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Park N, Correa Medina M, Martinez F, Throssel M, Dasgupta A, Knopfelmacher A, Villamin C, Rivas S, Tomczak N, Garg S, Layton L, Klein K. Trend towards reduction of transfusion reactions using prestorage leukocyte-reduced and pooled whole blood-derived platelets and cost savings compared with poststorage whole blood-derived random platelets as evidenced by real-time hemovigilance. Lab Med 2024; 55:251-254. [PMID: 38175635 DOI: 10.1093/labmed/lmad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Due to chemotherapy-induced neutropenia or hematologic malignancies, immunocompromised cancer patients may have higher incidence of febrile nonhemolytic transfusion reactions compared with the general population and frequently require platelet transfusions. This quality improvement project compared the safety of transfusion using prestorage leukocyte-reduced and pooled whole blood-derived platelets (Acrodose/WBD) with conventionally produced poststorage WBD platelets (RDP) using an active hemovigilance system. METHODS Every patient receiving a blood product at the hospital was virtually monitored in real time by trained nurses from a remote hemovigilance unit. These nurses monitor a digital dashboard, which populates a watch list of patients from the time blood product administration is initiated until 12 hours posttransfusion. Over the course of 6 months, 371 patients receiving 792 RDP transfusions and 423 patients receiving 780 Acrodose/WBD platelets transfusions were monitored for transfusion reactions. RESULTS We identified 26 transfusion reactions in RDP but only 12 transfusion reactions in the Acrodose/WBD platelet group. CONCLUSION Acrodose platelet transfusion was associated with fewer transfusion reactions, which resulted in significant cost savings.
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Affiliation(s)
- Nick Park
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Mayrin Correa Medina
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Fernando Martinez
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Marla Throssel
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine University of Kansas Medical Center, Kansas City, KS, US
| | - Adriana Knopfelmacher
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Colleen Villamin
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Sandra Rivas
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Nancy Tomczak
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Saahith Garg
- Department of Biochemistry, University of Texas Health Science Center at Houston, Houston, TX, US
| | - Lorraine Layton
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Kimberly Klein
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
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2
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Wood EM, Whitaker BI, Townsend M, Narayan S. How we forecast tomorrow's haemovigilance. Transfus Clin Biol 2024; 31:114-118. [PMID: 38460837 DOI: 10.1016/j.tracli.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
The field of haemovigilance continues to develop, building on more than forty years of international experience. This review considers the current scope and activities of haemovigilance around the world and explores aspects of preparation for the advent of new blood products and alternative therapies to transfusion; new tools for data acquisition (including patient- and donor-reported outcomes, and data from 'wearables') and the analysis and communication of haemovigilance results.
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Affiliation(s)
- Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia; Department of Clinical Haematology, Monash Health, Clayton Road, Clayton, Victoria 3168, Australia.
| | - Barbee I Whitaker
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Avenue, White Oak-71, Silver Spring, MD 20993, USA.
| | - Mary Townsend
- Vitalant, 9503 E Via de Ventura, Scottsdale, AZ 85259, USA.
| | - Shruthi Narayan
- Serious Hazards of Transfusion (SHOT), NHS Blood and Transplant, Manchester Blood Centre, Manchester M13 9LL, United Kingdom.
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Dutra VDF, Bonet-Bub C, Sakashita AM, Kutner JM. Infectious diseases and the impact on transfusion medicine: A historical review and lessons for the future. Transfus Clin Biol 2023; 30:376-381. [PMID: 37328129 DOI: 10.1016/j.tracli.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/01/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Abstract
Blood transfusion saves millions of lives each year. It is a well-established treatment, and many procedures are applied to avoid transmitted infections. However, throughout the history of transfusion medicine, many infectious diseases arose or were recognised, bringing up an impact on the blood supply, as the difficulties in diagnosing new diseases, the decrease in blood donors, the challenges for the medical team, the risks for the receptor and the related costs. This study aims to review historically the principal infectious diseases transmitted through the blood that circulated worldwide in the 20th and 21st centuries, considering the impact on the blood banks. Despite the current blood bank control of transfusion risks and the hemovigilance improvements, transmitted and emerging infections can still compromise the blood bank supply, as we have witnessed during the first waves of the COVID-19 pandemic. Moreover, new pathogens will continue emerging, and we must be prepared for the future.
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4
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Goldman M, Butler-Foster T, Lapierre D, O'Brien SF, Devor A. Trans people and blood donation. Transfusion 2020; 60:1084-1092. [PMID: 32343438 DOI: 10.1111/trf.15777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - Don Lapierre
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sheila F O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Aaron Devor
- Sociology Department, University of Victoria, Victoria, British Columbia, Canada
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5
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Fredrick J, Berger JJ, Menitove JE. Strategic issues currently facing the US blood system. Transfusion 2020; 60:1093-1096. [PMID: 32339298 DOI: 10.1111/trf.15769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jacquelyn Fredrick
- Former CEO Versiti, Milwaukee, WI and Chair, HHS Advisory Committee on Blood and Tissue Safety and Availability, USA
| | - James J Berger
- Senior Advisor for Blood and Tissue Policy, Washington DC, USA
| | - Jay E Menitove
- Former CEO and Medical Director, Community Blood Center of Greater Kansas City, Kansas City, MO and Clinical Professor, Pathology and Laboratory Medicine, Kansas University Medical Center, Kansas City, KS, USA
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6
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Christensen C, Jonsdottir-Buch SM, Sigurjonsson OE. Effects of amotosalen treatment on human platelet lysate bioactivity: A proof-of-concept study. PLoS One 2020; 15:e0220163. [PMID: 32294080 PMCID: PMC7159197 DOI: 10.1371/journal.pone.0220163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 03/24/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Clinical application of mesenchymal stromal cells (MSCs) usually requires an in vitro expansion step to reach clinically relevant numbers. In vitro cell expansion necessitates supplementation of basal mammalian cell culture medium with growth factors. To avoid using supplements containing animal substances, human platelet lysates (hPL) produced from expired and pathogen inactivated platelet concentrates can be used in place of fetal bovine serum. However, globally, most transfusion units are currently not pathogen inactivated. As blood banks are the sole source of platelet concentrates for hPL production, it is important to ensure product safety and standardized production methods. In this proof-of-concept study we assessed the feasibility of producing hPL from expired platelet concentrates with pathogen inactivation applied after platelet lysis by evaluating the retention of growth factors, cytokines, and the ability to support MSC proliferation and tri-lineage differentiation. METHODOLOGY/PRINCIPAL FINDINGS Bone marrow-derived MSCs (BM-MSCs) were expanded and differentiated using hPL derived from pathogen inactivated platelet lysates (hPL-PIPL), with pathogen inactivation by amotosalen/ultraviolet A treatment applied after lysis of expired platelets. Results were compared to those using hPL produced from conventional expired pathogen inactivated platelet concentrates (hPL-PIPC), with pathogen inactivation applied after blood donation. hPL-PIPL treatment had lower concentrations of soluble growth factors and cytokines than hPL-PIPC treatment. When used as supplementation in cell culture, BM-MSCs proliferated at a reduced rate, but more consistently, in hPL-PIPL than in hPL-PIPC. The ability to support tri-lineage differentiation was comparable between lysates. CONCLUSION/SIGNIFICANCE These results suggest that functional hPL can be produced from expired and untreated platelet lysates by applying pathogen inactivation after platelet lysis. When carried out post-expiration, pathogen inactivation may provide a valuable solution for further standardizing global hPL production methods, increasing the pool of starting material, and meeting future demand for animal-free supplements in human cell culturing.
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Affiliation(s)
- Christian Christensen
- The Blood Bank, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, Biomedical Center, University of Iceland, Reykjavik, Iceland
- Platome Biotechnology, Hafnarfjörður, Iceland
| | - Sandra Mjoll Jonsdottir-Buch
- The Blood Bank, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, Biomedical Center, University of Iceland, Reykjavik, Iceland
- Platome Biotechnology, Hafnarfjörður, Iceland
| | - Olafur Eysteinn Sigurjonsson
- The Blood Bank, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, Biomedical Center, University of Iceland, Reykjavik, Iceland
- Platome Biotechnology, Hafnarfjörður, Iceland
- School of Science and Engineering, University of Reykjavik, Reykjavik, Iceland
- * E-mail:
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7
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Sow C, Laughhunn A, Girard YA, Lanteri MC, Amar El Dusouqui S, Stassinopoulos A, Grellier P. Inactivation of Plasmodium falciparum in whole blood using the amustaline and glutathione pathogen reduction technology. Transfusion 2020; 60:799-805. [PMID: 32129497 PMCID: PMC7187285 DOI: 10.1111/trf.15734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/16/2020] [Accepted: 02/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Risk of transfusion-transmitted (TT) malaria is mainly associated with whole blood (WB) or red blood cell (RBC) transfusion. Risk mitigation relies mostly on donor deferral while a limited number of countries perform blood testing, both negatively impacting blood availability. This study investigated the efficacy of the pathogen reduction system using amustaline and glutathione (GSH) to inactivate Plasmodium falciparum in WB. STUDY DESIGN AND METHODS WB units were spiked with ring stage P. falciparum infected RBCs. Parasite loads were measured in samples at time of infection, after 24 hours at room temperature (RT), and after a 24-hour incubation at RT post-treatment with 0.2 mM amustaline and 2 mM GSH. Serial 10-fold dilutions of the samples were inoculated to RBC cultures and maintained up to 4 weeks. Parasitemia was quantified by cytometry. RESULTS The P. falciparum viability assay has a limit of detection of a single live parasite per sample. Input parasite titer was >5.7 log10 TCID50 per mL. A 24-hour incubation at RT paused parasite development in controls, but they retained viability and infectivity when tested in culture. In contrast, no infectious parasites were detected in the amustaline/GSH-treated sample after 4 weeks of culture. CONCLUSION A robust level of P. falciparum inactivation was achieved in WB using amustaline/GSH treatment. Parasite log reduction was >5.7 log10 TCID50 per mL. Development of such a pathogen reduction system may provide an opportunity to reduce the risk of TT malaria and improve blood availability.
