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Transfusion-Transmitted Diseases
Mudassar Zia, MD, Fellow, Department of Internal Medicine, Division of Geriatrics, Duke University Health System
Hesham M Taha, MD, FACP, MRCP(UK), Attending Physician, Department of Internal Medicine, Division of Hematology/Oncology,
Nassau University Medical Center
Updated: Nov 7, 2008

Introduction
Blood transfusion has been and continues to be a possible source of disease transmission, but the safety of the blood
supply in the United States continues to improve. In fact, the blood supply is the safest that it has ever been.

Potentially, a myriad of agents can be transmitted through blood transfusions, including bacteria, viruses, and parasites.

Transfusion-Transmitted Bacterial Infections

The most common infective agents to be transmitted through blood transfusion are, in fact, bacteria. A mute testimony to
this fact is extensive data from studies like the French Haemovigilance Bacthem study (regarding determinants of
transfusion-associated bacterial contamination),[1 ]the US BaCon study (regarding transfusion-transmitted bacterial
contamination in the US from 1998 through 2000),[2 ]and the United Kingdom Serious Hazard of Transfusion (SHOT)
program (data collection in the UK and Ireland regarding deaths or major complications of transfusion of blood or its
components).[3 ]The incidence of bacterial transmission depends on the blood product and also on the definition of the
cases.

The estimated residual risk of contamination of blood products with bacterial agents is 1 in 5,000 for platelets and 1 in
30,000 for red blood cells.[2,4 ]It has been proposed that the higher incidence of bacterial transmission via platelets is due
to the difference in the storage temperatures. Also important is the duration of storage, which has a direct correlation with
the likelihood of bacterial contamination.[5,6,7 ]

An important concept in the evaluation of data regarding transfusion-transmitted bacterial infections (TTBIs) is the
definition of a case. The Bacthem study provided widely accepted criteria based upon separation of the cases into
possible, probable, and definite contamination, and they are defined as follows[1 ]:

Possible contamination: The blood culture from a recipient grows a bacterial pathogen, with documentation of no
other apparent source, but there is failure to isolate the same bacteria from the donor blood product, either
because the culture is negative or it could not be done.

Probable contamination: The blood culture from the recipient is negative or could not be done, but there is definite
bacterial growth in the donor blood product.

Definite contamination: The blood culture from the recipient and the donor blood product grow the same bacteria.

Another intriguing dimension to TTBI is the fact that bacterial contamination per se does not mean definite production of
clinical disease in the recipient. Likely causes of this discrepancy include the following:

Insufficient bacterial inocula that may result in a positive culture from the donor product or the recipient but which is
not sufficient to produce clinical signs and symptoms

Infectivity and virulence of the bacteria under consideration

Contamination of the blood during testing procedures

Microbiologic spectrum of transfusion-transmitted bacterial contamination

The bacteria and, for that matter, any infective agent that potentially evades the sterility of the transfusion loop can come
from the donor's blood or skin and a contaminated environment. There is a multitude of microorganisms that are isolated

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from contaminated blood products. There is also a wide variation in the species of bacteria that is reported from different
parts of the world. Some of these organisms and species include the following:

The Bacthem study,[1 ]BaCon study,[2 ]and SHOT program[3 ]found a similar range of microorganisms. Isolates
from the Bacthem study included Yersinia, Proteus, Pseudomonas, Escherichia, Klebsiella, Acinetobacter, and
Serratia. Among gram-positive organisms, Propionibacterium, Staphylococcus, Bacillus, and Enterococcus were
isolated.

The Japanese Red Cross reported Propionibacterium acnes as the most common bacterial contaminant.[8 ]

Coagulase-negative staphylococci were the most common bacteria isolated, as reported from blood banks in
Holland.[9 ]

Some investigators have reported Yersinia enterocolitica as the most common isolate in TTBI. This organism is
capable of growing and multiplying at low temperatures, which may increase its chances of survival during storage
of blood products.[10 ]

Clinical features of TTBI

Although TTBI can produce a wide variety of clinical symptoms, including death, fever (>102 degrees F, or a >3.6
degrees F increase from the pretransfusion baseline), rigors, tachycardia, or an increase in heart rate by greater
than 40 bpm from the baseline and a fall of systolic blood pressure greater than 30 mm Hg is highly suggestive of the
condition. Chills and fever are the most commonly reported symptoms. Other clues include backache, abdominal pain,
vomiting, and hypothermia.[1,2 ]

As soon as TTBI is suspected, the following course of action should be taken:

Stop the transfusion.

