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Rare Infection Threatens to Spread in Blood Supply
NY Times ^ | 11/18/03 | Donald G. McNeil Jr

Posted on 11/18/2003 7:03:04 AM PST by neverdem

A parasitic infection common in Latin America is threatening the United States blood supply, public health experts say. They are especially concerned because there will be no test for it in donated blood until next year at the earliest.

The infection, Chagas disease, is still rare in this country. Only nine cases are known to have been transmitted by transfusion or transplant in the United States and Canada in the last 20 years.

But hundreds of blood recipients may be silently infected, experts say, and there is no effective treatment for them. After a decade or more, 10 to 30 percent of them will die when their hearts or intestines, weakened by the disease, explode.

Chagas is still little known in the United States, but in Mexico, Central America and South America, 18 million people are infected, and 50,000 a year die of it.

Experts expect it to become better known as new tests are developed.

"I wouldn't say that it's as rare as hen's teeth, but it's rare," said Dr. Ravi V. Durvasula, a Chagas expert at the Yale School of Public Health. "It's one of the top threats to the blood supply, but it's an emerging threat."

Because the disease is most common in rural areas from southern Mexico to northern Chile, the threat is greatest in American cities with many immigrants from those areas.

Across the United States, said Dr. David A. Leiby, a Chagas expert at the American Red Cross, the risk of getting a transfusion of infected blood is only about 1 in 25,000.

But in 1998 in Miami it was found to be 1 in 9,000, he said, and in Los Angeles the same year, he measured it at 1 in 5,400, up from 1 in 9,850 only two years earlier.

No more recent study of the blood supply has been done.

The only routine screening for Chagas now is in the standard set of questions asked of donors — whether they come from or have visited a country where Chagas is endemic and whether they ever slept in a thatched hut.

But that often isn't reliable, said Dr. Louis V. Kirchhoff, a professor at the University of Iowa's medical school who researches Chagas in Guadalajara, Mexico, where the chance of getting infected blood is 1 in 126. Potential donors "are kind of leery of those questions," he said, and may not answer honestly.

Since 1989, several advisory panels to the United States Food and Drug Administration have recommended that all donated blood be screened for Chagas. But no test has been approved yet.

Last year, the F.D.A. invited diagnostics companies to create one, and the two largest, Abbott Laboratories and Ortho-Clinical Diagnostics, are trying. But representatives of the companies said they were under little deadline pressure. Abbott's test may be ready next year.

Little sense of urgency exists because "there are always new things that come up," Dr. Leiby said. Hepatitis and AIDS were followed by mad cow disease, West Nile virus and bacterial contamination of platelets, so "Chagas gets pushed to the side," he said.

Mary Richardson, a spokeswoman for Ortho, which hopes to have a test by 2005, added: "Clinical trials take time. There's only so much speeding up you can do."

Nonetheless, she added, "the F.D.A. feels it's the next biggest threat."

An F.D.A. spokeswoman said her agency did not like to rank all the threats to the blood supply — including hepatitis, AIDS and West Nile virus — but reiterated that "we would certainly recommend a Chagas test if one is developed."

Prevalence rates in Latin America vary widely, from 25 percent in Bolivia to 1 percent in Mexico.

It is not found on Caribbean islands like Puerto Rico, the Dominican Republic or Cuba.

In some countries, it is a serious threat to the blood supplies; in one Bolivian city, half of the blood was infected.

About 30 tests are used in different countries, but none meet F.D.A. accuracy standards. Some Latin American blood banks disinfect with gentian violet, but it is unpopular because it gives recipients a purplish tinge.

(Page 2 of 2)

The disease is named for Carlos Chagas, the Brazilian doctor who described it in 1909. It is caused by a protozoan, Trypanosoma cruzi, which infects humans in a particularly disgusting way. Reduviids, also called kissing or assassin bugs, drop down from the thatch, follow the trail of carbon dioxide to the mouths of sleeping humans and suck their blood. They leave behind a protozoan-laden drop of feces, which the sleeper often inadvertently rubs into the itching wound.

