Friedman L I, Stromberg R R
American Red Cross, Holland Laboratory, Rockville, MD.
Rev Fr Transfus Hemobiol. 1993 Jan;36(1):83-91. doi: 10.1016/s1140-4639(05)80170-4.
Even though the risks associated with the transfusion of blood products are lower than ever before, considerable efforts are being employed to improve the safety of the blood supply. Based upon available data, a six log (99.9999%) reduction in virus level from screened and tested blood components should significantly reduce or eliminate the risk of post-transfusion infection. The objective has been to identify "generic" methods, that is, one that would be applicable to all virus. For red cells, physical and chemical approaches have been studied; for platelets, the approaches have been limited to chemical. The physical methods include depletion of leukocytes by filtration, removal of plasma by washing, and viral inactivation by heat. Among the chemicals investigated to inactivate or help displace virus are ozone, detergents, and hypochlorous acid. Several photochemicals have also received intensive investigation: merocyanine 540, a benzoporphyrin derivative, aluminum phthalocyanine, and methylene blue. For platelets, photochemical inactivation methods using merocyanine 540, and two psoralen derivatives, 8-methoxypsoralen (8-MOP) and aminomethyl trimethyl psoralen (AMT), have also been studied. Approaches which include washing are not suitable. For the most part, either viral removal or inactivation has been insufficient, or red cell or platelet damage unacceptable. However, there are a few indications that at least inactivation of a specific virus, such as HIV, may be possible without major cell damage. These studies are in their early stages and significant work remains. If feasibility is clearly shown in vitro, it is likely that in vivo primate studies to demonstrate safety and efficacy will be required.
尽管与输血制品相关的风险比以往任何时候都低，但人们仍在付出巨大努力来提高血液供应的安全性。根据现有数据，经筛查和检测的血液成分中病毒水平降低6个对数（99.9999%）应能显著降低或消除输血后感染的风险。目标是确定“通用”方法，即适用于所有病毒的方法。对于红细胞，已经研究了物理和化学方法；对于血小板，方法仅限于化学方法。物理方法包括通过过滤去除白细胞、通过洗涤去除血浆以及通过加热使病毒失活。在研究的用于灭活或帮助去除病毒的化学物质中，有臭氧、洗涤剂和次氯酸。几种光化学物质也受到了深入研究：部花青540、苯并卟啉衍生物、铝酞菁和亚甲蓝。对于血小板，还研究了使用部花青540以及两种补骨脂素衍生物8-甲氧基补骨脂素（8-MOP）和氨甲基三甲基补骨脂素（AMT）的光化学灭活方法。包括洗涤的方法不合适。在很大程度上，要么病毒去除或灭活不充分，要么红细胞或血小板损伤不可接受。然而，有一些迹象表明，至少灭活特定病毒（如HIV）而不造成主要细胞损伤是可能的。这些研究尚处于早期阶段，仍有大量工作要做。如果在体外清楚地显示出可行性，可能需要进行体内灵长类动物研究以证明安全性和有效性。
