tag:theconversation.com,2011:/uk/topics/blood-transfusion-18524/articlesBlood transfusion – The Conversation2022-02-03T13:11:31Ztag:theconversation.com,2011:article/1759062022-02-03T13:11:31Z2022-02-03T13:11:31ZHeading into the third year of the pandemic, the US blood supply is at a 10-year low<figure><img src="https://images.theconversation.com/files/443904/original/file-20220201-21-1mjhmc5.jpg?ixlib=rb-1.1.0&rect=209%2C83%2C6779%2C3845&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Blood donations have dropped at the same time that the need for blood is soaring. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/red-blood-cells-flowing-through-the-blood-stream-royalty-free-image/1280727099?adppopup=true">ExperienceInteriors/E+ via Getty Images</a></span></figcaption></figure><p>The blood supply in the U.S. is now at its lowest level in <a href="https://www.keyc.com/2022/01/05/nations-blood-supply-reaches-10-year-low/">over a decade</a>.</p>
<p>Many of the nation’s blood centers currently have only a <a href="https://www.npr.org/2022/01/17/1073661375/red-cross-declares-a-blood-crisis-as-supply-runs-out-at-hospitals-and-blood-bank">one-day supply of some blood types in inventory</a>. This is dangerous because blood transfusions are needed for many surgeries. Blood is also used in the treatment of diseases like sickle cell anemia and certain cancers – and is critical to help those who suffer injuries from accidents or disasters.</p>
<p>In January 2022, the American Red Cross declared its <a href="https://thehill.com/policy/healthcare/public-global-health/589152-red-cross-declares-first-national-blood-crisis">first-ever national blood crisis</a>. A <a href="https://www.ama-assn.org/press-center/press-releases/aha-ama-ana-joint-statement-blood-shortages">joint statement</a> by the American Hospital Association, the American Medical Association and the American Nurses Association said that the “severity and duration of this shortage could significantly jeopardize the ability of health care providers to meet the many urgent needs of our patients and communities.”</p>
<p>A consistent supply of blood is essential to the nation’s health. Blood is a precious lifesaving product that cannot be manufactured but must be donated. No substitute for blood exists. </p>
<p>Each day the U.S. needs about 29,000 units of red blood cells, 5,000 units of platelets and <a href="https://dx.doi.org/10.1016%2Fj.ajem.2020.06.058">6,500 units of plasma</a>, according to the <a href="https://www.redcrossblood.org/donate-blood/how-to-donate/how-blood-donations-help/blood-needs-blood-supply.html">American Red Cross</a>. The average blood transfusion is for three units, with a victim of a car accident requiring as many as 100. A single donation can help more than one patient. Convalescent plasma may even be used as <a href="https://www.washingtonpost.com/health/2021/12/21/covid-treatment-convalescent-plasma/">a treatment against COVID-19</a>, a possibility <a href="https://doi.org/10.1007/s43069-021-00072-1">our team has been researching</a>.</p>
<p><a href="https://people.umass.edu/nagurney/">I am a professor and director</a> of the Virtual Center for Supernetworks at the University of Massachusetts Amherst. <a href="https://scholar.google.com/citations?user=ecFsBp0AAAAJ&hl=en">My expertise is supply chains</a>, including <a href="https://link.springer.com/book/10.1007/978-1-4614-6277-4">perishable product supply chains</a> such as blood. The COVID-19 pandemic, heading into its third year, has exacerbated the challenges associated with the nation’s blood supply chains. Let me explain.</p>
<h2>Two years of dramatic change</h2>
<p>At the <a href="https://theconversation.com/how-coronavirus-is-upsetting-the-blood-supply-chain-133424">onset of the pandemic</a> in the winter of 2020, with growing fear and uncertainty, blood collections at many schools and other sites that traditionally hosted mobile blood drives closed. Throughout the nation, elective surgeries were canceled and procedures <a href="https://dx.doi.org/10.1016%2Fj.cll.2020.08.013">to preserve blood put into place</a>. </p>
<p>Even before the pandemic, blood service organizations faced many challenges – including economic ones – and the U.S. blood supply chain was going through major shifts. In pre-pandemic times, less than 10% of the U.S. population would donate blood in a given year, although 38% were eligible. Moreover, blood is perishable,<a href="https://supernet.isenberg.umass.edu/articles/CompetitionforBloodDonations.pdf"> with red blood cells lasting 42 days, and platelets only five days</a>, so regular replenishment is essential. </p>
<p>But in the past two years, since the World Health Organization <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020">declared the COVID-19 pandemic</a>, unforeseen ripple effects have resulted in an <a href="https://www.boston.com/news/health/2022/01/14/an-unprecedented-shortage-hospitals-in-massachusetts-are-desperate-for-blood-donors/">immense demand for blood</a>. Many people delayed medical treatment and may now be <a href="https://www.mskcc.org/news/covid-19-has-caused-national-blood-shortage-people-cancer-need-your-help">suffering from more advanced disease</a>. An increase in <a href="https://doi.org/10.1038/s41598-021-98813-z">gun violence</a>, <a href="https://www.ama-assn.org/system/files/issue-brief-increases-in-opioid-related-overdose.pdf">drug overdoses</a>, <a href="https://www.latimes.com/world-nation/story/2021-12-08/traffic-deaths-surged-during-covid-19-pandemic-heres-why">automobile accidents</a> – some due to driving under the influence as a consequence of pandemic-induced stress and challenges – and <a href="https://doi.org/10.1186/s12888-021-03570-y">other trauma</a> during the pandemic have also led to escalating demand for blood. </p>
<p>The American Red Cross <a href="https://www.boston.com/news/health/2022/01/14/an-unprecedented-shortage-hospitals-in-massachusetts-are-desperate-for-blood-donors/">reports that</a> since March 2020, blood donations have decreased by 10%, with a decrease of 62% in college and high school blood drives as many of those locations went remote. This age group represented about a quarter of all the donors in 2019, with a drop to about 10% of all donors during the pandemic. </p>