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Charles Darwin may have been infected on his travels; he suffered with Chagas symptoms for many years in England.

There is no vaccine and no effective treatment. The first phase, which starts within weeks of infection, may include fever and swollen glands, liver or spleen, but is rarely fatal except in infants and in adults with compromised immune systems. It is often misdiagnosed.

The disease can then lie dormant for 10 to 30 years, then kill suddenly as weakened organs rupture.

The failure of the blood industry and its regulators to develop a test since it was endorsed by a Blood Products Advisory Committee in 1989 seems to be a combination of bureaucratic inertia and divided responsibility for such a decision. Blood banks cannot use a test that the F.D.A. has not approved. The agency usually defers to its advisory committees, which have many experts from blood banks as members.

"It's a political process that is not always fully engaged," said Dr. Stuart J. Kahn of the Infectious Disease Research Institute, a Seattle group hunting cures for tropical diseases.

Dr. Hira Nakhasi, director of transfusion-transmitted diseases at the F.D.A., agreed that neither the blood banks nor his agency had been very aggressive. Things tended to move when "the public and media put pressure on," he said.

Cost concerns made blood banks hesitant, Dr. Kirchhoff said. It may cost $50 million to $100 million a year to screen the whole United States blood supply, he estimated, and "people will reasonably say, `Why should we do this if we're not seeing a lot of sick people?' "

Although perhaps 120 Americans a year get infected blood, he said, between 70 and 90 percent will not become seriously ill, and few of those who do will live long enough to die of Chagas.

Most transfusion recipients are fairly sick, and half die of other causes within two years anyway.

But he pointed out that the risk was growing rapidly. Census figures show that net immigration from Mexico is about 1,000 people a day, he said. Of those, 5 to 10 are probably infected.

Meanwhile, blood banks increased their appeals to Hispanics in the 1990's, under extra pressure when mad cow disease eliminated donors who had made long visits to Europe and AIDS eliminated gay men and other risk groups.

Interest in Chagas seems to be growing, Dr. Kahn said, because breakthroughs in biogenetics make it easier to attack diseases and because the interest of the Bill and Melinda Gates Foundation in third world health "put a lot of diseases up on the radar screen."


TOPICS: Breaking News; Culture/Society; Foreign Affairs; Government; Politics/Elections
KEYWORDS: bloodhounds; bloodsupply; bloodtransfusion; chagas; health; healthcare; immigration
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Another reason to control immigration.
1 posted on 11/18/2003 7:03:05 AM PST by neverdem
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To: vetvetdoug
This might interest you.
2 posted on 11/18/2003 7:07:49 AM PST by Darnright
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To: neverdem
Amen.

My wife and I have been worried about disease coming across the borders unchecked for years.

There are kids in Orange County, CA that have contracted TB from Souteast Asian immigrant's kids.

Just lovely.
3 posted on 11/18/2003 7:13:31 AM PST by Ribeye (Headwear courtesy of Reynolds Aluminum Products)
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To: neverdem
Yes, yet another reason to tighten immigration. How long will they wait? They used to inspect immigrants for disease before allowing them into the country (crude inspection methods to be sure, but at least they tried). Are they doing that now?
4 posted on 11/18/2003 7:14:23 AM PST by Eowyn-of-Rohan
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To: neverdem
"Chagas is still little known in the United States, but in Mexico, Central America and South America, 18 million people are infected, and 50,000 a year die of it."

"But in 1998 in Miami it was found to be 1 in 9,000, he said, and in Los Angeles the same year, he measured it at 1 in 5,400"

It must be shear coincidence that both of these cities have a LARGE illegal alien population and high infection rate because illegal immigration is GOOD for us. Right?
5 posted on 11/18/2003 7:26:41 AM PST by Blood of Tyrants (Even if the government took all your earnings, you wouldn’t be, in its eyes, a slave.)
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To: Ribeye
"There are kids in Orange County, CA that have contracted TB from Souteast Asian immigrant's kids."