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Affiliation(s)
- Cissé Sow
- MCAM, UMR 7245, Muséum National dʼHistoire Naturelle, CNRSParisFrance
| | | | | | | | | | | | - Philippe Grellier
- MCAM, UMR 7245, Muséum National dʼHistoire Naturelle, CNRSParisFrance
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8
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Danovic F, Lieshout-Krikke RW, Koopman RWW, van Kraaij MGJ. [Blood safety in the Netherlands: prevention of blood-transmitted infections]. Ned Tijdschr Geneeskd 2020; 164:D4060. [PMID: 32186817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Amongst the various blood-safety measures to prevent blood-transmitted infections in transfusion recipients, the most important are the selection of blood donors and the testing for infections of the donations. A look-back procedure aims to inform hospitals about potentially infected blood products and to trace the relevant recipients. The opposite, reverse look-back, can also occur: following a report that a patient has an infection of which blood transfusion may be the possible source, all possibly implicated donors will be screened for the particular agent. Over the period 2007-2017, 84 look-backs were carried out by the Dutch blood product organisation Sanquin. Transmission via blood products of the human immunodeficiency virus, hepatitis C virus, human T-cell Lymphotropic virus or Treponema pallidum were not found. Look-back identified four recipients with hepatitis-B virus infection. These recipients had received a blood product from donors with an occult chronic hepatitis-B virus infection. In the Netherlands, the risks associated with transmission of infection through blood products are minimal; however, transmission may still occur, despite extensive blood-safety measures.
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Affiliation(s)
- Fikreta Danovic
- Sanquin Bloedbank, Unit Transfusiegeneeskunde,Amsterdam
- Contact: Fikreta Danovic
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9
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Chung HJ, Hur M, Choi SG, Lee HK, Lee S, Kim H, Moon HW, Yun YM. Benefits of VISION Max automated cross-matching in comparison with manual cross-matching: A multidimensional analysis. PLoS One 2019; 14:e0226477. [PMID: 31869405 PMCID: PMC6927601 DOI: 10.1371/journal.pone.0226477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND VISION Max (Ortho-Clinical Diagnostics, Raritan, NJ, USA) is a newly introduced automated blood bank system. Cross-matching (XM) is an important test confirming safety by simulating reaction between packed Red Blood Cells (RBCs) and patient blood in vitro before transfusion. We assessed the benefits of VISION Max automated XM (A-XM) in comparison with those of manual XM (M-XM) by using multidimensional analysis (cost-effectiveness and quality improvement). MATERIALS AND METHODS In a total of 327 tests (130 patients), results from A-XM and M-XM were compared. We assessed the concordance rate, risk priority number (RPN), turnaround time, hands-on time, and the costs of both methods. We further simulated their annual effects based on 37,937 XM tests in 2018. RESULTS The concordance rate between A-XM and M-XM was 97.9% (320/327, kappa = 0.83), and the seven discordant results were incompatible for transfusion in A-XM, while compatible for transfusion in M-XM. None of the results was incompatible for transfusion in A-XM, while compatible for transfusion in M-XM, meaning A-XM detect agglutination more sensitively and consequently provides a more safe result than M-XM. A-XM was estimated to have a 6.3-fold lower risk (229 vs. 1,435 RPN), shorter turnaround time (19.1 vs. 23.3 min, P < 0.0001), shorter hands-on time (1.1 vs. 5.3 min, P < 0.0001), and lower costs per single test than M-XM (1.44 vs. 2.70 USD). A-XM permitted annual savings of 46 million RPN, 15.1 months of daytime workers' labor, and 47,042 USD compared with M-XM. CONCLUSION This is the first attempt to implement A-XM using VISION Max. VISION Max A-XM appears to be a safe, practical, and reliable alternative for pre-transfusion workflow with the potential to improve quality and cost-effectiveness in the blood bank.
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Affiliation(s)
- Hee-Jung Chung
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Sang Gyeu Choi
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Hyun-Kyung Lee
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Seungho Lee
- Department of Occupational and Environmental Medicine, Ajou University Medicine, Suwon, South Korea
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
| | - Yeo-Min Yun
- Department of Laboratory Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea
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10
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Storch EK, Custer BS, Jacobs MR, Menitove JE, Mintz PD. Review of current transfusion therapy and blood banking practices. Blood Rev 2019; 38:100593. [PMID: 31405535 DOI: 10.1016/j.blre.2019.100593] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 01/28/2023]
Abstract
Transfusion Medicine is a dynamically evolving field. Recent high-quality research has reshaped the paradigms guiding blood transfusion. As increasing evidence supports the benefit of limiting transfusion, guidelines have been developed and disseminated into clinical practice governing optimal transfusion of red cells, platelets, plasma and cryoprecipitate. Concepts ranging from transfusion thresholds to prophylactic use to maximal storage time are addressed in guidelines. Patient blood management programs have developed to implement principles of patient safety through limiting transfusion in clinical practice. Data from National Hemovigilance Surveys showing dramatic declines in blood utilization over the past decade demonstrate the practical uptake of current principles guiding patient safety. In parallel with decreasing use of traditional blood products, the development of new technologies for blood transfusion such as freeze drying and cold storage has accelerated. Approaches to policy decision making to augment blood safety have also changed. Drivers of these changes include a deeper understanding of emerging threats and adverse events based on hemovigilance, and an increasing healthcare system expectation to align blood safety decision making with approaches used in other healthcare disciplines.
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Affiliation(s)
| | - Brian S Custer
- UCSF Department of Laboratory Medicine, Blood Systems Research Institute, USA.
| | - Michael R Jacobs
- Department of Pathology, Case Western Reserve University, USA; Department of Clinical Microbiology, University Hospitals Cleveland Medical Center, USA.
| | - Jay E Menitove
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, USA
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11
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Atreya C, Glynn S, Busch M, Kleinman S, Snyder E, Rutter S, AuBuchon J, Flegel W, Reeve D, Devine D, Cohn C, Custer B, Goodrich R, Benjamin RJ, Razatos A, Cancelas J, Wagner S, Maclean M, Gelderman M, Cap A, Ness P. Proceedings of the Food and Drug Administration public workshop on pathogen reduction technologies for blood safety 2018 (Commentary, p. 3026). Transfusion 2019; 59:3002-3025. [PMID: 31144334 PMCID: PMC6726584 DOI: 10.1111/trf.15344] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Chintamani Atreya
- US Food and Drug Administration, Center for Biologics Evaluation and ResearchOffice of Blood Research and ReviewSilver SpringMaryland
| | - Simone Glynn
- National Heart Lung and Blood InstituteBethesdaMarylandUSA
| | | | | | - Edward Snyder
- Blood BankYale‐New Haven HospitalNew HavenConnecticut
| | - Sara Rutter
- Department of Pathology and Laboratory MedicineYale School of MedicineNew HavenConnecticut
| | - James AuBuchon
- Department of PathologyDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Willy Flegel
- Department of Transfusion MedicineNIH Clinical CenterBethesdaMaryland
| | - David Reeve
- Blood ComponentsAmerican Red CrossRockvilleMaryland
| | - Dana Devine
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Claudia Cohn
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Brian Custer
- Vitalant Research InstituteSan FranciscoCalifornia
| | - Raymond Goodrich
- Department of Microbiology, Immunology and PathologyColorado State UniversityFort CollinsColorado
| | | | | | - Jose Cancelas
- Hoxworth Blood CenterUniversity of Cincinnati HealthCincinnatiOhio
| | | | - Michelle Maclean
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST)University of StrathclydeGlasgowScotland
| | - Monique Gelderman
- Department of HematologyCenter for Biologics Evaluation and Research, US Food and Drug AdministrationSilver SpringMaryland
| | - Andrew Cap
- U.S. Army Institute of Surgical ResearchSan AntonioTexas
| | - Paul Ness
- Blood BankJohns Hopkins HospitalBaltimoreMaryland
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12
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Rutter S, Snyder EL. How do we … integrate pathogen reduced platelets into our hospital blood bank inventory? Transfusion 2019; 59:1628-1636. [PMID: 30883807 PMCID: PMC6850142 DOI: 10.1111/trf.15241] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/17/2022]
Abstract
For more than 50 years there has been an ongoing effort to combat transfusion-transmitted infections and provide patients with the safest possible blood. This initiative has driven much of the research within the transfusion community. Initial methods included screening donors for travel histories to banned areas and for high-risk behaviors, but pathogen-specific assays performed at the collection and manufacturing sites also have become key factors in assuring blood safety. Many of these have focused on donor and laboratory-based screening for transfusion-transmitted diseases, as evidenced by the hepatitis and human immunodeficiency virus screening in the 1970s, 1980s, and 1990s. More recently, this effort has expanded to develop donor screening assays to identify other blood-borne pathogens, such as Zika and West Nile viruses and Babesia. Bacterial contamination of units of platelets (PLTs), however, remains a significant concern. In recent years, the Food and Drug Administration has approved rapid tests to identify bacterially contaminated PLT units in the blood bank before transfusion. Other supplemental methods have been developed, however, that aim to inactivate blood-borne pathogen(s) present in the blood product, rather than to rely on our ability to identify and interdict contaminated and infected components. Pathogen reduction technology, as this is referred to, provides a proactive way to further reduce the risk posed by transfusion-transmitted infections.