<p>Most recently, donors who have tested positive with the <a href="https://theconversation.com/alpha-then-delta-and-now-omicron-6-questions-answered-as-covid-19-cases-once-again-surge-across-the-globe-174703">highly transmissible omicron variant</a> have had to cancel <a href="https://news.wttw.com/2022/01/17/red-cross-warns-national-blood-crisis-due-supply-shortage">scheduled appointments for donating blood</a>. The U.S. Food and Drug Administration recently released guidelines with updated information for blood establishments regarding <a href="https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/updated-information-blood-establishments-regarding-covid-19-pandemic-and-blood-donation">blood donations in the pandemic</a>. Donating blood is itself safe and, importantly, according to the FDA, globally there have been “no reported cases of transfusion-transmitted coronavirus, including SARS-CoV-2.”</p>
<p>The American Red Cross provides about 40% of the <a href="https://www.redcrossblood.org/donate-blood/how-to-donate/how-blood-donations-help/blood-needs-blood-supply.html">blood and blood components that are needed in the U.S.</a>. Donors can also donate blood at local community blood centers or hospitals, at <a href="https://www.vitalant.org/#">Vitalant</a> – formerly United Blood Services – or at member organizations of <a href="https://americasblood.org/">America’s Blood Centers</a>. These make up North America’s largest network of nonprofit community blood centers and operate more than 600 blood donation collection sites.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/443908/original/file-20220201-13-z8dv3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person holds an I Love You sign and small blood bag, with nurses and blood donors in the background." src="https://images.theconversation.com/files/443908/original/file-20220201-13-z8dv3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443908/original/file-20220201-13-z8dv3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443908/original/file-20220201-13-z8dv3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443908/original/file-20220201-13-z8dv3z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443908/original/file-20220201-13-z8dv3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443908/original/file-20220201-13-z8dv3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443908/original/file-20220201-13-z8dv3z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Blood donations have dropped by 10% since the beginning of the pandemic, according to the American Red Cross.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/blood-donation-royalty-free-image/1180246381?adppopup=true">Kmatta/Moment via Getty Images</a></span>
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</figure>
<h2>Not just numbers</h2>
<p>When it comes to blood shortages, people’s lives are on the line, and the stories are very personal. </p>
<p>A young pregnant mother in Louisiana who was suffering from COVID-19 and internal bleeding survived just long enough to see her <a href="https://www.knoe.com/2022/01/28/west-monroe-woman-loses-daughter-speaks-about-importance-blood-donation/">newborn daughter, thanks to blood donations</a>. An 11-year-old girl in West Virginia who is battling bone cancer <a href="https://www.wtrf.com/news/local-news/11-year-old-girl-battling-bone-cancer-during-nationwide-blood-shortage-crisis/">has received 18 blood transfusions</a>. An 8-year-old girl in Texas <a href="https://www.ksat.com/news/local/2022/01/13/doctors-and-patients-worry-during-nationwide-blood-crisis/">is suffering from T-cell leukemia </a> and relies on blood donations, but numerous blood drives in her area were canceled. These are just a few examples.</p>
<p>And the ability to receive regular transfusions is a <a href="https://wtop.com/local/2022/01/donated-blood-thats-direly-needed-who-does-it-help/">matter of life or death for those with certain illnesses</a>. </p>
<h2>The many links involved in blood supply</h2>
<p>The <a href="https://doi.org/10.1007/s10287-011-0133-z">blood supply chain is incredibly complex</a>. It consists of the collection of donations, testing, processing and distribution, with ultimate transfusion to recipients at health care facilities. Along with “getting blood from donor to recipient,” ample supplies are needed for collection, testing and transfusion.</p>
<p>Less well recognized, but of immense importance, is the labor required in this supply chain, which, along with the donors, serves as the backbone. Throughout the pandemic, <a href="https://theconversation.com/the-omicron-variant-is-deepening-severe-staffing-shortages-in-medical-laboratories-across-the-us-174459">workers have been getting sick</a> from COVID-19 and many have, sadly, lost their lives. The reduction in labor availability, along with decreases in productivity, have affected supply chains from <a href="https://www.springerprofessional.de/en/perishable-food-supply-chain-networks-with-labor-in-the-covid-19/18944940">food</a> to <a href="https://doi.org/10.1016/j.ijpe.2021.108080">health care</a>.</p>
<p>With COVID-19 infection rates <a href="https://www.cnn.com/2022/01/17/health/us-coronavirus-monday/index.html">surging across the nation</a>, blood collection services are also suffering from labor shortfalls, including of <a href="https://www.opb.org/article/2021/12/20/blood-collectors-phlebotomist-shortage-red-cross-donation-oregon-washington/">blood collection specialists</a>. The Red Cross is reporting that staffing shortages in parts of the country <a href="https://www.kmvt.com/2022/01/21/local-hospitals-feeling-effects-national-blood-shortage/">are among the biggest hurdles now</a>, with higher wages being offered in this health care sector to attract workers.</p>
