Current debate on pathogen inactivation of platelet concentrates--to use or not to use?

It is an important goal in transfusion practice to improve the quality and safety of platelet transfusions. Accordingly, blood services have implemented several complimentary measures such as continual improvement in donor selection, donor testing, newer development in collection/processing, including the diversion of the first part of collection to reduce the potential risk of bacterial contamination and the use of various platelet additive solutions and reduction in donor exposures through production multiple doses by apheresis procedures. Unfortunately despite considerable improvement in blood components safety bacterial transmission by platelet transfusion remains the major microbial cause of morbidity and mortality in transfusion medicine. Currently two major interventions are in practice, in some establishments, to reduce bacterial transfusion by platelets: selective/full bacterial screening and pathogen inactivation. The later is also effective against most known and unknown emerging nucleic acid containing viruses, as well as, parasites. In addition it also reduces the side effect associated with leucocytes, making its implementation highly appealing. In recent years, two methods for pathogen inactivation/reduction (abbreviation used later in this paper PI) of platelet concentrates have become available. Pathogen inactivation was the original term for the technology, but as it is argued that the inactivation may not be complete, some authors prefer the term "pathogen reduction". Although PI of cellular blood components is considered to be a "dream solution" to the problem of transfusion-related transmission of infectious diseases, the implementation of these precautionary interventional methods is not yet universally approved. The aim of this paper is to discuss some of the key issues in the debate on implementation of PI methods for platelet concentrates.