Edward L. Murphy, Jr., MD, MPH
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One of the most important studies in blood banking and funded by the National Institutes of Health, the Retrovirus Epidemiology Donor Study-II (REDS-II) is a multi-blood center epidemiological study of blood safety. Areas of research will include: 1) transfusion-related lung injury (TRALI), 2) studies of hemoglobin and iron balance in blood donors, especially women of child-bearing age, 3) studies of infectious diseases (HIV, WNV, HBV, HCV, emerging viruses, arboviruses, tick-borne infections, bacterial infections), 4) donor deferrals, namely, are the current donor history questions effective and efficient in eliminating at-risk donors. These studies will be supported by the collection of computerized blood donation data across the six participating blood centers, and the collection of blood samples for laboratory studies and repositories.
HTLV Outcomes Study
Human T-lymphotropic viruses- I and –II (HTLV-I and HTLV-II) are retroviruses commonly found in the populations of Japan, the Pacific Islands, the Caribbean, Central Africa, South America and British Columbia. Most HTLV carriers remain healthy, but one in 20 will develop one or several symptoms of the disease, such as loss of strength in the lower limbs (myelopathy), loss of bladder control, or leukemia. The viruses, for which there is no treatment, are transmitted in the same way as HIV, including blood transfusion. To prevent transfusion infection, blood donations are screened and eliminated if found to be positive for HTLV.
Dr. Murphy, one of the world’s experts in HTLV, is currently studying the health effects of long-term infection with the virus. His group has recruited a total of 151 blood donors who were positive for HTLV– I and 387 with HTLV-II, who were then matched with a control group. Every two years, subjects are seen by a nurse/counselor who performs health interviews, physical exams, and takes blood for a complete blood count and research testing. Findings have included the documentation of HTLV-associated myelopathy in both HTLV-I and II.
HCV Mortality Study
HCV is the greatest cause of chronic liver disease in the United States. It causes an estimated 10,000 to 12,000 deaths yearly. Because of the long latency of the disease (20-30 years), it is difficult to gauge mortality. Dr. Murphy’s group identified approximately 10,000 HCV positive donors within the Blood Systems Inc. network from 1991 through 2002 and matched them with a control group of similar size. Researchers used the Public Health Service National Death Index (NDI) to determine vital status of all participants, and cause of death for deceased subjects. Analyses found a three-fold higher death rate in the HCV positive group. Whereas death due to liver disease was most strongly linked to HCV, it was outnumbered by higher death rates due to alcohol or drug abuse, trauma, suicide and heart disease among HCV positives.
Dr. Murphy’s group is engaged in training blood bank professionals from other countries in a critical effort to prevent the transmission of infectious agents internationally. The United States has achieved such low levels of transfusion-transmitted infections (TTI) that these risks are negligible. Yet patients of developing countries, where donor selection and screening are poorly established, are still at great risk. This despite the fact that the prevention of TTIs has been proven to be a cost-effective public health strategy for controlling infections like HIV and HBV.
Current trainees come from Brazil, Honduras, Mexico, Argentina, South Africa and France. They learn clinical research methodologies applicable to blood safety research. Research-training courses are held in San Francisco and in their own countries.