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<p>Easing restrictions – such as <a href="https://www.tmj4.com/news/local-news/national-blood-shortage-sparks-renewed-call-to-lift-restrictions-on-gay-men-to-donate">those on gay and bisexual men</a> – could increase the availability of blood by about 2% to 4%. <a href="https://www.cbsnews.com/news/blood-shortage-gay-bisexual-men-donations-fda/">This is now being considered</a>. As we approach the third year of the pandemic, the need for blood donations and for supporting this complex supply chain is even greater than at the onset of the pandemic.</p><img src="https://counter.theconversation.com/content/175906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Nagurney does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Life-saving blood is needed for everything from treating cancers and chronic conditions to helping trauma victims. But blood donations have dropped to crisis levels during the pandemic.Anna Nagurney, Professor and Chair in Integrative Studies, UMass AmherstLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1260022019-11-21T13:59:08Z2019-11-21T13:59:08ZWhat are blood types?<figure><img src="https://images.theconversation.com/files/299910/original/file-20191101-88378-aznth2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Blood has special traits unique to every person.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/1074856703">TippaPatt/www.shutterstock.com</a></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><a href="https://theconversation.com/us/topics/curious-kids-us-74795">Curious Kids</a> is a series for children of all ages. If you have a question you’d like an expert to answer, send it to <a href="mailto:curiouskidsus@theconversation.com">curiouskidsus@theconversation.com</a>.</em></p>
<hr>
<blockquote>
<p><strong>What are blood types? – Harvey W., age 10, Tallahassee, Florida</strong></p>
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<hr>
<p>Blood may seem like it’s all the same, just a red liquid. But if you look at a drop of your own blood under a microscope, you would see objects floating in it that look like balls and doughnuts. </p>
<p>If you looked closer, you would see that the surface of these balls and doughnuts, blood cells and platelets, are sprinkled with more objects. Some of these objects on the surface, called antigens, can differ from person to person. These differences are what determines your blood type. </p>
<p>Is your blood type common or rare? Does your blood type give you the power to help anyone who may need blood or only people with a blood type that is exactly like yours? The answers depend on the antigens in your blood.</p>
<h2>A medical mystery</h2>
<p>At the beginning of the 1900s, if a person were hurt and had lost a lot of blood, doctors would give them donated blood, a transfusion, from another person. Sometimes the person who needed blood would get worse instead of better. Doctors didn’t know why. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/299912/original/file-20191101-88394-r2edhu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/299912/original/file-20191101-88394-r2edhu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/299912/original/file-20191101-88394-r2edhu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/299912/original/file-20191101-88394-r2edhu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/299912/original/file-20191101-88394-r2edhu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/299912/original/file-20191101-88394-r2edhu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/299912/original/file-20191101-88394-r2edhu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your blood type can be common or rare. Do you know what it is?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/222697294/">ChaNaWiT/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>At the time, scientists didn’t know that blood could differ from person to person. They assumed all blood was the same. Scientists performed experiments to try to understand what was going on. </p>
<p>In one experiment, the scientist <a href="https://kids.kiddle.co/Karl_Landsteiner">Karl Landsteiner</a>, mixed blood components from different people in a dish. Voila! He saw when certain blood was mixed, the <a href="https://www.ncbi.nlm.nih.gov/books/NBK2267/">blood clumped together</a>, forming a goo, while other combinations remained a red liquid. This scientist won a Nobel Prize in Medicine for his work with blood types. </p>
<p>With more testing, scientists were able to divide blood into three groups, or types, called type A, B and O. This helped them determine which combinations harmed people when they were mixed. </p>
<h2>Are you a super donor?</h2>
<p>The unique antigens you have in your blood are inherited from your parents. When you get your blood tested, the doctor or nurse can tell you if you have type A, B, AB, or O blood. </p>
<p>Another significant object in the blood is called the Rh D antigen. People with D antigen have positive blood and people without D antigen have negative blood. So, your blood type is often described as either positive or negative. </p>
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<img alt="" src="https://images.theconversation.com/files/299919/original/file-20191101-88403-1htndh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/299919/original/file-20191101-88403-1htndh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/299919/original/file-20191101-88403-1htndh7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/299919/original/file-20191101-88403-1htndh7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/299919/original/file-20191101-88403-1htndh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/299919/original/file-20191101-88403-1htndh7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/299919/original/file-20191101-88403-1htndh7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Healthy red blood cells.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/266252147/">www.shutterstock.com</a></span>
