1
|
Benson MA, Tolich D, Callum JL, Auron M. Plasma: indications, controversies, and opportunities. Postgrad Med 2024; 136:120-130. [PMID: 38362605 DOI: 10.1080/00325481.2024.2320080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/13/2024] [Indexed: 02/17/2024]
Abstract
Plasma is overused as a blood product worldwide; however, data supporting appropriate use of plasma is scant. Its most common utilization is for treatment of coagulopathy in actively bleeding patients; it is also used for coagulation optimization prior to procedures with specific coagulation profile targets. A baseline literature review in PUBMED and Google Scholar was done (1 January 2000 to 1 June 2023), utilizing the following search terms: plasma, fresh frozen plasma, lyophilized plasma, indications, massive transfusion protocol, liver disease, warfarin reversal, cardiothoracic surgery, INR < 2. An initial review of the titles and abstracts excluded all articles that were not focused on transfusional medicine. Additional references were obtained from citations within the retrieved articles. This narrative review discusses the main indications for appropriate plasma use, mainly coagulation factor replacement, major hemorrhage protocol, coagulopathy in liver disease, bleeding in the setting of vitamin K antagonists, among others. The correlation between concentration of coagulation factors and INR, as well as the proper plasma dosing with its volume being weight-based, is also discussed. A high value approach to plasma utilization is supported with a review of the clinical situations where plasma is overutilized or unnecessary. Finally, a discussion of novel plasma products is presented for enhanced awareness.
Collapse
Affiliation(s)
- Michael A Benson
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Deborah Tolich
- Blood Management, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jeannie L Callum
- Department of Laboratory Medicine and Pathobiology, Queens University, Kingston, ON, Canada
| | - Moises Auron
- Department of Hospital Medicine and Department of Pediatric Hospital Medicine, Cleveland Clinic, Outcomes Research Consortium, Cleveland, OH, USA
| |
Collapse
|
2
|
Katz LM, Dodd RY, Saa P, Gorlin JB, Palmer K, Hollinger FB, Stramer SL. Infectious disease agents and their potential threat to transfusion safety (an update to the 2009 Transfusion supplement). Transfusion 2024; 64 Suppl 1:S1-S3. [PMID: 38394041 DOI: 10.1111/trf.17626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 02/25/2024]
Affiliation(s)
- L M Katz
- Impact Life Blood Services, Medical Affairs, Emeritus Chief Medical Officer, Tipton, IA, USA
| | - Roger Y Dodd
- American Red Cross, Scientific Affairs, Vice President, Rockville MD, USA
| | - Paula Saa
- American Red Cross, Scientific Affairs, Executive Director, Rockville MD, USA
| | - J B Gorlin
- Memorial Blood Centers, A Division of New York Blood Centers, Physician Services, VP and Medical Director, St. Paul MN, USA
| | - K Palmer
- Association for the Advancement of Blood and Biotherapies, Regulatory Affairs, Director, Bethesda MD, USA
| | - F B Hollinger
- Baylor College of Medicine, Professor of Medicine, Molecular Virology & Epidemiology, Houston, TX, USA
| | - S L Stramer
- Infectious Diseases Consultant, North Potomac, MD, USA
| |
Collapse
|
3
|
Handke W, Gravemann U, Müller TH, Wagner FF, Schulze TJ, Seltsam A. New ultraviolet C light-based method for pathogen inactivation of red blood cell units. Transfusion 2022; 62:2314-2323. [PMID: 36087025 DOI: 10.1111/trf.17098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pathogen inactivation (PI) technologies for platelet concentrates and plasma are steadily becoming more established, but new PI treatment options for red blood cells (RBCs), the most commonly used blood component, still need to be developed. We present a novel approach to inactivating pathogens in RBC units employing ultraviolet C (UVC) light. METHODS Whole blood-derived leukoreduced RBCs suspended in PAGGS-C, a third generation additive solution, served as test samples, and RBCs in PAGGS-C or SAG-M as controls. Vigorous agitation and hematocrit reduction by diluting the RBCs with additional additive solution during illumination ensured that UVC light penetrated and inactivated the nine bacteria and eight virus species tested. Bacterial and viral infectivity assays and in vitro analyses were performed to evaluate the system's PI capacity and to measure the RBC quality, metabolic, functional, and blood group serological parameters of UVC-treated versus untreated RBCs during 36-day storage. RESULTS UVC treatment of RBCs in the PAGGS-C additive solution did not alter RBC antigen expression, but significantly influenced some in vitro parameters. Compared to controls, hemolysis was higher in UVC-treated RBC units, but was still below 0.8% at 36 days of storage. Extracellular potassium increased early after PI treatment and reached ≤70 mmol/L by the end of storage. UVC-treated RBC units had higher glucose and 2,3-diphosphoglycerate levels than controls. CONCLUSION As UVC irradiation efficiently reduces the infectivity of relevant bacteria and viruses while maintaining the quality of RBCs, the proposed method offers a new approach for PI of RBC concentrates.
