Pathogen inactivation of blood products
- Arthur J Silvergleid, MD
Arthur J Silvergleid, MD
- Section Editor — Transfusion Medicine
- Affiliate Associate Professor, Department of Pathology and Cell Biology
- University of South Florida, College of Medicine
- Medical Director, OneBlood, Inc.
The possibility of transmitting infectious organisms via blood products and plasma derivatives is a major public health concern. The paradigm for ensuring the safety of the blood supply using donor screening and laboratory testing is limited because it requires prior knowledge of the possible infectious agents, development of effective laboratory tests for each agent, and widespread application of that testing to all collected blood. For this reason, it has been a long-sought goal to find an effective way to sterilize blood after collection using a pathogen inactivation technology.
This topic review discusses available methods for pathogen inactivation of blood products including plasma, platelets, red blood cells, and plasma derivatives, and it provides evidence for the effectiveness and potential limitations of these procedures.
Approaches to reducing infectious risk using blood donor screening and blood product testing to eliminate products at risk of carrying infectious organisms are discussed in separate topic reviews. (See "Blood donor screening: Medical history" and "Blood donor screening: Laboratory testing" and "Blood donor screening: Procedures and processes to enhance safety for the blood recipient and the blood donor".)
GENERAL PRINCIPLES OF PATHOGEN INACTIVATION
Terminology — The terms pathogen inactivation and pathogen reduction have been used interchangeably by some authors. Strictly speaking, pathogen inactivation refers to complete prevention of infectivity by a pathogen, whereas pathogen reduction refers to decreasing the amount of an infectious pathogen, either by physical removal (eg, nanofiltration) or by an inactivation technique. Some experts have proposed that the term "pathogen inactivation" be used to refer to the processing of the component, and "pathogen-reduced blood component" be used to refer to the transfusable product because no method can guarantee complete sterility of the component .
Potential benefits — In principle, pathogen inactivation technologies have the potential to make the blood supply safer by broadly eliminating infectious organisms without the need to screen or test for specific pathogens. This is especially appealing for pathogens that cause asymptomatic infection (and thus would not be identified by donor screening), those with a long window period during which serologic testing would be ineffective, and emerging infectious diseases such as dengue virus, chikungunya virus, Zika virus, Babesia, and as yet unknown emerging pathogens for which donated blood is not screened.
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- GENERAL PRINCIPLES OF PATHOGEN INACTIVATION
- Potential benefits
- - Solvent/detergent and methylene blue
- - Amotosalen+UVA and riboflavin+UV
- AVAILABLE PRODUCTS
- Plasma derivatives including fibrinogen
- METHODS AND PRODUCTS UNDER DEVELOPMENT
- Universally ABO-compatible S/D Plasma
- Short wavelength UV light (UVC)
- RBCs and whole blood
- OTHER MEANS OF REDUCING INFECTIOUS RISK