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Affiliation(s)
- Sara Rutter
- Department of Laboratory Medicine, Division of Transfusion MedicineYale University School of MedicineNew HavenConnecticut
| | - Edward L. Snyder
- Department of Laboratory Medicine, Division of Transfusion MedicineYale University School of MedicineNew HavenConnecticut
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13
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Ayala-De la Cruz S, Flores-Aréchiga A, Llaca-Díaz J, Pérez-Chávez F, Salazar-Montalvo RG, Casillas-Vega N. [Serological screening in donors in Mexico: advances and technology]. Rev Med Inst Mex Seguro Soc 2019; 57:30-35. [PMID: 31071252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The residual risk of transfusion-related infections has decreased dramatically in countries that have routinely implemented serological screening. Most of the donation in Mexico is from replacement practice, a risk factor for positive serology. In Mexico, the altruistic donation is only 2.7%. The heterogeneity of technical factors, regional factors and internal policies of each center influences the variability of data on the prevalence of positive screening, as well as the prevalence of confirmed cases. The main advantage of nucleic acid technology is the detection of donors in the period of serological window or occult infections, being occult hepatitis reports in Mexican donors from 1 to 3.4%. The limitation of available technology, the scope of the clinic and perspectives, invites us to improve technology and health policies in the interest of transfusion safety.
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Affiliation(s)
| | | | | | | | | | - Néstor Casillas-Vega
- Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Departamento de Patología Clínica. Monterrey, Nuevo León, México
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14
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Kashosi TM, Mutendela JK, Mwenebitu DL, Maotela JK, Mubagwa K. [Assessment of virological quality of transfused blood in the town of Bukavu, South Kivu, Democratic Republic of Congo]. Pan Afr Med J 2018; 30:193. [PMID: 30455822 PMCID: PMC6235500 DOI: 10.11604/pamj.2018.30.193.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 05/28/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In Bukavu, transfused blood is selected using rapid diagnostic tests (RDTs). These tests are easily performed without specialized equipments. This study aims to evaluate the virological quality of transfused blood assessed using rapid diagnostic tests. METHODS A blood sample was drawn from a blood bag and collected in a 4ml dry tube in 5 Health Care Facilities over a month. Counter analysis was performed on each sample using rapid tests and ELISA. Intrinsic and extrinsic values were calculated. Cohen's kappa coefficient was used to evaluate the reliability of RDT compared with ELISA. RESULTS Three hundred and twelve samples were collected; 5 samples were positive for one or the other virologic marker while 307 samples were negative in all the tests. However Elisa showed, out of the 307 samples which were RDT test negative, 15 other positive samples including 3 samples positive for HIV, 3 for HCV and 9 for HBV. In addition, ELISA validated some RDT-positive samples and contradicted other results. Sensitivity and positive predictive value from rapid diagnostic tests were very low. The reliability of these tests was satisfactory, medium or low. CONCLUSION Blood assessed using RDTs poses a non negligible risk of viral infections. This study highlights the need for more reliable and efficient tests in our Health Care Facilities.
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Affiliation(s)
- Théophile Mitima Kashosi
- Laboratoire de Recherche Biomédicale et de Santé Publique, Département de Sciences Biomédicales, Faculté de Médecine et Santé Communautaire, Université Évangélique en Afrique (UEA), République Démocratique du Congo
- Centre Internationale de Formation et de Recherches Avancées, Bukavu, République Démocratique du Congo
- Section Techniques de Laboratoire, Institut Supérieur des Techniques Médicales (ISTM) de Bukavu, République Démocratique du Congo
| | | | - David Lupande Mwenebitu
- Département de Biologie Clinique, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu, République Démocratique du Congo
| | - Jeff Kabinda Maotela
- Centre Provincial de Transfusion Sanguine (CPTS) de Bukavu, Sud-Kivu, République Démocratique du Congo
| | - Kanigula Mubagwa
- Centre Internationale de Formation et de Recherches Avancées, Bukavu, République Démocratique du Congo
- Département Scientifique Cardiovanculaire, Université de Leuven, Leuven, Belgique
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15
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Bello-López JM, Delgado-Balbuena L, Rojas-Huidobro D, Rojo-Medina J. Treatment of platelet concentrates and plasma with riboflavin and UV light: Impact in bacterial reduction. Transfus Clin Biol 2018; 25:197-203. [PMID: 29656962 DOI: 10.1016/j.tracli.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/16/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Transfusion of hemocomponents is essential for clinical and surgical procedures and therefore their safety has increased. An option for pathogen reduction includes the combination of riboflavin and UV light. To our knowledge, there are no studies in Latin America that demonstrate the effectiveness of the pathogen reduction in hemocomponents. The objective of this work was to evaluate the efficiency of a pathogens reduction system in platelets concentrates (PC) and plasma. MATERIALS AND METHODS PC and plasma were contaminated with Escherichia coli, Klebsiella pneumoniae, Streptococcus pyogenes and Staphylococcus epidermidis at 104 to 106 CFU and subjected to bacterial reduction. After bacterial reduction, hemocomponents were subjected to cultivation of surviving bacteria by automated method and classical colonies quantification. Additionally, quality control testing was performed in order to confirm the integrity of platelets and coagulation laboratory values in plasma before and after bacterial reduction. RESULTS The bacterial death in PC/plasma was expressed by Logarithmic Reduction Value as follows: for both strains (E. coli and S. pyogenes) 4/4, 5/5 and 6/6; for K. pneumoniae 2.54/2.23, 2.94/2.22 and 3.44/2.98, for S. epidermidis 4/4, 3.11/5 and 3.23/4.19, for 104, 105 and 106 CFU, respectively. In PC and plasma, platelet count, pH (at 22°C), activated partial thromboplastin time (aPTT), prothrombin time (PT), fibrinogen, factor VIII and total proteins (TP) were slightly modified. CONCLUSIONS UV light with riboflavin is able to reduce an important number of pathogens in hemocomponents; however, the bacterial reduction is influenced by the nature and quantity of the pathogen.
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Affiliation(s)
- J M Bello-López
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico; Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico.
| | - L Delgado-Balbuena
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico
| | - D Rojas-Huidobro
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico
| | - J Rojo-Medina
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico
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16
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Seed CR, Hewitt PE, Dodd RY, Houston F, Cervenakova L. Creutzfeldt-Jakob disease and blood transfusion safety. Vox Sang 2018; 113:220-231. [PMID: 29359329 DOI: 10.1111/vox.12631] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 01/09/2023]
Abstract
Transmissible spongiform encephalopathies (TSEs) are untreatable, fatal neurologic diseases affecting mammals. Human disease forms include sporadic, familial and acquired Creutzfeldt-Jakob disease (CJD). While sporadic CJD (sCJD) has been recognized for near on 100 years, variant CJD (vCJD) was first reported in 1996 and is the result of food-borne transmission of the prion of bovine spongiform encephalopathy (BSE, 'mad cow disease'). Currently, 230 vCJD cases have been reported in 12 countries, the majority in the UK (178) and France (27). Animal studies demonstrated highly efficient transmission of natural scrapie and experimental BSE by blood transfusion and fuelled concern that sCJD was potentially transfusion transmissible. No such case has been recorded and case-control evaluations and lookback studies indicate that, if transfusion transmission occurs at all, it is very rare. In contrast, four cases of apparent transfusion transmission of vCJD infectivity have been identified in the UK. Risk minimization strategies in response to the threat of vCJD include leucodepletion, geographically based donor deferrals and deferral of transfusion recipients. A sensitive and specific, high-throughput screening test would provide a potential path to mitigation but despite substantial effort no such test has yet appeared. The initial outbreak of vCJD appears to be over, but concern remains about subsequent waves of disease among those already infected. There is considerable uncertainty about the size of the infected population, and there will be at least a perception of some continuing risk to blood safety. Accordingly, at least some precautionary measures will remain in place and continued surveillance is necessary.
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Affiliation(s)
- C R Seed
- Australian Red Cross Blood Service, Perth, WA, Australia
| | | | - R Y Dodd
- American Red Cross Scientific Affairs, Gaithersburg, MD, USA
| | - F Houston
- The Roslin Institute, University of Edinburgh, Midlothian, Scotland
| | - L Cervenakova
- The Plasma Protein Therapeutics Association (PPTA), Annapolis, MD, USA
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17
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Garban F, Guyard A, Labussière H, Bulabois CE, Marchand T, Mounier C, Caillot D, Bay JO, Coiteux V, Schmidt-Tanguy A, Le Niger C, Robin C, Ladaique P, Lapusan S, Deconinck E, Rolland C, Foote AM, François A, Jacquot C, Tardivel R, Tiberghien P, Bosson JL. Comparison of the Hemostatic Efficacy of Pathogen-Reduced Platelets vs Untreated Platelets in Patients With Thrombocytopenia and Malignant Hematologic Diseases: A Randomized Clinical Trial. JAMA Oncol 2018; 4:468-475. [PMID: 29392283 PMCID: PMC5885167 DOI: 10.1001/jamaoncol.2017.5123] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/09/2017] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Pathogen reduction of platelet concentrates may reduce transfusion-transmitted infections but is associated with qualitative impairment, which could have clinical significance with regard to platelet hemostatic capacity. OBJECTIVE To compare the effectiveness of platelets in additive solution treated with amotosalen-UV-A vs untreated platelets in plasma or in additive solution in patients with thrombocytopenia and hematologic malignancies. DESIGN, SETTING, AND PARTICIPANTS The Evaluation of the Efficacy of Platelets Treated With Pathogen Reduction Process (EFFIPAP) study was a randomized, noninferiority, 3-arm clinical trial performed from May 16, 2013, through January 21, 2016, at 13 French tertiary university hospitals. Clinical signs of bleeding were assessed daily until the end of aplasia, transfer to another department, need for a specific platelet product, or 30 days after enrollment. Consecutive adult patients with bone marrow aplasia, expected hospital stay of more than 10 days, and expected need of platelet transfusions were included. INTERVENTIONS At least 1 transfusion of platelets in additive solution with amotosalen-UV-A treatment, in plasma, or in additive solution. MAIN OUTCOMES AND MEASURES The proportion of patients with grade 2 or higher bleeding as defined by World Health Organization criteria. RESULTS Among 790 evaluable patients (mean [SD] age, 55 [13.4] years; 458 men [58.0%]), the primary end point was observed in 126 receiving pathogen-reduced platelets in additive solution (47.9%; 95% CI, 41.9%-54.0%), 114 receiving platelets in plasma (43.5%; 95% CI, 37.5%-49.5%), and 120 receiving platelets in additive solution (45.3%; 95% CI, 39.3%-51.3%). With a per-protocol population with a prespecified margin of 12.5%, noninferiority was not achieved when pathogen-reduced platelets in additive solution were compared with platelets in plasma (4.4%; 95% CI, -4.1% to 12.9%) but was achieved when the pathogen-reduced platelets were compared with platelets in additive solution (2.6%; 95% CI, -5.9% to 11.1%). The proportion of patients with grade 3 or 4 bleeding was not different among treatment arms. CONCLUSIONS AND RELEVANCE Although the hemostatic efficacy of pathogen-reduced platelets in thrombopenic patients with hematologic malignancies was noninferior to platelets in additive solution, such noninferiority was not achieved when comparing pathogen-reduced platelets with platelets in plasma. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01789762.
