LYME DISEASE, THE UNKNOWN, AND THE RISK TO THE BLOOD SUPPLY

 

When I do talks on Lyme disease, I'm often asked if the bacteria (Borrelia spp.) that cause the illness are transmissible via blood transfusions. The default answer of health authorities has long been no. However, the worldwide absence of screening tests capable of accurately and consistently detecting the presence of Lyme bacteria in the blood supply makes it difficult to give a definitive answer to that question. Hopefully, once the technology improves and researchers are able to consider the question with the assistance of more accurate tools, the answer will continue to be no, but only time will tell.

It is an interesting question, however. Interesting because a significant percentage of people who suffer from the advanced stages of Lyme disease are dogged by chronic symptoms long after receiving the treatment recommended in current guidelines. In theory, antibiotic treatment of up to 30 days should more than knock out the bacterial infection and yet for a great many Lyme disease sufferers, symptoms persist for years afterwards for reasons that are not yet fully understood.
Tiny tick on a large finger

For decades it was believed that an autoimmune syndrome was at fault. According to the autoimmune theory of ongoing illness, the reason that Lyme sufferers continue to show symptoms associated with the disease long after receiving a short course of antibiotics is not because of persistent infection, but rather because of an inappropriate immune system response to that infection, which can sometimes take months or even years to simmer down after the bacteria have been defeated.

In recent years, this autoimmune theory has been rapidly falling out of favor as evidence mounts that persistent infection may very well be at the root of the problem. Indeed, any number of peer-reviewed papers have been published over the past decade which bear witness to the truly awesome survival skills of borrelia bacteria. But the persistence of Lyme bacteria isn't the only possible infectious cause for these ongoing symptoms. The idea that Lyme sufferers may be contracting novel pathogens - infectious organisms still unknown to medical science or not yet associated with illness in humans - when they are contracting Lyme disease is quickly gaining ground and, in Canada, an increasing number of resources are being directed towards identifying these as yet unidentified infectious agents.

This is where my own concerns about the safety of Canada's blood supply are centred. A recent search of the Canadian Blood Services website showed no restrictions on Lyme disease sufferers donating blood beyond a general temporary deferral directed at anyone who does not feel well. This would certainly rule out most chronic Lyme disease sufferers for whom "does not feel well" would be an egregious understatement. But consider for a moment that we are talking about a group of patients that both mounting evidence and educated guesses suggest may very well have been infected with either antibiotic-resistent bacteria or pathogens whose exact identities remain unknown and then ask yourself this: Is a general temporary deferral really good enough?

Picture of ticks

It is interesting to note that at the present time, anyone who has ever been diagnosed with chronic fatigue syndrome (CFS) is indefinitely banned by Canadian Blood Services from donating blood due to suspicions that a retrovirus, called xenotropic murine leukemia virus-related virus (XMRV), may be the cause of persistent symptoms linked to that illness. Retroviruses are nasty organisms. When they infect a human cell, they write their own genetic code into the DNA of that cell, causing the human cell to replicate the virus as part of its regular duties. That's why retroviruses, such as human immunodeficiency virus (HIV), are so difficult to eradicate from the human body. They literally become a part of your DNA once they infect you. It is therefore not surprising that when a 2009 study suggested a possible link between XMRV and CFS, Canadian health authorities moved swiftly to ban anyone who had ever been diagnosed with CFS from donating blood. It was the right and appropriate action to take.

I would like to tell you that the Canadian Blood Services ban on CFS sufferers donating blood was the first time I ever stumbled across XMRV. It wasn't. The first time I came across this retrovirus was in a paper authored by senior public health officials from British Columbia back in 2011. In a section dealing with the chronic, persistent symptoms that dog so many Lyme sufferers, those officials mentioned that they were continuing to look into both infectious and non-infectious causes. When it came to possible infectious causes, the only organism they mentioned by name was XMRV, the retrovirus that caused CFS patients to be banned from donating blood. Yet to this day, there continues to be no ban on Lyme disease patients donating blood.

Most Canadians over a certain age can remember the tainted blood scandal that rocked this country more than 20 years ago. The failure of health authorities to put into place adequate safeguards led to HIV entering our blood supply and ultimately infecting thousands of unsuspecting Canadians. In the wake of that scandal, Canadians made it very clear that we expect those in charge of our blood supply to err on the side of caution. I believe they have done that by banning all CFS patients from donating blood. I also believe they are making a potentially grave error in not banning Lyme disease patients from doing the same. The moment senior public health officials in this country authored a paper in which they questioned the role a retrovirus might be playing in the persistent symptoms of Lyme disease was the moment that Canadian Blood Services should have responded with an immediate ban. That didn't happen.

Ticks in a test tube

If you were to call Canadian Blood Services today, they would likely tell you what I have already told you: That there is a temporary deferral in place discouraging anyone who does not feel well from donating blood, something that would certainly apply to anyone actively battling chronic Lyme disease. But I would counter that the temporary deferral also applies to anyone suffering from an active case of CFS. The reason CFS sufferers are currently the subject of a permanent ban is because some of them do get better and, in the absence of symptoms, would not be prevented from donating blood by the temporary deferral. That, in a nutshell, is what makes the permanent ban so important: Having no symptoms does not mean that CFS sufferers are not potential carriers of a retrovirus that can ultimately be passed through the blood supply to unsuspecting recipients. They very well could be. The same holds true for Lyme disease sufferers. Many do eventually recover from the illness, although it may take many months or years, and once Lyme disease sufferers are symptom-free, they are permitted to donate blood. There is currently no a permanent ban stopping them from doing that.

To this day, the connection between XMRV and CFS has never been proven. Suspicion that the retrovirus may be involved in the syndrome is what led to the ban on blood donations and it's what will keep that ban in effect until XMRV has been definitively ruled out. And since XMRV is one of the infectious organisms being considered as the possible cause for chronic Lyme disease symptoms, it's in the best interest of the Canadian public that anyone who has ever been diagnosed with Lyme disease be banned from donating blood until such time as validated, peer-reviewed research pinpoints the exact cause (or causes) of Lyme's chronic symptoms. Only then will we be able to say what threat Lyme disease patients pose to the blood supply.

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External links:

Lyme Disease in British Columbia: Are we really missing an epidemic?

Canadian Blood Services - Eligibility

US Centers for Disease Control and Prevention - Xenotropic murine leukemia virus-related virus (XMRV)

I Can Has Science: The Machinery of Retroviruses Part 1: What is a Retrovirus?


Picture of Vanessa FarnsworthVanessa Farnsworth is a British Columbia-based writer with an in-depth knowledge of Lyme disease. Her work has been published in magazines & journals across Canada and in the United States.
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