Department of Transfusion Medicine and Haematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Br J Haematol. 2019 Sep;186(5):655-667. doi: 10.1111/bjh.16093. Epub 2019 Jul 14.
Pathogen reduction technologies (PRTs) have been developed to further reduce the current very low risks of acquiring transfusion-transmitted infections and promptly respond to emerging infectious threats. An entire portfolio of PRTs suitable for all blood components is not available, but the field is steadily progressing. While PRTs for plasma have been used for many years, PRTs for platelets, red blood cells (RBC) and whole blood (WB) were developed more slowly, due to difficulties in preserving cell functions during storage. Two commercial platelet PRTs use ultra violet (UV) A and UVB light in the presence of amotosalen or riboflavin to inactivate pathogens' nucleic acids, while a third experimental PRT uses UVC light only. Two PRTs for WB and RBC have been tested in experimental clinical trials with storage limited to 21 or 35 days, due to unacceptably high RBC storage lesion beyond these time limits. This review summarizes pre-clinical investigations and selected outcomes from clinical trials using the above PRTs. Further studies are warranted to decrease cell storage lesions after PRT treatment and to test PRTs in different medical and surgical conditions. Affordability remains a major administrative obstacle to PRT use, particularly so in geographical regions with higher risks of transfusion-transmissible infections.
病原体减少技术 (PRT) 的开发是为了进一步降低目前极低的输血传播感染风险，并对新出现的感染威胁做出快速响应。并非所有血液成分都有适合的 PRT，但该领域正在稳步发展。虽然已有多年来一直使用用于血浆的 PRT，但血小板、红细胞 (RBC) 和全血 (WB) 的 PRT 发展较为缓慢，这是因为在储存过程中难以保持细胞功能。两种商业化的血小板 PRT 使用紫外线 (UV) A 和 UVB 光，同时添加氨甲喋呤或核黄素以灭活病原体的核酸，而第三种实验性 PRT 仅使用 UVC 光。两种用于 WB 和 RBC 的 PRT 在实验性临床试验中进行了测试，储存时间限制在 21 天或 35 天以内，因为超过这些时间限制后 RBC 储存损伤过高，无法接受。本文综述了使用上述 PRT 的临床前研究和部分临床试验结果。进一步的研究是必要的，以降低 PRT 处理后的细胞储存损伤，并在不同的医疗和手术条件下测试 PRT。在具有更高输血传播感染风险的地区，可负担性仍是 PRT 使用的主要行政障碍。
