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