Hailey Johnson
Lyme disease is a tick-borne bacterial infection that is one of the fastest-growing infectious diseases in the United States. While Lyme disease is typically diagnosed through blood tests that detect antibodies to the Lyme bacteria, there is some concern about the possibility of transfusion-associated Lyme disease. This has raised questions about whether blood banks test for Lyme disease before accepting blood donations. So, do blood banks routinely test for Lyme disease?
| Characteristics | Values |
|---|---|
| Lyme disease testing | Done on a sample of blood; in certain cases, a CSF test may be done |
| Blood test procedure | A health care professional will take a blood sample from a vein in the arm, using a small needle |
| CSF test procedure | A procedure called a lumbar puncture, also known as a spinal tap |
| Lyme disease diagnosis | Detects antibodies to the Lyme bacteria |
| Lyme disease treatment | Antibiotics |
| Blood transfusion cases | No reports of transfusion-associated infection with Borrelia burgdorferi |
| Blood donation testing | ABO group (blood type) and Rh type (positive or negative), as well as for any unexpected red blood cell antibodies |
| Lyme disease blood test | ELISA test, followed by a Western blot test for confirmation |
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What You'll Learn
Lyme disease blood tests
Lyme disease testing is typically done on a blood sample, although in certain cases, a CSF (cerebrospinal fluid) test may be required. A healthcare professional will take a blood sample from a vein in the patient's arm using a small needle, which usually takes less than five minutes.
The blood test checks for the presence of antibodies to the Lyme disease bacteria in the blood sample. It can take several weeks after infection for the immune system to produce enough antibodies to be detected by the test. The ELISA test is often used to detect these antibodies, and if this test is positive, it must be confirmed with another test called the Western blot test. Only a positive Western blot test can confirm a diagnosis of Lyme disease.
Lyme disease is one of the fastest-growing infectious diseases in the United States, and it can live in stored blood. However, blood banks do not routinely test for Lyme disease before accepting blood donations due to the low likelihood of finding positive samples and the associated costs. Potential donors with a confirmed diagnosis of Lyme disease or a reported tick bite may be deferred for a certain period at some blood collection facilities.
It is important to note that Lyme disease is difficult to diagnose, as its symptoms are common to many other conditions, and test results alone cannot confirm the disease. In addition to blood tests, a person's symptoms and medical history are also considered in the diagnostic process.
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CSF tests
Lyme disease is typically diagnosed through blood tests that detect antibodies to the Lyme bacteria. However, in certain cases, a CSF test may be required, especially if the patient's symptoms indicate possible nervous system involvement.
CSF, or cerebrospinal fluid, is a clear liquid that surrounds the brain and spinal cord. To obtain a CSF sample, a healthcare provider performs a procedure known as a lumbar puncture or spinal tap. During this procedure, the patient lies on their side or sits on an examination table, and the provider inserts a thin, hollow needle between the vertebrae in the lower spine to extract a small amount of CSF for testing.
The CSF test for Lyme disease specifically looks for the presence of Borrelia burgdorferi (BB)-specific antibodies in the cerebrospinal fluid. This test is often ordered when patients exhibit neurological symptoms such as a stiff neck or numbness in the hands and feet, suggesting possible central nervous system involvement.
The results of the CSF test can help determine whether Lyme disease has spread to the nervous system. A negative CSF test indicates the absence of Lyme disease antibodies in the CSF, but it does not rule out the possibility of Lyme disease affecting the nervous system. On the other hand, a positive CSF test confirms the presence of Lyme disease antibodies in the CSF, and if the antibody levels are higher in the CSF than in the blood, it suggests that Lyme disease may have spread to the nervous system.
In addition to the CSF test, patients with suspected Lyme neuroborreliosis (LNB) may undergo further CSF analysis, including the calculation of the intrathecal index, which compares the ratio of BB antibodies in the CSF to those in the serum. This index can provide strong evidence of central nervous system invasion by Lyme disease.
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ELISA tests
Lyme disease is caused by the bacteria Borrelia burgdorferi, transmitted by the bite of infected blacklegged ticks. Lyme disease testing is usually done on a sample of blood, although in certain cases, a CSF (cerebrospinal fluid) test may be done if symptoms indicate that the infection has spread to the nervous system.
The ELISA test is a blood test that detects antibodies to the Lyme bacteria in the blood. It is a conventional enzyme-linked immunoassay test that does not test for B. burgdorferi itself. A positive ELISA result means that antibodies were seen in the blood sample, indicating a current or past infection. However, this does not confirm a diagnosis of Lyme disease, as a positive ELISA result may also occur with certain other diseases, such as rheumatoid arthritis.
If the ELISA test is positive, it must be followed up with another test called the Western blot test. Only a positive Western blot test can confirm the diagnosis of Lyme disease. The Centers for Disease Control and Prevention (CDC) recommends this two-tiered testing approach for Lyme disease diagnosis. The ELISA test is designed to be very sensitive, meaning that almost everyone who has Lyme disease (and some people who do not) will test positive. Therefore, the Western blot test is necessary to confirm the results and reduce the likelihood of false positives.
