Treating Hepatitis C in People with Compensated Cirrhosis Is Most Cost-effective Approach

SUMMARY: Interferon-based combination therapy for chronic hepatitis C virus (HCV) infection is most cost-effective -- saving more than $55,000 compared with no treatment -- when initiated in patients with compensated cirrhosis rather than waiting until progression to decompensated cirrhosis or HCV recurrence after a liver transplant, according to research from the University of California at Los Angeles reported in the June 2010 issue of Liver Transplantation.

By Liz Highleyman

Treatment with pegylated interferon plus ribavirin can cause difficult side effects and cures only about half of people with chronic hepatitis C. Furthermore, HCV leads to advanced liver disease such as cirrhosis (replacement of functional liver cells with scar tissue) or hepatocellular carcinoma (a type of liver cancer) in only a minority of patients. Therefore, clinicians attempt to wait long enough to be sure an individual is progressing and truly needs treatment, while not waiting too long, since interferon does not work as well and side effects can be worse in people with severe disease.

Experts have debated the best time to start treatment for people with advanced liver disease. Interferon and ribavirin are more likely to cause adverse events in people with cirrhosis, but these are also the patients who stand to benefit most if successful therapy can halt or slow disease progression.

Compensated cirrhosis means the liver is heavily scarred but can still carry out most if its vital functions. Decompensated cirrhosis means the liver is no longer working properly to filter blood, leading to conditions such as portal hypertension, bleeding varicose veins in the esophagus, ascites (abdominal fluid build-up), and hepatic encephalopathy (neurocognitive impairment).

Sammy Saab and colleagues sought to determine the most cost-effective timing for pegylated interferon plus ribavirin treatment (48 weeks) in patients with advanced liver disease related to genotype 1 HCV infection -- the most difficult type to treat.

The study included about 4000 participants followed over 17 years. The investigators used a Markov mathematical model to compare treatment 4 treatment strategies, with approximately equal numbers of patients in each group:

1 No treatment;
2 Antiviral therapy for patients with compensated cirrhosis;
3 Antiviral therapy for patients with decompensated cirrhosis;
4 Antiviral therapy for patients with progressive fibrosis due to recurrent HCV post-transplantation.

They looked at outcomes including total cost per patient, number of quality-adjusted life years (QALYs) saved, cost per QALY saved, number of deaths, number of cases of hepatocellular carcinoma, and number of liver transplants required.

Results

All 3 treatment strategies were cost-saving compared with no therapy, but treating patients with compensated cirrhosis was much more cost-effective and greatly improved survival:      

• Treatment during compensated cirrhosis: increased QALYs by 0.950 and saved $55,31 compared with no treatment.
• Treatment during decompensated cirrhosis: increased QALYs by 0.044 and saved $5511.
• Treatment during HCV recurrence after transplantation: increased QALYs by 0.061 and saved $3223.

Compared with no treatment, antiviral therapy for patients with compensated cirrhosis resulted in:

• 119 fewer deaths;
• 54 fewer cases of hepatocellular carcinoma;
• 66 fewer liver transplants.

In conclusion, the study authors wrote, "the treatment of patients with compensated cirrhosis was found to be the most cost-effective strategy and resulted in improved survival and decreased cost in comparison with all other strategies."

"This study provides pharmacoeconomic evidence in support of treating HCV in patients with compensated cirrhosis before progression to more advanced liver disease," they added.

In an accompanying editorial, hepatology experts Angel Rubin and Marina Berenguer from Valencia, Spain, offered the caveat that models such as this do not take into account all the many variables that can affect disease progression and treatment response, recommending that "Physicians must decide whether the most cost-effective approach is the most appropriate one in each individual."

Investigator affiliations: Departments of Medicine, University of California at Los Angeles, Los Angeles, CA; Department of Surgery, University of California at Los Angeles, Los Angeles, CA; Harbor-UCLA Medical Center, Torrance, CA; Huntington Medical Research Institutes, Pasadena, CA.

