HIV Infection
Thalassaemic patients were affected
by the outbreak of transfusion-associated human immunodeficiency virus (HIV)
infection occurring in most Western countries during the early 1980s. In 1984,
the frequency of infection in 66 thalassaernics in New York was 12% [55], A
similar figure was reported in Italy [56]. Subsequently, the frequency of HIV
infection decreased to 2.9% in 1990 [7, 24], and 1.8% in 1998 [10]. This was
due to two main reasons: (a) the efficacy of anti-HIV screening for blood
donations, implemented in 1985, and <b) the high mortality among
HIV-infected thalassaeruics (25% over a 6-year period) [7].
Currently,
blood supply can be considered reasonably safe with regard to the risk of
acquiring HIV infection.
Transmission of human parvovirus
(HPV) B19 through blood transfusion in patients with 3-TM has been documented
[50]. Because of its propensity to infect proliferating haematopoietic cells,
HPV B19 can cause life-threatening aplastic crisis in thaiassaemics [50, 71 ].
Cardiac involvement has also been reported, in anecdotal cases [50].
Until 1990, cytomegaiovirus (CMV)
infection contributed substantially to morbidity among thalassaemic patients
[73], but recent updates on this issue are lacking. In Western countries,
however, a decline of the rate of transfusion-associated CMV infection could
reasonably be expected due to the increasing use of leucoreduced red cells,
which are effective in preventing CMV transmission [74].
Of
many possible bacterial contaminants of blood supply, Yersinia enterocolitica
merits lo be mentioned because of increased frequency in patients with iron
overload [5, 16]. The data collected in 14 cases of yersiniosis observed over
15 years in two North American clinics were recently reported by Adamkiewicz et
al. [75]. The clinical pattern was generally characterized by fever and
gastrointestinal symptoms. Of note, clinical signs occurred within 10 days of
blood transfusion in 57% of the patients, suggesting blood-borne infection.
Dr. Nada Fathy
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