Today we will be discussing pathogen reduction which inactivates bacteria, viruses and parasites that may contaminate blood products. European countries have been using pathogen reduction systems for over 10 years, and the FDA has recently approved pathogen reduction systems for platelets and plasma. Pathogen reduction technology for red cells is lagging, but is under development.
Dr. Edward Snyder, who wrote a perspective in “The New England Journal of Medicine”, explains the technique:
“The technologies vary from inactivation of the membrane of the various organisms by solvent detergent processes, others use ultraviolet light of varying wavelengths with other chemicals to inactivate the DNA and RNA preventing their replication.”
Since red cells, plasma and platelets lack nuclei it is possible to destroy or inactivate pathogens, with relatively little damage to the blood products. Although pathogen reduction systems reduce both the recovery and survival of the platelets, they may allow platelets to be stored longer. Another advantage of pathogen reduction is its prophylactic capacity to inactivate novel pathogens before they are even identified.
Dr. Richard Kaufman, who recently presented at the AABB Symposium on Implementation of Pathogen-Reduced Blood Components, discusses another advantage:
“Pathogen reduction methods inactivate leukocytes. It’s likely that they will be able to replace irradiation as means of preventing transfusion-associated graph-versus-host disease.”
Although pathogen reduction systems have several advantages, they also have drawbacks. For example, current pathogen reduction systems are limited in their ability to treat non-enveloped viruses such as hepatitis E and bacterial spores. In addition, the additional cost of this technology is in question.
Dr. Snyder comments on the implementation of pathogen reduction systems in the United States:
“Unless there is a mandate from the federal government or a requirement from the voluntary accrediting agencies to require use of some technology in order to prevent additional pathogen spread, it’s going to be a very difficult process. The hospitals are being squeezed, blood centers are being squeezed. So the biggest hold up is going to be in the cost.”
This proactive approach, which has been safely used in Europe, will help maintain a safer blood supply by deactivating many newly emerging pathogens and allow safer transfusions.
We’ll be back with another edition of Transfusion News on June 15. Thanks for joining us.
References
1. Snyder EL, Stramer SL, Benjamin RJ. The safety of the blood supply–time to raise the bar. The New England Journal of Medicine 2015;372:1882-5.
2. AABB Symposium on Implementation of Pathogen-Reduced Blood Components. Symposium conducted at Bethesda, MD. April 2015.
Dear Sir/Madam,
Although Pathogen Reduction System has own advantages with current room temperature stored-PCs but it might cause (un-)known mutations and more complex diseases in the recipients. If even 1% of recipients get allergic and septic reaction, is not expectable anymore. I am wondering that the Pharmaceutical Companies who suggest such alternatives studied in vivo side effects of their compound in every recipients. What happens in vivo with (temporarily) inactive compounds and metabolites? Why then try it? Maybe interesting for Research but unknown additives might produce more complex Platelet additive solutions and misplaces main focus of PCs transfusion.
Please try at first stop to produce microbial growth environment. Under current condition and storage at room temperature such technologies are rather “a waste of time and effort”, excluding under very emergency situations.
Regards,
Dr. Bahram A. Badlou
It would be extremely useful to have data quantifying the magnitude of the problem that is being addressed by attempts at further pathogen reduction. What are the current rates of post-platelet complication that can be reliably ascribed to the various cellular and molecular sources? To the extent that they are measurable, then we can determine whether the clinical burdens they impose are of a size that merits development of improved approaches. That measurability will also assure that costs and risks can be credibly compared to risks and benefits of the proposed approaches. This would seem most desirable in the area of GVHD–its current rate of occurrence, its clinical burden, and its reduction or prevention.