7/2/10

References

S Saab, DR Hunt, MA Stone, and others. Timing of hepatitis C antiviral therapy in patients with advanced liver disease: a decision analysis model. Liver Transplantation 16(6): 748-759 (Abstract). June 2010.

A Rubin and M Berenguer. An economic analysis of antiviral therapy in patients with advanced hepatitis C virus disease: still not there! (Editorial). Liver Transplantation 16(6): 697-700. June 2010.

Other source

Wiley-Blackwell. Antiviral therapy during compensated cirrhosis most cost-effective approach. Media advisory. May 27, 2010.

http://www.hivandhepatitis.com/hep_c/news/2010/0702_2010_b.html

Discovery of a hepatitis C-related virus in bats may reduce outbreaks in humans

Contact: Stephanie Berger
sb2247@columbia.edu
212-305-4372
Columbia University's Mailman School of Public Health

July 1, 2010 -- Viral hepatitis affects more than 500 million people worldwide and is a cause of liver failure and liver cancer. While vaccines are available for hepatitis A and B, this is not the case for hepatitis C, which affects as much as two percent of the population in the U.S. Scientists today are reporting discovery of a virus related to hepatitis C in Asian bats, which may provide insights into the origins of the hepatitis C virus and into the mechanisms by which infectious diseases move from other species to humans.

The full study findings are published online in the publication PLoS Pathogens.

Transmitted by blood transfusion or sexual intercourse, hepatitis C is a common cause of liver failure. Viruses related to hepatitis C, known as GB-viruses, have previously been found only in primates. Now, using cutting-edge molecular techniques, an international team of investigators has identified a GB-virus in Pteropus giganteus bats in Bangladesh. The work was completed at the Center for Infection and Immunity (CII) at Columbia University's Mailman School of Public Health, led by W. Ian Lipkin, MD; the International Centre for Diarrheal Disease Research in Bangladesh; 454 Life Sciences, a Connecticut-based division of Roche Corporation; and the Wildlife Trust in New York City. Using gene sequencing methods, the investigators confirmed the viral genetic material in the serum of five of 98 bats, and in the saliva of one, to be related to GBV-A and –C viruses. Further analysis of the two identified strains, tentatively named GBV-D, suggests that P. giganteus bats are a natural reservoir for this virus. According to the research team, the fact that bat saliva can contain GBV-D nucleic acids provides a biologically plausible mechanism for this agent to be transmitted from infected bats to other hosts, including humans.

Bats are often important hosts for emerging infectious disease agents with significant impact on human health including rabies, ebola, Marburg, hendra, nipah, and SARS viruses. Opportunities for transmission to humans are particularly prominent in countries like Bangladesh, where people live in close association with bats.

"This discovery underscores the importance of international programs focused on microbe hunting in hot spots of emerging infectious diseases," said Dr. Ian Lipkin, John Snow Professor of Epidemiology and director of the CII. "Finding this novel flavivirus in bats significantly broadens the host range of GB-like agents and may provide insights into the origins of hepatitis C," added Thomas Briese, PhD, lead molecular biologist on the team and Mailman School associate professor and associate director of CII.

"The Indian subcontinent and South Asia are areas where we are ardently working to identify the next possible pandemic disease," stated Peter Daszak, President of Wildlife Trust. "Identification of the natural reservoir of a virus, even if it may not directly infect people, is critical to surveillance and reducing the risk of outbreaks of infectious disease," noted Jonathan Epstein, associate vice president of Conservation Medicine Programs at Wildlife Trust.

