Scientists may still be debating the role of viruses in chronic fatigue syndrome, but blood banks aren’t taking any chances. Last summer the AABB, a nonprofit that represents blood-collecting organizations, advised people with the disorder, marked by severe fatigue and aches lasting six months or more, to self-defer from blood donation. Last December the American Red Cross went further, banning people who revealed during a predonation interview that they had the syndrome from ever giving blood at its centers.

The cause for this abundance of caution is XMRV (xenotropic murine leukemia virus–related virus), a retro­virus that has been associated with chronic fatigue syndrome. In a highly publicized 2009 study published in Science, XMRV was found in 67 percent of patients and 3.7 percent of healthy controls. But subsequent studies failed to find the virus in people with or without the syndrome, suggesting to some that XMRV may be a laboratory contaminant that skewed the initial trial.

How worried should one be about XMRV in the blood supply? Not very. There has been no evidence of anyone contracting chronic fatigue syndrome from a blood transfusion, so the risk is hypothetical. And more stringent measures, such as screening potential donors for the syndrome via questionnaire, would take attention away from diseases such as HIV and hepatitis B that are unequivocally blood-borne, says Harvey Klein, chair of the AABB task force examining this issue.

Still, experts are weighing whether or not to test donated blood. The first step in that process is agreeing on a standard method for detecting the virus in the blood. A team at the National Heart, Lung, and Blood Institute is comparing the different nucleic acid tests and blood-sample preparation techniques used by various labs—including the Centers for Disease Control and the Food and Drug Administration—to find the best one.

If the test that comes out on top confirms the results of the 2009 study, that is, if it consistently detects XMRV in blood samples from chronic fatigue syndrome patients and does not detect it in negative controls, “we will have identified sensitive and specific methods to detect XMRV in blood samples,” says Simone Glynn, who chairs the NHLBI working group overseeing the study.

The next step would be to use that test to check for the presence of XMRV in large numbers of blood donor samples. If the virus is prevalent, the team would examine frozen blood samples and check for evidence of transfusion transmission. “Conversely, if we do not find evidence of XMRV in the blood samples from patients with chronic fatigue syndrome who were previously found to be positive, we would conclude that these viruses do not appear to be present in blood,” Glynn says.

For now, excluding people with the syndrome from blood donation is prudent, says Ian Lipkin, director of the Center for Infection and Immunity at the Columbia University Mailman School of Public Health, who is heading the National Institutes of Health–funded investigation into the connection between chronic fatigue syndrome and XMRV. “My sense is that the number of people with the syndrome likely to be sufficiently fit to make blood donations is so few that the Red Cross and AABB have decided for a variety of reasons, scientific and otherwise that it’s just not worth the risk.” 

This article was originally published with the title Donor Fatigue.

4 Comments

1. 1. MeganB 03:52 AM 7/7/11

   "There has been no evidence of anyone contracting chronic fatigue syndrome from a blood transfusion, so the risk is hypothetical".
   
   Perhaps the people who should be documenting cases of post blood transfusion CFS have been recalcitrant in writing up said case histories, as they appear in their medical practices. As these specific cases may appear to be very randomised and spasmodic to the average doctor in their busy medical practices, the importance of producing the evidence and connecting the dots for such may be overlooked.
   
   Collectively though when Doctor A in one part of the world and Doctor B in another, takes due care to really think about what their patient may be saying in relation to post transfusion onset of CFS, the picture may look very different.
   
   Anecdotal evidence is not acceptable but who has specifically done either quantitative or qualitative research on this potential causation?

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2. 2. Evolver 03:47 PM 7/7/11

   MeganB, it's a good question. The studies would not be performed by doctors in the clinic, mostly for the reasons you suggest. Instead, the question would be answered by research scientists. Researchers ask chronic fatigue sufferers whether they have had blood transfusions and compare their incidence of CF against those that have not received transfusions. These studies have been performed and no relation has arisen. Clearly more research is warranted on CF, but that would require more science funding, which in turn would require a sea change in the priorities of the American public.

