Transfusion-related diseases

Stoller described ICU-discharge survival rate as 32% at two years, with a slower decline up to five years for ventilator-independent patients (43). We found the use of NIV at home in 31.5% of patients following PMV (16). Survival rates were poor (49% at one year and worse) in patients with COPD. In a research series by Pilcher, 38% of patients were fully weaned and 35% required HMV, most of the latter needing only nocturnal noninvasive support. Patients with NMD and transfusion-related diseases (TRD) were less likely to be weaned but had a reduced mortality, compared with those with COPD in whom survival rate was 58% at one year and 47% at three years (17). 

The use of recombinantly produced (X,-antitrypsin would reduce the risk of transfusion-related viral disease however, its half-life is too short to produce adequate serum levels without daily infusion. Studies have shown that the recombinant product can be administered as an aerosol. It diffuses across the respiratory epithelium, enters the lung lymph, and eventually reaches the systemic circulation. Unfortunately, it is not known whether this therapy has any influence on the development or progression of emphysema. Further carefully controlled, multicenter trials are necessary. 

Iatrogenic CJD is the second most common acquired human prion disease and these cases are the result of accidental infection due to contact with prion contaminated tissues or instruments during medical procedures (Table 29.1). The mode of prion infection include surgical equipment (e.g., surgical insd uments, depth electrodes), transplantation of human tissues (comeal, dura mater), intramuscular injections with growth hormone or gonadotrophin extracted from human pituitary tissues, or blood transfusion (reviewed by Will, 2003). The most likely source of infection is from donors with subclinical sCJD, except for the tw o transfusion-related cases that have been linked to blood donors who developed vCJD several years later (reviewed by Ironside, 2006). The incubation period in these transfusion related cases was 5 to 6 years, v hich is shorter than primary vCJD infection in humans. 

Hepatitis C virus (HCV) Hepatitis caused by hepatitis C virus was one form of non-A, non-B hepatitis nntU 1989, when a test became available that identified 50-70% of acute, self-limiting cases and more than 80% of chronic cases of transfusion-related non-A, non-B hepatitis (165). In the USA 80-90% of post-transfnsion hepatitis were of the non-A, non-B type (166). Post-transfnsional non-A, non-B hepatitis is in general less severe than hepatitis B, and is asymptomatic and anicteric in abont 60-80% of cases. However, there is evidence that non-A, non-B hepatitis tends to progress to chronic liver disease (167,168). 

Centers for Disease Control and Prevention (CDC). Transfusion-related transmission of yellow fever vaccine virus—California, 2009. MMWR Morb Mortal Wkly Rep 2010 59(2) 34-7. 

Adverse events related to transfusion of blood components have been reported, including febrile non-hemolytic transfusion reactions, mild febrile reactions, acute and delayed hemolytic transfusion reactions, transfusion-related acute lung injury (TRALl), anaphylactic and other allergic reactions, graft-versus-host disease (GvHD), transfusion-associated circulatory overload (TACO), viral infections, post-transfusion bacteremia, transfusion-associated sepsis (TAS), hemosiderosis, post-transfusion purpura, and new allo-antibody formation [18 , 19 ]. Whole blood, erythrocytes, leukocytes, platelets, and plasma for transfusion (fresh frozen plasma, FFP) are involved. Quite a number of these adverse effects, such as TRALl, TACO, TAS, and allergic/anaphylactic reactions can be difficult to evaluate. 

An important application, recently developed, is represented by sterilizing blood components, in particular, platelet concentrate. Recently, clinical trials carried out with a novel psoralen S-59 derivative demonstrated the efficacy of the photochemical treatment, thus offering the potential to reduce transfusion-related viral and antibacterial diseases. 

On the wider scale, ionised calcium in sera measured with the calcium ion-selective electrode have helped in studying the direct effect of calcium on the hyperparathyroidism of chronic renal failure when it was shown that rats on low calcium diet developed larger parathyroids and more severe bone disease at the end of four weeks while diets with above normal calcium levels produced no additional benefits [130]. Other studies include the relation between hypercalcemia and normal ionised serum calcium in a case of myelomatosis [86], the detection of hypocalcemia in susceptible neonates [68], and studies on serum ionised calcium changes following citrated blood transfusion in anaesthetised subjects [93]. The transfusion studies showed six patients during anaesthesia to have a decrease of 0.135 mmol dm" after 500 cm and 0.15 mmol dm" after 1000 cm blood, respectively. However, the calcium ion concentration increased by a mean of 0.075 mmol dm" in 10 min following complete infusion of the blood [93]. 

Sensory systems Eyes Vitelliform or egg yolk-like cysts in the retinal macula are typical of Best s disease, an autosomal inherited retinopathy and can also occur in deferoxamine-related retinopathy. This has again been reported in a woman with (unspecified) thalassemia who had been treated with regular blood transfusions and intramuscular and subcutaneous deferoxamine for about 20 years [20 ]. She had bilaterally reduced visual acuity of sudden onset and there were no indicators of a genetic disposition. 

Interferon - Human interferon was shown to have a limited but measurable activity against a number of strains of adenovirus. The absence of interferon in serial serum specimens collected prior to and during the incubation and acute phase of transfusion associated hepatitis may in part be related to the chronicity of the disease. Human leukocytal interferon has been utilized in at least two controlled clinical trials. In the first trial it was administered to patients with confirmed Influenza and found to rapidly and dramatically reduce the systemic symptoms (headache, dizziness, malaise) and to a lesser degree the respiratory tract symptoms. 

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