At least there is a reasonably effective screening program for TB that can be given to folks from SE Asia, who are mostly legal immigrants.

The medical literature is rife with articles about multi-drug resistant TB from south of the border.
6 posted on 11/18/2003 7:40:51 AM PST by neverdem (Say a prayer for New York both for it's lefty statism and the probability the city will be hit again)
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To: Eowyn-of-Rohan
IIRC, legal immigrants are tested for HIV/AIDS and TB, the latter being a "PPD" skin test that shows an obvious reaction if positive in 48 - 72 hours. If that happens, then the person must obtain a chest X-ray.
7 posted on 11/18/2003 7:47:09 AM PST by neverdem (Say a prayer for New York both for it's lefty statism and the probability the city will be hit again)
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To: neverdem
Nice, now we're getting diseases passed to us from Illegal aliens and immigrants.

Why even bother having a federal government?
8 posted on 11/18/2003 7:59:12 AM PST by Bikers4Bush
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To: neverdem
Thanks for the info, but looks like they had better start checking for more than HIV and TB... IF possible
9 posted on 11/18/2003 8:50:29 AM PST by Eowyn-of-Rohan
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To: neverdem
I just don't see these illegal immigrants rushing off the the Red Cross to donate blood. What am I missing here?
10 posted on 11/18/2003 8:56:25 AM PST by OldFriend (DEMS INHABIT A PARALLEL UNIVERSE)
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To: OldFriend
"I just don't see these illegal immigrants rushing off the the Red Cross to donate blood. What am I missing here?"

Your missing the increasing prevalence due to immigration, the lack of any good screening test for a disease that has no effective treatment.
11 posted on 11/18/2003 9:03:19 AM PST by neverdem (Say a prayer for New York both for it's lefty statism and the probability the city will be hit again)
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To: Bikers4Bush
I couldn't agree more with controlling immigration, but I must point out that Chagas' disease exists in America naturally, without having to be imported. This problem could well have developed even with sealed borders. And then there's the problem of travelers bringing it home as well.
Glock22, gastroenterologist
12 posted on 11/18/2003 9:08:11 AM PST by Glock22
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To: neverdem
But I still don't see even legal immigrants rushing to donate blood. Unless of course, the Red Cross continues to pay for blood......as they did in the past in certain districts in San Francisco.
13 posted on 11/18/2003 9:10:55 AM PST by OldFriend (DEMS INHABIT A PARALLEL UNIVERSE)
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To: JustPiper
Here's another one for the Ping list.
14 posted on 11/18/2003 9:13:39 AM PST by DumpsterDiver
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To: Glock22
It may exist in America naturally but I've never heard of it until now and the article indicates that it's most prevalent in illegal havens like Floriduh and Cookifornia.

While it's possible that we COULD have developed it I find more likely that it's being brought to us from unsanitary places. Even as you pointed out it being brought back by travelers.

There was a time when we actually required immigrants to show up with lung x-rays to keep out TB. Hell now we refuse to stop anyone who wants to from crawling across the border and seting up shop.
15 posted on 11/18/2003 9:13:50 AM PST by Bikers4Bush
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To: Glock22
This protozoan also will infect animals. T. Cruzi has been diagnosed in dogs from Texas and down on the border fairly often. The Texas State Veterinarian is well aware of the problem, she mentioned it as one of emerging diseases when I spoke with her back in February.
16 posted on 11/18/2003 9:15:12 AM PST by vetvetdoug
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To: neverdem
Correction: "Because the disease is most common in rural areas from southern Mexico to northern Chile, the threat is greatest in American cities with many illegal immigrants from those areas.

"The disease is named for Carlos Chagas, the Brazilian doctor who described it in 1909. It is caused by a protozoan, Trypanosoma cruzi, which infects humans in a particularly disgusting way. Reduviids, also called kissing or assassin bugs, drop down from the thatch, follow the trail of carbon dioxide to the mouths of sleeping humans and suck their blood. They leave behind a protozoan-laden drop of feces, which the sleeper often inadvertently rubs into the itching wound.