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Affiliation(s)
- Frédéric Garban
- University Grenoble Alpes, Centre National de Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité–Institut Mathématiques Appliquées de Grenoble 38000, Grenoble, France
- Service d’Hématologie, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
- Etablissement Français du Sang, Grenoble, France
| | - Audrey Guyard
- Centre d’Investigation Clinique 1406–Innovation Technologique, Institut national de la santé et de la recherche médicale, Grenoble, France
- Service de Biostatistiques, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | - Helene Labussière
- Service d’Hématologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Claude-Eric Bulabois
- University Grenoble Alpes, Centre National de Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité–Institut Mathématiques Appliquées de Grenoble 38000, Grenoble, France
- Service d’Hématologie, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | - Tony Marchand
- Service d’Hématologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Christiane Mounier
- Service d’Hématologie, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Denis Caillot
- Service d’Hématologie, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Jacques-Olivier Bay
- Service d’Hématologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Valérie Coiteux
- Service d’Hématologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Aline Schmidt-Tanguy
- Service d’Hématologie, Centre Hospitalier Universitaire d’Angers, Angers, France
| | - Catherine Le Niger
- Service d’Hématologie, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Christine Robin
- Service d’Hématologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Patrick Ladaique
- Service d’Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Simona Lapusan
- Service d’Hématologie, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eric Deconinck
- Service d’Hématologie, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Carole Rolland
- University Grenoble Alpes, Centre National de Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité–Institut Mathématiques Appliquées de Grenoble 38000, Grenoble, France
| | - Alison M. Foote
- Cellule Publication, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | - Anne François
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Chantal Jacquot
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - René Tardivel
- Etablissement Français du Sang, La Plaine Saint-Denis, France
- Etablissement Français du Sang, Rennes, France
| | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine Saint-Denis, France
- Unité mixte de recherche 1098, Institut national de la santé et de la recherche médicale, Université de Franche-Comté, Etablissement Français du Sang, Besançon, France
| | - Jean-Luc Bosson
- University Grenoble Alpes, Centre National de Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité–Institut Mathématiques Appliquées de Grenoble 38000, Grenoble, France
- Centre d’Investigation Clinique 1406–Innovation Technologique, Institut national de la santé et de la recherche médicale, Grenoble, France
- Service de Biostatistiques, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
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18
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Bello-López JM, Castañeda-García C, Muñoz-Estrada C, Machorro-Peréz AJ. External quality control program in screening for infectious diseases at blood banks in Mexico. Transfus Apher Sci 2018; 57:97-101. [PMID: 29452838 DOI: 10.1016/j.transci.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Quality control for the detection of infectious markers in blood banks is a necessary activity to ensure the accuracy of donor screening results. Considering that in Mexico blood safety is one of the goals of the National Action Programs, it is essential to evaluate banks through an External Quality Control Program. OBJECTIVE To analyze one of the evaluations that showed the greatest participation (2014-2/lot46) of banks in the Mexican Republic in the detection of transfusion-transmitted diseases. MATERIALS AND METHODS A randomized panel of infectious markers of HIV, HCV, HBV, Treponema pallidum and Trypanosoma cruzi was manufactured under high quality standards. The evaluation criteria for each infectious marker were the identification of false positives and false negative results. Additionally, technologies used to detect infectious markers were requested for each bank. RESULTS Of the 503 banks, only 374 participated in the evaluation. Technologies based on chemiluminescence, immunofluorescence and immunocolorimetry were used to detect viral markers. Even rapid tests for T. pallidum continue to be the methods of choice with 42%. Trypanosoma cruzi was 20% with fast techniques versus 80% with automated tests. Highest incidence of false positives was identified for T. pallidum and HBV, followed by T. cruzi, HIV and HCV. Fourteen (3.74%) false negatives results were identified for T. cruzi, followed by T. pallidum (n = 5/1.33%), HCV (n = 4/1.06) and HVB/HIV (n = 2/0.53%). CONCLUSION False positive results identified for each infectious marker was considered high. This evidence will allow us to focus on areas of opportunity during serologic screening with greater emphasis on good laboratory practices.
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Affiliation(s)
- J Manuel Bello-López
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico; Research Unit in Microbiology and Toxicology, Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico.
| | - Cristina Castañeda-García
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico
| | - Celerino Muñoz-Estrada
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico
| | - Antonio José Machorro-Peréz
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360, Mexico City, Mexico
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19
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Drew VJ, Barro L, Seghatchian J, Burnouf T. Towards pathogen inactivation of red blood cells and whole blood targeting viral DNA/RNA: design, technologies, and future prospects for developing countries. Blood Transfus 2017; 15:512-521. [PMID: 28488960 PMCID: PMC5649960 DOI: 10.2450/2017.0344-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/15/2016] [Indexed: 01/22/2023]
Abstract
Over 110 million units of blood are collected yearly. The need for blood products is greater in developing countries, but so is the risk of contracting a transfusion-transmitted infection. Without efficient donor screening/viral testing and validated pathogen inactivation technology, the risk of transfusion-transmitted infections correlates with the infection rate of the donor population. The World Health Organization has published guidelines on good manufacturing practices in an effort to ensure a strong global standard of transfusion and blood product safety. Sub-Saharan Africa is a high-risk region for malaria, human immunodeficiency virus (HIV), hepatitis B virus and syphilis. Southeast Asia experiences high rates of hepatitis C virus. Areas with a tropical climate have an increased risk of Zika virus, Dengue virus, West Nile virus and Chikungunya, and impoverished countries face economical limitations which hinder efforts to acquire the most modern pathogen inactivation technology. These systems include Mirasol® Pathogen Reduction Technology, INTERCEPT®, and THERAFLEX®. Their procedures use a chemical and ultraviolet or visible light for pathogen inactivation and significantly decrease the threat of pathogen transmission in plasma and platelets. They are licensed for use in Europe and are used in several other countries. The current interest in the blood industry is the development of pathogen inactivation technologies that can treat whole blood (WB) and red blood cell (RBC). The Mirasol system has recently undergone phase III clinical trials for treating WB in Ghana and has demonstrated some efficacy toward malaria inactivation and low risk of adverse effects. A 2nd-generation of the INTERCEPT® S-303 system for WB is currently undergoing a phase III clinical trial. Both methodologies are applicable for WB and components derived from virally reduced WB or RBC.
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Affiliation(s)
- Victor J. Drew
- International PhD Program of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
| | - Lassina Barro
- International PhD Program of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
- National Center of Blood Transfusion, Ouagadougou, Burkina Faso, United Kingdom
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality Improvement/Safety, Audit/Inspection and DDR Strategy, London, United Kingdom
| | - Thierry Burnouf
- International PhD Program of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
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20
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Di Minno G, Navarro D, Perno CF, Canaro M, Gürtler L, Ironside JW, Eichler H, Tiede A. Pathogen reduction/inactivation of products for the treatment of bleeding disorders: what are the processes and what should we say to patients? Ann Hematol 2017; 96:1253-1270. [PMID: 28624906 PMCID: PMC5486800 DOI: 10.1007/s00277-017-3028-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/22/2017] [Indexed: 12/11/2022]
Abstract
Patients with blood disorders (including leukaemia, platelet function disorders and coagulation factor deficiencies) or acute bleeding receive blood-derived products, such as red blood cells, platelet concentrates and plasma-derived products. Although the risk of pathogen contamination of blood products has fallen considerably over the past three decades, contamination is still a topic of concern. In order to counsel patients and obtain informed consent before transfusion, physicians are required to keep up to date with current knowledge on residual risk of pathogen transmission and methods of pathogen removal/inactivation. Here, we describe pathogens relevant to transfusion of blood products and discuss contemporary pathogen removal/inactivation procedures, as well as the potential risks associated with these products: the risk of contamination by infectious agents varies according to blood product/region, and there is a fine line between adequate inactivation and functional impairment of the product. The cost implications of implementing pathogen inactivation technology are also considered.