Aggressively hydrate and resuscitate the patient.

Make sure the symptoms are not due to a mismatched blood product because of a clerical error, and make the
blood bank aware of the possibility of an infection. The blood product should be sent for a culture and Gram stain in
an attempt to confirm TTBI and to isolate bacteria.

Repeat the type and cross-match, and also collect blood for a Coombs test and bacterial culture from the recipient.

The patient should be started on empiric parenteral antibiotics until isolation of an agent is available to help in
narrowing down the antibiotic coverage.

In order to prevent an infective incident, strict sterile precautions and donor screening are required.[11,12,13,14,15,16 ]

Donors who are febrile and likely infected should be deferred.

Chlorhexidine or iodine should be used to to properly disinfect the venepuncture site.

The initial aliquot of donor blood should be discarded to prevent contamination with the skin flora.

Attempt to identify bacterial contamination by laboratory methods. This is especially important for platelet
products. Identification can be done by culture method or nonculture methods, including Gram staining, metabolic
screening for markers of contamination, etc. A negative culture for 24-48 hours before the product is released for
transfusion is highly recommended.

Bactericidally treat the donated blood.

Transfusion-Transmitted Viral Infections

HIV

HIV is a member of the Lentivirus family of retroviruses. It is the causative agent of acquired immunodeficiency syndrome
(AIDS). The estimated number of HIV-infected people in the US ranges from 850,000 to 950,000.[17 ]Individuals who

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engage in male-male sexual behavior are the largest group of patients at risk,[18 ]and less than 1% of HIV cases are
attributed to blood or blood product transfusions. Note: The risk of transmission of HIV through blood products is 1 in 2
million units (2,135,000) in the US, 1 in 7.8-10 million units in Canada, and 1 in 1 million to 1 in 5 million in parts of Europe.
[19,20,21 ]

With the 2002-2003 licensure of HIV minipool nucleic acid testing (MP-NAT), HIV-1 p24 antigen testing has been
eliminated as a blood donor screening test, because the window period reduction that is achieved with this assay is only 6
days as compared with a window period reduction of approximately 11 days for NAT. MP-NAT detects viral RNA rather
than the p24 protein; because the viral RNA appears in blood before p24, an infection can be detected earlier and, hence,
the window period is reduced. Furthermore, all p24-antigen–positive, anti-HIV–negative donors are positive by HIV
MP-NAT.[22,23,24 ]HIV-positive individuals are permanently deferred from blood donations.

HBV

HBV is a Hepadna virus that is capable of withstanding extreme temperatures and humidity. The viral genome consists of
a partially double-stranded circular DNA of 3.2 kilobase (kb) pairs that encodes 4 overlapping, open reading frames.
Hepatitis B is a worldwide healthcare problem, especially in developing areas. An estimated one third of the global
population has been infected with HBV. Approximately 300 million people are lifelong carriers, and only 2% spontaneously
seroconvert annually. In the US, 300,000 cases of acute HBV disease are reported to the Centers for Disease Control
and Prevention (CDC).[25 ]

HBV is transmitted hematogenously and sexually. The outcome of this infection ranges from a complicated viral-host
interaction that results in either an acute symptomatic disease, an asymptomatic disease, or a chronic carrier state. Later
consequences are cirrhosis and the development of hepatocellular carcinoma (HCC). Note: The residual risk of
transmission of HBV is estimated to be close to 270,000 in the US and 1 in 70,000 to 1,000,000 units in various parts of
Europe.[26 ]

Hepatitis B surface antigen (HBsAg) detection is a routine in many parts of the world. However, some chronic carriers have
such a low viral load that screening by HBsAg may not be able to detect the infection in the donor. To overcome this
obstacle, many blood banks in several countries also attempt to detect antibody against the hepatitis B core antigen
(anti-HBcAg or anti-HBc).[27,28 ]

The core antibody develops early in the course of the infection and remains positive even in patients with
low-level viremia. Hepatitis B poses another problem in some chronically infected people in whom HBV DNA is present in
the blood products, but also in whom HBsAg is not detectable and anti-HBc is also equivocal. NAT has tremendous
potential in this area of transfusion medicine.[21,29,30 ]Hepatitis B–positive donors are permanently deferred from giving
blood.