###

The Center for Infection and Immunity at the Mailman School is dedicated to global research and training programs focused on pathogen surveillance and discovery, and to understanding how gene-environment-timing interactions contribute to health and disease. http://www.cii.columbia.edu/

About the Mailman School of Public Health

The only accredited school of public health in New York City and among the first in the nation, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting millions of people locally and globally. The Mailman School is the recipient of some of the largest government and private grants in Columbia University's history. Its more than 1000 graduate students pursue master's and doctoral degrees, and the School's 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as infectious and chronic diseases, health promotion and disease prevention, environmental health, maternal and child health, health over the life course, health policy, and public health preparedness. http://www.mailman.columbia.edu/

http://www.eurekalert.org/pub_releases/2010-07/cums-doa070110.php

Nutrition in Hepatic Encephalopathy

Rajagopal Chadalavada, MD
Raja Shekhar Sappati Biyyani, MD
John Maxwell, MD
Kevin Mullen, MD

Division of Gastroenterology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.

Correspondence: Kevin D. Mullen, MD, 2500 MetroHealth Dr, Cleveland, OH 44109; e-mail: kdmullen@metrohealth.org.

Protein calorie malnutrition (PCM) is a well-known complication of chronic liver disease (CLD). A major contribution to PCM in CLD is restriction of dietary protein intake. After many decades of injudicious reduction in dietary protein, cirrhotic patients are now prescribed appropriate amounts of protein. PCM in CLD is known to be associated with life-threatening complications. In the general approach to these patients, the initial and most important step for the clinician is to recognize the extent of malnutrition. Most patients tolerate a normal amount of dietary protein without developing hepatic encephalopathy (HE). Oral branched-chain amino acids (BCAAs) have a limited role in HE. Patients who exhibit dietary protein intolerance originally were thought to be best treated with BCAA formulations. Mixed evidence has been reported in multiple studies. In keeping with other reports, this article shows that in animal protein–intolerant patients, even those with advanced cirrhosis, vegetable protein–based diets are well tolerated. Another approach to management of apparent dietary intolerance is to optimize HE treatment with available medications. This article reviews the causes of HE, minimal HE, and PCM; examines nutrition requirements and assessment; and discusses treatment options for malnutrition in HE.

Key Words: hepatic encephalopathy • nutrition assessment • nutrition therapy • malnutrition • liver diseases • liver cirrhosis

Nutrition in Clinical Practice, Vol. 25, No. 3, 257-264 (2010)
DOI: 10.1177/0884533610368712

http://ncp.sagepub.com/cgi/content/abstract/25/3/257

The Use of Mind-Body Medicine and Prayer Among Adult Patients With Chronic Hepatitis C

Gastroenterology Nursing:
May/June 2010 - Volume 33 - Issue 3 - p 210–216
doi: 10.1097/SGA.0b013e3181e01a7b

Richmond, Jacqueline A. PhD, MPH, RN; Bailey, Donald E. Jr. PhD, RN; McHutchison, John G. MD; Muir, Andrew J. MD

AbstractThe use of mind–body medicine by patients with chronic hepatitis C has not been reported. The prevalence and reasons for using mind–body medicine and prayer among a cohort of patients with chronic hepatitis C are described. Use of mind–body medicine and prayer was investigated as a component of a larger exploratory, descriptive study of the use of complementary and alternative medicine by patients with hepatitis C attending a tertiary healthcare facility in the United States. An investigator-designed self-administered questionnaire (n = 149) and semistructured interview (n = 28) were completed by participants. Eighty-eight percent (n = 105) of participants had used mind–body medicine in the past 12 months. The most commonly used therapies were prayer for health reasons (90%), deep breathing (29%), and meditation (29%). Mind–body medicine was most commonly used to relieve tension and promote general well-being. The use of mind–body medicine was widespread among patients with chronic hepatitis C. To provide patient-centered healthcare, health providers need to be aware of the alternative support strategies, including mind–body medicine, used by patients.


Source

Increased risk of hospitalization for acute hepatitis in patients with previous exposure to NSAIDs.

Lee CH, Wang JD, Chen PC.

Pharmacoepidemiol Drug Saf. 2010 May 13;19(7):708-714. [Epub ahead of print]
Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.