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3. 3. renethorpe 01:58 AM 7/22/11

   To say the symptoms of the illness is severe fatigue and aches is such an insult to suffers maybe you should read this.
   
   
   Source: Journal of Internal Medicine
   
   Preprint
   
   Date: July 2011
   
   URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x
   
   
   
   
   
   Myalgic Encephalomyelitis: International Consensus Criteria
   
   -----------------------------------------------------------
   
   Bruce M Carruthers MD, CM, FRCP(C), Marjorie I van de
   
   Sande BEd, Kenny L De Meirleir MD, PhD, Nancy G Klimas
   
   MD, Gordon Broderick PhD, Terry Mitchell MA, MD, FRCPath,
   
   Don Staines MBBS, MPH, FAFPHM, FAFOEM, AC Peter Powles
   
   MRACP, FRACP, FRCP(C), ABSM, Nigel Speight MA, MB, BChir,
   
   FRCP, FRCPCH, DCH, Rosamund Vallings MNZM, MB, BS, MRCS,
   
   LRCP, Lucinda Bateman MS, MD, Barbara Baumgarten-
   
   Austrheim MD, David S Bell MD, FAAP, Nicoletta Carlo-
   
   Stella MD, PhD, John Chia MD, Austin Darragh MA, MD,
   
   FFSEM. (RCPI, RCSI), FRSHFI Biol I (Hon), Daehyun Jo MD,
   
   PhD, Don Lewis MD, Alan R Light PhD, Sonya Marshall-
   
   Gradisbik PhD, Ismael Mena MD, Judy A Mikovits PhD,
   
   Kunihisa Miwa MD, PhD, Modra Murovska MD, PhD, Martin L
   
   Pall PhD, Staci Stevens MA
   
   
   
   
   
   Abstract
   
   
   
   The label 'chronic fatigue syndrome' (CFS) has persisted
   
   for many years because of lack of knowledge of the
   
   etiological agents and of the disease process. In view of
   
   more recent research and clinical experience that strongly
   
   point to widespread inflammation and multisystemic
   
   neuropathology, it is more appropriate and correct to use
   
   the term 'myalgic encephalomyelitis' (ME) because it
   
   indicates an underlying pathophysiology. It is also
   
   consistent with the neurological classification of ME in
   
   the World Health Organization's International
   
   Classification of Diseases (ICD G93.3). Consequently, an
   
   International Consensus Panel consisting of clinicians,
   
   researchers, teaching faculty and an independent patient
   
   advocate was formed with the purpose of developing
   
   criteria based on current knowledge. Thirteen countries
   
   and a wide range of specialties were represented.
   
   Collectively, members have approximately 400 years of
   
   both clinical and teaching experience, authored hundreds
   
   of peer reviewed publications, diagnosed or treated
   
   approximately 50,000 ME patients, and several members
   
   coauthored previous criteria. The expertise and experience
   
   of the panel members as well as PubMed and other medical
   
   sources were utilized in a progression of suggestions/
   
   drafts/reviews/revisions. The authors, free of any
   
   sponsoring organization, achieved 100% consensus
   
   

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4. 4. renethorpe 02:03 AM 7/22/11

   (continued) through
   
   a Delphi type process.
   
   
   
   The scope of this paper is limited to criteria of ME and
   
   their application. Accordingly, the criteria reflect the
   
   complex symptomatology. Operational notes enhance
   
   clarity and specificity by providing guidance in the
   
   expression and interpretation of symptoms. Clinical and
   
   research application guidelines promote optimal
   
   recognition of ME by primary physicians and other health
   
   care providers, improve consistency of diagnoses in
   
   adult and paediatric patients internationally, and
   
   facilitate clearer identification of patients for
   
   research studies.
   
   
   
   --------

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