Hepatitis A and Hepatitis E

The hepatitis A virus (HAV) is a single-stranded RNA enterovirus and a member of the Picornaviridae family. In humans,
viral replication depends on hepatocyte uptake and synthesis, and assembly occurs exclusively in liver cells. The common
method of HAV transmission is via the feco-oral route, but the infection may also rarely be transmitted through blood
transfusion.[31,32 ]

The hepatitis E virus (HEV) is classified in the Caliciviridae family and has many similarities with HAV. The common mode
of transmission is also feco-oral, but HEV may also be transfusion transmitted.[33,34 ]

Both of these nonenveloped viruses are not inactivated by the methods used in the production of blood components
subjected to plasma fractionation and processed by solvent and detergent methods alone.[31,32,33,34 ]

HCV

HCV is a spherical, enveloped, single-stranded RNA virus belonging to the Flaviviridae family. The World Health
Organization (WHO) estimates 170 million individuals worldwide are infected with HCV, with a wide variation in the
prevalence of the disease. For example, in 2000, Frank et al reported that Egypt had the highest number of reported HCV
infections, largely attributed to the use of contaminated, parenteral, antischistosomal therapy.[35 ]This led to a mean 22%
prevalence of HCV antibodies in persons living in Egypt. According to the CDC, an estimated 1.8% of the US population is
positive for HCV antibodies.[23,27,36 ]

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HCV is predominantly transmitted by means of percutaneous exposure to infected blood. In developed countries, most
new HCV infections are related to intravenous drug abuse and are found because of intensive screening and lookback
programs. The screening of blood donors for the HCV antibody since 1990 has decreased the risk of transfusion-
associated HCV infection to less than 1 case in 103,000 transfused units. The use of polymerase chain reaction (PCR)
has reduced the risk of acquiring HCV from blood transfusions to 1 in 230,000 donations. The newer assays have
decreased the window period after infection to 1-2 weeks.[19,20,21,36 ]

Blood transfusion was a major risk for acute HCV infection in the past, with more than 10% of transfusion recipients
acquiring the infection in some studies.[26 ]The screening of blood donors by donor history and elevated serum alanine
aminotransferase (ALT) caused a striking reduction of non-A, non-B posttransfusion hepatitis, even before HCV was
identified. The subsequent initiation of donor screening for anti-HCV antibodies in 1990 has nearly eliminated the risk of
posttransfusion acute HCV infection.[26 ]

Detection of HCV infection by MP-NAT is the standard of care in the US for the detection of the viral RNA. The HCV
MP-NAT has reduced the window period for the detection of infection by 80-90% when compared with HCV testing by
detection of antibodies.[22 ]Hepatitis C–positive donors are permanently deferred from blood donations.

West Nile Virus

West Nile virus (WNV) is a flavivirus, and it is transmitted by mosquito bite. The organism has the potential of being
transmitted through blood. The infection is usually asymptomatic and goes undetected, but it may cause
meningoencephalitis, especially in individuals who are older and who have a depressed immunity, with a mortality rate of
about 2.6%. In 2002, there were about 9858 cases of WNV infection reported to the CDC.[37,38 ]

There are 2 important properties of WNV when compared with HCV, which is also a flavivirus. First, the transmission of
WNV is seasonal, unlike HCV, and second, even though a low-level viremia may exist for several months in the presence
of immunoglobulin M (IgM), transmission occurs from donors who are acutely infected.[39,40,41 ]