Collapse
Affiliation(s)
- Wiebke Handke
- Bavarian Red Cross Blood Service, Nuremberg, Germany
| | - Ute Gravemann
- German Red Cross Blood Service NSTOB, Springe, Germany
| | | | | | | | - Axel Seltsam
- Bavarian Red Cross Blood Service, Nuremberg, Germany
| |
Collapse
|
4
|
Ye H, Xu H, Qiao M, Guo R, Ji Y, Yu Y, Chen Y, Gai X, Li H, Liu Q, Zhuang Y. MicroRNA expression profiles analysis of apheresis platelets treated with vitamin B 2 and ultraviolet-B during storage. Transfus Apher Sci 2021; 60:103079. [PMID: 33602623 DOI: 10.1016/j.transci.2021.103079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/30/2021] [Accepted: 02/04/2021] [Indexed: 11/18/2022]
Abstract
Whether platelet (PLT) microRNA (miRNA) profiles are affected by pathogen reduction technology (PRT) using vitamin B2 and ultraviolet-B (VB2-PRT) remains unclear. Samples from VB2-PRT-treated (experimental group, E_) and untreated (control group, C_) apheresis PLTs were taken on days 1, 3 and 5 of storage, designated as E_1, E_3, E_5, C_1, C_3 and C_5, respectively. The miRNA expression profiles were assessed by DNA Nano Ball (DNB) sequencing technology, and verified by quantitive real-time fluorescence quantitative PCR (qRT-PCR). Compared with the expression profiles of PLT miRNAs, 3895 miRNAs were identified in the E_ groups while 4106 were in the C_ groups. There were 487 significant differentially expressed miRNAs in E_1 vs C_1 group, including 220 upregulated and 287 downregulated, such as miR-146a-5p and let-7b-5p. There were 908 significant differentially expressed miRNAs in E_3 vs C_3 group, including 297 upregulated and 611 downregulated, such as miR-142-5p and miR-7-5p. There were 229 significant differentially expressed miRNAs in E_5 vs C_5 group, including 80 upregulated and 149 downregulated, such as miR-3529-3p and miR-451a. These differentially expressed miRNAs had been suggested to have functional roles in energy homeostasis, cell communication, proliferation, migration and apoptosis. GO analysis showed a significant enrichmen in relevant biological process categories as receptor activity, signal transduction, cell transport, motility and chemotaxis. The significantly enriched KEGG pathway of predicted target genes was Glycosaminoglycan biosynthesis in E_ vs C_ groups. These new observation could provide insights on the understanding of change of miRNA profiles of PLT treated with VB2-PRT.
Collapse
Affiliation(s)
- Hui Ye
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China; School of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Huicong Xu
- Domestic Marketing System of Shenzhen Mindray Biomedical Electronics Co, Ltd, Jinan 250012, Shandong Province, China
| | - Mingming Qiao
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China
| | - Rui Guo
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated With Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Yanbo Ji
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated With Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Yuan Yu
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China
| | - Yuanfeng Chen
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China
| | - Xia Gai
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China
| | - Honglei Li
- School of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Qun Liu
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China
| | - Yunlong Zhuang
- Institute of Hematology, Blood Center of Shandong Province, Jinan 250014, Shandong Province, China.
| |
Collapse
|
5
|
Herzig MC, Fedyk CG, Montgomery RK, Schaffer BS, Bynum JA, Pidcoke HF, Cap AP. Blood component separation of pathogen-reduced whole blood by the PRP method produces acceptable red cells but platelet yields and function are diminished. Transfusion 2020; 60 Suppl 3:S124-S133. [PMID: 32478864 DOI: 10.1111/trf.15766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study evaluated blood components processed by the platelet rich plasma (PRP) method from fresh whole blood (FWB) treated with a pathogen reduction technology (PRT). The effects of storage temperature on PRT treated platelet concentrates (PCs) were also examined. STUDY DESIGN AND METHODS PRT was performed using riboflavin and ultraviolet light on FWB in citrate phosphate dextrose anticoagulant. Following PRT, red blood cells (RBCs), PCs, and plasma for fresh frozen plasma (FFP), were isolated by sequential centrifugation. RBCs were stored at 4°C, FFP at -80°C, and PC at 22°C or at 4°C. Components were assayed throughout their storage times for blood gases, chemistry and CBC, hemostatic function as well as platelet (PLT) and RBC integrity. RESULTS Component processing following PRT resulted in a significant drop in platelet recovery. Most PRT-PC bags fell below AABB guidelines for platelet count. PRT-PC also showed a decrease in clot strength and decreased aggregometry response. Platelet caspases were activated by PRT. Storage at 4°C improved platelet function. In PRT-FFP, prothrombin time and partial thromboplastin time (PT and aPTT) were prolonged; factors V, VII, VIII, and XI, protein C, and fibrinogen were significantly decreased. Free hemoglobin was elevated two-fold in PRT-RBC. CONCLUSION Blood components isolated by the PRP method from PRT-treated WB result in a high percentage of PC that fail to meet AABB guidelines. FFP also shows diminished coagulation capacity. However, PRT-RBC are comparable to control-RBC. PRT-WB retains acceptable hemostatic function but alternatives to the PRP method of component separation may be more suitable.
