The Rationale for Pathogen-Inactivation Treatment of Blood Components

Progress in Hematology


Blood transfusion provides an ideal portal of entry for microorganisms. Although current residual risks of microbial infection by transfusion are extremely low in the developed world, the requirements for even safer blood are paradoxically increasing. Such requirements are partly a legacy of the tragic transmissions of human immunodeficiency virus (HIV) by blood early in the acquired immunodeficiency syndrome pandemic and are legally expressed in consumer protection laws imposing strict product liability. Enhanced safety is called for, not only for recognized agents (especially bacteria, which cause most current transfusion-transmissible infections [TTIs]and have only recently been addressed) but also for potential future “emerging” TTIs. These possibilities are not merely theoretical. TTIs of HIV-1, HIV-2, hepatitis B virus vaccine escape mutants, human herpesvirus 8, West Nile fever virus, and variant Creutzfeld-Jakob disease amply demonstrate the continual emergence of such threats. For recognized agents, the possibilities of test errors, misreporting, process-control failures, and false-negative results (although rare with modern automation) remain. In principle, an all-embracing, pan-effective microbe-inactivation procedure offers a potential solution to blood safety concerns. Such procedures may also allow the removal of several existing antimicrobial interventions. However, blood services remain to be convinced that the various prerequisites for safe and effective pathogen inactivation have been met. Not the least of these prerequisites is that all blood components can be inactivated to provide a single streamlined alternative blood safety strategy. Furthermore, the huge potential value of effective pathogen-inactivation systems for developing countries should not be forgotten once such systems are perfected.

Key words

Pathogen inactivation Residual risk Product liability Emerging agents Window period 


  1. 1.
    Barbara JA J. Microbiology in Blood Transfusion. Bristol, UK: John Wright; 1983.Google Scholar
  2. 2.
    MMWR. Update: detection of West Nile virus in blood donations: United States, 2003. MMWR [serial online]. 2003;52(Dispatch): 1–3. Available at: mm52d918a1.htm. Accessed September 14,2004.Google Scholar
  3. 3.
    Laupacis A, Brown J, Costello B, et al. Prevention of posttransfusion CMV in the era of universal WBC reduction: a consensus statement. Transfusion. 2001;41:560–569.PubMedCrossRefGoogle Scholar
  4. 4.
    Pennington J, Taylor GP, Sutherland J, et al. Persistence of HTLV-I in blood donations after leukocyte depletion. Blood. 2002;100:677–681.PubMedCrossRefGoogle Scholar
  5. 5.
    Barbara JAJ, Eglin R, eds. Nucleic acid amplification technology for blood donor screening. Transfus Med. 2002;12(theme issue):227–285.PubMedCrossRefGoogle Scholar
  6. 6.
    Simmonds P, Kurtz J, Tedder RS.The UK blood transfusion service: over a (patent) barrel? Lancet. 2002;359:1713–1714.PubMedCrossRefGoogle Scholar
  7. 7.
    Barbara JAJ. Why ‘safer than ever’ may not be quite safe enough. Transfus Med Hemother. 2004;31(suppl 1):2–10.CrossRefGoogle Scholar
  8. 8.
    McDonald C, Roy A, Mahajan P, Smith R, Charlett A, Barbara JA. Relative values of the interventions of diversion and improved donor-arm disinfection to reduce the bacterial risk from blood transfusion. Vox Sang. 2004;86:178–182.PubMedCrossRefGoogle Scholar
  9. 9.
    Barbara JAJ. Evolution of microbial safety. Hematol J. 2004; 5(suppl 3):S69-S73.PubMedCrossRefGoogle Scholar
  10. 10.
    SHOT Office. Serious hazards of transfusion annual report 2003 [SHOT Web site]. July 5, 2004. Available at: http://www.shot-uk. org/SHOT%20Report%202003.pdf. Accessed September 14,2004.Google Scholar
  11. 11.
    Schreiber G, Busch M, Kleinman S, Korelitz J. The risk of transfusion- transmitted viral infections: the Retrovirus Epidemiology Donor Study. N Engl J Med. 1996;334:1685–1690.PubMedCrossRefGoogle Scholar
  12. 12.
    Soldan K, Barbara JAJ, Ramsay ME, Hall AJ. Estimates of the risk of hepatitis B virus, hepatitis C virus and human immunodeficiency virus infectious donations entering the blood supply in England, 1993-2001. Vox Sang. 2003;84:274–286.PubMedCrossRefGoogle Scholar
  13. 13.
    Hepatitis patients win compensation. BBC News Online. March 26, 2001. Available at: Accessed September 14,2004.Google Scholar
  14. 14.
    Jongerius J, Wester M, Cuyper H, et al. New hepatitis B virus mutant form in a blood donors that is undetectable in several hepatitis B surface antigen screening assays. Transfusion. 1998;38:56–59.PubMedCrossRefGoogle Scholar
  15. 15.
    Peden AH, Head MW, Ritchie DL, Bell JE, Ironside JW Preclinical vCJD after blood transfusion in a PRNP codon 129 heterozygous patient. Lancet. 2004;364:527–529.PubMedCrossRefGoogle Scholar
  16. 16.
    Mollison PL, Engelfriet CP, Contreras M. Infectious agents transmitted by transfusion. In: Blood Transfusion in Clinical Medicine. London, UK: Blackwell Science; 1997:509–557.Google Scholar

Copyright information

© The Japanese Society of Hematology 2004

Authors and Affiliations

  1. 1.Microbiology Consultant to the National Blood ServiceColindaleUK

Personalised recommendations