An 84-year-old man complains of worsening angina pectoris that started
3 months earlier. The patient has had aortic stenosis for about 10 years. He
also has diabetes, which is controlled with oral agents.
An echocardiogram shows no change in ejection velocity, size of gradient,
or size of valve orifice compared with previous ultrasound studies; however,
catheterization reveals significant coronary artery disease. Because he
has diabetes, valve replacement and coronary artery bypass graft (CABG)
The patient accepts the risks of surgery, but he is concerned about the
blood transfusions that he is likely to require during the perioperative period.
He has read and heard about the "dangerous blood supply" in the popular
media. He is especially concerned about the possibility of contracting such
viral infections as AIDS and hepatitis C.
Which of the following presents the greatest risk for this patient?
A. Infection with HIV-1 or HIV-2.
B. Hepatitis C virus (HCV) infection.
C. West Nile virus infection.
D. Hepatitis B virus (HBV) infection.
E. Variant Creutzfeldt-Jakob disease.
1. Dodd RY, Notari EP 4th, Stramer SL. Current prevalence and incidence of infectious
disease markers and estimated window-period risk in the American Red
Cross blood donor population. Transfusion. 2002;42:975-979.
2. Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of
acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med.
3. Iwamoto M, Jernigan DB, Guasch A, et al. Transmission of West Nile virus from
an organ donor to four transplant recipients. N Engl J Med. 2003;348:2196-2203.