Collapse
Affiliation(s)
- Maryanne C Herzig
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Chriselda G Fedyk
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Robbie K Montgomery
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Beverly S Schaffer
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - James A Bynum
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA.,Institute of Biomedical Studies, Baylor University, Waco, Texas, USA.,Joint Interdisciplinary Biomedical Engineering Program, UT San Antonio & UT Health San Antonio, San Antonio, Texas, USA
| | - Heather F Pidcoke
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Andrew P Cap
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA.,Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| |
Collapse
|
6
|
Cushing MM, Haas T, Karkouti K, Callum J. Which is the preferred blood product for fibrinogen replacement in the bleeding patient with acquired hypofibrinogenemia-cryoprecipitate or fibrinogen concentrate? Transfusion 2020; 60 Suppl 3:S17-S23. [PMID: 32478877 DOI: 10.1111/trf.15614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 11/28/2022]
Abstract
The importance of the targeted treatment of acquired hypofibrinogenemia during hemorrhage with a concentrated fibrinogen product (either cryoprecipitate or fibrinogen concentrate) cannot be underestimated. Fibrinogen concentrate is a pathogen inactivated, pooled product that offers a highly purified single factor concentrate. Cryoprecipitate is a pooled product that comes with a spectrum of other coagulation factors which may further enhance (additional procoagulant effect) or even disturb (prothrombotic risk) hemostasis. The pros and cons of each product are discussed.
Collapse
Affiliation(s)
- Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Thorsten Haas
- Department of Anesthesia, Zurich University Children's Hospital, Zurich, Switzerland
| | - Keyvan Karkouti
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.,Department of Anesthesia and Pain Management, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| |
Collapse
|
7
|
Appassakij H, Silpapojakul K, Promwong C, Rujirojindakul P. The Potential Impact of Chikungunya Virus Outbreaks on Blood Transfusion. Transfus Med Rev 2019; 34:23-28. [PMID: 31303361 DOI: 10.1016/j.tmrv.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
Chikungunya virus (CHIKV) is responsible for large periodic epidemics in both endemic and nonendemic areas where competent mosquitoes are present. Transmission of CHIKV by transfusion during explosive outbreaks has never been documented, and the true impact of CHIKV infection on blood transfusion during an outbreak is unknown. Considerations include not only transfusions in the active outbreak areas but also returning travelers to nonendemic areas. Because there are no documented cases of transfusion-transmitted CHIKV, there are no standard guidelines regarding transfusion policies during a chikungunya fever outbreak. We review current information from studies during outbreaks with the goal of estimating the potential effect of different blood safety interventions (eg, querying donors for possible CHIKV exposure, chikungunya fever-related symptoms, screening for CHIKV RNA).
Collapse
Affiliation(s)
- Hatsadee Appassakij
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
| | | | | | - Pairaya Rujirojindakul
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
| |
Collapse
|
8
|
Leach Bennett J, Devine DV. Risk-based decision making in transfusion medicine. Vox Sang 2018; 113:737-749. [DOI: 10.1111/vox.12708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/29/2018] [Accepted: 08/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | - Dana V. Devine
- Canadian Blood Services; Ottawa ON Canada
- Centre for Blood Research; University of British Columbia; Vancouver BC Canada
| |
Collapse
|
9
|
Budget impact of implementing platelet pathogen reduction into the Italian blood transfusion system. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 16:483-489. [PMID: 30201081 DOI: 10.2450/2018.0115-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/26/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite improvements in blood donor selection and screening procedures, transfusion recipients can still develop complications related to infections by known and emerging pathogens. Pathogen reduction technologies (PRT) have been developed to reduce such risks. The present study, developed whithin a wider health technology assessment (HTA) process, was undertaken to estimate the costs of the continuing increase in the use of platelet PRT in Italy. MATERIALS AND METHODS A multidisciplinary team was established to perform the HTA and conduct a budget impact analysis. Quantitative data on platelet use were derived from the 2015 national blood transfusion report and from the Italian Platelets Transfusion Assessment Study (IPTAS). The current national fee of 60 Euro per platelet PRT procedure was used to quantify the costs to the Italian National Health Service (INHS). The analysis adopts a 3-year time-frame. In order to identify the impact on budget we compared a scenario representing an increased use of PRT platelets over time with a control scenario in which standard platelets are used. RESULTS Progressive implementation of PRT for 20%, 40% and 66% of annual adult platelet doses could generate an increase in annual costs for the INHS amounting to approximately 7, 14 and 23 million Euros, respectively. Use of kits and devices suitable for the treatment of multiple adult platelet doses in one PRT procedure could lower costs. DISCUSSION In order to fully evaluate the societal perspective of implementing platelet PRT, the increase in costs must be balanced against the expected benefits (prevention of transfusion-transmissible infections, white cell inactivation, extension of platelet storage, discontinuation of pathogen detection testing). Further studies based on actual numbers of platelet transfusion complications and their societal cost at a local level are needed to see the full cost to benefit ratio of platelet PRT implementation in Italy, and to promote equal treatment for all citizens.