Abstract

BACKGROUND: Epidemiological studies related to hospitalization due to the hepatotoxicity of traditional non-steroidal anti-inflammatory drugs (NSAIDs) are infrequent, and case reports of hepatotoxicity of nimesulide, celecoxib, and rofecoxib seem to be increasing. The reimbursement database of National Health Insurance (NHI) in Taiwan provided an opportunity for post-marketing surveillance. We conducted this study to determine the association between the use of hepatoxic NSAIDs and increased hospitalizations related to acute hepatitis. METHODS: We included hospitalized subjects with a major diagnosis of acute or sub-acute necrosis of liver or toxic hepatitis and excluded viral and other causes of hepatobiliary diseases from the NHI database from 1 April 2001 to 31 December 2004. We applied two kinds of models to analyze by uni-directional and bi-directional case-crossover designs during the 28 days exposure periods and performed conditional logistic regression models. RESULTS: There were 4519 cases of hospitalization relating to acute hepatitis, and the odds ratios of celecoxib, nimesulide, dicofenac, ibuprofen, and other hepatoxic NSAIDs were significantly increased. Compared with the adjusted odds ratios of other hepatoxic NSAIDs (OR = 2.13, 95%CI = 2.00, 2.28), celecoxib (OR =1.92, 95%CI = 1.38, 2.69) was similar during the 28 days by our uni-directional case-crossover design. CONCLUSIONS: Our results provide evidence for an increased risk of hospitalization with acute hepatitis among hepatoxic NSAIDs including celecoxib users. Further mechanistic research is warranted in order to document celecoxib's hepatotoxicity. Copyright (c) 2010 John Wiley & Sons, Ltd.

PMID: 20582911 [PubMed - as supplied by publisher]

Source

VA secretary: St. Louis mistakes 'unacceptable'

By JIM SALTER (AP) – 12 minutes ago

ST. LOUIS — The Veterans Administration said Thursday that the chief of dental services at a St. Louis VA Medical Center has been placed on administrative after the hospital urged nearly 2,000 veterans to return for blood tests because inadequately sterilized equipment may have exposed them to viral infections during dental procedures.

An independent board will also investigate how employees failed to properly sterilize the dental equipment that potentially exposed veterans to infections including hepatitis and HIV, the administration said.

"The mistakes made at the St. Louis VA Medical Center are unacceptable, and steps have been and continue to be taken to correct this situation and assure the safety of our veterans," VA Secretary Eric Shinseki said.

The VA sent letters out Monday to 1,812 veterans who had dental procedures at the St. Louis center from Feb. 1, 2009, through March 11 of this year, saying reviews determined that some sterilization steps in preparing dental instruments were not in compliance with standards.

Officials say the infection risk is extremely low, and no illnesses have been uncovered so far out of some 100 veterans who have come in for blood work that will screen for hepatitis B, hepatitis C and HIV.

Rep. Russ Carnahan, D-Mo., said the House Veterans' Affairs Committee also said they will investigate what happened at the center and planned to hold a hearing in St. Louis. The announced investigations follow demands for action by several lawmakers from Missouri and Illinois — the St. Louis region's five VA facilities serve veterans in both states.

VA Under Secretary for Health Dr. Robert Petzel said he found there was a need for an independent review by the national Administrative Investigation Board "to determine the reasons for failure to follow correct procedures."

No date has been set for the Veterans' Affairs Committee hearing in St. Louis. Two Missouri congressmen, Republican Blaine Luetkemeyer and Democrat William Lacy Clay, also asked the House Oversight and Government Reform Committee to investigate. Both serve on that committee.

Lawmakers also want to know why it took so long for the VA to inform the veterans about the mistakes. The problem was uncovered in March and letters went out Monday.

Marcena Gunter, a spokeswoman for the St. Louis center, said the delay was because officials were evaluating the risk posed to veterans.

The name of the suspended chief of dental services was not released. A VA spokeswoman did not respond to interview requests.