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Affiliation(s)
- Giovanni Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Regional Reference Centre for Coagulation Disorders, Federico II University, Via S. Pansini 5, 80131, Naples, Italy.
| | - David Navarro
- Department of Microbiology, Microbiology Service, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Mariana Canaro
- Department of Hemostasis and Thrombosis, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Lutz Gürtler
- Max von Pettenkofer Institute for Hygiene and Medical Microbiology, University of München, Munich, Germany
| | - James W Ironside
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, School of Clinical Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Hermann Eichler
- Institute of Clinical Hemostaseology and Transfusion Medicine, Saarland University Hospital, Homburg, Germany
| | - Andreas Tiede
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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21
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Staples S, O'Callaghan C, Staves J, Murphy MF. Electronic remote blood issue: near patient blood allocation using an automated blood storage system. Transfusion 2017; 57:2059-2060. [PMID: 28594095 DOI: 10.1111/trf.14167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/11/2017] [Accepted: 04/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Sophie Staples
- Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Clare O'Callaghan
- Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
- Haemonetics Corporation, Braintree, Massachusetts
| | - Julie Staves
- Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Michael F Murphy
- Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
- NHS Blood and Transplant, Watford, Hertfordshire, United Kingdom
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22
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Dosunmu AO, Akinbami AA, Ismail AK, Olaiya MA, Uche EI, Aile IK. The cost-effectiveness of predonation screening for transfusion transmissible infections using rapid test kits in a hospital-based blood transfusion centre. Niger Postgrad Med J 2017; 24:162-167. [PMID: 29082905 DOI: 10.4103/npmj.npmj_33_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Blood transfusion practice emphasises safety, efficacy and appropriate use. These require cost-effective programme management. This study focused on the cost of screening for transfusion transmissible infections (TTI). METHODS This was a 1 year (2016) analysis of screening in a hospital-based transfusion centre. The cost of screening all blood donors by ELISA was compared to the cost of serial screening starting from rapid kit, taking into account, the estimated cost of blood bags prevented from discard after ELISA screening (attributable cost). The cost of voluntary donor drive plus cost of ELISA screening was compared with the present cost of screening. RESULTS A total of 5591 donors were screened for HIV, hepatitis B and C using the rapid kit, 291 donors were deferred (5.2%). A total of 5300 units were further screened by ELISA. A total of 435 blood units (8.2%) were discarded due to TTI positivity. TTI positivity rate was 12.98%. Only 2.36% were voluntary donors and among these 9.1% were TTI positive. The attributable cost of serial screening was 55,653.5 USD while that of screening by ELISA only was 55,910 USD. The attributable cost of rapid screening for only hepatitis B and then ELISA was 53,313.9 USD taking into consideration that 187 blood units would be prevented from undue discard. CONCLUSIONS This analysis demonstrated that with proper donor selection, rapid screening for hepatitis B virus only before ELISA screening is more cost-effective. This will also reduce the waiting time for donors and counselling if HIV positive.
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Affiliation(s)
- Adedoyin Owolabi Dosunmu
- Department of Haematology and Blood Transfusion, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | | | - Ayobami Kamal Ismail
- Department of Haematology and Blood Transfusion, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Modupe Adebimpe Olaiya
- Lagos State Blood Transfusion Committee, Lagos Island Maternity Hospital, Lagos, Nigeria
| | - Ebele Ifeyinwa Uche
- Department of Haematology and Blood Transfusion, Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Igbinoba Kingsley Aile
- Department of Haematology and Blood Transfusion, Lagos State University Teaching Hospital, Ikeja, Nigeria
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Yonemura S, Doane S, Keil S, Goodrich R, Pidcoke H, Cardoso M. Improving the safety of whole blood-derived transfusion products with a riboflavin-based pathogen reduction technology. Blood Transfus 2017; 15:357-364. [PMID: 28665269 PMCID: PMC5490732 DOI: 10.2450/2017.0320-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/19/2016] [Indexed: 01/06/2023]
Abstract
Worldwide safety of blood has been positively impacted by technological, economic and social improvements; nevertheless, growing socio-political changes of contemporary society together with environmental changes challenge the practice of blood transfusion with a continuous source of unforeseeable threats with the emergence and re-emergence of blood-borne pathogens. Pathogen reduction (PR) is a proactive strategy to mitigate the risk of transfusion-transmitted infections. PR technologies for the treatment of single plasma units and platelet concentrates are commercially available and have been successfully implemented in more than 2 dozen countries worldwide. Ideally, all labile blood components should be PR treated to ensure a safe and sustainable blood supply in accordance with regional transfusion best practices. Recently, a device (Mirasol® Pathogen Reduction Technology System) for PR treatment of whole blood using riboflavin and UV light has received CE marking, a significant step forward in realising blood safety where WB transfusion is the norm, such as in sub-Saharan Africa and in far-forward combat situations. There is also keen interest in the ability to derive components from Mirasol®-treated whole blood, as it is seen as a more efficient and economical means to implement universal PR in the blood centre environment than treatment of components with different PR systems.
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Affiliation(s)
| | - Suzann Doane
- Terumo BCT, Lakewood, CO, United States of America
| | - Shawn Keil
- Terumo BCT, Lakewood, CO, United States of America
| | - Raymond Goodrich
- Terumo BCT, Lakewood, CO, United States of America
- Infectious Disease Research Center, Colorado State University, Fort Collins, CO, United States of America
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Abstract
Although considerable progress has been made in improving the blood service system in China over the last 2 decades, many challenges remain. A number of issues have received public attentions; however, others continue to be underacknowledged and controversial. This article describes 3 of these important and less emphasized issues: first, the ambiguity of the definition of voluntary nonremunerated blood donation and its relationship to an adequate blood supply; second, the current inadequacies of cost recovery from the blood service system; and third, the lack of a universally implemented program of hemovigilance. Currently, there is controversy regarding these challenges. Open recognition and discussion offers the prospect of bringing solutions closer to reality.
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Affiliation(s)
- Yongming Zhu
- Shanghai Blood Center, WHO Collaborating Center for Blood Transfusion Services, Shanghai, China.
| | - Dongfu Xie
- Shanghai Blood Center, WHO Collaborating Center for Blood Transfusion Services, Shanghai, China
| | - Xun Wang
- Shanghai Blood Center, WHO Collaborating Center for Blood Transfusion Services, Shanghai, China
| | - Kaicheng Qian
- Shanghai Blood Center, WHO Collaborating Center for Blood Transfusion Services, Shanghai, China
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He M, Wang J, Chen L, Liu J, Zeng P. The Impact of Emerging Infectious Diseases on Chinese Blood Safety. Transfus Med Rev 2017; 31:94-101. [PMID: 27923518 PMCID: PMC7126663 DOI: 10.1016/j.tmrv.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/19/2016] [Accepted: 10/24/2016] [Indexed: 12/16/2022]
Abstract
Emerging infectious diseases (EIDs) have always been one of the major threats to public health. Although the implementation of mandatory testing for 4 classical transfusion-transmitted infectious-human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis-has reduced the transfusion risk of these pathogens, the potential threat of various EID agents and their constantly evolving variants to blood safety in China is not fully understood. This review presents 9 representative EID agents that are autochthonous and epidemic nationally or regionally in China. The epidemiologic status and distribution of these EID agents among donors and/or healthy populations are summarized. The potential risks of these EID agents to blood safety are discussed. The review also explores strategies to strengthen hemovigilance systems and studies to further evaluate the impact of EID agents on blood safety.
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Affiliation(s)
- Miao He
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Jingxing Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Limin Chen
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
| | - Jing Liu
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Peibin Zeng
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.
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Cumming M, Osinski A, O'Hearn L, Waksmonski P, Herman M, Gordon D, Griffiths E, Knox K, McHale E, Quillen K, Rios J, Pisciotto P, Uhl L, DeMaria A, Andrzejewski C. Hemovigilance in Massachusetts and the adoption of statewide hospital blood bank reporting using the National Healthcare Safety Network. Transfusion 2017; 57:478-483. [PMID: 27774608 DOI: 10.1111/trf.13872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/26/2016] [Indexed: 11/29/2022]
Abstract
A collaboration that grew over time between local hemovigilance stakeholders and the Massachusetts Department of Public Health (MDPH) resulted in the change from a paper-based method of reporting adverse reactions and monthly transfusion activity for regulatory compliance purposes to statewide adoption of electronic reporting via the National Healthcare Safety Network (NHSN). The NHSN is a web-based surveillance system that offers the capacity to capture transfusion-related adverse events, incidents, and monthly transfusion statistics from participating facilities. Massachusetts' hospital blood banks share the data they enter into NHSN with the MDPH to satisfy reporting requirements. Users of the NHSN Hemovigilance Module adhere to specified data entry guidelines, resulting in data that are comparable and standardized. Keys to successful statewide adoption of this reporting method include the fostering of strong partnerships with local hemovigilance champions and experts, engagement of regulatory and epidemiology divisions at the state health department, the leveraging of existing relationships with hospital NHSN administrators, and the existence of a regulatory deadline for implementation. Although limitations exist, successful implementation of statewide use of the NHSN Hemovigilance Module for hospital blood bank reporting is possible. The result is standardized, actionable data at both the hospital and state level that can facilitate interfacility comparisons, benchmarking, and opportunities for practice improvement.
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Affiliation(s)
- Melissa Cumming
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Anthony Osinski
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Lynne O'Hearn
- Department of Transfusion Medicine and Pathology, Baystate Medical Center
| | - Pamela Waksmonski
- Division of Health Care Facility Licensure and Certification, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Michele Herman
- Department of Pathology, Division of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Deborah Gordon
- Department of Pathology, Heywood Hospital, Gardner, Massachusetts
- Department of Pathology, Athol Memorial Hospital, Athol, Massachusetts
| | - Elzbieta Griffiths
- Department of Pathology, Mount Auburn Hospital, Cambridge, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Kim Knox
- Infection Prevention and Control Department, Milford Regional Medical Center, Milford, Massachusetts
| | - Eileen McHale
- Bureau of Healthcare Safety and Quality, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Karen Quillen
- Department of Pathology & Laboratory Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Jorge Rios
- New England Region American Red Cross Blood Services, Dedham, Massachusetts
| | - Patricia Pisciotto
- New England Region American Red Cross Blood Services, Dedham, Massachusetts
| | - Lynne Uhl
- Department of Pathology, Division of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Alfred DeMaria
- Bureau of Infectious Disease and Laboratory Sciences, Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Chester Andrzejewski
- Department of Transfusion Medicine and Pathology, Baystate Medical Center
- Tufts University School of Medicine, Boston, Massachusetts
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Affiliation(s)
- A Shander
- Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, Estados Unidos de América; TeamHealth Research Institute, Englewood, New Jersey, Estados Unidos de América.