Collapse
|
10
|
Brixner V, Kiessling AH, Madlener K, Müller MM, Leibacher J, Dombos S, Weber I, Pfeiffer HU, Geisen C, Schmidt M, Henschler R, North A, Huang N, Mufti N, Erickson A, Ernst C, Rico S, Benjamin RJ, Corash LM, Seifried E. Red blood cells treated with the amustaline (S-303) pathogen reduction system: a transfusion study in cardiac surgery. Transfusion 2018; 58:905-916. [PMID: 29498049 DOI: 10.1111/trf.14528] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nucleic acid-targeted pathogen inactivation technology using amustaline (S-303) and glutathione (GSH) was developed to reduce the risk of transfusion-transmitted infectious disease and transfusion-associated graft-versus-host disease with red blood cell (RBC) transfusion. STUDY DESIGN AND METHODS A randomized, double-blind, controlled study was performed to assess the in vitro characteristics of amustaline-treated RBCs (test) compared with conventional (control) RBCs and to evaluate safety and efficacy of transfusion during and after cardiac surgery. The primary device efficacy endpoint was the postproduction hemoglobin (Hb) content of RBCs. Exploratory clinical outcomes included renal and hepatic failure, the 6-minute walk test (a surrogate for cardiopulmonary function), adverse events (AEs), and the immune response to amustaline-treated RBCs. RESULTS A total of 774 RBC unis were produced. Mean treatment difference in Hb content was -2.27 g/unit (95% confidence interval, -2.61 to -1.92 g/unit), within the prespecified equivalence margins (±5 g/unit) to declare noninferiority. Amustaline-treated RBCs met European guidelines for Hb content, hematocrit, and hemolysis. Fifty-one (25 test and 26 control) patients received study RBCs. There were no significant differences in RBC usage or other clinical outcomes. Observed AEs were within the spectrum expected for patients of similar age undergoing cardiovascular surgery requiring RBCs transfusion. No patients exhibited an immune response specific to amustaline-treated RBCs. CONCLUSION Amustaline-treated RBCs demonstrated equivalence to control RBCs for Hb content, have appropriate characteristics for transfusion, and were well tolerated when transfused in support of acute anemia. Renal impairment was characterized as a potential efficacy endpoint for pivotal studies of RBC transfusion in cardiac surgery.
Collapse
Affiliation(s)
- Veronika Brixner
- Institute for Transfusion Medicine and Immunohematology of Johann Wolfgang Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Arndt-Holger Kiessling
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Katharina Madlener
- Department of Haemostaseology and Transfusion Medicine, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Markus M Müller
- Institute for Transfusion Medicine and Immunohematology of Johann Wolfgang Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Johannes Leibacher
- Institute for Transfusion Medicine and Immunohematology of Johann Wolfgang Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Sarah Dombos
- Institute for Transfusion Medicine and Immunohematology of Johann Wolfgang Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Iuliia Weber
- Institute for Transfusion Medicine and Immunohematology of Johann Wolfgang Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Hans-Ulrich Pfeiffer
- Institute for Transfusion Medicine and Immunohematology of Johann Wolfgang Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Christof Geisen
- Institute for Transfusion Medicine and Immunohematology of Johann Wolfgang Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Michael Schmidt
- Institute for Transfusion Medicine and Immunohematology of Johann Wolfgang Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Reinhard Henschler
- Blood Center Zürich, Swiss Red Cross, Schlieren, Switzerland.,Red Cross Blood Service Graubünden, Chur, Switzerland
| | | | | | | | | | | | | | | | | | - Erhard Seifried
- Institute for Transfusion Medicine and Immunohematology of Johann Wolfgang Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| |
Collapse
|
11
|
|
12
|
Seltsam A. Pathogen Inactivation of Cellular Blood Products-An Additional Safety Layer in Transfusion Medicine. Front Med (Lausanne) 2017; 4:219. [PMID: 29255710 PMCID: PMC5722787 DOI: 10.3389/fmed.2017.00219] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/20/2017] [Indexed: 01/23/2023] Open
Abstract
In line with current microbial risk reduction efforts, pathogen inactivation (PI) technologies for blood components promise to reduce the residual risk of known and emerging infectious agents. The implementation of PI of labile blood components is slowly but steadily increasing. This review discusses the relevance of PI for the field of transfusion medicine and describes the available and emerging PI technologies that can be used to treat cellular blood products such as platelet and red blood cell units. In collaboration with the French medical device manufacturer Macopharma, the German Red Cross Blood Services developed a new UVC light-based PI method for platelet units, which is currently being investigated in clinical trials.
Collapse
Affiliation(s)
- Axel Seltsam
- German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany
| |
Collapse
|
13
|
Kiely P, Wood EM, Gambhir M, Cheng AC, McQuilten ZK, Seed CR. Emerging infectious disease agents and blood safety in Australia: spotlight on Zika virus. Med J Aust 2017; 206:455-460. [PMID: 28566073 DOI: 10.5694/mja16.00833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/07/2016] [Indexed: 01/30/2023]
Abstract
Emerging infectious diseases (EIDs) are infectious diseases whose incidence has increased in humans in the past 20 years or could increase in the near future. EID agents may represent a threat to blood safety if they infect humans, cause a clinically significant illness, include an asymptomatic blood phase in the course of infection, and are transmissible by transfusion. EID agents are typically not well characterised, but there is a consensus that we can expect ongoing outbreaks. Strategies to manage the risk to blood safety from EIDs include ongoing surveillance, regular risk assessments, modelling transfusion transmission risk, and deferral of donors with a recent travel history to outbreak areas. The 2015-16 Zika virus (ZIKV) outbreak in the Americas is the largest reported ZIKV outbreak to date, and it highlights the unpredictable nature of EID outbreaks and how quickly they can become a major public health problem. This ZIKV outbreak has provided evidence of a causal link between the virus and microcephaly in newborns. In assessing the potential risk of ZIKV to blood safety in Australia, it should be noted that a relatively small number of imported ZIKV infections have been reported in Australia, there have been no reported cases of local ZIKV transmission, and the geographical distribution of the potential ZIKV mosquito vector in Australia (Aedes aegypti) is limited to northern Queensland. Moreover, reported transfusion-transmitted ZIKV cases worldwide are rare. At present, ZIKV represents a low risk to blood safety in Australia.