The VA said patients who have had dental procedures since March 11 are not at risk because procedures were corrected.

Shinseki said that over the past 18 months, VA has implemented more stringent safety oversight at its medical facilities, and that oversight led to the identification of problems at the St. Louis facility.

VA centers around the country have had problems in recent years. In 2007, Walter Reed Army Medical Center in Washington came under scrutiny over concerns about conditions at the hospital and treatment of veterans. At the time, St. Louis VA officials said they were working to fix similar problems.

That same year, a surgeon at the VA hospital in Marion, Ill., resigned after a patient bled to death following gall bladder surgery. All inpatient surgeries were suspended. The VA found at least nine deaths between October 2006 and March 2007 resulted from substandard care at the Marion hospital, and another 10 patients died after receiving questionable care that complicated their health.

Copyright © 2010 The Associated Press. All rights reserved.

Source


Text of the senators' letter

Wednesday, Jun. 30, 2010

General Eric Shinseki Secretary of Veterans Affairs
Department of Veterans Affairs
810 Vermont Avenue, Northwest
Washington, DC 20420

Dear Secretary Shinseki: Please note our deep disappointment and concern that 1,812 St. Louis area veterans were potentially exposed between February 2009 and March 2010 to dangerous blood-borne diseases, including Hepatitis B and C and HIV, through possible contact with improperly cleaned dental devices at the John Cochran VA Medical Center (VAMC) in St. Louis, Missouri. In light of other recent revelations by the VA Inspector General regarding problems with reprocessing of endoscopes at John Cochran and frequent customer service satisfaction problems reported at John Cochran, we are concerned about VA management of the facility. Veterans receiving care at John Cochran deserve the best quality care available, including absolute assuredness that the hospital is meeting the most basic and critical professional standards of cleanliness and conduct. We are also deeply concerned that the VA took four months to notify veterans who may have been endangered by the flawed procedures at the John Cochran VAMC, as well as to notify the area Congressional delegation so that we might assist our constituents. We appreciate that the VA acted quickly to remedy the flawed cleaning procedures but the failure to share information in a timely fashion about the situation is unacceptable. In addition, a follow up visit to John Cochran by VA Headquarters staff was not conducted until May, some two months after the initial inspection revealed problems with the cleaning of the dental devices. When a significant failure in procedures occurs, like that discovered at the John Cochran VAMC dental clinic, we would expect a more timely response and more aggressive oversight. The VA has decided to dedicate $5 million in funding to make infrastructure and other improvements at the John Cochran VAMC in light of this troubling incident. While we applaud the VA’s efforts to address aggressively underlying problems, including infrastructure problems that could have contributed to the failures in the dental clinic, we must be kept apprised of how the $5 million in renovations will be spent and prioritized. Please keep us informed about any follow up actions that the VA takes to train staff and improve standard operating procedures in the dental clinic and elsewhere in the hospital.

In closing, as you evaluate each of the 1,812 veterans who have received letters from the VA about potential exposure from improperly handled dental devices, we ask for an accounting of any health irregularities identified and attributed to the exposure. We know you value the health and safety of each and every veteran and strongly urge you to make sure that no veteran’s health goes unchecked in this case. We are committed to working with you, Mr. Secretary, to provide veterans with the resources they need to heal—resources they earned through their great service. The repeated failures to follow simple rules and regulations, however, is wholly unacceptable, and we want to know the measures you plan to implement in order to ensure this catastrophe never happens again. We thank you for your immediate attention to this matter and look forward to your reply. Should you have additional questions please feel free to contact us directly or to have your staff contact Tressa Guenov in Senator McCaskill’s office, Bo Prosch in Senator Bond’s office or Gabe Chavez in Senator Durbin’s office.