Just damn. What next? Will they bring in alien facehuggers?

17 posted on 11/18/2003 9:25:34 AM PST by SpinyNorman
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To: neverdem
Isn't this how HIV got into the blood supply...

Seems like history repeating itself... Profit before compassion...
18 posted on 11/18/2003 10:25:34 AM PST by dwd1 (M. h. D. (Master of Hate and Discontent))
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To: Conservababe
Healthcare exploding hearts and intestines ping...
19 posted on 11/18/2003 10:35:54 AM PST by Born Conservative ("Forgive your enemies, but never forget their names" - John F. Kennedy)
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To: neverdem
Chagas is arguably better than this parasite (see paragraph 3)
20 posted on 11/18/2003 10:48:00 AM PST by Born Conservative ("Forgive your enemies, but never forget their names" - John F. Kennedy)
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To: Born Conservative
Good grief!
21 posted on 11/18/2003 10:56:22 AM PST by stanz (Those who don't believe in evolution should go jump off the flat edge of the Earth.)
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To: Born Conservative
What a link, LOL. I vaguely remember reading about this strange critter. Thanks a lot.
22 posted on 11/18/2003 11:05:27 AM PST by neverdem (Say a prayer for New York both for it's lefty statism and the probability the city will be hit again)
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To: Born Conservative
Thanks for the ping. Years ago, it was possible that one person could donate his own blood directly to the designated person who needed a transfusion. Sure, it had to be processed, but it still went directly from one donor to the patient.

We can't do that anymore and I blame the Red Cross. Your donated blood must go into the bank.

But, I do remember a case in my hospital. The patient needed elective, but serious, surgery. He was of the Jehovah Witness religion. He could not receive a blood transfusion, if needed, but he could receive his own blood back, according to his beliefs. So, my hospital outpatient lab accomadated him by allowing him to donate to himself, so to speak, before the surgery. Somehow they were able to process the blood and get it back to him during surgery.

Now, why can't we do this for every patient, if possible? I would rather receive blood from someone I know, if the right type of course, than a stranger. And I would be willing to pay more the transfusion to be safe.
23 posted on 11/18/2003 11:22:41 AM PST by Conservababe
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To: neverdem
Very interesting. My stomach and lower intestines ruptured in 1989 and they could never figure out what caused it. The lab work all came back negative. I was so sick, I spent 21 days in the hospital after a six hour surgery. NM has always had a large number of illegals and it's possible I could have received bad blood from a previous surgery. I don't know that this is what it was, but it's more than we've had to go on since it happened. Thanks for posting this. I'm going to talk to my doctor about it.
24 posted on 11/18/2003 11:30:32 AM PST by NRA2BFree (Nuke the UN!)
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To: NRA2BFree
When folks have prolonged abdominal complaints over more than a few days, docs usually request a stool sample to check for ova and parasites.

However, that's not the case with this protozoa. They draw blood samples and might be able to visualize the organism in a microscope. If unsuccessful, there are available more sophisticated biochemical tests looking for specific anti-bodies to T. cruzi.

Contrary to this story, there are medicines to treat this condition except they may not always work and can have bad side effects.

However, most folks with this disease, if left untreated, will die from congestive heart failure or a fatal arrhythmia.

Without crapping in your pants, go see your doc, please.

