[Prion diseases and blood transfusion]

[Biologics in Rhinology - Forthcoming Personalized Concepts: the Future Starts Today]

Sinunasale Erkrankungen zählen mit zu den häufigsten chronischen Erkrankungen und führen zu einer erheblichen Störung der Lebensqualität, ein komorbides Asthma ist häufig. Trotz leitliniengerechter Therapie ist anzunehmen, dass mind. 20% der Patienten ihre Erkrankungssymptome nicht adäquat kontrollieren können. Neben den etablierten chirurgischen und konservativen Therapieoptionen finden sich nun vielversprechende Therapieansätze, die bspw. mittels therapeutischer Antikörper mechanistisch gezielt in die Pathophysiologie der Erkrankungen eingreifen können. Die Auswahl der geeigneten Patienten durch geeignete Biomarker und die richtige Therapie zum richtigen Stadium der Erkrankung anbieten zu können, ist das Ziel stratifizierter Medizin und eine wichtige Perspektive für die HNO.Chronic diseases of the nose and the paranasal sinuses are most common, frequently associated with bronchial asthma, and result in substantial reduction of quality of life. Despite optimal treatment according to guidelines, approx. 20 % of the patients will report inadequate control of symptoms. Apart from well established surgical and conservative approaches in therapy new therapeutic antibodies are available that aim specifically pathophysiological targets. The optimal allocation of effective therapy for patients using appropriate biomarkers at the most suitable timepoint is the hallmark of stratified medicine and an important perspective in ENT.

[Prions--clinical significance, epidemiology and possibilities of transmission through blood and blood products]

INTRODUCTION

Prions play a leading role in development of transmissible spongiform encephalopathies (TSE). These infectious particles, smaller than viruses and viroids, consist of special kind of proteins and don't contain nucleic acids. Due to that, they are named defective viruses.

BIOCHEMICAL CHARACTERISTICS

Prion protein determined as PrPcs was isolated in infective material of all known prion diseases. This represents an abnormal conformer of PrPc prion protein, normally synthesized in all cells, predominantly in neurons of vertebrates.

PATHOGENESIS OF TSE

Transmissible spongiform encephalopathies are neurodegenarative diseases whose pathogenesis includes modification of secondary structure of normal glycoprotein--prion protein. In human peripheral blood, PrP are expressed in T and B lymphocytes, NK cells, monocytes, dendritic cells, platelets and plasma.

EPIDEMIOLOGICAL STUDIES

Investigations of transmission of prions to experimental animals, showed that lymphoid tissues are infectious in the earliest phase of the disease. Experimental transmission of sporadic Creutzfeldt-Jakob disease (CJD) by intracerebral inoculation of experimental animals with whole blood, buffy coat, platelet concentrates, plasma, early cohn fractions and albumin preparations, has been reported. A small number of clinical studies reported transmission of CJD by human blood, urine and lymphoid tissues and the role of B lymphocytes in neuroinvasion and transmission of prions.

CONCLUSION

Thus, importance of prion diseases in blood transfusion is obvious, latrogenic transmission of prion diseases by blood and blood products, can't be neglected. Moreover, it is necessary to find markers in prion diseases as well as new technologies and methodologies in blood transfusion practice to minimize the theoretical risk of transmission of prion diseases by blood and blood products.

[The impact of the implementation of staying in the United Kingdom for six months or more as donor exclusion criteria on the donor base of the Basque Country]

BACKGROUND

To reduce the risk of new variant Creutzfeldt-Jakob disease by blood products some countries exclude persons who have spent six months or more cumulatively in the United Kingdom as blood donors.

METHOD

We asked our donors about this selection criteria to evaluate the loss of blood donors and donations in case of implementation of this measure.

RESULTS

11,681 donors and 1,648 refused persons were analyzed. 123 (1.05%) and 11 (0.66%) respectively fulfilled this criteria.

CONCLUSIONS

In case of implementation of this selection criteria 1% of blood donors and 1.77% blood donations would be lost.