Collapse
Affiliation(s)
- Philip Kiely
- Australian Red Cross Blood Service, Melbourne, VIC
| | | | | | | | | | - Clive R Seed
- Australian Red Cross Blood Service, Melbourne, VIC
| |
Collapse
|
14
|
Rebulla P, Vaglio S, Beccaria F, Bonfichi M, Carella A, Chiurazzi F, Coluzzi S, Cortelezzi A, Gandini G, Girelli G, Graf M, Isernia P, Marano G, Marconi M, Montemezzi R, Olivero B, Rinaldi M, Salvaneschi L, Scarpato N, Strada P, Milani S, Grazzini G. Clinical effectiveness of platelets in additive solution treated with two commercial pathogen-reduction technologies. Transfusion 2017; 57:1171-1183. [DOI: 10.1111/trf.14042] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/13/2016] [Accepted: 12/20/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Paolo Rebulla
- Blood Transfusion Service, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Stefania Vaglio
- Italian National Blood Center, National Institute of Health; Rome Italy
| | - Francesco Beccaria
- Blood Transfusion Service and Hematology 1; IRCCS San Martino University Hospital; Genoa Italy
| | - Maurizio Bonfichi
- Blood Transfusion Service and Hematology; IRCCS Policlinico San Matteo; Pavia Italy
| | - Angelo Carella
- Blood Transfusion Service and Hematology 1; IRCCS San Martino University Hospital; Genoa Italy
| | - Federico Chiurazzi
- Blood Transfusion Service and Hematology; Federico II University Hospital; Naples Italy
| | - Serelina Coluzzi
- Blood Transfusion Service and Hematology; Umberto I Hospital; Rome Italy
| | - Agostino Cortelezzi
- Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - Giorgio Gandini
- Blood Transfusion Service and Hematology; University Hospital; Verona Italy
| | - Gabriella Girelli
- Blood Transfusion Service and Hematology; Umberto I Hospital; Rome Italy
| | - Maria Graf
- Blood Transfusion Service and Hematology; Federico II University Hospital; Naples Italy
| | - Paola Isernia
- Blood Transfusion Service and Hematology; IRCCS Policlinico San Matteo; Pavia Italy
| | - Giuseppe Marano
- Italian National Blood Center, National Institute of Health; Rome Italy
| | - Maurizio Marconi
- Blood Transfusion Service, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Rachele Montemezzi
- Blood Transfusion Service and Hematology; University Hospital; Verona Italy
| | - Barbara Olivero
- Blood Transfusion Service, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Marianna Rinaldi
- Blood Transfusion Service and Hematology; University Hospital; Verona Italy
| | - Laura Salvaneschi
- Blood Transfusion Service and Hematology; IRCCS Policlinico San Matteo; Pavia Italy
| | - Nicola Scarpato
- Blood Transfusion Service and Hematology; Federico II University Hospital; Naples Italy
| | - Paolo Strada
- Blood Transfusion Service and Hematology 1; IRCCS San Martino University Hospital; Genoa Italy
| | - Silvano Milani
- Laboratory of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Giuliano Grazzini
- Italian National Blood Center, National Institute of Health; Rome Italy
| |
Collapse
|
15
|
Appassakij H, Promwong C, Rujirojindakul P, Khuntikij P, Silpapojakul K. Risk of transfusion-transmitted chikungunya infection and efficacy of blood safety implementation measures: experience from the 2009 epidemic in Songkhla Province, Thailand. Transfusion 2016; 56:2100-7. [PMID: 27362275 DOI: 10.1111/trf.13675] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/27/2016] [Accepted: 02/22/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND To date, neither is there a standard guideline for maintaining a safe blood supply during a chikungunya fever (CHIKF) outbreak nor has a study been performed on actual transfusion-transmitted CHIKF to recipients. This study estimated the potential incidence of transfusion-transmitted CHIKF and compared the efficacies of various blood safety intervention strategies to mitigate the transfusion-transmitted CHIKF risk. STUDY DESIGN AND METHODS A Web-based tool named the European Up-Front Risk Assessment Tool (EUFRAT) was used to estimate the risk of transfusion-transmitted CHIKF using data inputs from the 2009 Songkhla epidemic in Thailand. RESULTS The mean and maximal risks of viremic donations during the entire epidemic period were estimated to be 0.9 (95% confidence interval [CI], 0.0-2.7) and 4.8 (95% CI, 0.5-9.1), respectively. This meant that the potential risk of transfusion-transmitted CHIKF to recipients receiving all infective end products in the absence of blood safety measures was from 10.9 (95% CI, 1.8-20.4) to 57.6 (95% CI, 36.4-79.5). Based on experience from the 2009 Thai epidemic, the proportion of 10% asymptomatic cases, for instance, with predonation screening for CHIKF-related symptoms and follow-up observation in donors at risk was estimated to be 88.4% (95% CI, 69.9%-100.0%) to 99.1% (95% CI, 79.6%-100.0%) effective in reducing this transfusion risk compared to 83.7% (95% CI, 65.8%-100.0%) to 90.7% (95% CI, 72.1%-100.0%) by predonation screening for donors at risk of chikungunya virus infection alone. CONCLUSION This study suggests that prompt blood screening measures can reduce the risk of transfusion-transmitted CHIKF and maintain a safe blood supply during an outbreak.