The current strategy to break the chain of WNV transmission via blood is NAT. MP-NAT is done in the US to detect the
viral infection. An intriguing situation is the high risk of residual transmission in some early phase viremic patients. Thus,
NAT is used on individual donor samples (ie, individual donation nucleic acid testing [ID-NAT]) to detect these low-level
viremic patients instead of pool testing (ie, MP-NAT). This is especially useful to interdict transmission in the
high-incidence season. For donors who are detected positive for WNV infection, the the US Federal Drug Administration
(FDA) recommends deferral for at least 120 days.[42,43,44,45 ]

Cytomegalovirus

Cytomegalovirus (CMV) belongs to the herpes group of viruses. Transmission is well documented throughout the
literature; the organism's transmission is prevented by transfusing leukocyte-depleted blood products, which is consistent
with the fact that CMV is a leukocyte-associated pathogen. The organism is a major concern when it comes to transfusing
immunocompromised hosts. For this reason, all immunocompromised patients are given CMV-seronegative or leukocyte-
depleted blood products.[46,47,48,49 ]

HTLVs

Both HTLV-1 and HTLV-2 have been shown to be transmitted by blood transfusion. The residual risk of transmission is 1
in 3 million in the US. Infection by these retroviruses may result in HTLV-related myelopathy/tropical spastic paraparesis
(HAM/TSP) and adult T-cell leukemia/lymphoma. Various laboratories test for the presence of these agents by different
serologic or nucleic acid–based tests, including enzyme immunoassay (EIA) and PCR.[50,51,52,53 ]

Parvovirus B19

Parvovirus is a nonenveloped virus that is usually transmitted by the respiratory route and eventually infects hematopoietic
cells. The virus is also transmitted vertically from mother to child and via blood products. Transmission by blood products
is common, because the virus does not have a lipid envelope and, hence, inactivation methods like methylene blue
inactivation or solvent-detergent method are ineffective.[54 ]

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The spectrum of clinical results of parvovirus infection depends mainly on the immune status of the recipient.
The parvovirus may cause bone marrow failure in immunocompromised patients and patients with sickle cell disease. In
the immunocompromised host, the disease is self-limited without subsequent complications. Pregnant women can
transmit the virus vertically to the fetus, leading to fetal hydrops (heart failure).[55,56 ]This is of importance when considering
the fact that many pregnant women receive RhoGAM (anti-D immunoglobulin; Ortho-Clinical Diagnostics, Inc, Raritan, NJ)
to prevent sensitization by fetal antigens. PCR-based tests are being developed to counteract this problem.[57 ]
Transfusion-Transmitted Protozoal Infections
Malaria

Malaria is endemic in many tropical and subtropical regions of the world. Over 300 million people worldwide are infected,
with 1 million fatalities annually.[58 ]The causative agent of malaria is Plasmodium, which has 4 species, namely the
following:

1. Plasmodium falciparum
2. P malariae
3. P ovale
4. P vivax

Malaria is spread mainly through mosquito bites, but cases have been reported about transfusion-transmitted malaria. The
risk of spread depends on the prevalence of the disease. In highly endemic areas like Benin, one third of screened blood
donors were found to have P falciparum trophozoites and, hence, their blood was unsafe.[59 ]

In areas with a low malara prevalence, donors who are recent travelers or who are immigrants from endemic areas are
potential sources for transmission of the infection.[59,60,61 ]The FDA recommends that donors with a history of malaria be
deferred for 3 years after becoming asymptomatic. Provided that donors are asymptomatic, travelers to endemic
areas are deferred for 1 year after they return to the US.

Trypanosoma cruzi

T cruzi is the causative agent of Chagas disease, which is generally spread by the bite of the reduviid bug. The illness has
an acute and a chronic form. The acute form principally affects children in endemic areas that include Central and South
America and parts of Mexico and manifests as fever, lymphadenopathy, and hepatosplenomegaly. In severe cases,
myocarditis and encephalitis may occur. The disease may take a more indolent course, and after a latency of decades, it
can present with serious end-organ damage, causing chagasic cardiomyopathy and megaesophagus.[62,63,64 ]