It is important to note that the conventional ELISA test measures OspA (outer surface protein A) antibodies, which can lead to inaccurate results for individuals who have been immunized with the discontinued LYMErix vaccine. In such cases, the ELISA test may not provide accurate results.
The ELISA test is typically performed on a blood sample collected from a vein in the arm, usually from the inside of the elbow or the back of the hand. There is very little risk involved with the procedure, although some people may experience slight pain, bruising, or bleeding at the site of the needle insertion. These symptoms usually resolve quickly.
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Western blot tests
Lyme disease is diagnosed by testing for antibodies against the Lyme disease bacteria in the blood. The Western blot test is a commonly used test for Lyme disease that is often used as a second test to confirm a positive ELISA test result. The ELISA test is a type of enzyme-linked immunoassay that detects antibodies to the Lyme bacteria.
The Western blot test looks at whether the patient has an immune response to the Lyme disease bacteria by checking for the production of IgM or IgG antibodies to specific proteins (known as antigens) on the bacteria. When the IgM or IgG antibodies combine with these specific proteins from the Lyme disease bacteria, dark spots or "bands" are produced on the Western blot test strip. The CDC considers a Western blot test to be positive for Lyme disease if at least two of three IgM bands are positive within 30 days of symptom onset, or five of ten IgG bands are positive at any time.
The Western blot test has been part of a two-step testing system since 1994 and is considered more sensitive than the ELISA test for late-stage Lyme disease. The advantage of the Western blot test is that it can provide additional information to help determine if someone has Lyme disease. However, it is important to note that a positive Western blot test does not necessarily mean that an active infection is present, as the test can remain positive for many years after the infection is gone.
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Blood transfusion risks
Blood transfusions are generally considered safe, but like any medical procedure, there are some associated risks. These risks are rare but can include allergic reactions and infections.
Allergic Reactions
In rare cases, a patient may experience an allergic reaction to a blood transfusion. This can occur if the patient's body recognizes the donated blood as foreign and mounts an immune response. Symptoms of an allergic reaction can include hives, itching, and, in severe cases, anaphylaxis.
Infections
There is also a small risk of acquiring an infection from a blood transfusion, as it is possible for certain viruses, bacteria, or parasites to be transmitted through blood. However, this risk is very low in countries with established blood banking systems and rigorous screening procedures. In the US, for example, donated blood is routinely tested for infectious diseases such as HIV, hepatitis B, syphilis, and Trypanosoma cruzi (the parasite that causes Chagas disease).
Transfusion-Associated Lyme Disease
While there have been no reported cases of transfusion-associated Lyme disease, it is still a concern worth considering. Lyme disease is caused by the Borrelia burgdorferi bacterium, transmitted by tick bites. The risk of transfusion-associated Lyme disease is thought to be low, as the current screening procedures effectively eliminate or nearly eliminate blood transfusion cases of infectious diseases. However, there is a lack of routine serologic testing or molecular analyses to fully ensure that asymptomatic, Borrelia-infected donors are excluded from the donor pool.
Additionally, studies have shown that the relapsing fever spirochete Borrelia miyamotoi, a close relative of Borrelia burgdorferi, can survive and infect mice after being stored under standard blood banking conditions. This suggests that transmission of this pathogen through blood transfusion is possible, although it is not clear if it can cause infection or disease manifestations in humans.
Other Risks
Other potential risks associated with blood transfusions include:
- Delayed hemolytic reactions: This occurs when the recipient's body produces antibodies against the transfused red blood cells, resulting in their destruction.
- Transfusion-related acute lung injury (TRALI): A rare but serious complication that can occur when antibodies in the donated blood react with the recipient's white blood cells, causing inflammation and fluid accumulation in the lungs.
- Transfusion-associated circulatory overload (TACO): This occurs when the volume of blood transfused exceeds the recipient's circulatory system capacity, leading to respiratory distress and congestive heart failure.
- Transfusion-transmitted cancers: In rare cases, blood transfusions have been associated with the transmission of certain cancers, such as leukemia and lymphomas. However, the risk is extremely low, especially with modern screening techniques.
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Frequently asked questions
Lyme disease is a tickborne disease caused by the Borrelia burgdorferi bacteria. It is the most common tickborne disease in the United States.
Lyme disease is typically tested for using a blood sample taken from a vein in the arm. This blood test looks for antibodies to the Lyme bacteria. In some cases, a CSF test may be done to test for Lyme disease in the nervous system.
Blood donations are typically tested for various disease markers, including infectious diseases such as HIV, hepatitis B, and syphilis. While there is no routine serologic testing or molecular analysis for Lyme disease in blood donations, potential donors with a confirmed diagnosis of Lyme disease or a reported tick bite may be deferred from donating blood.
While there have been no reported cases of transfusion-associated Lyme disease, it is still a concern worth considering. The risk of transmission is low due to the current screening procedures in place for blood transfusions.
The symptoms of Lyme disease can vary and are common to many other conditions. Early symptoms may include a rash, stiff neck, or numb hands and feet. If left untreated, Lyme disease can lead to long-term damage to the nervous system or joints.