Sincerely,
Claire McCaskill UNITED STATES SENATOR
Christopher Bond UNITED STATES SENATOR
Richard Durbin UNITES STATES SENATOR

© 2007 Belleville News-Democrat and wire service sources.
All Rights Reserved. http://www.belleville.com/

Source

See Also:
Military men and women suffer abuse at the hands of their own doctors
VA hospital may have infected 1,800 veterans with HIV

Eiger BioPharmaceuticals Announces New HCV Synergy Data

Publication describes high level of synergy of clemizole with protease inhibitor class

PALO ALTO, Calif., July 1, 2010 /PRNewswire/ -- Eiger BioPharmaceuticals, Inc., a biotechnology company developing antiviral therapies, announced today the publication of research from the lab of Stanford scientist and Eiger Founder, Dr. Jeffrey Glenn, M.D., Ph.D. and colleagues entitled, "The Hepatitis C Virus (HCV) NS4B RNA Binding Inhibitor Clemizole is Highly Synergistic with HCV Protease Inhibitors".

"This work demonstrates that clemizole can yield high-level synergy with the protease inhibitor class," said David Cory, President and CEO of Eiger. "Inclusion of clemizole in future anti-HCV cocktails represents an attractive paradigm for increasing virologic response rates and may minimize unwanted side effects and combat drug resistance to HCV protease inhibitors."

"Clemizole appears to be able to dramatically increase the in vitro efficacy of other agents such as the NS3 protease inhibitors in advanced clinical development," said Jeffrey Glenn, M.D., Ph.D., Founder of Eiger. "The addition of clemizole to regimens may allow protease inhibitors to be used at lower doses, thereby maintaining the desired antiviral efficacy while avoiding the toxicities associated with the protease inhibitors such as severe rash and anemia. Clemizole has the potential to be an ideal component of future anti-HCV cocktails."

About NS4B and Clemizole

Binding of the non-structural protein NS4B to the 3' terminus of the HCV negative RNA strand is a recently identified target for drug intervention. The requirement of this target for viral replication has been genetically validated. The two component nature of this target, involving interaction between NS4B and HCV-RNA, creates mutational constraints that should decrease resistance to pharmacologic inhibitors, compared to agents designed against a single component target such as the NS3 protease. Clemizole hydrochloride was identified as a specific inhibitor of NS4B-RNA binding. The anti-HCV activity of clemizole is currently being investigated across genotypes in multiple HCV clinical proof of concept trials as a cocktail component with standard of care medications.

About Eiger BioPharmaceuticals, Inc. http://www.eigerbio.com/

Eiger is focused on the discovery and development of new antiviral agents against novel targets for the treatment of hepatitis virus infections. Eiger's pipeline includes repurposed clinical stage therapeutic agents as well as preclinical NCEs from discovery that exhibit antiviral activity against Hepatitis C, Hepatitis D, and other viruses. Eiger investors include InterWest Partners http://www.interwest.com/ and Vivo Ventures http://www.vivoventures.com/.

SOURCE Eiger BioPharmaceuticals, Inc.

Source

Military men and women suffer abuse at the hands of their own doctors

July 1, 8:51 AM
Fort Lauderdale Domestic Violence & Abuse Examiner
Cheryl Whittaker

It is not enough to drive down the streets of Ft. Lauderdale every single day and witness day after day our homeless military personnel out on the streets begging for food, money, and shelter because they are being abused by the military and society.

Oh how we forget that these men and women have suffered enough abuse going in to war, watching their own peers die in front of their faces, coming home with disabilities and mental problems, to go seek help and suffer abuse at the hands of their American doctors and hospital staff.

These men and women who fought for our country are now faced with being at risk of HIV infection from unsafe dental practices. 1800 soldiers being mailed letters stating they may have been exposed to HIV from unclean dental equipment.

Over 3800 soldiers exposed to HIV and Hepititis C from having unclean colonoscopy equipment used on them in procedures.

What would a U.S. government run health care system look like? Well, one big indication is to examine what is going on at places where the United States government is already running health care. One of those place is at VA hospitals, and the reality is that the level of care that our veterans receive can only be described as horrific, abuse, and neglect.

