Transfusion‐associated infections: 50 years of relentless challenges and remarkable progress

Abstract

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...

Seroprevalence and molecular diagnosis of Toxoplasma gondii infection among blood donors in southern Iran

“…Healthy seropositive blood donors, especially those who are in the acute phase of the infection, may play a major role in this case [9].…”

Performance Evaluation of the Elecsys Syphilis Assay for the Detection of Total Antibodies to Treponema pallidum

“…The risk of syphilis via transfusion is now very small, with one case reported in the previous 50 years in the United States (13,14), because T. pallidum does not typically survive Ͼ120 h outside the human host and under the cooled storage conditions of banked blood. However, the WHO still recommends the testing of blood samples (20)(21)(22), because the diagnosis of previous or active syphilis might somehow be a surrogate marker for behaviors that exposed the subject to the risk of acquiring other sexually transmitted viruses, such as HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV).…”

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From Bloodless Surgery to Patient Blood Management

“…Advancements in blood processing and blood banking have resulted in decreasing risks of transmitting blood-borne infections and transfusion errors. 1 Although the risks still persist and are unlikely ever to be completely eliminated (after all, to err is human), the incidence of these severe complications is relatively low. 2 On the other hand, allogeneic transfusion is emerging as a potent risk factor for many other complications commonly seen in hospitalized patients, such as lung injury and nosocomial infections, and as an independent predictor of, and contributor to, worse patient outcomes (eg, higher risk of morbidity and mortality without (or with less) allogeneic blood transfusion are often similar to or better than the outcomes of patients who are transfused or receive more blood.…”