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Transfusion Related Transmission of Infectious Disease



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- Discussion:
    - septic reaction: considered when high fever and hypotension accompany a transfusion reaction;
    - transmission of disease:
            - HIV: risk is estimated to be about 1 in 200,000-800,000;
            - hepatitis B: estimated risk is 1 in 200,000;
            - hepatitis C:
                   - probably 2-3% of population has hepatitis C antibodies, and hepatitis C related cirrhosis is the leading cause of liver transplantation in the US;
                   - now that 2nd generation screening tests are available, estimated transfusion risk is 1 in 3,000-5,000 (but may be as low as 1:100,000);
                   - infection tends to be chronic and perisistent eventhough patients may be asymptomatic - long term, cirrhosis may develop in 20%;
                   - clincical findings: ascites, heptosplenomegaly, and encephalopathy;
                   - lab test will reveal elevated LFT's (ALT), and liver biopsy may reveal portal or bridging fibrosis,
                          and at least moderate degrees  of inflammation and necrosis;
                   - be aware that combination of interferon and ribavirin has been FDA approved for treatment of hepatitis C;
                          - w/ needle stick injury, consider inteferon treatment (50 % effective);
                          - w/ no treatment, risk of infection is about 3.5%;
                   - patients need to avoid contaminating family members avoid sharing utensiles, toothbrushes ect;
                   - references:
                          - Hepatitis C Virus Infection:  Review and Implications for the Orthopaedic Surgeon
                          - Incidence of hepatitis C in patients requiring orthopaedic surgery.
                          - The declining risk of post-transfusion hepatitis C virus infection.



Medical News & Perspectives: As the Blood Supply Gets Safer, Experts Still Call for Ways to Reduce the Need for Transfusions.