Schmidt Michael, Sireis Walid, Seifried Erhard
German Red Cross, Institute for Transfusion Medicine and Immunohaematology, Johann Wolfgang Goethe University, Frankfurt/M., Germany.
Transfus Med Hemother. 2011;38(4):259-265. doi: 10.1159/000330305. Epub 2011 Jul 7.
BACKGROUND: Through the implementation of modern technology, such as nucleic acid testing, over the last two decades, blood safety has improved considerably in that the risk of viral infection is less than 1 in a million blood transfusions. By contrast, the residual risk of transfusion-associated bacterial infection is stable at approximately 1 in 2,000 to 1 in 3,000 in platelets. To improve blood safety with regard to bacterial infections, many countries have implemented bacterial screening methods as part of their blood donor screening programmes. METHODS: BACTERIAL DETECTION METHODS ARE CLUSTERED INTO THREE GROUPS: i) culture methods in combination with the 'negative-to-date' concept, ii) rapid detection systems with a late sample collection, and iii) bedside screening tests. RESULTS: The culture methods are convincing because of their very high analytical sensitivity. Nevertheless, false-negative culture results and subsequent fatalities were reported in several countries. Rapid bacterial systems are characterised as having short testing time but reduced sensitivity. Sample errors are prevented by late sample collection. Finally, bedside tests reduce the risk for sample errors to a minimum, but testing outside of blood donation services may have risks for general testing failures. CONCLUSION: Bacterial screening of blood products, especially platelets, can be performed using a broad range of technologies. Each system exhibits advantages and disadvantages and offers only a temporary solution until a general pathogen inactivation technology is available for all blood components.
背景：在过去二十年中，通过实施核酸检测等现代技术，血液安全性有了显著提高，病毒感染风险在每百万次输血中低于1例。相比之下，血小板中输血相关细菌感染的残留风险稳定在约2000分之一至3000分之一。为提高细菌感染方面的血液安全性，许多国家已将细菌筛查方法作为其献血者筛查计划的一部分实施。方法：细菌检测方法分为三类：i）结合“至今阴性”概念的培养方法，ii）样本采集较晚的快速检测系统，iii）床边筛查试验。结果：培养方法因其极高的分析灵敏度而令人信服。然而，几个国家报告了假阴性培养结果及随后的死亡病例。快速细菌检测系统的特点是检测时间短但灵敏度降低。通过较晚采集样本可防止样本误差。最后，床边试验将样本误差风险降至最低，但在献血服务之外进行检测可能存在一般检测失败的风险。结论：血液制品，尤其是血小板的细菌筛查可使用多种技术进行。每个系统都有优缺点，并且在通用病原体灭活技术可用于所有血液成分之前，都只能提供临时解决方案。
