Lindholm Paul F, Annen Kyle, Ramsey Glenn
Department of Pathology, Northwestern University, Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL 60611, USA.
Infect Disord Drug Targets. 2011 Feb;11(1):45-56. doi: 10.2174/187152611794407746.
The use of blood donor history and state-of-the-art FDA-licensed serological and nucleic acid testing (NAT) assays have greatly reduced the "infectious window" for several transfusion-transmitted pathogens. Currently transmission of human immunodeficiency virus (HIV), Human T-cell Lymphotropic Virus (HTLV), hepatitis viruses and West Nile Virus are rare events. The seroprevalence of cytomegalovirus in the donor population is high and cytomegalovirus infection can cause significant complications for immunocompromised recipients of blood transfusion. Careful use of CMV seronegative blood resources and leukoreduction of blood products are able to prevent most CMV infections in these patients. Currently, bacterial contamination of platelet concentrates is the greatest remaining infectious disease risk in blood transfusion. Specialized donor collection procedures reduce the risk of bacterial contamination of blood products; blood culture and surrogate testing procedures are used to detect potential bacterially contaminated platelet products prior to transfusion. A rapid quantitative immunoassay is now available to test for the presence of lipotechoic acid and lipopolysaccharide bacterial products prior to platelet transfusion. Attention has now turned to emerging infectious diseases including variant Creutzfeldt-Jakob disease, dengue, babesiosis, Chagas' disease and malaria. Challenges are presented to identify and prevent transmission of these agents. Several methods are being used or in development to reduce infectivity of blood products, including solvent-detergent processing of plasma and nucleic acid cross-linking via photochemical reactions with methylene blue, riboflavin, psoralen and alkylating agents. Several opportunities exist to further improve blood safety through advances in infectious disease screening and pathogen inactivation methods.
利用献血者病史以及美国食品药品监督管理局（FDA）许可的先进血清学和核酸检测（NAT）分析方法，已大幅缩短了几种输血传播病原体的“感染窗口期”。目前，人类免疫缺陷病毒（HIV）、人类嗜T细胞病毒（HTLV）、肝炎病毒和西尼罗河病毒的传播已极为罕见。献血人群中巨细胞病毒的血清阳性率很高，巨细胞病毒感染会给输血的免疫功能低下受者带来严重并发症。谨慎使用巨细胞病毒血清阴性血液资源以及对血液制品进行白细胞滤除，能够预防这些患者中的大多数巨细胞病毒感染。目前，血小板浓缩物的细菌污染是输血中尚存的最大传染病风险。专门的献血采集程序可降低血液制品细菌污染的风险；输血前采用血培养和替代检测程序来检测潜在的细菌污染血小板制品。现在有一种快速定量免疫测定法可在血小板输血前检测脂磷壁酸和脂多糖细菌产物的存在。目前注意力已转向包括变异型克雅氏病、登革热、巴贝斯虫病、恰加斯病和疟疾在内的新发传染病。识别和预防这些病原体的传播面临挑战。正在使用或研发几种方法来降低血液制品的感染性，包括对血浆进行溶剂 - 去污剂处理以及通过与亚甲蓝、核黄素、补骨脂素和烷基化剂的光化学反应进行核酸交联。通过传染病筛查和病原体灭活方法的进展，存在进一步提高血液安全性的若干机会。