| | - F Gilsanz
- Servicio de Anestesia-Reanimación, Hospital Universitario La Paz, Madrid, España
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Amiral J, Seghatchian J. Measurement of extracellular vesicles as biomarkers of consequences or cause complications of pathological states, and prognosis of both evolution and therapeutic safety/efficacy. Transfus Apher Sci 2016; 55:23-34. [PMID: 27475803 DOI: 10.1016/j.transci.2016.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Utility of EVs, as biomarkers of cause or consequence of various pathological complications, and prognosis of blood components' therapy in terms of safety/efficacy and their potential associated hazards, primed by EVs involvements in pro-inflammatory, immunomodulatory and activations of both pro/anti-coagulatory and others associated pathways, as well as various cellular cross talks, are highlighted as the fundamental. Today EVs are becoming the "buzz" words of the current diagnosis, development and research [DDR] strategies, with the aim of ensuring safer therapeutic approaches in the current clinical practices, also incorporating their potential in long term cost effectiveness in health care systems. The main focus of this manuscript is to review the current opinions in some fundamental areas of EVs involvements in health and diseases. Firstly, our goal is highlighting what are EVs/MVs/MPs and how are they generated in physiology, pathology or blood products; classification and significance of EVs generated in vivo; followed by consequences and physiological/pathological induced effects of EVs generation in vivo. Secondly, specific cell origin EVs and association with malignancy; focus on EVs carrying TF and annexin V as a protective protein for harmful effects of EVs, and associations with LA; and incidence of anti-annexin V antibodies are also discussed. Thirdly, utility of EVs is presented: as diagnostic tools of disease markers; prognosis and follow-up of clinical states; evaluation of therapy efficacy; quality and risk assessment of blood products; followed by the laboratory tools for exploring, characterizing and measuring EVs, and/or their associated activity, using our own experiences of capture based assays. Finally, in perspective, the upcoming low volume sampling, fast, reliable and reproducibility and friendly use laboratory tools and the standardization of measurement methods are highlighted with the beneficial effects that we are witnessing in both wound healing and tissue remodeling, with an expected blockbuster status EVs as future therapeutic directions.
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Affiliation(s)
- Jean Amiral
- Hyphen BioMed, Neuville sur Oise, Paris, France.
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, UK
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Cicchetti A, Berrino A, Casini M, Codella P, Facco G, Fiore A, Marano G, Marchetti M, Midolo E, Minacori R, Refolo P, Romano F, Ruggeri M, Sacchini D, Spagnolo AG, Urbina I, Vaglio S, Grazzini G, Liumbruno GM. Health Technology Assessment of pathogen reduction technologies applied to plasma for clinical use. Blood Transfus 2016; 14:287-386. [PMID: 27403740 PMCID: PMC4942318 DOI: 10.2450/2016.0065-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although existing clinical evidence shows that the transfusion of blood components is becoming increasingly safe, the risk of transmission of known and unknown pathogens, new pathogens or re-emerging pathogens still persists. Pathogen reduction technologies may offer a new approach to increase blood safety. The study is the output of collaboration between the Italian National Blood Centre and the Post-Graduate School of Health Economics and Management, Catholic University of the Sacred Heart, Rome, Italy. A large, multidisciplinary team was created and divided into six groups, each of which addressed one or more HTA domains.Plasma treated with amotosalen + UV light, riboflavin + UV light, methylene blue or a solvent/detergent process was compared to fresh-frozen plasma with regards to current use, technical features, effectiveness, safety, economic and organisational impact, and ethical, social and legal implications. The available evidence is not sufficient to state which of the techniques compared is superior in terms of efficacy, safety and cost-effectiveness. Evidence on efficacy is only available for the solvent/detergent method, which proved to be non-inferior to untreated fresh-frozen plasma in the treatment of a wide range of congenital and acquired bleeding disorders. With regards to safety, the solvent/detergent technique apparently has the most favourable risk-benefit profile. Further research is needed to provide a comprehensive overview of the cost-effectiveness profile of the different pathogen-reduction techniques. The wide heterogeneity of results and the lack of comparative evidence are reasons why more comparative studies need to be performed.
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Affiliation(s)
- Americo Cicchetti
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Alexandra Berrino
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Marina Casini
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Paola Codella
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppina Facco
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Alessandra Fiore
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Marano
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Marco Marchetti
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuela Midolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberta Minacori
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Refolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Romano
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Matteo Ruggeri
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Sacchini
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio G. Spagnolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Irene Urbina
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Giuliano Grazzini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
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Blood transfusions for malaria 'could be made safer'. Community Pract 2016; 89:8. [PMID: 27443021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Johns DM, Bayer R, Fairchild AL. Evidence and the Politics of Deimplementation: The Rise and Decline of the "Counseling and Testing" Paradigm for HIV Prevention at the US Centers for Disease Control and Prevention. Milbank Q 2016; 94:126-62. [PMID: 26994712 PMCID: PMC4941977 DOI: 10.1111/1468-0009.12183] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
POLICY POINTS In situations of scientific uncertainty, public health interventions, such as counseling for HIV infection, sometimes must be implemented before obtaining evidence of efficacy. The history of HIV counseling and testing, which served as the cornerstone of HIV prevention efforts at the US Centers for Disease Control and Prevention (CDC) for a quarter of a century, illustrates the influence of institutional resistance on public health decision making and the challenge of de-implementing well-established programs. CONTEXT In 1985, amid uncertainty about the accuracy of the new test for HIV, public health officials at the Centers for Disease Control and Prevention (CDC) and AIDS activists agreed that counseling should always be provided both before and after testing to ensure that patients were tested voluntarily and understood the meaning of their results. As the "exceptionalist" perspective that framed HIV in the early years began to recede, the purpose of HIV test counseling shifted over the next 30 years from emphasizing consent, to providing information, to encouraging behavioral change. With this increasing emphasis on prevention, HIV test counseling faced mounting doubts about whether it "worked." The CDC finally discontinued its preferred test counseling approach in October 2014. METHODS Drawing on key informant interviews with current and former CDC officials, behavioral scientists, AIDS activists, and others, along with archival material, news reports, and scientific and governmental publications, we examined the origins, development, and decline of the CDC's "counseling and testing" paradigm for HIV prevention. FINDINGS Disagreements within the CDC emerged by the 1990s over whether test counseling could be justified on the basis of efficacy and cost. Resistance to the prospect of policy change by supporters of test counseling in the CDC, gay activists for whom counseling carried important ethical and symbolic meanings, and community organizations dependent on federal funding made it difficult for the CDC to de-implement the practice. CONCLUSIONS Analyses of changes in public health policy that emphasize the impact of research evidence produced in experimental or epidemiological inquiries may overlook key social and political factors involving resistance to deimplementation that powerfully shape the relationship between science and policy.
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Affiliation(s)
- David Merritt Johns
- Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University
| | - Ronald Bayer
- Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University
| | - Amy L Fairchild
- Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University
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Knutson F, Osselaer J, Pierelli L, Lozano M, Cid J, Tardivel R, Garraud O, Hervig T, Domanovic D, Cukjati M, Gudmundson S, Hjalmarsdottir IB, Castrillo A, Gonzalez R, Brihante D, Santos M, Schlenke P, Elliott A, Lin JS, Tappe D, Stassinopoulos A, Green J, Corash L. A prospective, active haemovigilance study with combined cohort analysis of 19,175 transfusions of platelet components prepared with amotosalen-UVA photochemical treatment. Vox Sang 2015; 109:343-52. [PMID: 25981525 PMCID: PMC4690512 DOI: 10.1111/vox.12287] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 03/24/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES A photochemical treatment process (PCT) utilizing amotosalen and UVA light (INTERCEPT(™) Blood System) has been developed for inactivation of viruses, bacteria, parasites and leucocytes that can contaminate blood components intended for transfusion. The objective of this study was to further characterize the safety profile of INTERCEPT-treated platelet components (PCT-PLT) administered across a broad patient population. MATERIALS AND METHODS This open-label, observational haemovigilance programme of PCT-PLT transfusions was conducted in 21 centres in 11 countries. All transfusions were monitored for adverse events within 24 h post-transfusion and for serious adverse events (SAEs) up to 7 days post-transfusion. All adverse events were assessed for severity (Grade 0-4), and causal relationship to PCT-PLT transfusion. RESULTS Over the course of 7 years in the study centres, 4067 patients received 19,175 PCT-PLT transfusions. Adverse events were infrequent, and most were of Grade 1 severity. On a per-transfusion basis, 123 (0.6%) were classified an acute transfusion reaction (ATR) defined as an adverse event related to the transfusion. Among these ATRs, the most common were chills (77, 0.4%) and urticaria (41, 0.2%). Fourteen SAEs were reported, of which 2 were attributed to platelet transfusion (<0.1%). No case of transfusion-related acute lung injury, transfusion-associated graft-versus-host disease, transfusion-transmitted infection or death was attributed to the transfusion of PCT-PLT. CONCLUSION This longitudinal haemovigilance safety programme to monitor PCT-PLT transfusions demonstrated a low rate of ATRs, and a safety profile consistent with that previously reported for conventional platelet components.
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Affiliation(s)
- F Knutson
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - J Osselaer
- Cliniques Universitaires de Mont Godinne, Universite Catholique de Louvain, Yvoir, Belgium
| | - L Pierelli
- Department of Experimental Medicine, Sapienza University of Roma, Rome, Italy
| | - M Lozano
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - J Cid
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | | | - O Garraud
- EFS Auvergne Loire, St. Etienne, France
| | - T Hervig
- Department of Immunology and Transfusion Medicine, University of Bergen, Bergen, Norway
| | - D Domanovic
- Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - M Cukjati
- Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - S Gudmundson
- Blood Bank, National University Hospital, Reykjavik, Iceland
| | | | - A Castrillo
- Transfusion Centre of Galicia, Santiago de Compostela, Spain
| | - R Gonzalez
- Transfusion Centre of Galicia, Santiago de Compostela, Spain
| | - D Brihante
- Servico de Imuno-Hemoterapia, Instituto Portugues de Oncologia de Lisboa, Lisbon, Portugal
| | - M Santos
- Servico de Imuno-Hemoterapia, Instituto Portugues de Oncologia de Lisboa, Lisbon, Portugal
| | - P Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | | | - J-S Lin
- Cerus Corporation, Concord, CA, USA
| | - D Tappe
- Cerus Corporation, Concord, CA, USA
| | | | - J Green
- Cerus Corporation, Concord, CA, USA
| | - L Corash
- Cerus Corporation, Concord, CA, USA
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Herrmann IK, Schlegel AA, Graf R, Stark WJ, Beck-Schimmer B. Magnetic separation-based blood purification: a promising new approach for the removal of disease-causing compounds? J Nanobiotechnology 2015; 13:49. [PMID: 26253109 PMCID: PMC4528690 DOI: 10.1186/s12951-015-0110-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/29/2015] [Indexed: 01/02/2023] Open
Abstract
Recent studies report promising results regarding extracorporeal magnetic separation-based blood purification for the rapid and selective removal of disease-causing compounds from whole blood. High molecular weight compounds, bacteria and cells can be eliminated from blood within minutes, hence offering novel treatment strategies for the management of intoxications and blood stream infections. However, risks associated with incomplete particle separation and the biological consequences of particles entering circulation remain largely unclear. This article discusses the promising future of magnetic separation-based purification while keeping important safety considerations in mind.
