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Can Creutzfeldt-Jakob disease be transmitted by transfusion?
1Laboratory of Central Nervous System Studies, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
Insights
The infectious agent of Creutzfeldt-Jakob disease (CJD) is in blood, but studies show blood transfusions do not transmit CJD. Future prevention requires screening blood donors for CJD risk factors.
Area of Science:
- Neurology
- Infectious Diseases
- Transfusion Medicine
Background:
- Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disorder caused by a transmissible agent.
- The CJD agent is present in various body tissues, though pathology is limited to the brain.
- Experimental models and limited human studies suggest blood, particularly leukocytes, may harbor infectious CJD agents.
Purpose of the Study:
- To evaluate the risk of Creutzfeldt-Jakob disease (CJD) transmission via blood transfusion.
- To assess the infectivity of blood during different stages of CJD.
- To inform future strategies for preventing iatrogenic CJD transmission through blood products.
Main Methods:
- Review of epidemiologic studies on CJD transmission.
- Analysis of data from nearly 2000 patients studied over two decades.
- Examination of experimental animal models of CJD infectivity.
- Identification of risk factors for harboring the CJD agent.
Main Results:
- Epidemiologic data do not support blood transfusion as a route for CJD transmission.
- No cases of CJD were confirmed to be acquired from blood donors among studied patients.
- Experimental evidence indicates potential infectivity in blood during clinical and preclinical CJD stages.
Conclusions:
- While blood may contain the CJD agent, current evidence does not link transfusion to disease transmission.
- Continued vigilance and screening of blood donors are crucial to prevent potential iatrogenic CJD.
- Screening should focus on individuals with neurological disease, family history, or specific iatrogenic exposure risks.
Abstract:
The transmissible agent of Creutzfeldt-Jakob disease, a dementing neurodegenerative disorder, is present in many tissues of the body, even though its pathologic consequences are confined to the brain. Experimental animal models of the disease have shown that blood (most probably the leukocyte component) can be infectious in both the clinical and preclinical incubation stages of the disease, and there are also a few reported isolations of the agent from whole blood, buffy coats, or serum from humans with Creutzfeldt-Jakob disease. Despite this potential for blood-borne iatrogenic infection, epidemiologic studies do not support the contention that the administration of blood, blood components, or blood derivatives transmits the disease; in particular, not one of nearly 2000 patients who have been studied during the past two decades has been shown to have acquired the disease from a blood donor who later died of Creutzfeldt-Jakob disease. This fact does not diminish our responsibility to preclude such an occurrence from happening in the future, and will require an unremitting effort to screen from the blood donor population all individuals with a higher than average risk of harboring the infectious agent; namely, donors with neurologic disease, a family history of neurologic disease, or a history of events that have been identified as leading to iatrogenic Creutzfeldt-Jakob disease, such as neurosurgical procedures involving dura mater homografts or treatment with native pituitary hormones.