Collapse
Affiliation(s)
- Hatsadee Appassakij
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | | | - Pairaya Rujirojindakul
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Paiwon Khuntikij
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | | |
Collapse
|
16
|
Kleinman S, Stassinopoulos A. Risks associated with red blood cell transfusions: potential benefits from application of pathogen inactivation. Transfusion 2015; 55:2983-3000. [PMID: 26303806 PMCID: PMC7169855 DOI: 10.1111/trf.13259] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/02/2015] [Accepted: 06/22/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Red blood cell (RBC) transfusion risks could be reduced if a robust technology for pathogen inactivation of RBC (PI-RBCs) were to be approved. MATERIALS AND METHODS Estimates of per-unit and per-patient aggregate infectious risks for conventional RBCs were calculated; the latter used patient diagnosis as a determinant of estimated lifetime exposure to RBC units. Existing in vitro data for the two technologies under development for producing PI-RBCs and the status of current clinical trials are reviewed. RESULTS Minimum and maximum per-unit risk were calculated as 0.0003% (1 in 323,000) and 0.12% (1 in 831), respectively. The minimum estimate is for known lower-risk pathogens while the maximal estimate also includes an emerging infectious agent (EIA) and endemic area Babesia risk. Minimum and maximum per-patient lifetime risks by diagnosis grouping were estimated as 1.5 and 3.3%, respectively, for stem cell transplantation (which includes additional risk for cytomegalovirus transmission); 1.2 and 3.7%, respectively, for myelodysplastic syndrome; and 0.2 and 44%, respectively, for hemoglobinopathy. DISCUSSION There is potential for PI technologies to reduce infectious RBC risk and to provide additional benefits (e.g., prevention of transfusion-associated graft-versus-host disease and possible reduction of alloimmunization) due to white blood cell inactivation. PI-RBCs should be viewed in the context of having a fully PI-treated blood supply, enabling a blood safety paradigm shift from reactive to proactive. Providing insurance against new EIAs. Further, when approved, the use of PI for all components may catalyze operational changes in blood donor screening, laboratory testing, and component manufacturing.
Collapse
Affiliation(s)
- Steve Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | | |
Collapse
|
17
|
Larrea L, Ortiz-de-Salazar MI, Martínez P, Roig R. Quantitative analysis of plasma proteins in whole blood-derived fresh frozen plasma prepared with three pathogen reduction technologies. Transfus Apher Sci 2015; 52:305-10. [DOI: 10.1016/j.transci.2015.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/21/2014] [Accepted: 01/08/2015] [Indexed: 01/02/2023]
|
18
|
Cinqualbre J, Kientz D, Remy E, Huang N, Corash L, Cazenave JP. Comparative effectiveness of plasma prepared with amotosalen-UVA pathogen inactivation and conventional plasma for support of liver transplantation. Transfusion 2015; 55:1710-20. [PMID: 25857325 DOI: 10.1111/trf.13100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 11/26/2014] [Accepted: 12/07/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Liver transplant may require large-volume plasma transfusion with increased risk of transfusion-transmitted infection (TTI). Pathogen inactivation of plasma with amotosalen-UVA offers the potential to mitigate TTI risk. STUDY DESIGN AND METHODS A retrospective cohort design was used to compare the therapeutic efficacy and key safety outcomes for liver transplants supported with quarantine plasma (Q-FFP [reference]) or amotosalen-UVA plasma (IBS plasma [test]). The outcomes evaluated were volume of plasma, the numbers of red blood cell (RBC) components, and the total dose of platelets (PLTs) transfused during and 7 days after transplant. The safety outcomes were acute hepatic artery thrombosis (HAT) and mortality. RESULTS Transplantation and transfusion records for 212 Q-FFP transplants and 215 IBS plasma transplants were reviewed. Not all transplants required plasma; 161 received Q-FFP and 174 received IBS plasma. Among the transplants that required plasma, there were significant differences in median values between cohorts for delay to transplantation (p=0.002), model end-stage liver disease score (p<0.001), pretransplant hematocrit (p=0.006), and graft cold perfusion time (p=0.033). The median volumes of plasma transfused were not different for test and reference (2.160 L vs. 1.969 L, p=0.292). Transplants in the test cohort required a mean of 3.7% more RBC components (p=0.767) and on average a 16.5% increase in total PLT dose (p=0.518). No significant differences were observed for the frequency of acute HAT or mortality. CONCLUSION In this retrospective study, IBS plasma provided therapeutic support of liver transplant not different from Q-FFP.
Collapse
Affiliation(s)
- Jacques Cinqualbre
- Pôle des Pathologies Digestives-Hépatiques-Transplantations, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | | | | | | |
Collapse
|
19
|
Affiliation(s)
- Roger Y Dodd
- American Red Cross, Holland Laboratory, Rockville, MD.
