International Team of Scientists Warn Against Emerging Pathogens

A team of scientists from the U.S., Scotland and several other countries recently published a report that draws attention to the potential threat posed by new infectious agents to individuals with bleeding disorders. The report entitled, “Clinical Perspectives of Emerging Pathogens in Bleeding Disorders,” appeared in the January 21, 2006 issue of The Lancet.

The researchers believe that because thousands of hemophilia patients were infected with viruses (HIV/AIDS, HCV) in the1980s through treatment with blood products, it should offer proof of the risk of blood-borne pathogens. Also, recent news from the United Kingdom of a third case of variant Creutzfeldt-Jakob disease (vCJD) linked to a blood transfusion further underscores the danger emerging pathogens pose to the world’s blood supply. Read “UK Public Health Agency Announces Third Transfusion-Related Case of vCJD”.

In the 1990s, the availability of recombinant factor products, which are manufactured in a laboratory using DNA technology, offered theoretically safer treatment alternatives for bleeding disorder patients. Although many patients in first world nations use these products, many more people living in the developing world have little to no access to these safer drugs. According to Jamie Siegel, MD, associate professor of medicine at Jefferson Medical College and director of the hemophilia treatment center at Thomas Jefferson University, “there will always be emerging pathogens and we won’t always know what they are. We know that these pathogens may be in the blood supply, and if we have a population dependent on plasma derived products, they are always at risk.”

In addition, due to efficacy and cost, some patients in the U.S. continue to use plasma-derived products, which are theoretically more open to contamination because they are manufactured using plasma pooled from the blood of multiple donors. Dr. Siegel understands that preferred drug lists (PDL), which have been implemented as cost-saving measures in state Medicaid programs, may limit patient access to recombinant products. “It means you could create a two-tiered system and medical assistance patients may get plasma-derived products and potentially not get as good care as those with private insurance,” said Siegel. “It means they may have limited access to the safest treatments.”

There has not been a reported case of blood product-related HIV infection since the late 1980s or HCV infection since the early 1990s. Plasma-derived products are significantly safer than they were 20 years ago with tighter blood donation screening methods and advanced modes of viral inactivation integrated into the manufacturing process.

National Hemophilia Foundation’s Medical and Scientific Advisory Council (MASAC) recommends recombinant factor VIII products as the treatment of choice for patients with hemophilia A or B. Read MASAC’s Recommendation Concerning the Treatment of Hemophilia and Other Bleeding Disorders (#165).

Source: Thomas Jefferson University news release dated February 13, 2006