Individuals from endemic areas may become chronic carriers of the T cruzi parasite and are responsible for transmission
of T cruzi through blood transfusion. Such cases are well known in high-prevalence areas. Seroprevalence in the US
ranges from 0.12 to 0.20%, but only 7 cases have been reported to be transmitted by blood. Serologic testing and
deferral of positive donors is a policy in endemic countries, and an enzyme-linked immunosorbent
assay (ELISA)–based screening test has been instituted in the US as well.[62,64 ]

Babesia microti

B microti is an intraerythrocytic protozoan parasite that produces a malarialike illness and is the principal cause of human
babesiosis in the US. The majority of the cases have been reported from the Northeast. The common mode of
transmission is via an Ixodes tick bite, but B microti can also be acquired via transfusion of infected blood.

The clinical spectrum of B microti infection ranges from asymptomatic individuals to severe disease with massive
parasitemias that cause hemolytic anemia, thrombocytopenia, shock, and death. The risk of severe infection is particularly
high in patients who have HIV infection, have had a splenectomy, or are immunosuppressed. Leukoreduction does
not reduce the transmission risk because B microti is intraerythrocytic.

Leishmania donovani

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L donovani belongs to a group of intracellular parasites. The common mode of transmission is a bite by sandflies of the
genus Phlebotomus. Cases have been reported in highly endemic areas regarding transmission by transfusion of blood
products. For this reason, people returning to the US from war zones in Iraq are being deferred from donations for 1
year.[65 ]
Miscellaneous Agents
Prion diseases

Two forms of Creutzfeldt-Jakob disease (CJD) have been reported in the literature, namely classical CJD and variant CJD
(vCJD). vCJD is a form of human bovine spongiform encephalopathy (BSE) that is transmissible through eating infected
tissues or potentially via blood transfusions. Initially, there was evidence of vCJD transmission through blood transfusion in
animal studies, but cases have been reported from high-prevalence areas in Europe where the prion disease resulted due
to the administration of blood products.

An interesting fact to note is that people who have had transfusion-transmitted vCJD did not receive leukocyte-depleted
blood. A unique challenge with respect to prion disease in the context of transfusion medicine is the prolonged
asymptomatic phase and carrier states. In order to counteract this, donor deferral becomes critical. Donors in
high-prevalence countries in Europe are being deferred permanently if they themselves received blood products after
1980.[66,67,68,69,70 ]

Other viruses that have been shown to be transmissible via blood include hepatitis G (HGV) and transfusion-transmitted
virus (TTV). The clinical impact of their transmission on a larger scale is still to be deciphered.[71,72 ]

Ensuring Safety
The FDA has the vital role of ensuring that the 3.5 million patients who receive a blood transfusion each year are protected
by 5 layers of overlapping safeguards. This FDA blood-safety system includes the following measures:

Blood Donor Screening

Donors are informed about the potential disease transmission risks of their blood and are required to answer questions
about factors that may have a bearing on the safety of their blood. For example, donors with a history of intravenous drug
abuse are routinely deferred. Since November 1999, the FDA has requested that the blood industry defer potential donors
who have lived in European countries with reported or suspected cases of BSE and those who might be carriers of the
BSE agent.

Donor screening is primarily done through a questionnaire. In 2005, the FDA approved a Uniform Donor History
Questionnaire (UDHQ), which is used by many blood centers. Key questions in this questionnaire are related to the
prevention of TTBIs and include the following (not all-inclusive; yes/no responses, unless otherwise indicated)[73 ]:

Are you

Feeling healthy and well today?

Currently taking an antibiotic?

Currently taking any other medication for an infection?

In the past 8 weeks have you

Had contact with someone who had a smallpox vaccination?

In the past 12 months have you

Had a blood transfusion?

Come into contact with someone else’s blood?

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Had an accidental needle-stick?

Had sexual contact with anyone who has HIV/AIDS or has had a positive test for the HIV/AIDS virus?

Had sexual contact with a prostitute or anyone else who takes money or drugs or other payment for sex?

Had sexual contact with anyone who has ever used needles to take drugs or steroids, or anything notprescribed by
their doctor?

Had sexual contact with anyone who has hemophilia or has used clotting factor concentrates?

