Hervig Tor, Seghatchian Jerard, Apelseth Torunn Oveland
Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway; The Gade Institute, University of Bergen, Norway.
Blood Components Technology Consultancy, 50 Primrose Hill Road, London, England, UK.
Transfus Apher Sci. 2010 Dec;43(3):411-414. doi: 10.1016/j.transci.2010.10.012. Epub 2010 Nov 13.
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.
提高血小板输注的质量和安全性是输血实践中的一个重要目标。因此，血液服务机构已采取了多项补充措施，如不断改进献血者选择、献血者检测、采集/处理方面的新进展，包括将采集的第一部分血液分流以降低细菌污染的潜在风险，使用各种血小板添加剂溶液，以及通过单采程序生产多剂量产品来减少献血者暴露。不幸的是，尽管血液成分的安全性有了显著提高，但血小板输血导致的细菌传播仍然是输血医学中发病和死亡的主要微生物原因。目前，在一些机构中，有两种主要干预措施用于减少血小板的细菌输血：选择性/全面细菌筛查和病原体灭活。后者对大多数已知和未知的含核酸新兴病毒以及寄生虫也有效。此外，它还减少了与白细胞相关的副作用，使其实施极具吸引力。近年来，已有两种血小板浓缩物病原体灭活/减少（本文后面简称为PI）的方法可用。病原体灭活是该技术的最初术语，但由于有人认为灭活可能不完全彻底，一些作者更喜欢使用“病原体减少”这个术语。尽管细胞血液成分的PI被认为是解决输血相关传染病传播问题的“理想方案”，但这些预防性干预方法的实施尚未得到普遍认可。本文的目的是讨论血小板浓缩物PI方法实施辩论中的一些关键问题。
