The long and winding road to pathogen reduction of platelets, red blood cells and whole blood

Abstract

Summary 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.

Coronavirus Disease 2019: Coronaviruses and Blood Safety

“…Generally, no single PRT is suitable for all blood products because some blood components are damaged by the PRT treatment [55,56]. In-house studies of methods to inactivate coronaviruses in plasma and platelet concentrates focused mainly on heat and solvent/detergent (S/D) treatment.…”

“…Methylene blue plus visible light also has the ability to inactivate coronaviruses in plasma [45,48]. Cost remains a major administrative obstacle to PRT use [55]. Therefore, whether or not these PRTs should be implemented in response to SARS-CoV-2depends on the severity and prevalence of COVID-19 in different regions and on the actual risk of transfusion transmission of SARS-CoV-2.…”

Blood Safety in SARS-CoV-2 Infection

“…To know more precisely whether the risk of transmission of SARS-CoV-2 by transfusion is higher than the other coronaviruses, further investigation is required (1). The routine use of PRT methods in transfusion medicine for all blood products is controversial since some blood components are damaged by this method and these methods impose a high cost on blood banking services (24,25). Therefore, whether these PRTs should be applied depends on the severity and prevalence of SARS-COV-2 in various parts of the world.…”

“…After the outbreak of SARS and MERS, a few studies evaluated the pathogen inactivation/reduction technologies (PRTs). Some blood products could be damaged by PRT; therefore, a single PRT is not advised for all blood products (24,25). Two principal methods for the inactivation of viruses are heat and solvent/detergent (S/D).…”

Is blood transfusion safety will be a challenge during COVID-19 infection?

“…Methylene blue plus visible light also can inactivate coronaviruses in plasma [27,38]. PRT cost still a significant barrier to its use [36]. The degree and prevalence of COVID-19 in different countries and the real risk of transmission of SARS-Cov-2 by transfusion are the major determinants of usage PRT in response to SARS-CoV-2 [3].…”