Female donors: Had sexual contact with a male who has ever had sexual contact with another male? (Males: check
"I am male.")

Had sexual contact with a person who has hepatitis?

Lived with a person who has hepatitis?

Had a tattoo?

Had ear or body piercing?

Had or been treated for syphilis or gonorrhea?

Been in juvenile detention, lockup, jail, or prison for more than 72 hours?

From 1977 to the present, have you

Received money, drugs, or other payment for sex?

Male donors: had sexual contact with another male, even once? (Females: check "I am female.")

Have you EVER

Had a positive test for the HIV/AIDS virus?

Used needles to take drugs, steroids, or anything notprescribed by your doctor?

Used clotting factor concentrates?

Had hepatitis?

Had malaria?

Had Chagas' disease?

Had babesiosis?

Received a dura mater (or brain covering) graft?

Had sexual contact with anyone who was born in or lived in Africa?

Been in Africa?

Have any of your relatives had Creutzfeldt-Jakob disease?

Screening on Donated Blood

After donation, each unit of donated blood undergoes a series of tests for infectious diseases for the following:

HBV and HCV

HIV-1 and HIV-2

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HTLV-1 and HTLV-2

Syphilis

T cruzi

Note: Apheresis platelets are also tested for bacterial contamination.

Donor Deferral Lists

Blood establishments must keep current a list of deferred donors and use it to make sure that they do not collect blood
from anyone on the list.

Quarantine

Donated blood must be quarantined until it is tested and shown to be free of infectious agents.

Inactivation of Pathogens

See Inactivation of Pathogens, below.

Lookback
A very important case scenario in transfusion medicine is lookback. Lookback programs are designed to identify and notify
recipients who may have received blood products from a previously negative, screened donor who has now become
positive for an infectious agent. This situation is especially of concern with transfusion-transmitted HCV infections. Thus,
lookback programs are an attempt to reduce further blood-borne transmission of the infectious agent and provide a
chance for the infected recipients to seek medical attention.

Canada organized a huge lookback program to identify over 100,000 individuals who received blood products in
the 1980s. Of the recipients involved in the lookback program, 50,000 tested positive for HCV. It is estimated that about
half of these newly diagnosed cases were due to infected blood.[74,75 ]

As per the FDA guidelines, once a blood bank identifies an HCV-positive donor, it must perform the following[76 ]:

Do a confirmatory test after a positive screen to confirm the diagnosis

Quarantine/destroy the blood products, if any, from the newly diagnosed HCV donor

Inform the hospitals where the patient has donated blood previously
The informed hospitals must look up their records and identify the patients who received blood products
from that particular donor.
Once the recipients are identified, the current attending physician or the physician who initially ordered the
blood product must be made aware.
The informed physician has the responsibility to follow up with the recipients and notify them.

Inactivation of Pathogens
A desirable inactivation method would interfere the least with the function of blood products and yet be effective against
infectious agents. Some of these methods are described below.

Solvent-Detergent Method

The solvent-detergent method is used to disrupt membranes of lipid-enveloped viruses without affecting the majority of
plasma proteins, except protein S. Hence, the method is effective in destroying HIV, HTLV, Epstein-Barr virus (EBV),
HBV, and HCV, but the solvent-detergent method is not effective against HAV and parvovirus. This method can be used in
the preparation of coagulation factors.[77,78 ]

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Methylene Blue

Methylene blue is a dye that combines with cellular elements. Once it is exposed to light, the dye becomes active and
disrupts the wall to which it is attached. The method has been used extensively in Europe to inactivate viruses. Limitations
of the methylene blue method include ineffectiveness against intracellular pathogens and likely interaction with coagulation
factors. Methylene blue also gives a tinge to the treated units; recipients who receive a lot of such treated blood products
may have skin discoloration. Filters have become available in some countries that can remove the dye before transfusion
and thus avoid this problem.[79 ]

Note: Neither the solvent-detergent method nor the methylene blue method is capable of inactivating prions, the putative
cause of vCJD. Accordingly, the selection of donors from areas in which vCJD has not been reported is the only method
currently available for preventing spread of this infection via transfusion of blood products.