I'm sorry if I scared anyone.
25 posted on 11/18/2003 12:18:13 PM PST by neverdem (Say a prayer for New York both for it's lefty statism and the probability the city will be hit again)
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To: neverdem
Linking this thread I posted a bit ago for reference: http://www.freerepublic.com/focus/f-news/889385/posts
26 posted on 11/18/2003 12:28:32 PM PST by Calpernia (Innocence seldom utters outraged shrieks. Guilt does.)
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To: Calpernia
Thanks for the link. How did you retrieve it, by entering "Tainted blood" into the FR search function?
27 posted on 11/18/2003 12:40:39 PM PST by neverdem (Say a prayer for New York both for it's lefty statism and the probability the city will be hit again)
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To: neverdem
I was the poster of that thread.
28 posted on 11/18/2003 1:35:35 PM PST by Calpernia (Innocence seldom utters outraged shrieks. Guilt does.)
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To: Conservababe
Self-donation has been around for a while. I know several people who used it. It hasn't been shown that one has a better survival rate when using one's own blood. (I would think so, but the statistics just aren't ther.) Also, this procedure only applies to elective surgery. Blood has a short shelf life. The good news is the blood by products (plasma, and a few others) are generally safer than whole blood.
29 posted on 11/18/2003 1:46:42 PM PST by Doctor Stochastic (Vegetabilisch = chaotisch is der Charakter der Modernen. - Friedrich Schlegel)
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To: Calpernia
I noticed that. I was asking how did you retrieve it? Are you maintaining a log of the titles you post?
30 posted on 11/18/2003 1:49:37 PM PST by neverdem (Say a prayer for New York both for it's lefty statism and the probability the city will be hit again)
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To: neverdem
Oh, I have it saved in my FR links.
31 posted on 11/18/2003 1:52:59 PM PST by Calpernia (Innocence seldom utters outraged shrieks. Guilt does.)
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To: Conservababe
Whole blood currently has a shelf life of 42 days. Frozen blood has a shelf life of several years. Undoubtably your friend was able to donate his own blood, which was frozen, and given to him at a later date during the elective surgery.

Next question; why isn't all donated blood frozen? It is much more expensive, as it requires additional equipment to freeze and reconstitute the blood.
32 posted on 11/18/2003 2:03:35 PM PST by thepainster
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To: Doctor Stochastic
Yes, but we are talking about blood donors with diseases that can be transmitted. I would rather self donate or have someone I know donate to me. Of course, that would not be possible in an emergency situation.
33 posted on 11/18/2003 2:05:59 PM PST by Conservababe
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To: thepainster
Next question; why isn't all donated blood frozen? It is much more expensive, as it requires additional equipment to freeze and reconstitute the blood.

I would pay the expense to have a safe transfusion rather than take the chance of blood from donors who are not screened other than asking questions during the interview before drawing and a mere token screening afterwards. And I especially mistrust the donors who are paid for their blood. Seems a lot of people do not realize that all donors are not the ones who donate freely at the Red Cross drives.

34 posted on 11/18/2003 2:14:10 PM PST by Conservababe
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To: Calpernia
"Oh, I have it saved in my FR links."

How did you do that, if you don't mind explaing that?
35 posted on 11/18/2003 2:21:19 PM PST by neverdem (Say a prayer for New York both for it's lefty statism and the probability the city will be hit again)
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To: Ribeye
We had US Navy crew afflicted with TB a while back. They live in close quarters and picked it up somewhere. I think there were 9 or so with it.
36 posted on 11/18/2003 2:30:34 PM PST by oldironsides
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To: Bikers4Bush
Why even bother having a federal government?

Some one has to collect your money.

37 posted on 11/18/2003 2:31:29 PM PST by itsahoot (The lesser of two evils, is evil still...Alan Keyes)
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To: neverdem
>>>How did you do that, if you don't mind explaing that?

Oh! I get it.

When you see a thread posted that you like, RIGHT AT THE END of the posted article are two options, REPORT ABUSE and BOOKMARK

If you click BOOKMARK, it is added to your FR Profile LINKS page.

You can access these links under your profile. Top Nav link of the Profile page has a LINKS hyperlink. That will be where your saved links go.

Click my Freeper name. On my Profile Page you will see LINKS (Top Nav Bar). If you click that, you will see all the links I've saved.

