Klein Harvey G
Department of Transfusion Medicine, Clinical Center, Building 10, Room 1C-711, National Institutes of Health, Bethesda, MD 20892, USA.
Biologicals. 2010 Jan;38(1):100-4. doi: 10.1016/j.biologicals.2009.10.008. Epub 2010 Jan 15.
Blood is safer than it has ever been, however the progression of transfusion from dangerous intervention to reliable supportive care been non-linear. Disparities resulting from geography, economy, and social class persist. Some risks are known, others are unknown but predictable, and still others may be totally unpredictable. Among the known risks are infectious and immunologic events that can be calculated per unit of blood transfused. These risks vary by component. Among the unknown risks are the potential for emerging pathogens transmitted by blood and for processing or storage lesions to result in short or long-term toxicity. National registries provide some reassurance that transfusion may not affect mortality significantly beyond the first few weeks after administration. Nevertheless, transmission of novel pathogens, repeated allogeneic stimulation, and infusion of cytokines or chemokines may have unrecognized consequences. Blood safety can be effected dramatically with small investment in developing countries. In the developed world, technologies such as pathogen inactivation, antigen camouflage, component substitutes, or cell expansion promise relatively small advances in safety at substantial cost. No strategy guarantees zero-risk.
血液比以往任何时候都更安全，然而输血从危险的干预措施发展到可靠的支持性治疗的过程并非线性。地理、经济和社会阶层造成的差异依然存在。一些风险是已知的，另一些是未知但可预测的，还有一些可能完全不可预测。已知风险包括每单位输血可能发生的感染性和免疫性事件。这些风险因成分而异。未知风险包括血液传播新出现病原体以及加工或储存损伤导致短期或长期毒性的可能性。国家登记系统提供了一些保证，即输血在给药后的最初几周之后可能不会显著影响死亡率。尽管如此，新型病原体的传播、反复的同种异体刺激以及细胞因子或趋化因子的输注可能会产生未被认识到的后果。在发展中国家，只需少量投资就能显著提高血液安全性。在发达国家，诸如病原体灭活、抗原伪装、成分替代或细胞扩增等技术虽有望以高昂成本在安全性上取得相对小的进展，但没有任何策略能保证零风险。