| |
Collapse
|
20
|
Huisman EL, de Silva SU, de Peuter MA. Economic evaluation of pooled solvent/detergent treated plasma versus single donor fresh-frozen plasma in patients receiving plasma transfusions in the United States. Transfus Apher Sci 2014; 51:17-24. [DOI: 10.1016/j.transci.2014.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
|
21
|
Busch MP. Infectious risks of blood transfusions: Recent advances in testing technologies and new approaches to surveillance and decision-making. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/voxs.12082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. P. Busch
- Blood Systems Research Institute; University of California San Francisco; San Francisco CA USA
| |
Collapse
|
22
|
Oei W, Kretzschmar ME, Zaaijer HL, Coutinho R, van der Poel CL, Janssen MP. Estimating the transfusion transmission risk of Q fever. Transfusion 2014; 54:1705-11. [DOI: 10.1111/trf.12539] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/04/2013] [Accepted: 11/10/2013] [Indexed: 12/24/2022]
Affiliation(s)
- Welling Oei
- University Medical Centre Utrecht; Utrecht the Netherlands
| | - Mirjam E.E. Kretzschmar
- University Medical Centre Utrecht; Utrecht the Netherlands
- National Institute for Public Health and the Environment; Bilthoven the Netherlands
| | | | - Roel Coutinho
- University Medical Centre Utrecht; Utrecht the Netherlands
- National Institute for Public Health and the Environment; Bilthoven the Netherlands
| | | | | |
Collapse
|
23
|
Loh YS, Johnson L, Kwok M, Marks DC. Pathogen reduction treatment alters the immunomodulatory capacity of buffy coat-derived platelet concentrates. Transfusion 2013; 54:577-84. [PMID: 23829895 DOI: 10.1111/trf.12320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/30/2013] [Accepted: 05/19/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Storage of platelet concentrates (PCs) after Mirasol pathogen reduction technology (PRT) treatment changes platelet (PLT) surface marker expression and secretion of immunomodulatory factors. Given that PLTs are known to participate in immune function, PRT may alter the way PLTs interact with the immune cells of a recipient upon transfusion. As such, the aim of this study was to assess the effects of PRT treatment on the functional ability of PLTs to interact with peripheral blood mononuclear cells (PBMNCs). STUDY DESIGN AND METHODS Buffy coat-derived PCs were pooled and split to obtain matched pairs. One unit was treated using the Mirasol PRT system, while the control PC remained untreated. After 5 days of storage, either the PLTs or the PLT supernatants from the PCs were cocultured with PBMNCs, with or without lipopolysaccharide (LPS). The immunomodulatory factors secreted into culture medium after coculture were examined. RESULTS PRT-treated PLTs and PLT supernatant significantly increased the interleukin (IL)-8 concentration, which was manifested only in the presence of LPS. Conversely, PRT-treated PLTs secreted less soluble P-selectin (sCD62P) upon coculture with PBMNCs. CONCLUSION PRT-treatment induced differential secretion of IL-8 and sCD62P during coculture, which may be attributed to either bioactive substances present in PLT supernatant or as a result of cell-cell interactions.
Collapse
Affiliation(s)
- Yen S Loh
- Research and Development, Australian Red Cross Blood Service, Sydney, Australia
| | | | | | | |
Collapse
|
24
|
Pogłód R, Rosiek A, Łętowska M. [Emerging infectious diseases in the context of blood safety]. ACTA ACUST UNITED AC 2013; 44:284-293. [PMID: 32226059 PMCID: PMC7094095 DOI: 10.1016/j.achaem.2013.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/02/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Ryszard Pogłód
- Instytut Hematologii i Transfuzjologii, Dyrektor: prof. dr hab n.med. Krzysztof Warzocha, Warszawa, Polska
| | - Aleksandra Rosiek
- Instytut Hematologii i Transfuzjologii, Dyrektor: prof. dr hab n.med. Krzysztof Warzocha, Warszawa, Polska
| | - Magdalena Łętowska
- Instytut Hematologii i Transfuzjologii, Dyrektor: prof. dr hab n.med. Krzysztof Warzocha, Warszawa, Polska
| |
Collapse
|
25
|
Seltsam A, Müller TH. Update on the use of pathogen-reduced human plasma and platelet concentrates. Br J Haematol 2013; 162:442-54. [PMID: 23710899 DOI: 10.1111/bjh.12403] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The use of pathogen reduction technologies (PRTs) for labile blood components is slowly but steadily increasing. While pathogen-reduced plasma is already used routinely, efficacy and safety concerns impede the widespread use of pathogen-reduced platelets. The supportive and often prophylactic nature of blood component therapy in a variety of clinical situations complicates the clinical evaluation of these novel blood products. However, an increasing body of evidence on the clinical efficacy, safety, cost-benefit ratio and development of novel technologies suggests that pathogen reduction has entered a stage of maturity that could further increase the safety margin in haemotherapy. This review summarizes the clinical evidence on PRTs for plasma and platelet products that are currently licensed or under development.
Collapse
Affiliation(s)
- Axel Seltsam
- Institute Springe, German Red Cross Blood Service NSTOB, Springe, Germany.
| | | |
Collapse
|
26
|
Huisman EL, van Eerd MC, Ouwens JNM, de Peuter MA. Cost-effectiveness and budget impact study of solvent/detergent (SD) treated plasma (octaplasLG®) versus fresh-frozen plasma (FFP) in any patient receiving transfusion in Canada. Transfus Apher Sci 2013; 51:25-34. [PMID: 23707561 DOI: 10.1016/j.transci.2013.04.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/25/2013] [Indexed: 11/16/2022]
Abstract
The objectives of this study were to evaluate the cost-effectiveness and budget impact of octaplasLG(®) compared with fresh-frozen plasma (FFP) in all patients receiving a transfusion in Canada. A decision analytic framework was used to model acute and long-term complications that could follow plasma transfusion. Over a life time horizon, the cost with octaplasLG(®) were CA$612.91, which is CA$303.14 less than those with FFP. OctaplasLG(®) resulted in 0.021 quality adjusted life years (QALYs) gained in comparison with FFP. Because of higher efficacy and lower costs, octaplasLG(®) is expected to be the dominant treatment option over FFP in Canada.
