of CJD. Patients with nvCJD present at a relatively young age and differences in clinical features include behavioural changes, dysaesthesia and ataxia and development of progressive dementia leading to death after around 7 1/2 - 22 1/2 months, after the incubation period (Turner, 1999), which is still unknown, but is thought to be around 30 years. The infective prion in nvCJD is different from the one found in 'classical' CJD and is thought to be widespread through the highly vascularized lymphoreticular system, (Hill et al 1997). ...read more.

Middle

Leucodepletion as a precautionary measure has also been shown to reduce transmission rates of cytomegalovirus, (Dumont et al, 2001). In view of all these concerns, the UK blood transfusion service (BTS) and regulatory authorities have chosen to apply other precautionary principles in evaluating strategies, which could also reduce the risk of transmission of nvCJD. Apart from leucodepletion of blood products, these measures include donor selection and exclusion and a ban on using UK plasma for the manufacture of fractionated products, such as albumin, clotting factor and immunoglobulin. Overall, the precautionary measures mentioned above and a promotion of the appropriate use of blood products throughout the National Health Service is thought to ensure the best way of preventing transmission of nvCJD from blood transfusion. Part 2: New-variant Creutzfeldt Jakob Disease (nvCJD) was initially described in 1996 in the UK. It is a rare, neurological illness believed to be caused by a prion, a newly identified type of disease-causing agent or protein. It is different from a virus in that there is no immune response to infection and there is a very long time between infection and onset of symptoms. ...read more.

Conclusion

Even though this has been proven in some animal models, it is not yet known whether nvCJD will prove to be transmissible between humans by blood transfusion, but the risk cannot be excluded and for this reason, the UK blood services have taken certain specific precautionary measures to safe guard against or reduce the risk of nvCJD infection by blood transfusion. These include: * Donor selection and exclusion: High risk individuals are excluded. * Leucodepletion (removal of white blood cells) of all blood components. * Promotion of appropriate use of blood and blood products through the NHS * Withdrawal and recall of any blood components obtained from any individual who later develops nvCJD. Overall, the chance of acquiring nvCJD from a blood transfusion is extremely low and the benefits of having a blood transfusion when needed have to be weighed against the disadvantages. In the UK, further precautionary measures are also being revised and considered and ultimately, the responsibility to ensure that patients are treated with blood only when there is a real benefit so it is weighted against the uncertain risk of transmitting nvCJD falls on the medical professionals involved in the treatment. ...read more.

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