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<p>What blood type are you? Blood type is important, for example, if you have positive blood and donate to someone whose blood is negative, that recipient’s immune system might attack your donated blood cells that are sprinkled with D antigens. If you have type O negative blood, you are a super donor; your blood can be given to almost anyone. Negative blood types are somewhat <a href="https://www.redcrossblood.org/donate-blood/blood-types.html">rare</a>. Only about 14 out of 100 people have any form of negative blood. AB negative blood type is the rarest in the United States, only about 6 people in 1,000 have it. </p>
<p>Even with all scientists know about blood, we are still discovering more about why blood types exist.</p>
<p>For example, researchers have shown that different blood types respond differently to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061611/">diseases</a>. Studies have found that cells from type O blood are less likely than other types to clump together and cause medical problems for people with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878475/pdf/ukmss-30441.pdf">malaria</a>.</p>
<p>Scientists <a href="https://scholar.google.com/citations?user=w_InbNoAAAAJ&hl=en&oi=ao">like me</a> continue to study blood and identify additional differences within it. We’re working to understand more about blood and if its variability has any effect on you or me.</p>
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<p class="fine-print"><em><span>Christine Helms does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Every person’s blood is identified by type. Why does this matter?Christine Helms, Assistant Professor of Physics, University of RichmondLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/824752017-09-28T14:04:22Z2017-09-28T14:04:22ZThe possible outcomes for victims of the tainted blood scandal, 40 years on<figure><img src="https://images.theconversation.com/files/187834/original/file-20170927-24182-1rmkdyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bad blood.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/blood-transfusion-medicinepatien-upper-gi-bleeding-442801486?src=tPdmzGJ09zyzFe3xmzYjwg-1-0">chaiyawat chaidet/Shutterstock</a></span></figcaption></figure><p>Following the announcement of a <a href="https://www.theguardian.com/society/2017/jul/11/contaminated-blood-scandal-theresa-may-orders-inquiry">public inquiry into the blood contamination scandal</a> of the 1980s, a UK court has now ruled that surviving victims may <a href="https://www.theguardian.com/society/2017/sep/26/contaminated-blood-scandal-victims-win-ruling-to-launch-high-court-action">sue the government to obtain compensation</a>. After decades, the thousands of victims and their families will feel they have finally been given an opportunity to obtain justice. </p>
<p>Around 5,000 people with haemophilia became infected with hepatitis C and HIV following treatment with contaminated blood products between the 1970s and early 1990s as a result of negligence and failings by UK health authorities. At least 2,400 have since died, but until now there has been no UK public inquiry into the scandal, or no real opportunity to obtain financial compensation for the harm caused.</p>
<p>The issue began with the development of <a href="https://www.wfh.org/en/page.aspx?pid=635">concentrated blood clotting factors</a> in the 1970s – products derived from blood that proved transformative to patients with haemophilia, allowing them to lead relatively normal lives. Health authorities all over the world aimed for self-sufficiency in blood-based products, but the UK was slow to do so. Instead, it relied on imports from the US, many of which were manufactured from blood plasma drawn from thousands of paid donors. These included products coming from high-risk populations such as prisoners and drug addicts, where hepatitis C and HIV were more common. While Scotland became largely self-sufficient, the rest of Britain still imported most of its supply from the US during the 1980s – when the risk of HIV was at its greatest. </p>
<p>The dangers of blood contamination were well understood at the time – and donor screening, HIV testing and heat treatment were recommended by scientists worldwide. But these precautions were not taken up quickly enough in the UK – often because of costs – meaning patients were exposed to unnecessary risks. </p>
<p>British victims and their families have fought for decades to get to the bottom of how such a failure could have happened, yet to date <a href="https://www.escholar.manchester.ac.uk/api/datastream?publicationPid=uk-ac-man-scw:198260&datastreamId=FULL-TEXT.PDF">no individual or public authority has been held accountable</a>. Victims were instead offered minimal “<a href="http://www.mirror.co.uk/news/uk-news/victims-contaminated-blood-scandal-werent-10854692"><em>ex-gratia</em> payments</a>” on condition that they dropped their claims. </p>
<p>Other countries took a very different approach: in France, for example, more than 30 people including blood centre officials, doctors and ministers were <a href="https://www.research.manchester.ac.uk/portal/en/publications/the-role-of-the-criminal-law-in-healthcare-in-france(2940b3d7-f3aa-4d80-8146-04e2d299fdda).html">prosecuted for criminal offences including negligence and deception</a> – and two senior officials were jailed. </p>
<p>So the announcement of an inquiry by British prime minister Theresa May, after years of pressure from MPs and campaign groups, including the mayor of Greater Manchester, Andy Burnham – who has even claimed there is evidence of a “<a href="https://www.theguardian.com/society/2017/apr/26/andy-burnham-demands-nhs-contaminated-blood-inquiry">criminal cover-up</a>” – has been seen as a last chance for those affected.</p>
<h2>The battle for a public inquiry</h2>