Collapse
Affiliation(s)
- Eline L Huisman
- MAPI Consultancy, De Molen 84, 3995 AX Houten, The Netherlands.
| | | | | | | |
Collapse
|
27
|
Glynn SA, Busch MP, Dodd RY, Katz LM, Stramer SL, Klein HG, Simmons G, Kleinman SH, Shurin SB. Emerging infectious agents and the nation's blood supply: responding to potential threats in the 21st century. Transfusion 2013; 53:438-54. [PMID: 22690676 PMCID: PMC3644861 DOI: 10.1111/j.1537-2995.2012.03742.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 04/23/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Simone A Glynn
- Transfusion Medicine and Cellular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Oei W, Janssen MP, van der Poel CL, van Steenbergen JE, Rehmet S, Kretzschmar MEE. Modeling the transmission risk of emerging infectious diseases through blood transfusion. Transfusion 2012; 53:1421-8. [PMID: 23113823 DOI: 10.1111/j.1537-2995.2012.03941.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/05/2012] [Accepted: 09/08/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND A timely risk assessment is desired to guide decisions on preventive transfusion safety measures during emerging infectious disease (EID) outbreaks. The European Up-Front Risk Assessment Tool (EUFRAT) model was developed to provide quantitative transmission risk estimates of EIDs through blood transfusion. STUDY DESIGN AND METHODS The generic model comprises five sequential steps to estimate the infection risks in the blood transfusion chain: 1) the prevalence of infection in the donor population, 2) the risk of obtaining infected donations, 3) infected components, 4) infected blood products, and 5) the risk of transmitting the infection to recipients. The model uses inputs from epidemiologic characteristics of an EID and transfusion practice. The model was applied to data from a recent chikungunya outbreak in Italy. RESULTS Based on data from the outbreak peak, an estimated prevalence of 1.07 (95% confidence interval [CI], 0.38-2.03) per 100,000 donors would lead to 0.04 infected donations (95% CI, 0.01-0.10), 0.13 infected blood components, 0.13 infected end products, and 0.0001 severe infections in recipients. This estimated risk can be reduced by increasing the duration of quarantine of the donated blood and becomes zero after 7 or more days of quarantine. The model also estimated the probability of a donor returning from the outbreak area and subsequently donating infected blood in his home country to be 0.30 (95% CI, 0.01-0.65) per 100,000. CONCLUSION The model can be used to quantify EID outbreak risks to blood transfusion recipients and the effect of targeted safety interventions and as such support public health decision-making.
Collapse
Affiliation(s)
- Welling Oei
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | | | | | | | | | | |
Collapse
|
29
|
Kleinman S, Reed W, Stassinopoulos A. A patient-oriented risk-benefit analysis of pathogen-inactivated blood components: application to apheresis platelets in the United States. Transfusion 2012; 53:1603-18. [DOI: 10.1111/j.1537-2995.2012.03928.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/24/2012] [Accepted: 08/25/2012] [Indexed: 12/21/2022]
|
30
|
Reid S, Johnson L, Woodland N, Marks DC. Pathogen reduction treatment of buffy coat platelet concentrates in additive solution induces proapoptotic signaling. Transfusion 2012; 52:2094-103. [PMID: 22320126 DOI: 10.1111/j.1537-2995.2011.03558.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pathogen reduction technology (PRT) can potentially reduce the risk of transfusion-transmitted infections. However, PRT treatment of platelet (PLT) concentrates also results in reduced PLT quality and increased markers of apoptosis during storage. The aim of this study was to investigate changes to the expression and activation of proteins involved in apoptosis signaling. STUDY DESIGN AND METHODS Samples from riboflavin and ultraviolet light PRT-treated and untreated (control) buffy coat-derived PCs in 70% SSP+ and 30% plasma were taken on Days 1, 5, and 7 of storage. Phosphatidylserine (PS) exposure, expression of Bcl-2 family proteins, cytochrome c release, and cleavage of caspase-3 and caspase-3 substrates were analyzed using flow cytometry and Western blotting. RESULTS Compared to untreated controls, markers of apoptosis signaling were increased after PRT and subsequent storage. PS exposure on the PLT outer membrane was significantly higher after PRT on Days 5 and 7 of storage (p < 0.05). Expression of proapoptotic Bak and Bax was higher after PRT and subsequent storage. Cytochrome c release and caspase-3 cleavage were also greater and occurred earlier in the PRT-treated PLTs. The cleavage of caspase-3 substrates gelsolin and ROCK I were also increased after PRT, compared to untreated controls. CONCLUSIONS This study demonstrated an increase in proapoptotic signaling during PLT storage, which was exacerbated by PRT. Many of these differences emerged outside the current 5-day storage period. These changes may not currently influence PLT transfusion quality, but will need to be carefully evaluated when considering extending PLT storage beyond 5 days.
Collapse
Affiliation(s)
- Samantha Reid
- Research and Development, Australian Red Cross Blood Service, and the School of Medical and Molecular Biosciences, University of Technology, Sydney, New South Wales, Australia
| | | | | | | |
Collapse
|
31
|
|
32
|
|