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Affiliation(s)
- I K Herrmann
- Institute of Anesthesiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
| | - A A Schlegel
- Department of Surgery, Swiss HPB and Transplant Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - R Graf
- Department of Surgery, Swiss HPB and Transplant Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - W J Stark
- Institute for Chemical and Bioengineering, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093, Zurich, Switzerland.
| | - Beatrice Beck-Schimmer
- Institute of Anesthesiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
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Irsch J, Seghatchian J. Update on pathogen inactivation treatment of plasma, with the INTERCEPT Blood System: Current position on methodological, clinical and regulatory aspects. Transfus Apher Sci 2015; 52:240-4. [PMID: 25824703 DOI: 10.1016/j.transci.2015.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
After the INTERCEPT Blood System for pathogen inactivation (PI) of plasma was locally validated and approved and is now in routine use in Portugal, a conference was arranged in Portugal, by the IPST, in Coimbra, on 19th November 2014. One of the presentations informed about the current status of the INTERCEPT technology for plasma and a subsequent round table discussion, focused on the methodological and logistical aspects as well as on the experience from clinical studies and routine therapeutic use of INTERCEPT treated plasma units. Moreover, in view of current interests, both the global regulatory issues and hemovigilance data obtained were highlighted. This manuscript provides a brief summary of what has been discussed during presentations and the Q/A round table session. It was agreed between speaker and the moderator of the session to report a consensus opinion on the importance of INTERCEPT to improve the safety of plasma products in a standardized way in terms of quality indicators of hemostasis and the clinical effectiveness as well as the reliability of the technology for plasma pathogen inactivation, to be reported as part of a theme section from Portugal and to be published in Transfusion Apheresis Science in early 2015. The session started showing the beneficial advantages of the INTERCEPT technology, which has already become the standard of practice in Portugal and in more than 20 other countries, and then highlighted some of the methodological and global quality/clinical aspects, which are not usually discussed. We hope the topic discussed here would be of interest to readers of Transfusion Apheresis Science.
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Affiliation(s)
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection, and DDR Strategy, London, UK
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Neisser-Svae A, Seghatchian J. The state of the art of removal of prion proteins in SD-FFP, by specific prion affinity chromatography and its impact on the hemostatic characteristics of the product. Transfus Apher Sci 2015; 52:237-9. [PMID: 25748229 DOI: 10.1016/j.transci.2015.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent Coimbra' Conference, on the pre-launch of pathogen reduced-FFP for the local clinical use, the question was raised, by the moderator, on the efficacy of the current methodology used for prion removal processes and its influence on the overall quality and safety of the final product. This brief paper put together by speaker of this session and the moderator, as a consensus of opinions, which was largely discussed during Q&A session, to make it available to a large group of readers of transfusion apheresis science, who might be interested to this topic. In short the capacity of the current process of Octaplas to remove prion is in order of 5.6 log10/ID50 reduction based on several animal studies. Moreover the changes in coagulation and inhibitors are within acceptable range and bioequivalent to untreated FFP with no sign of inferiority. This paper describes in brief a technology update on solvent/detergent treated plasma, an alternative to FFP but with increased pathogen safety. The biochemical profile of the final product is comparable with FFP and contains all clinically relevant plasma proteins. Furthermore, Octaplas is a product that, in long term, reduces health care costs.
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Affiliation(s)
- Andrea Neisser-Svae
- Vice President Scientific & Medical Affairs, Intensive Care & Emergency Medicine. Octapharma USA, 121 River Street, Hoboken, New Jersey 07030, USA.
| | - Jerard Seghatchian
- International Consultant in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategy, London, UK.
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Tsen SWD, Kingsley DH, Kibler K, Jacobs B, Sizemore S, Vaiana SM, Anderson J, Tsen KT, Achilefu S. Pathogen reduction in human plasma using an ultrashort pulsed laser. PLoS One 2014; 9:e111673. [PMID: 25372037 PMCID: PMC4221090 DOI: 10.1371/journal.pone.0111673] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/27/2014] [Indexed: 11/18/2022] Open
Abstract
Pathogen reduction is a viable approach to ensure the continued safety of the blood supply against emerging pathogens. However, the currently licensed pathogen reduction techniques are ineffective against non-enveloped viruses such as hepatitis A virus, and they introduce chemicals with concerns of side effects which prevent their widespread use. In this report, we demonstrate the inactivation of both enveloped and non-enveloped viruses in human plasma using a novel chemical-free method, a visible ultrashort pulsed laser. We found that laser treatment resulted in 2-log, 1-log, and 3-log reductions in human immunodeficiency virus, hepatitis A virus, and murine cytomegalovirus in human plasma, respectively. Laser-treated plasma showed ≥70% retention for most coagulation factors tested. Furthermore, laser treatment did not alter the structure of a model coagulation factor, fibrinogen. Ultrashort pulsed lasers are a promising new method for chemical-free, broad-spectrum pathogen reduction in human plasma.
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Affiliation(s)
- Shaw-Wei D. Tsen
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri, United States of America
| | - David H. Kingsley
- U. S. Department of Agriculture, Agricultural Research Service, Food Safety and Intervention Technologies Research Unit, James W. W. Baker Center, Delaware State University, Dover, Delaware, United States of America
| | - Karen Kibler
- Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
| | - Bert Jacobs
- Biodesign Institute, Arizona State University, Tempe, Arizona, United States of America
| | - Sara Sizemore
- Department of Physics, Arizona State University, Tempe, Arizona, United States of America
- Center for Biophysics, Arizona State University, Tempe, Arizona, United States of America
| | - Sara M. Vaiana
- Department of Physics, Arizona State University, Tempe, Arizona, United States of America
- Center for Biophysics, Arizona State University, Tempe, Arizona, United States of America
| | - Jeanne Anderson
- Department of Hematology, Barnes Jewish Hospital, St Louis, Missouri, United States of America
| | - Kong-Thon Tsen
- Department of Physics, Arizona State University, Tempe, Arizona, United States of America
- Center for Biophysics, Arizona State University, Tempe, Arizona, United States of America
| | - Samuel Achilefu
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri, United States of America
- Biochemistry and Molecular Biophysics, Washington University School of Medicine, St Louis, Missouri, United States of America
- Biomedical Engineering, Washington University School of Medicine, St Louis, Missouri, United States of America
- * E-mail:
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38
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Harm SK, Delaney M, Aubuchon JP, Triulzi DJ, Yazer MH. Letter on Bacterial contamination in platelet concentrates. Vox Sang 2014; 107:312. [PMID: 25040131 DOI: 10.1111/vox.12170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/07/2014] [Indexed: 11/30/2022]
Affiliation(s)
- S K Harm
- Department of Pathology, The Institute for Transfusion Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Shittu AO, Olawumi HO, Adewuyi JO. Pre-donation screening of blood for transfusion transmissible infections: the gains and the pains - experience at a resource limited blood bank. Ghana Med J 2014; 48:158-62. [PMID: 25709126 PMCID: PMC4335446 DOI: 10.4314/gmj.v48i3.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To determine whether or not pre-donation testing of blood donors affords substantial cost savings without compromise to blood transfusion safety. Pre-donation testing of blood donors for Transfusion Transmissible Infections (TTIs) is done in most developing countries because substantial cost savings are made from resources, materials and man-hours which would have been spent to procure infected blood units. Simple rapid test kits used in pre-donation testing is not as sensitive as the Enzyme Linked Immuno-sorbent Assay (ELISA) method used in post-donation screening in a quality assured manner. DESIGN It is a retrospective study where records of pre- and post-donation tests done in donor clinic of University of Ilorin Teaching Hospital, between January and December 2010 were retrieved. All processes and inputs were evaluated and costs calculated for pre-donation testing by simple rapid techniques and post donation screening by ELISA. RESULTS 5000 prospective donors were tested in the study period. The cost of single rapid Pre-donation testing was less than that of single ELISA Post-donation screen. The cost of double rapid Pre-donation and Post donation ELISA screen exceeded the cost of single post donation ELISA screen. Substantial cost savings were made when single rapid Pre-donation testing is relied on. More blood units were found reactive for the TTIs with the more expensive Post-donation ELISA. CONCLUSION Pre-donation testing of blood donors was not cost effective. Although, there is an apparent savings if pre-donation testing is not followed by post-donation ELISA testing, it is done at a compromise to blood transfusion safety.