<p>The inquiry’s aim is to investigate the failings of authorities at the time. Criminal proceedings may follow if there is evidence of criminal conduct. It has been a long time coming. Lobbying by victims of the contamination for compensation <a href="https://www.escholar.manchester.ac.uk/api/datastream?publicationPid=uk-ac-man-scw:198260&datastreamId=FULL-TEXT.PDF">started in England in 1987</a>, with demands for a public inquiry the following year. Resistance in Westminster to launch a public inquiry was reflected in the following statement by Lord Warner, then minister of state for health, in 2006: “We do not consider that a public inquiry is justified as we do not believe that any new light will be shed on this issue as a result”. </p>
<p>Yet the <a href="http://www.archercbbp.com/report.html">Archer Inquiry</a>, an independent report funded by donations, and so not a formal public inquiry, published a report in 2009 that stated “there was something to hide” and that “secrecy fosters suspicion”. Following devolution the Scottish Executive held the <a href="http://www.penroseinquiry.org.uk">Penrose Inquiry</a> into the scandal which reported in 2015 and made a number of recommendations to ensure blood safety in Scotland, but was angrily dismissed by campaigners as “<a href="http://www.scotsman.com/news/blood-scandal-victims-condemn-penrose-inquiry-1-3728511">a waste of time and money</a>” for failing to apportion blame. Successive governments in Westminster have failed to act on what was a national scandal.</p>
<h2>What are the possible outcomes?</h2>
<p>It is hoped that those infected by tainted blood and their families will discover exactly who was responsible. But will criminal charges be brought? Several options are available to prosecutors. </p>
<p>Where those infected by contaminated blood have died, individuals identified as responsible may be charged with <a href="http://www.cps.gov.uk/legal/h_to_k/homicide_murder_and_manslaughter/#gross">gross negligence manslaughter</a>. Where the collective fault of an organisation can be identified, a charge of <a href="http://www.cps.gov.uk/legal/a_to_c/corporate_manslaughter">corporate manslaughter</a> might be brought – but in cases where victims died before this crime was introduced via the <a href="http://www.legislation.gov.uk/ukpga/2007/19/contents">Corporate Manslaughter and Homicide Act 2007</a>, prosecution under the old common law offence of corporate manslaughter is unlikely to succeed. </p>
<p>For injuries short of death, individuals who recklessly supplied the contaminated blood could be prosecuted for <a href="http://www.legislation.gov.uk/ukpga/Vict/24-25/100/section/20">grievous bodily harm</a> under Section 20 of the Offences Against the Person Act 1861. Proving that individuals were grossly negligent or reckless – and that this negligence or recklessness caused the death of the victim – will be hard. Proving the Department of Health guilty of corporate manslaughter might arguably be easier, although prosecutors would also need to demonstrate how the department’s policies or practices <a href="https://www.escholar.manchester.ac.uk/api/datastream?publicationPid=uk-ac-man-scw:198260&datastreamId=FULL-TEXT.PDF">directly led to the contamination of blood products</a>, causing the victims’ injuries and deaths.</p>
<p>There have been instances where doctors have been charged with gross negligence manslaughter following <a href="http://www.uhs.nhs.uk/HealthProfessionals/Clinical-law-updates/Manslaughter-by-doctors.aspx">the death of patients through negligence</a>, and one instance of a <a href="https://www.theguardian.com/society/2016/jan/28/frances-cappuccini-caesarean-death-trial-collapses">prosecution of an NHS Trust for corporate manslaughter</a>, which was unsuccessful.</p>
<p>Due to the time that has passed and the complexity of the law, it is quite possible that the courts will be unable to hold anyone criminally accountable. But the decision to allow victims to begin proceedings against the government goes some way towards providing victims some level of justice. If a rigorous, victim-centred inquiry is also conducted, they and the public may at least find some closure in their search for the truth of the failings that scarred thousands of people’s lives.</p>
<p>Handled properly, this inquiry will at least send the message that such professional and institutional failings are unacceptable – and the government’s admission of liability would be a first step toward providing victims with the justice they have sought for so long.</p><img src="https://counter.theconversation.com/content/82475/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melinee Kazarian does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A public inquiry into the infected blood scandal will identify where fault lies, but what reparations are the courts able to provide?Melinee Kazarian, Lecturer in Healthcare Law, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/621792017-03-06T19:24:49Z2017-03-06T19:24:49ZExplainer: what are blood groups and why do they matter?<p>If you’ve ever needed a blood transfusion, or donated blood, you probably would have been asked your blood type. While it was once thought all blood was the same, we now know there are different types of blood, called blood groups. Transfusions between blood groups can be catastrophic, even deadly, so knowing the blood type of donors and recipients is of the utmost importance. </p>
<p>Our bodies contain trillions of red blood cells. Each is covered in an array of proteins and sugars, inherited from our parents, which determine our blood group. We can all be classified into group A, B, AB or O, based on which sugars coat our red blood cells. </p>
<p>We’re also classified as positive or negative, based on whether our blood cells carry a protein called the Rhesus D (RhD) antigen. These two blood group systems (ABO and Rh) give us the eight main blood types: O-, O+, B-, B+, A-, A+, AB-, AB+. </p>
<p><iframe id="tc-infographic-176" class="tc-infographic" height="720" src="https://cdn.theconversation.com/infographics/176/e0bc573a28765ef0177e50122a7960b9e2ce4d22/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>But there are also <a href="http://resources.transfusion.com.au/cdm/ref/collection/p16691coll1/id/863">more than 300 different antigens</a> – proteins and sugars that activate the immune system – expressed on red cells and 36 recognised blood group systems. And they’re just the ones we know about. </p>
