Progress Toward a Pathogen-Free Blood Supply

McCullough, Jeffrey

doi:10.1086/375232

Cited by 26 publications

(19 citation statements)

References 40 publications

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“…In contrast, IVIG obtained from blood donors from the United States without WNV-specific antibodies had no similar protective effect (Ben-Nathan et al, 2003). Several case reports also show efficacy of IVIG containing WNV-specific antibodies in aborting human WNV infection (Hamdan et al, 2002; Agrawal and Peterson, 2003), although other case studies found no clear benefit (Haley et al, 2003). A double-blind placebo-controlled multicenter trial was initiated in 2003 to compare the efficacy of an Israeli IVIG preparation that had a high-titer anti-WNV antibody (Omr-IgG-am; Omrix, Tel Aviv) with that of U.S. IVIG (Polygam; Baxter Healthcare Corp., Deerfield, IL, USA), which lacked detectable anti-WNV antibody.…”

Section: Treatment For Neuroinvasive West Nile Infectionmentioning

confidence: 99%

Neuromuscular Manifestations of West Nile Virus Infection

2012

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The most common neuromuscular manifestation of West Nile virus (WNV) infection is a poliomyelitis syndrome with asymmetric paralysis variably involving one (monoparesis) to four limbs (quadriparesis), with or without brainstem involvement and respiratory failure. This syndrome of acute flaccid paralysis may occur without overt fever or meningoencephalitis. Although involvement of anterior horn cells in the spinal cord and motor neurons in the brainstem are the major sites of pathology responsible for neuromuscular signs, inflammation also may involve skeletal or cardiac muscle (myositis, myocarditis), motor axons (polyradiculitis), and peripheral nerves [Guillain–Barré syndrome (GBS), brachial plexopathy]. In addition, involvement of spinal sympathetic neurons and ganglia provides an explanation for autonomic instability seen in some patients. Many patients also experience prolonged subjective generalized weakness and disabling fatigue. Despite recent evidence that WNV may persist long-term in the central nervous system or periphery in animals, the evidence in humans is controversial. WNV persistence would be of great concern in immunosuppressed patients or in those with prolonged or recurrent symptoms. Support for the contention that WNV can lead to autoimmune disease arises from reports of patients presenting with various neuromuscular diseases that presumably involve autoimmune mechanisms (GBS, other demyelinating neuropathies, myasthenia gravis, brachial plexopathies, stiff-person syndrome, and delayed or recurrent symptoms). Although there is no specific treatment or vaccine currently approved in humans, and the standard remains supportive care, drugs that can alter the cascade of immunobiochemical events leading to neuronal death may be potentially useful (high-dose corticosteroids, interferon preparations, and intravenous immune globulin containing WNV-specific antibodies). Human experience with these agents seems promising based on anecdotal reports.

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Section: Treatment For Neuroinvasive West Nile Infectionmentioning

confidence: 99%

Neuromuscular Manifestations of West Nile Virus Infection

2012

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“…Despite this, allogeneic blood transfusion still carries a risk of exposure to blood borne pathogens, such as viral hepatitis and HIV. Blood is screened with nucleic acid amplification testing, which has reduced the risk of HIV transmission through donated blood to approximately one in 1.9 million 1. Another complication that can occur with blood transfusions is inaccurate cross-matching, which ran result in antigen binding and subsequent agglutination.…”

Section: Introductionmentioning

confidence: 99%

A Review of Blood Substitutes: Examining The History, Clinical Trial Results, and Ethics of Hemoglobin-Based Oxygen Carriers

Chen

Scerbo

Kramer

2009

Clinics

186

125

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The complications associated with acquiring and storing whole blood for transfusions have launched substantial efforts to develop a blood substitute. The history of these efforts involves a complicated mixture of science, ethics, and business. This review focuses on clinical trials of the three hemoglobin-based oxygen carriers (HBOC) that have progressed to Phase II or III clinical trials: He-mAssist (Baxter; Deerfield, IL, US), PolyHeme (Northfield; Evanston, IL, US), and Hemopure (Biopure; Cambridge, MA, US). Published animal studies and clinical trials carried out in a perioperative setting have demonstrated that these products successfully transport and deliver oxygen, but all may induce hypertension and lead to unexpectedly low cardiac outputs. Overall, these studies suggest that HBOCs resulted in only modest blood saving during and after surgery, no improvement in mortality and an increased incidence of adverse reactions. To date, the results from these perioperative studies have not led to regulatory approval. All three companies instead chose to focus their efforts on large trials of trauma patients in the pre-hospital setting.Baxter abandoned the development of HemAssist after a trial in the U.S. was prematurely halted when the first 100 patients showed significantly increased mortality rates as compared to patients treated with blood products. Northfield’s PolyHeme trial demonstrated a non-significant trend towards increased mortality and a very modest reduction in the subsequent need for blood. The testing of Biopure’s Hemopure for trauma patients has been halted for several years because of FDA concerns over trial design and study justification. Ethical concerns have also been raised regarding the design and implementation of all HBOC clinical trials.Thus, the available evidence suggests that HemAssist, Polyheme, and Hemopure are associated with a significant level of cardiovascular dysfunction. The next generation of HBOCs remains under development.

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“…Although allogeneic blood is now reportedly safer than ever [15], safety issues with the blood supply still exist [16]. Furthermore, blood is a scarce resource that is becoming even more so.…”

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confidence: 99%

Untitled

Monk

2004

Crit Care

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Preoperative anemia in a surgical patient predisposes to poor outcomes and allogeneic blood transfusions. As an alternative to transfusions, pharmacologic management of preoperative anemia with recombinant human erythropoietin (rHuEPO) has been well studied in many different types of surgery. rHuEPO, when used alone or in combination with preoperative autologous blood donation before elective surgery, stimulates erythropoiesis and helps to avoid or reduce the need for allogeneic blood transfusions. The clinical evidence on preoperative use of rHuEPO in orthopedic, cardiac, and cancer surgery, as well as in bloodless surgery, is reviewed.

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Progress Toward a Pathogen-Free Blood Supply

Cited by 26 publications

References 40 publications

Neuromuscular Manifestations of West Nile Virus Infection

Neuromuscular Manifestations of West Nile Virus Infection

A Review of Blood Substitutes: Examining The History, Clinical Trial Results, and Ethics of Hemoglobin-Based Oxygen Carriers

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