Blood Transfusion Risks

[twiceblsd]

Hello,

My husband and I have identical twins that were born at 27 wks, both received a red cell transfusion while in the NICU. When they were about 2, one of the girls developed ALL (acute lymphoblastic leukemia) and her twin followed a year later. Over the 2+ years they received chemo, both received several blood transfusions, for red cells and platelets. After treatment, they were both tested for Hep. B, Hep. C, and HIV, all were negative. At the 5 year post-treatment mark we were told that they were considered cured of ALL and that they are now like "normal" kids (minus yearly oncology visits for late effects).

They are now 14 and have been shaving underarms and legs for years. Being twins, they share everything, including a razor.  I did not give this a second thought since they have tested negative for all known blood borne pathogens and their heme/onc doctors have never mentioned concerns about their past transfusions. Recently I have been beating myself up for not considering any FUTURE viruses that haven't yet been discovered. One could be passing unknown viruses to the other or vice versa. We have explained all this to our girls and they are not sharing razors anymore but I can't seem to forgive myself for not thinking of this.

I wasn't sure if I needed to seek the advice of an infectious disease specialist or if this was something you have knowledge of and I don't expect you to have a crystal ball, I was just hoping to get ANY information that might ease my mind a little.

Are there any new blood borne pathogens being studied now?

Their last transfusion was about 10 years ago, do the chances of having an unknown pathogen decrease with time?

How often are current pathogens transmitted through razors?

Thank you very much          

[H. Hunter Handsfield, M.D.]

Both results are entirely negative.  This is an enzyme immunoassay (EIA) test, the same technology for most antibody tests like those for HIV, HCV, herpes, and many others.  With an EIA, any numerical value below the cut-off for a positve result -- in this case 0.9 -- is negative.  These results do not suggest that daugher 1 has "a little bit" of HCV antibody.  If the same test were repreated several times, on either daughter, it could give quite variable results, such as 0.3, 0.8, 0.4, etc.  As long as it's below 0.9, no antibody is present and the result is negative.

[twiceblsd]

Thanks for your response, it does make me feel a little better to know that pathogens are very rarely spread via a razor. We continue to follow up with their hem/onc doctor annually.

Yes, both of our daughters had ALL and several blood transfusions. Their history has unfortunately made me a very anxious, hyper-vigilant mother. I was looking over their test results from last year and I have a few questions about their HCV results. I didn't see an "ask the expert" forum for Hepatitis C so I was wondering if you could explain their results to me?

Daughter 1) HCV Ab  0.2
Daughter 2) HCV Ab  <0.1

The range is 0.0-0.9 s/co ratio and I noticed a comment below that: "non-reactive HCV antibody screen is consistent with no HCV infection".

Does this result say that they have some HCV antibodies? Shouldn't the result be NEGATIVE or 0.0 if they have never developed antibodies to HCV?

I was doing some reading on the CDC website and it sounds like they are recommending a different test as of May, 2013. Is that correct?

Thanks again, this is a wonderful service.

[H. Hunter Handsfield, M.D.]

I see I misuderstood -- that both kids had ALL.  But it doesn't change my opinions or advice.  Sorry if that caused any confusion.  

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  However, I'm not sure I can help.

You and your kids have been through a lot.  I'm very happy to hear the one with leukemia has recovered completely; this is one of the most spectacular advances in medicine in our lifetimes.

I am unaware of any current suspicions of as yet undiscovered bloodborne viruses.  It's impossible to disprove a negative proposition, so I suppose it oculd happen.  However, if such viruses exist, it's a fair bet they are relatively harmless.  How can I say this?  Because there seem to be no serious health problems whose pattern of occurrence -- the epidemiology of the disease -- suggest transmission between affected persons through blood or sexual contact.  I'll remind you that these features -- blood and sex -- were understood in great detail about AIDS before the virus was discovered.  I would expect that if and when a new bloodborne virus emerges, we would have the same epidemiologic clues.  Until and unless some such illness shows up, and appears to be spreading widely in the way HIV/AIDS did in the early 1980s, you shouldn't be worried about it.

I agree it's a good idea to teach your kids to not share razors, toothbrushes, etc with other persons, especially as they approach an age when they'll be living on their own.  That said, it is extremely rarely for any bloodborne infection to be spread by razors; this is one of those theoretical risks that rarely is a serious risk.  Among the millions of people with HIV, HBV, or HCV infections, I'm not aware of any reports of cases that were acqually acquired by shared razors.  Virtually all cases can be traced to more obvious blood or sexual risks.  (The main risk of sharing razors is skin infections like staph or strep bacteria.)

As your daughter's oncologist undoubtedly has said, the daugher who recovred from ALL should be monitored for life.  But to my knowledge, the risks she faces most likely are attributable entirely to her chemotherapy and not likely to unknown health effects (infectious or otherwise) from her transfusions.  That said, this is definitely outside my expertise -- if the oncologist advises otherwise, trust him or her more than me!

I hope this has helped.  Best wishes--  HHH, MD