Current and Emerging Infectious Risks of Blood Transfusions

Abstract

THE BLOOD SUPPLY IN THE UNITED States and other developed countries has never been as safe as it is now. During the past several decades, there have been dramatic progressive reductions in the risk of transfusion-transmitted clinically significant blood-borne infections. This has been accomplished as a result of extensive research to characterize transfusiontransmitted pathogens, development of strategies to measure infection rates in blood donor and recipient populations, characterization of the dynamics of early viremia, and implementation of progressively more restrictive donor eligibility criteria and increasingly sensitive laboratory screening methods. In addition, regulatory oversight by the US Food and Drug Administration (FDA) has been strengthened, resulting in enhanced quality assurance programs in blood collection and transfusion facilities. Pathogen reduction methods, already successfully applied to pooled plasma derivatives (eg, albumin, clotting factor concentrates, immunoglobulin preparations) are now in development for cellular blood components and fresh-frozen plasma. If these methods are approved by the FDA and widely implemented, they could virtually eliminate the risk of transmission by transfusions of both known and emerging infectious agents in technologically advanced countries. This progress needs to be balanced against the continued emergence of potential new transfusiontransmissible pathogens and the disparity in blood safety in developing countries where resources are insufficient to enable basic infectious disease donor screening.