Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.
Transfus Med Rev. 2023 Oct;37(4):150769. doi: 10.1016/j.tmrv.2023.150769. Epub 2023 Oct 4.
The tragedy of transfusion-associated hepatitis and HIV spurred a decades-long overhaul of the regulatory oversight and practice of blood transfusion. Consequent to improved donor selection, testing, process control, clinical transfusion practice and post-transfusion surveillance, transfusion in the United States and other high-income countries is now a very safe medical procedure. Nonetheless, pathogens continue to emerge and threaten the blood supply, highlighting the need for a proactive approach to blood transfusion safety. Blood donor populations and the global transfusion infrastructure are under-utilized resources for the study of infectious diseases. Blood donors are large, demographically diverse subsets of general populations for whom cross-sectional and longitudinal samples are readily accessible for serological and molecular testing. Blood donor collection networks span diverse geographies, including in low- and middle-income countries, where agents, especially zoonotic pathogens, are able to emerge and spread, given limited tools for recognition, surveillance and control. Routine laboratory storage and transportation, coupled with data capture, afford access to rich epidemiological data to assess the epidemiology and pathogenesis of established and emerging infections. Subsequent to the State of the Science in Transfusion Medicine symposium in 2022, our working group (WG), "Emerging Infections: Impact on Blood Science, the Blood Supply, Blood Safety, and Public Health" elected to focus on "leveraging donor populations to study the epidemiology and pathogenesis of transfusion-transmitted and emerging infectious diseases." The 5 landmark studies span (1) the implication of hepatitis C virus in post-transfusion hepatitis, (2) longitudinal evaluation of plasma donors with incident infections, thus informing the development of a widely used staging system for acute HIV infection, (3) explication of the dynamics of early West Nile Virus infection, (4) the deployment of combined molecular and serological donor screening for Babesia microti, to characterize its epidemiology and infectivity and facilitate routine donor screening, and (5) national serosurveillance for SARS-CoV-2 during the COVID-19 pandemic. The studies highlight the interplay between infectious diseases and transfusion medicine, including the imperative to ensure blood transfusion safety and the broader application of blood donor populations to the study of infectious diseases.
输血相关性肝炎和 HIV 的悲剧促使人们对血液监管和输血实践进行了长达几十年的彻底改革。由于改进了供者选择、检测、过程控制、临床输血实践和输血后监测，美国和其他高收入国家的输血现在是一种非常安全的医疗程序。尽管如此，病原体仍在不断出现并威胁着血液供应，这凸显了采取积极主动的方法来确保输血安全的必要性。血液供者人群和全球输血基础设施是传染病研究中未充分利用的资源。血液供者是一般人群中规模庞大、人口统计学上多样化的亚群，为他们提供了易于获得的横断面和纵向样本，用于血清学和分子检测。血液供者采集网络跨越了不同的地理位置，包括在低收入和中等收入国家，由于缺乏识别、监测和控制工具，病原体，特别是人畜共患病原体，能够出现和传播。常规的实验室储存和运输，加上数据采集，使人们能够获得丰富的流行病学数据，以评估已建立和新兴感染的流行病学和发病机制。在 2022 年输血医学科学状况专题讨论会之后，我们的工作组（WG）“新兴感染：对血液科学、血液供应、血液安全和公共卫生的影响”选择专注于“利用供者人群研究输血传播和新兴传染病的流行病学和发病机制”。这 5 项具有里程碑意义的研究涵盖了以下五个方面：（1）丙型肝炎病毒在输血后肝炎中的作用，（2）对感染性血浆供者的纵向评估，从而为广泛使用的急性 HIV 感染分期系统的发展提供了信息，（3）阐述了西尼罗河病毒早期感染的动态，（4）结合分子和血清学供者筛查用于微小巴贝斯虫，以描述其流行病学和感染性，并促进常规供者筛查，以及（5）在 COVID-19 大流行期间进行全国性 SARS-CoV-2 血清学监测。这些研究突出了传染病学和输血医学之间的相互作用，包括确保输血安全的必要性，以及更广泛地应用血液供者人群来研究传染病。
