Risks associated with red blood cell transfusions: potential benefits from application of pathogen inactivation

Kleinman, Steve; Stassinopoulos, Adonis

Reducing risk to essentially zero for most current transfusion-transmitted pathogens (HIV, HCV, HBV, HTLV, WNV, syphilis, CMV, Babesia). Substantially decreasing or completely eliminating risk for pathogens with the potential for a very high genomic titer (e.g., dengue). 61, 140 Depending upon the robustness of the PI technology and the infectious dose of a particular pathogen, full inactivation of such pathogens could be achieved for all units or a substantial proportion of cases depending on the pathogen load. A greater margin of protection against TA-GVHD than irradiation due to robust WBC inactivation. 67, [69] [70] [71] [72] [73] [74] 141 The possible reduction of WBC alloimmunization would provide HSCT candidate recipients with a higher likelihood of successful HLA matching to potential HSCT donors. Operational benefits in blood manufacturing and inventory management. Dual RBC inventories for both CMV and irradiation status could be eliminated and recall of RBC units associated with bacterially contaminated PLTs could be discontinued. Eliminating a blind spot of the current testing paradigm, which requires that a pathogen be detectable by NAT in a plasma sample or that the donor has developed a robust serologic response to an intracellular organism (e.g., Babesia); PI would obviate the need to implement a more logistically complex cellular-based PCR platform. Eliminating donor screening questions including travel to malaria-endemic areas, a history of babesiosis or Chagas disease, and travel to WNVendemic areas (asked ex-US). Since malaria travel deferrals are very common, their elimination could have a significant impact on the number of eligible donors.