When ABC news ran their story about the VA hospitals they found horrible, unconceivable conditions that our Veterans are suffering at the hands of their own people.

Bathrooms filthy with what appeared to be human excrement

Dirty linens from some patients mixed in with clean supplies

Examining tables that had dried blood and medications still on them

Equipment used to sterilize surgical instruments that had broken down

Some patients were forced to beg for food and water

Vets neglected so badly that they developed horrific bedsores and dangerous infections

As July 4th is coming we must remember the reason we are a free country is because men and women risk their lives to keep it a free country. It is our independence day as a country and we are a free country not because of our government but because of brave men and women who fight for our country.

Help stop veteran abuse. If you know of veterans being abused contact the U.S. Department of Veterans Affairs - 810 Vermont Avenue, NW - Washington, DC 20420

In Miami and Broward County

The Bruce W. Carter Department of Veterans Affairs Medical Center Patient Advocate is Cynthia Korland. Available from 7:30 a.m. to 4:30 p.m., and may be reached at (305) 575-3392 (305) 575-3392 or at room number 1D165. The fax number is (305) 575-3385.

The Broward County VA Outpatient Clinic Patient Advocate, Sheila McClendon, is available from 8:00 a.m. to 4:30 p.m., and may be reached by calling (954) 475-6500 (954) 475-6500 extension 8729.

Source

Also See: VA hospital may have infected 1,800 veterans with HIV

Blood transfusion risks and reactions

 
 by Omar Salvador  Have the people's trust and confidence in the medical procedure of blood transfusion been fully restored today, more than twenty years after that infamous blood supply scandal in the 1980s? Recall that in that disgraceful period, many people were infected with the dreaded human immunodeficiency virus (HIV) and thousands more were affected by hepatitis C from contaminated blood products. Experts admit that in spite of today's modern medical technology, not a few people have very little faith on the safety of blood transfusion and many more continue to fear the prospect of being infected with a disease transmitted through a blood transfusion.Contracting hepatitis (hepatitis B or hepatitis C) or such other viral diseases (bacterial infection, malaria, or HIV) from tainted blood is the greatest risk associated with a blood transfusion. But though risks of disease (and even death) do exist, they are rather negligible when compared to the chances of receiving the wrong blood. Safeguards are in place; yet there may be an instance (and there were actual cases in the past, in fact) when a clerk commits an error or when an overly worried health-care worker takes hold of the wrong blood unit. As a matter of fact, a wrong blood type (or incompatible blood) is one of the most common causes of death from a blood transfusion. In an incompatible-blood transfusion, a fatal immune-system reaction may take place. But even in cases when the correct blood type has been transfused, some recipients may have had some minor reactions. A typical reaction, which usually abates in two hours or less, is characterized by chills and fever. What's more distressing though is the risk of infection following an operation. Remember that a transfusion is essentially a transplant; the patient's immune system is momentarily suppressed as he is going through a blood transfusion. Because of this, it is highly probable that a susceptibility to infection from germs is created by the procedure. The severity and continuance of an infection are usually determined by the strength of the patient's immune system prior to the blood transfusion. Having had numerous blood transfusions can also pose a real danger. In such a case, the person may become abnormally susceptible to the extraneous proteins in the blood of other people, and it may then be hard to look for compatible donors. Blood banks have always been warily watchful; if there exists even the slightest of possibilities that blood may be contaminated, it is immediately discarded. To ensure that their blood supply is safe or taint-free, blood banks make potential donors go through an extensive and rigorous screening process. Aside from this, all donated blood is examined for contaminants. In some cases, however, as when a donor has been infected of late by a certain virus and has not yielded a measurable level of immunoglobulin, that particular virus may not be detected. Still, as mentioned earlier, the probability of one's contracting a disease through a blood transfusion is extremely low.

http://www.helium.com/items/1877641-blood-transfusion-risks-and-reactions