Hello and welcome to Transfusion News. Today we will be discussing Ebola virus disease, which was a special hot topic session at the 2014 AABB Annual Meeting. Ebola virus is a negative-stranded RNA virus that is a member of the filovirus family. The Zaire strain of the current outbreak has a mortality rate of approximately 70%, which has resulted in over 5,000 deaths.
Dr. Koepsell, who has been involved in the treatment of these patients, notes:
“The virus transmission is thought to be by direct contact with infected bodily fluids from someone who is sick…and so we don’t worry about it crossing across an airplane, breathing someone else’s air. It’s thought to be direct contact with infected fluids.”
Although transfusion-transmitted Ebola infections are highly unlikely, pre-transfusion testing remains controversial. Dr. Koepsell says:
“What it really comes down to for the transfusion service is knowing how to handle specimens safely, securing the specimens, and tracking who is involved with the testing of those specimens, as well as what do you do afterwards as far as the contamination procedures.”
The transfusion medicine service is also critical for one possible treatment of Ebola, which involves use of convalescent plasma from Ebola survivors.
Dr. Winkler, who has also been involved in the treatment of Ebola patients, describes how convalescent plasma may possibly help patients:
“Convalescent plasma can be used as a therapy in providing antibodies from survivors to actually neutralize the virus. The concept of using convalescent plasma was initially used in 1995 during an outbreak of Ebola virus disease in the Democratic Republic of Congo. From that study, we know that there was increased survival in patients who received convalescent whole blood transfusion.”
Unfortunately, we do not know the exact mechanism for the beneficial effects of convalescent plasma, nor do we know the optimal dose. The WHO recommends four to five hundred milliliters of convalescent plasma, but patients in the United States have received greater quantities. The WHO is beginning to evaluate the effects of convalescent plasma and two other antiviral treatments in Africa.
Use of convalescent plasma in the US requires an emergency investigational new drug application. The AABB’s Ebola Policy Working Group is currently streamlining this process.
We’ll be back with another edition of Transfusion News on December 15th. Thanks for joining us.
References
- Presentation Slide Handout from AABB Annual Meeting 2014, Philadelphia. Hot Topic Session: Ebola and Transfusion Medicine. Accessed online November 14, 2014. http://static.coreapps.net/aabbam14/dailies/03db66b5ffa421bb850a31cf39e86419.pdf
- Ebola Treatment Trials to Start at MSF Sites in December. Accessed online November 14, 2014. http://www.doctorswithoutborders.org/article/ebola-treatment-trials-start-msf-sites-december
- Katz, LM and Tobian, A. Ebola virus disease, transmission risk to laboratory personnel and pretransfusion testing. Transfusion 2014; in press.
- AABB Association Bulletin #14-08. Deferral for Blood Donation of Persons Under Public Health Surveillance for Possible Exposure to Ebola Virus. October 14, 2014. Accessed online November 14, 2014. http://www.aabb.org/programs/publications/bulletins/Documents/ab14-08.pdf
- Special Annual Meeting Ebola Session Highlights Practical Information. AABB Weekly Report November 7, 2014; 20 (38).
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