38 posted on 11/18/2003 3:45:05 PM PST by Calpernia (Innocence seldom utters outraged shrieks. Guilt does.)
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To: neverdem
See, right under Keywords:

TOPICS: Breaking News; Culture/Society; Foreign Affairs; Government; Politics/Elections; Testing; Click to Add Topic
KEYWORDS: BLOODHOUNDS; BLOODTRANSFUSION; HEALTH; HEALTHCARE; IMMIGRATION; Click to Add Keyword


[ Report Abuse | Bookmark ] <-----That Bookmark link will save to YOUR profile links page.
39 posted on 11/18/2003 3:45:59 PM PST by Calpernia (Innocence seldom utters outraged shrieks. Guilt does.)
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To: Conservababe
You can donate blood for your self (autologous donation) or for someone else (designated donation). You actually do pay more for this service. It is done every day. The other poster was correct, though, in saying that there is no evidence that it is safer to receive a designated donation. It is safe to receive blood from a frequent donor who is tested each and every time.
LL
40 posted on 11/18/2003 3:57:55 PM PST by Lighthouse Lady
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To: Lighthouse Lady
By the way, no one pays for blood anymore. At least not whole blood. There are plasma centers who pay for blood though.
LL
41 posted on 11/18/2003 4:00:32 PM PST by Lighthouse Lady
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To: Calpernia
Thank's a lot. I tried bookmarking an article for the first time, just before I saw your last 2 comments. Thank you again for your reply.
42 posted on 11/18/2003 4:12:38 PM PST by neverdem (Say a prayer for New York both for it's lefty statism and the probability the city will be hit again)
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To: Lighthouse Lady
I meant plasma...duh... Plasma centers pay for plasma.
LL
Must be time to go home...
43 posted on 11/18/2003 4:13:40 PM PST by Lighthouse Lady
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To: Lighthouse Lady
You can donate blood for your self (autologous donation) or for someone else (designated donation). You actually do pay more for this service. It is done every day. The other poster was correct, though, in saying that there is no evidence that it is safer to receive a designated donation. It is safe to receive blood from a frequent donor who is tested each and every time.

Well, if it is all the same to you, I would rather receive blood from my brother who I know and can give me his medical history. But, I do know that he is not an addict on any IV drugs, is not homosexual and has not traveled to Mexico, ever. And don't give me that line of testing each and every time. What tests? Can you name them all? It is minimal at best.

44 posted on 11/18/2003 5:24:56 PM PST by Conservababe
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To: neverdem
Without crapping in your pants, go see your doc, please.

LOL! Ladies don't do those kind of things. :)

45 posted on 11/18/2003 5:31:26 PM PST by NRA2BFree (Nuke the UN!)
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To: boop
After a decade or more, 10 to 30 percent of them will die when their hearts or intestines, weakened by the disease, explode.

I'm sorry but exploding intestines? Sounds alot like urban legend.

46 posted on 11/18/2003 6:52:55 PM PST by softengine (I want to live in Theory........Everything works there.)
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To: neverdem
,,, no cure, but there may be revenge.
47 posted on 11/18/2003 7:03:40 PM PST by shaggy eel
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To: neverdem
Let diseased animals into the herd - the whole herd dies.
48 posted on 11/18/2003 7:07:03 PM PST by PeyersPatches (I AM intestinal fortitude)
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To: neverdem
The only routine screening for Chagas now is in the standard set of questions asked of donors — whether they come from or have visited a country where Chagas is endemic and whether they ever slept in a thatched hut.

I have done both. Why wasn't I asked these questions when I donated a year ago?

49 posted on 11/18/2003 7:11:02 PM PST by Harmless Teddy Bear (No matter how subtle the wizard, a knife between the shoulder blades will seriously cramp his style)
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To: neverdem
Another reason to control immigration.

Both illegal and legal immigration should be halted (starting right now) for at least 20 to 30 years, to allow time for the third-worlders already here to assimilate and become Americanized. If we do this, and at the same time undertake an immense deportation (of illegals) effort, there's still a chance our republic can be saved.

50 posted on 11/18/2003 7:15:58 PM PST by Mr. Mojo
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