The National Marrow Donor Program has benefited a substantial number of patients in need of marrow transplants from closely HLA-matched unrelated donors and has facilitated the recruitment of unrelated donors into the donor pool and the access to suitable marrow.

T he possibility of transfusion-transmitted infections has been a worry from the beginning of the modern era of blood banks. Beginning with the evidence that syphilis could be transmitted by blood transfusion and followed by increasing concerns about hepatitis, alarm peaked in the 1980s with the recognition of transfusion-associated AIDS and appreciation of the magnitude of transfusion transmission of hepatitis C virus (HCV). In more recent years the story has been one of remarkable successes in reducing transmission of known viral agents and rapid responses to emerging infectious diseases that are documented to be transmitted by blood transfusion.This review will address the response of the blood banking community to the major transfusion-transmitted infectious diseases (TTIDs) over the past 50 years, during which time the evolving appreciation of risk and progress in addressing TTIDs has been documented by more than 1000 publications in TRANSFUSION. Figure 1, which presents the annual number of publications in the journal focused on TTIDs relative to total publications, serves to demonstrate the increasing importance of TTIDs to the transfusion medicine community. It is evident that papers on TTIDs grew from a handful of papers per year that represented a minor proportion of the journal's publications to more than 50 papers per year representing 25% of articles appearing in TRANSFUSION in the 1980s and 1990s. The papers represented in the figure chronicle the remarkable contributions of several generations of scientists who not only aggressively addressed blood safety concerns but also advanced our understanding of methods of detection, natural history, and pathogenesis of TTIDs through studies of infected donors and recipients. SYPHILISThe evidence that syphilis can be transmitted by blood transfusion is unequivocal, with 138 cases published before 1941. 1 Blood donors were tested for syphilis long before blood banks became common. 2 In the early years of blood banking serologic tests for syphilis employed the nonspecific assay for antibodies to cardiolipin, usually using the VDRL or RPR versions of the original Wasserman test. In recent years automated assays have been developed that test for specific treponemal antibody, and almost all blood banks use that approach. In the initial switch from cardiolipin tests to tests with treponemal antibody, the rate of positive screening tests rose sharply, ABBREVIATIONS: BSE = bovine spongiform encephalopathy; IFA = indirect immunofluorescence assay; IND = investigational new drug; NANB = non-A, non-B; PRT(s) = pathogen reduction technology(-ies); PTH = posttransfusion hepatitis; PTLV(s) = primate T-lymphotropic virus(-es); TTID(s) = transfusiontransmitted infectious disease(s); TTV = transfusion-transmitted virus; vCJD = variant Creutzfeldt-Jacob disease; WNV = West Nile virus. Number of publications in TRANSFUSION, by year, focused on TTIDs (solid bars) relative to total publications (open bars), demonstrating the increasing importance of TTIDs to the transfusion medi...

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Little information is available regarding the risk of human immunodeficiency virus type 1 (HIV-1) infection for patients transfused before routine anti-HIV-1 screening of blood donors was instituted in March 1985. A model was developed for estimating both the proportion and the number of transfusion recipients in the San Francisco Bay area who were infected by HIV-1 during each of the 7 years preceding routine donor screening for anti-HIV-1. The model is based on analysis of 1) donation histories of HIV-1-infected donors identified at the regional blood center; 2) HIV-1 seroprevalence estimates for homosexual and bisexual men in San Francisco; and 3) HIV-1 infection and survival rates for recipients traced by the Transfusion Safety Study and Irwin Memorial Blood Centers' Look Back Program. The incidence of transfusion-associated HIV-1 infection is estimated to have risen rapidly from the first occurrence in 1978 to a peak in late 1982 of approximately 1.1 percent per transfused unit. The decrease after 1982 coincided with the implementation of high-risk donor deferral measures. It is estimated that, overall, approximately 2135 transfusion recipients were infected with HIV-1 in the San Francisco region alone. This number suggests a higher prevalence of transfusion-associated HIV-1 infection than has been generally recognized and indicates the need for continued tracing of potentially exposed recipients. The data also strongly support the effectiveness of early donor education and self-exclusion measures and emphasize the importance of continued research and development in this area.