VARIANT CREUTZFELDT-JAKOB DISEASE (vCJD) AND ...

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PAT/IC 4 v.3 4 Since 1980 have you had any transfusions of blood or blood components (red cells, plasma, cryoprecipitate or platelets)? If yes have you either: i) received more than 50 units of blood or blood components? or ii) received blood or blood components on more than 20 occasions? Patients who have received blood from more than 80 donors have been identified as at increased risk of vCJD. This does not include: • Autologous transfusion • Plasma products such as IVIG, albumin, coagulation factors and anti-D Further information is available from the HPA http://www.hpa.org.uk/vCJDpresurgicalassessment Where possible, please provide the names of all hospitals where you received blood or blood components. iii) Emergency surgery or neuro-endoscopy which may involve contact with high risk tissue In the event that a patient about to have emergency surgery or neuro-endoscopy is unable to answer any questions, a family member or someone close to the patient should be asked the CJD risk questions set out in Table 2. If the family member is not able to provide a definitive answer to the CJD risk questions, the surgery or neuro-endoscopy should proceed but all instruments should be quarantined (see below) following the procedure. The patient’s GP should be contacted after the surgery or neuro-endoscopy and asked as to whether the patient is at increased risk of CJD or vCJD according to the questions set out in Table 2. See “Transmissible spongiform encephalopathy agents : Safe working and the prevention of infection” - Annex J. Department of Health for further advice iv) Additional actions during pre-surgery assessment for CJD/vCJD risk In addition to asking the CJD/vCJD risk questions the following actions should also be carried out before any surgical or endoscopic procedure involving contact with high risk tissue. The clinician undertaking the pre-surgery assessment should: • Check the patient’s medical notes and/or referral letter for any mention of CJD or vCJD. • Consider whether there is a risk that the patient may be showing early signs of CJD or vCJD ie. consider whether the patient may have an undiagnosed neurological disease involving cognitive impairment or ataxia. Page 12 of 22
PAT/IC 4 v.3 Table 3. Actions to be taken following patient’s response to questions in Table 2 Patient’s response No to all questions Yes to any of questions 1,2 or 3 Action Surgery or neuro-endoscopy can proceed using normal infection control procedures Further investigation should be undertaken to assess the nature of the patient’s CJD risk – and this assessment recorded in the patient’s notes. If the patient is found to be at increased risk of CJD orvCJD, or the risk status is unknown, special infection control precautions should be taken, including quarantining of instruments (see below) and the Infection Prevention and Control team consulted for advice. Also see “Transmissible spongiform encephalopathy agents : Safe working and the prevention of infection” - Annex J. Department of Health for further advice Yes to question 4 A highly transfused vCJD risk assessment form (see “Transmissible spongiform encephalopathy agents : Safe working and the prevention of infection” - Annex J Appendix D. ) should be completed if • The patient has received more than 50 units of blood or blood components or • The patient has received blood or blood components on more than 20 occasions The results of the risk assessment, including the number of transfusions to date, should be recorded in the patient’s medical notes. If the patient has received fewer than 80 donor exposures, the patient is not considered to be at increased risk of vCJD. Surgery or neuro-endoscopy can proceed using normal infection control procedures. If the patient has received 80 or more donor exposures, the patient is confirmed as “at increased risk” of vCJD. Special infection control precautions should be taken, including quarantining of instruments (see below) and the Infection Prevention and Control team consulted for advice. The highly transfused vCJD risk assessment form should be forwarded to the HPA CJD section. For further advice and guidance see “Transmissible spongiform encephalopathy agents : Safe working and the prevention of infection” - Annex J. Department of Health and Pre-surgical assessment for vCJD risk in neurosurgery and eye surgery units. Information for clinicians. HPA 2009 Unable to respond See section 10.1 part iii - above Page 13 of 22
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VARIANT CREUTZFELDT-JAKOB DISEASE (vCJD) AND ...

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