Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Room 3733, Los Angeles, CA 90048, USA.
Transfus Med Rev. 2011 Apr;25(2):133-44. doi: 10.1016/j.tmrv.2010.11.005. Epub 2011 Feb 23.
Universal white blood cell (WBC) reduction was introduced in Europe to prevent transmission of variant Creutzfeldt-Jakob disease (vCJD) by transfusion. Findings from rodent models indicate that WBC reduction should not prevent vCJD transmission because the residual plasma infectivity suffices to infect transfusion recipients even under optimistic infectivity assumptions. Although infectivity in human blood may not partition in the manner in which it is distributed in rodents, prion-reduction filters remove the residual plasma infectivity in rodent models. Precautionary introduction of prion filtration in the UK--for patients without dietary exposure to bovine spongiform encephalopathy and in the absence of a reported case of vCJD transmission attributable to infectivity residing in plasma--is consistent with the (already in place for such subjects) precautionary importation to the UK of fresh frozen plasma from low-risk countries. Thus, implementation of prion filtration in the UK does not imply that universal WBC reduction--as currently practiced in Europe--does not abrogate transmission of vCJD. Because neither a human case of vCJD transmission through transfusion of WBC-reduced red blood cells nor a case of experimental bovine spongiform encephalopathy transmission by WBC-reduced transfusion to sheep has been reported, it cannot be concluded that ordinary WBC reduction is ineffective in preventing transfusion transmission in humans. Accordingly, universal WBC reduction for the prevention of vCJD in Europe should continue.
全血白细胞（WBC）减少已在欧洲被引入，以防止通过输血传播变异型克雅氏病（vCJD）。来自啮齿动物模型的研究结果表明，WBC 减少不应阻止 vCJD 的传播，因为即使在乐观的感染性假设下，残留的血浆感染性足以感染输血接受者。尽管人类血液中的感染性可能不会像在啮齿动物模型中那样分布，但朊病毒减少过滤器可以去除啮齿动物模型中的残留血浆感染性。在英国，对没有食用过牛海绵状脑病的患者，并且在没有报告由于血浆中存在的感染性而导致 vCJD 传播的情况下，预防性地引入朊病毒过滤，这与（已经为这些人群实施）从低风险国家进口新鲜冷冻血浆到英国的预防性措施是一致的。因此，在英国实施朊病毒过滤并不意味着普遍减少 WBC（目前在欧洲实施）不会阻止 vCJD 的传播。由于没有报道过通过输注减少 WBC 的红细胞传播 vCJD 的人类病例，也没有报道过通过输注减少 WBC 的绵羊传播实验性牛海绵状脑病的病例，因此不能得出结论认为普通减少 WBC 在预防人类输血传播中无效。因此，欧洲应继续普遍减少 WBC 以预防 vCJD。