<p>While most people know they are, for example, A+ or O-, few people will know (and never need to know) what their expression of other red cell antigens are.</p>
<h2>How were blood groups discovered?</h2>
<p>Transfusion has been practised intermittently <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588804/pdf/yjbm00009-0056.pdf">since the 1660s</a>. But blood groups weren’t discovered until 1900, before which it was assumed that all blood was of the same type. </p>
<p>This led to some catastrophic transfusions of animal blood into humans in attempts to transfer certain qualities (for example, so the recipient would become meek like a lamb). There were also some fatal transfusions between humans. </p>
<p>For this reason, the practice was banned in the UK and France for more than 100 years.</p>
<p>In 1900, physician <a href="https://www.nobelprize.org/nobel_prizes/medicine/laureates/1930/landsteiner-facts.html">Karl Landsteiner</a>’s experiments showed that some people’s red cells “reacted” with plasma samples from other people, while others did not. This led to him describing the ABO system, the most important blood group system and the basis of safe modern transfusion. </p>
<p>After receiving the 1930 Nobel Prize for Medicine for this work, Landsteiner was experimenting with the blood of Rhesus monkeys when he discovered what is now known as the RhD antigen. </p>
<h2>Compatibility</h2>
<p>If we need to transfuse blood from one person to another, we want to give donor blood that is compatible with the recipient’s blood to minimise the chance of a transfusion reaction. </p>
<p>So if a person is group A, this means she can receive a red cell transfusion from either a group A or a group O donor. She should not receive group B or AB red cells, as she has naturally occurring antibodies (proteins formed as part of the immune response) that will likely cause a transfusion reaction, which may be serious – even <a href="http://www.transfusion.com.au/adverse_transfusion_reactions/classification_and_incidence">fatal</a>.</p>
<p>Around 31% of Australians are A+. It’s the second most common blood group after O+, which make up 40% of the <a href="http://www.donateblood.com.au/learn/about-blood">Australian population</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/135753/original/image-20160829-17872-xwxx3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/135753/original/image-20160829-17872-xwxx3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/135753/original/image-20160829-17872-xwxx3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/135753/original/image-20160829-17872-xwxx3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/135753/original/image-20160829-17872-xwxx3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/135753/original/image-20160829-17872-xwxx3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/135753/original/image-20160829-17872-xwxx3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">O negative people are universal donors.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-294586571/stock-photo-giving-blood-during-operation.html?src=lvi-MTLSLjTg1w8zL0DsQQ-1-2">www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Group O negative people are called “universal donors”. Their red cells express neither group A nor B sugars, nor the RhD antigen, and so are unlikely to cause a reaction in recipients. </p>
<p>Emergency departments and some ambulances carry a stock of O negative blood, because in an emergency this is the safest blood to give a critically ill, bleeding patient of unknown blood type. Only 9% of the Australian population are O negative. </p>
<p>The Australian Red Cross Blood Service needs a diverse group of blood donors to meet the needs of our increasingly diverse patient population. </p>
<h2>What are blood groups for?</h2>
<p>It is likely all of the molecules that cover the surface of cells serve some purpose – often completely unrelated to transfusion. </p>
<p>One of the 36 blood group systems mentioned above is the Colton blood group. This is interesting because the molecules recognised by the immune system as Colton blood group antigens are actually located on an <a href="https://www.nobelprize.org/nobel_prizes/chemistry/laureates/2003/agre-diploma.html">aquaporin (AQP1) molecule</a> - one of a family of molecules responsible for water passage into and out of cells, and abundant in the red cell membrane. Professor Peter Agre and colleagues described this in 1992 and he received a <a href="https://www.nobelprize.org/nobel_prizes/chemistry/laureates/2003/agre-lecture.pdf">Nobel Prize</a> for this work.</p>
<p>Another interesting example is the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1378024/pdf/10762551.pdf">Duffy protein</a>, named after a haemophiliac patient <a href="http://www.ncbi.nlm.nih.gov/books/NBK2271/">Mr Duffy</a>. In 1950, he developed an antibody to what we know today as the Duffy “a” antigen, to which he had been exposed by receiving a blood transfusion.</p>
<p>One of the known functions of the Duffy antigens is binding one type of malaria parasite, <em>Plasmodium vivax</em>, which grants it entry into the red cell, where it can multiply and then cause the cell to burst. </p>
<p>The red cells of people who lack Duffy antigens are more resistant to infection by this parasite. More than two-thirds of people of African origin lack the Duffy antigens, whereas it is rare for people originating from Europe or Asia to do so. </p>
<p>Many thousands of years ago, in Africa where the <em>Plasmodium vivax</em>-bearing mosquitoes flourished, people who lacked Duffy antigens were resistant to this potentially fatal form of malaria and survived to parent future generations, passing on this particular resilience to their offspring.</p>
