title: Dealing with the uncertain risk of variant Creutzfeldt-Jakob disease transmission by coagulation replacement products.
abstract: The identification of variant Creutzfeldt-Jakob disease (vCJD) in the UK in 1996 led to significant concerns about the possibility of secondary transmission, however the prevalence of subclinical vCJD and risks of vCJD transmission by plasma are not known. In the UK, public health precautions have been implemented in all recipients of coagulation factor concentrates manufactured from UK plasma pools between 1980 and 2001. The recent demonstration of abnormal prion protein in a spleen sample at autopsy of a UK haemophilic patient who received coagulation factor concentrates to which a donor incubating vCJD had contributed most likely represents the first case of vCJD transmission by coagulation factor concentrates. We review the uncertainties that surround risk of vCJD transmission by coagulation factor concentrates, the challenges in dealing with undefined risks, the rationale behind current policies and the implementation of vCJD surveillance and risk management measures in bleeding disorder patients in the UK.
authors: Centre for Haematology, Imperial College London, London, UK. c.millar@imperial.ac.uk
authors: Carolyn M
authors: CM
authors: Millar
authors: Mike
authors: M
authors: Makris
mesh_terms: D025861:Blood Coagulation Disorders, Inherited / Q000628:therapy; D001779:Blood Coagulation Factors / Q000009:adverse effects / Q000627:therapeutic use; D007562:Creutzfeldt-Jakob Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D011994:Recombinant Proteins / Q000627:therapeutic use; D018570:Risk Assessment / Q000379:methods; D065227:Transfusion Reaction
chemical_list: D001779:Blood Coagulation Factors; D011994:Recombinant Proteins