Synthetic Psoralen

Amotosalen is a synthetic psoralen that acts after exposure to ultraviolet light to form cross-links in nucleic acid chains and
stops the multiplication of pathogens. This method inactivates almost all of the currently screened agents (eg, HIV, HAV, T
cruzi, gram-negative rods), including enveloped and nonenveloped virus, bacteria, and protozoa. The drawback to
synthetic psoralen is a reduction in platelet activity, thus requiring more frequent platelet transfusions.[80,81,82,83,84 ]

Riboflavin

Riboflavin (vitamin B2) is used to inactivate pathogens in platelets and plasma and is approved for this use in Europe.
Riboflavin binds to DNA and RNA to create cross-links when photoactivated. It appears to be effective in inactivating HIV
and WNV, as well as some bacteria and protozoa.

Role of Leukodepletion

Some infectious agents reside within leukocytes, and hence, their transmission can be interrupted if the blood product is
depleted of leukocytes. CMV is the major pathogen that can be transmitted through leukocytes and cause significant
mortality and morbidity in transplant recipients and immunocompromised cancer patients.

Even though filtration of the blood to remove leukocytes has been used extensively, filtered red blood cell units from
CMV-positive donors is believed to be the primary predictor of transfusion-transmitted CMV in some studies. This has
raised the issue of whether leukocyte-depleted blood products are as good as CMV-seronegative products.[85 ]A
Canadian consensus panel on this issue quotes, "we cannot definitely say whether one is better than the other, nor can we
say that they are equivalent."[86 ]Additional data on this issue may clarify the answer in future.[86,87 ]

In a nutshell, production of safe blood products is an important healthcare issue. As we manage to control the known
threats, new challenges will continue to arrive. Careful donor selection, vigilant screening, lookback programs, inactivation
of pathogens, and continuous efforts to develop new techniques of screening and inactivation will be required to make
blood products, and thus blood transfusions, continually safe.

References

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transfusion-associated bacterial contamination: results of the French BACTHEM Case-Control
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4. Kleinman SH, Kamel HT, Harpool DR, et al. Two-year experience with aerobic culturing of apheresis and whole
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Keywords
transfusion-transmitted diseases, transfusion-transmitted virus, TTV, transfusion, blood transfusion, blood transfusions,
bacterial transmission, bacterial contamination, West Nile fever virus, malaria, cytomegalovirus, CMV, human
immunodeficiency virus, HIV, parvovirus B19, B19, hepatitis B, HBV, hepatitis A, HAV, hepatitis C, HCV, hepatitis E, HEV,
hepatitis G virus, HGV

transfusion reactions, West Nile virus, WNV, human T-lymphotropic virus, HTLV, Trypanosoma cruzi, T cruzi, Babesia
microti, B microti, Leishmania donovani, L donovani, prion disease blooddonor, Creutzfeldt-Jakob disease, CJD, variant
Creutzfeldt-Jakob disease, vCJD, lookback, leukodepletion, methylene blue inactivation, solvent-detergent method,
amotosalen, John Cunningham virus, JCV

Contributor Information and Disclosures

Author

Mudassar Zia, MD, Fellow, Department of Internal Medicine, Division of Geriatrics, Duke University Health System
Mudassar Zia, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Hesham M Taha, MD, FACP, MRCP(UK), Attending Physician, Department of Internal Medicine, Division of
Hematology/Oncology, Nassau University Medical Center
Hesham M Taha, MD, FACP, MRCP(UK) is a member of the following medical societies: American College of Physicians,
American Medical Association, American Society of Clinical Oncology, American Society of Hematology, Royal College of
Physicians, and Royal College of Physicians and Surgeons of Glasgow
Disclosure: Nothing to disclose.

Pharmacy Editor

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Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Sacher, MB, BCh, MD, FRCPC, Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center,
University of Cincinnati Academic Health Center
Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Association for the
Advancement of Science, American Association of Blood Banks, American Clinical and Climatological Association,
American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International
Society of Blood Transfusion, International Society on Thrombosis and Haemostasis, and Royal College of Physicians
and Surgeons of Canada
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan
Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology,
American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer
Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education,
American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical
Oncology, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

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