<p>Fascinatingly, the normal function of ABO and Rh, the two most important blood group systems, is still essentially unknown. <a href="http://www.ncbi.nlm.nih.gov/books/NBK2267/">The frequency of ABO antigens</a> varies greatly between different populations, and so it is thought that perhaps particular ABO blood types confers survival advantage in different settings. </p>
<p>Different ABO blood types occur more frequently in some medical conditions. Stomach ulcers, for example, are <a href="http://aje.oxfordjournals.org/content/172/11/1280.full.pdf+html">more common</a> in those with group O blood but stomach cancer is more common in those with group A blood. We don’t really know exactly why this occurs, or its consequences.</p><img src="https://counter.theconversation.com/content/62179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our bodies contain trillions of red blood cells. Each is covered in an array of proteins and sugars, inherited from our parents, which determine our blood group.Erica Wood, Associate Professor; Head, Transfusion Research Unit, Monash UniversityLucy Fox, Clinical Research Fellow in Haematology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/444082015-07-08T20:06:44Z2015-07-08T20:06:44ZRare and deadly, Creutzfeldt-Jakob disease remains a bit of a medical mystery<figure><img src="https://images.theconversation.com/files/87741/original/image-20150708-31560-16q3575.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Creutzfeld-Jacob disease occurs in about one to two in every million people each year, most often in late middle-age.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/a_mason/4006709/">Andrew Mason/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Creutzfeld-Jacob disease (CJD) is a rare degenerative disease of the brain that causes rapidly progressive loss of memory and muscle control followed by death, usually within 12 months of onset. In developed countries such as Australia, <a href="http://www.cjd.ed.ac.uk">it occurs</a> in about one to two in every million people each year, most often in late middle-age.</p>
<p>The <a href="http://www.abc.net.au/news/2015-07-07/frank-burton-diagnosed-with-creutzfeldt-jakob-disease-in-sydney/6602544">recent report</a> that Frank Burton – a former financial officer of the Sydney Swans – has contracted CJD and only has a short time to live, is a real tragedy for the man and his family. </p>
<p>But the reporting of such a celebrity case only serves to highlight that we still don’t know how to prevent a disease that most often goes unreported in the media, and unremarked on, except by family and friends.</p>
<h2>Two Nobel prizes later</h2>
<p>Inevitably, media about CJD has been intermittent, reflecting changes in attention and our understanding over the years. </p>
<p>By the 1960s, scientists had recognised that the microscopic changes in the brain of CJD patients were spongiform, that is, they resembled the porous structure of a sponge. And they knew this was similar to what happened in the brain of people <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2581658/">dying from kuru</a>, a disease that had become an epidemic among the isolated Fore people in Papua New Guinea. </p>
<p>Kuru was known to almost certainly result from the cannibalism of diseased individuals. It was shown to be transmissible to chimpanzees following injection of kuru brain, and CJD was also subsequently shown to be transmissible. </p>
<p>Carleton Gajdusek, the American physician and medical researcher who <a href="http://www.nobelprize.org/nobel_prizes/medicine/laureates/1997/prusiner-bio.html">won the 1976 Nobel Prize</a> for leading that work, initially thought that CJD and kuru were caused by related viruses. But no such virus could be identified in the brains of CJD or kuru patients. And it eventually became clear that the capacity to transmit disease to animals depended on a changed structural protein in diseased tissue. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/87740/original/image-20150708-31583-1qa9gqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/87740/original/image-20150708-31583-1qa9gqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/87740/original/image-20150708-31583-1qa9gqi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/87740/original/image-20150708-31583-1qa9gqi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/87740/original/image-20150708-31583-1qa9gqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=518&fit=crop&dpr=1 754w, https://images.theconversation.com/files/87740/original/image-20150708-31583-1qa9gqi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=518&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/87740/original/image-20150708-31583-1qa9gqi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=518&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Papua New Guinean tribe - though not this one - suffered a ‘kuru’ epidemic, which was linked to cannibalism.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Picturesque_New_Guinea_Plate_XXXIX_-_Group_and_Native_House,_Mairy_Pass.jpg">John William Lindt/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>This transmissible protein was named a “prion” by the American neurologist and biochemist <a href="https://en.wikipedia.org/wiki/Stanley_B._Prusiner">Stan Prusiner</a>. He also developed the concept that, over time, a small amount of an abnormal (injected) prion could create more of itself by changing the shape of the normal prion in brain, leading to the onset of “prion diseases” such as CJD or kuru. </p>
<p>The prion concept was well supported by animal experiments, leading to a <a href="http://ind.ucsf.edu/ind/aboutus/faculty/prusiners">Nobel Prize for Prusiner</a> in 1997. </p>
<p>By the 1980s, there had been alarming reports of CJD being inadvertently transmitted to human patients by grafts of dura mater, the tough outer membrane enveloping the brain and spinal cord. And by hormones prepared from deceased people who were presumably incubating CJD, whose tissues must have been contaminated by abnormal prions. </p>