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Affiliation(s)
- A O Shittu
- Department of Haematology and Blood Transfusion, University of Ilorin
| | - H O Olawumi
- Department of Haematology and Blood Transfusion, University of Ilorin
| | - J O Adewuyi
- Department of Haematology and Blood Transfusion, University of Ilorin
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40
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Klamroth R, Gröner A, Simon TL. Pathogen inactivation and removal methods for plasma-derived clotting factor concentrates. Transfusion 2014; 54:1406-17. [PMID: 24117799 PMCID: PMC7169823 DOI: 10.1111/trf.12423] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/26/2013] [Accepted: 08/01/2013] [Indexed: 11/28/2022]
Abstract
Pathogen safety is crucial for plasma-derived clotting factor concentrates used in the treatment of bleeding disorders. Plasma, the starting material for these products, is collected by plasmapheresis (source plasma) or derived from whole blood donations (recovered plasma). The primary measures regarding pathogen safety are selection of healthy donors donating in centers with appropriate epidemiologic data for the main blood-transmissible viruses, screening donations for the absence of relevant infectious blood-borne viruses, and release of plasma pools for further processing only if they are nonreactive for serologic markers and nucleic acids for these viruses. Despite this testing, pathogen inactivation and/or removal during the manufacturing process of plasma-derived clotting factor concentrates is required to ensure prevention of transmission of infectious agents. Historically, hepatitis viruses and human immunodeficiency virus have posed the greatest threat to patients receiving plasma-derived therapy for treatment of hemophilia or von Willebrand disease. Over the past 30 years, dedicated virus inactivation and removal steps have been integrated into factor concentrate production processes, essentially eliminating transmission of these viruses. Manufacturing steps used in the purification of factor concentrates have also proved to be successful in reducing potential prion infectivity. In this review, current techniques for inactivation and removal of pathogens from factor concentrates are discussed. Ideally, production processes should involve a combination of complementary steps for pathogen inactivation and/or removal to ensure product safety. Finally, potential batch-to-batch contamination is avoided by stringent cleaning and sanitization methods as part of the manufacturing process.
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Affiliation(s)
- Robert Klamroth
- Center for Vascular MedicineVivantes Klinikum im FriedrichshainBerlinGermany
| | - Albrecht Gröner
- Preclinical Research and Development, Pathogen SafetyCSL BehringMarburgGermany
| | - Toby L. Simon
- Plasma Research and Development/CSL PlasmaCSL BehringKing of PrussiaPennsylvania
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Samokhvalov IM, Karev EA, Badalov VI, Nemchenko NS, Vasil'ev MA, Zhirnova NA, Meshakov DP, Litvinenko SG, Golovko KP, Denisov AV, Dmitrieva EV. [Safety criteria for blood refusion in military field surgery and trauma surgery]. Voen Med Zh 2014; 335:26-30. [PMID: 25046933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Massive intracavitary hemorrhage in case if severe concomitant injury is the most frequent cause of death. Necessity of blood loss replacement requires effective and safe methods. One of them is blood reinfusion - technically less complicated method. The article shows advantages of using the hardware and filtration methods of blood sampling and reinfusion, developed scale rapid diagnosis of the level of hemolysis of autologous blood. Using of the method of filtration blood sampling provides 2X minimal amount of free hemoglobin than using an aspirator and reinfusion of blood with the contents therein to free hemoglobin 2.0g/ L prevents the risk of developing the syndrome and massive blood transfusion reduces the incidence of deaths at 11%. In patients with massive intracavitary hemorrhage it is advisable to use the method of semi-quantitative rapid analysis of free hemoglobin color scale.
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Busby H, Kent J, Farrell AM. Revaluing donor and recipient bodies in the globalised blood economy: transitions in public policy on blood safety in the United Kingdom. Health (London) 2014; 18:79-94. [PMID: 23467898 PMCID: PMC3930469 DOI: 10.1177/1363459313476966] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The clinical use of blood has a long history, but its apparent stability belies the complexity of contemporary practices in this field. In this article, we explore how the production, supply and deployment of blood products are socially mediated, drawing on theoretical perspectives from recent work on 'tissue economies'. We highlight the ways in which safety threats in the form of infections that might be transmitted through blood and plasma impact on this tissue economy and how these have led to a revaluation of donor bodies and restructuring of blood economies. Specifically, we consider these themes in relation to the management of recent threats to blood safety in the United Kingdom. We show that the tension between securing the supply of blood and its products and ensuring its safety may give rise to ethical concerns and reshape relations between donor and recipient bodies.
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Gehrie E, Keiser A, Dawling S, Travis J, Strathmann F, Booth GS. Primary prevention of pediatric lead exposure requires new approaches to transfusion screening. J Pediatr 2013; 163:855-9. [PMID: 23582137 PMCID: PMC4795168 DOI: 10.1016/j.jpeds.2013.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/22/2013] [Accepted: 03/04/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To facilitate further assessment of transfusion-associated lead exposure by designing a procedure to test packed red blood cells (pRBCs) prepared for transfusion. STUDY DESIGN The relationship between pRBCs and whole blood lead concentration was investigated in 27 samples using a modified clinical assay. Lead concentrations were measured in 100 pRBC units. RESULTS Our sample preparation method demonstrated a correlation between whole blood lead and pRBC lead concentrations (R(2) = 0.82). In addition, all 100 pRBC units tested had detectable lead levels. The median pRBC lead concentration was 0.8 μg/dL, with an SD of 0.8 μg/dL and a range of 0.2-4.1 μg/dL. In addition, after only a few days of storage, approximately 25% of whole blood lead was found in the supernatant plasma. CONCLUSION Transfusion of pRBCs is a source of lead exposure. Here we report the quantification of lead concentration in pRBCs. We found a >20-fold range of lead concentrations in the samples tested. Pretransfusion testing of pRBC units according to our proposed approach or donor screening of whole blood lead and selection of below-average units for transfusion to children would diminish an easily overlooked source of pediatric lead exposure.
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Affiliation(s)
- Eric Gehrie
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Amaris Keiser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sheila Dawling
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - James Travis
- ARUP Institute for Clinical and Experimental Pathology, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Frederick Strathmann
- ARUP Institute for Clinical and Experimental Pathology, University of Utah Health Sciences Center, Salt Lake City, UT
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Garrett S. Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
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Neoh K, Zanker C, Bennett M. Mechanism based treatments for anaemia in advanced cancer. BMJ 2013; 347:f5002. [PMID: 23935086 DOI: 10.1136/bmj.f5002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- Michael F Murphy
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford OX3 9BQ, UK
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Affiliation(s)
- Cheryl A Lobo
- Department of Blood-Borne Parasites, Lindsley Kimball Research Institute, New York Blood Center, New York, New York, United States of America.
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Balint B, Vucetic D, Todorovic-Balint M, Borovcanin N, Jovanovic-Cupic S, Mandusic V. Safety improving by complementary serological and molecular testing combined with pathogen reduction of the donated blood in window period. Transfus Apher Sci 2013; 49:103-4. [PMID: 23820432 DOI: 10.1016/j.transci.2012.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 09/18/2012] [Indexed: 12/11/2022]
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Hechler B, Ohlmann P, Chafey P, Ravanat C, Eckly A, Maurer E, Mangin P, Isola H, Cazenave JP, Gachet C. Preserved functional and biochemical characteristics of platelet components prepared with amotosalen and ultraviolet A for pathogen inactivation. Transfusion 2013; 53:1187-200. [PMID: 23067365 DOI: 10.1111/j.1537-2995.2012.03923.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 07/23/2012] [Accepted: 08/15/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND Platelet concentrate (PC) functionality decreases during storage. This is referred to as the storage lesion. Pathogen inactivation may accelerate or induce lesions, potentially accounting for reduced viability. Our aim was to characterize functional and biochemical properties of platelets (PLTs) from photochemically treated buffy-coat PCs (PCT-PCs) compared to those from conventional PCs. STUDY DESIGN AND METHODS Four PCT-PCs and four conventional PCs were stored for 6.5 days and PLT function and proteomic profiles were examined at various time points during storage. To evaluate their intrinsic properties, samples of stored PLTs were taken, washed, and suspended in Tyrode's buffer before testing. RESULTS PLT counts and morphology were conserved although a slight increase in the PLT volume was observed after PCT. Glycoprotein (GP) IIbIIIa, IaIIa, and VI expression remained stable while GPIbα declined similarly in both types of PCs. A steep decrease (50%) in GPV occurred on Day 1.5 in PCT-PCs and Day 2.5 in control PCs. For both PCT- and control PCs, P-selectin expression and activated GPIIbIIIa remained low during storage. PCT- and control PCs were fully responsive to aggregation agonists up to Day 4.5 and exhibited similar perfusion functionality. Mitochondrial membrane potential and annexin A5 binding of PCT-PCs and control PCs were comparable. Two-dimensional differential in-gel electrophoresis and mass spectrometry profiles for 1882 protein spots revealed only three proteins selectively changed in PCT-PCs compared to control-PCs. CONCLUSION Washed treated and untreated PCs have similar functional, morphologic, and proteomic characteristics provided that PLTs are suspended in an appropriate medium during testing.
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Affiliation(s)
- Béatrice Hechler
- INSERM, UMR_S949, Université de Strasbourg, Etablissement Français du Sang-Alsace (EFS-Alsace), Strasbourg, France
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Abstract
BACKGROUND Chagas disease is a parasitic infection by Trypanosoma cruzi, typically transmitted via infected triatomine bug fecal contamination of bite sites. Other routes of infection include congenital, oral, organ transplantation, and blood product transmission. STUDY DESIGN AND METHODS From 2007 until 2011, New York Blood Center screened donations for the presence of T. cruzi antibodies using a Food and Drug Administration-approved test. Confirmatory testing was performed and recipients of units donated by confirmed-positive donors were investigated via lookback. RESULTS A total of 204 donors were T. cruzi antibody positive representing 0.019% of all donors during this time period (1,066,516 unique donors screened). Of the enzyme-linked immunosorbent assay-reactive donors, 77 were confirmed positive by radioimmunoprecipitation assay (0.007%). At least 154 units from 29 of the confirmed-positive donors had been transfused to 141 recipients. At the time of lookback, 48 of the 141 recipients were alive and seven underwent T. cruzi screening. Two recipients were found to be immunofluorescence assay (IFA) positive. Both IFA-positive recipients received a leukoreduced apheresis platelet unit (two separate donations) from the same confirmed positive donor, a 72-year-old immigrant from Argentina. CONCLUSIONS Lookback analysis was able to identify the first two cases of probable transfusion-transmitted T. cruzi infection since implementation of the national screening program, which increases the total number of reported cases in the United States to 8.
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