<p>Medical authorities moved to eliminate the risk by banning such grafts, and by sourcing hormones prepared using recombinant DNA rather than hormones prepared from human tissues.</p>
<p>But the 1980s delivered another shock when mad-cow disease (BSE or bovine spongiform encephalopathy) erupted in the cattle population of the United Kingdom and other countries. The outbreak was traced to the practice of using meat and bone meal, prepared from slaughtered cattle, as a feeding supplement for calves. </p>
<p>It was soon realised that this practice (effectively <a href="http://www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm136222.htm">bovine cannibalism</a>) was amplifying the proportion of altered prion in successive generations of cattle, and driving the BSE outbreak.</p>
<p>Soon after action was taken to control the outbreak, there were concerns about whether the inadvertent consumption of BSE-affected tissues by the British public would result in transmission of prion disease to humans. Sure enough, in 1995, the first cases of variant CJD – a version of the illness that results from BSE exposure – were diagnosed, affecting people at a much younger age than the more usual (sporadic) form of CJD. </p>
<p>By 2013, when the outbreak of variant CJD seemed over, there had been 177 cases recognised in United Kingdom, with smaller numbers in other, less affected countries. Over the same time period, there had been some 2,000 cases of <a href="http://www.cjd.ed.ac.uk/">sporadic CJD in the United Kingdom</a>.</p>
<h2>Reducing risk</h2>
<p>Medical authorities have acted to reduce the possibility of human-to-human transmission of CJD by introducing more stringent procedures for cleaning and sterilising surgical instruments that might inadvertently transmit traces of prion from person to person. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/87730/original/image-20150708-31572-18bcqby.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/87730/original/image-20150708-31572-18bcqby.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/87730/original/image-20150708-31572-18bcqby.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/87730/original/image-20150708-31572-18bcqby.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/87730/original/image-20150708-31572-18bcqby.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/87730/original/image-20150708-31572-18bcqby.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/87730/original/image-20150708-31572-18bcqby.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People who ate meat contaminated with mad-cow disease developed ‘variant CJD’.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/121483302@N02/14013976368/in/photolist-5irBoZ-e6bxVS-nmnhWd-r4tc8L-amfAiK-89uGPg-7YtQjh-wvPGo-xsnAt-8DSqkk-dRaBzx-7JuMTZ-34ayXy-5AxN8K-u2G854-6VESwi-98USB8-u2TWWG-7N5zHY-28PfE-9Fpxqy-8E3y5Y-2VqGc-8FMohx-2U36r-9rK5sd-3n8sj-5btvat-5pnr6R-5jU1V9-pzijGv-2qaNWY-52q7qw-6S4T75-6MY5G-mCfjJ-PkaN4-7xc8PW-8hQteB-dTY26A-5fXMAk-6tY2Uo-6FzpYP-7wHfv2-JTzXd-GCtAc">Global Panorama/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Restrictions on blood transfusion were also introduced to reduce the possibility that blood donors might have been exposed to BSE-affected material. But that was not before three people in the United Kingdom had developed variant CJD after <a href="http://www.ncbi.nlm.nih.gov/pubmed/24916465">exposure to a blood transfusion</a> from a person who later developed the disease. </p>
<p>Although the epidemic of variant CJD now seems to be over, there are unanswered questions about the number of people in the United Kingdom who were exposed to BSE, and who might still be at risk of disease, or of transmitting it to others. </p>
<p>Australia is fortunate in that we didn’t have outbreaks of BSE or variant CJD. And if the world attends to feeding practices in cattle and other species, it’s unlikely there will be any future outbreaks of transmissible versions of prion disease in animals or people.</p>
<p>Still, the origin of sporadic CJD, the most usual transmissible form of the disease in humans, remains something of a puzzle. Early Australian work indicated that sporadic CJD risk was slightly greater in people with a history of surgery. This is consistent with the idea that a seeding dose of altered prion might have been <a href="http://www.ncbi.nlm.nih.gov/pubmed/10073510">transmitted by surgery</a> or transfusion many years previously. </p>
<p>Subsequent work suggests sporadic CJD risk may be <a href="http://www.ncbi.nlm.nih.gov/pubmed/25279832">most increased</a> in people exposed to surgery as children. There’s continuing uncertainty about this, but we should be reassured on two grounds: first that sporadic CJD is still very rare, so that the absolute risk is still only one to two for every million people. And second that the necessary steps have already been taken to reduce the possibility of any further transmission by way of surgery or blood transfusion. </p>
<p>We can trust these preventive measures will serve us well into the future. Meanwhile as research proceeds, we should come to better understand why abnormal prions are more likely to cause disease when exposure happens at younger ages. </p>
<p>One possibility is that older people are often protected from abnormal prions by an immune response, which is less effective in younger people. Such understanding could open up new ways of preventing prion diseases.</p>
<p><em><strong>Correction:</strong> This article previously said “Blood donations are now routinely tested to exclude any contaminated with altered prions.” This is incorrect and the sentence has been removed.</em></p><img src="https://counter.theconversation.com/content/44408/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Mathews does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>News that a Sydney man has contracted Creutzfeld-Jacob disease serves to highlight that we still don’t know how to prevent a disease that most often goes unreported, and unremarked on.John Mathews, Honorary Professorial Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.