Abstract
The development of pathogen reduction technologies (PRT) for labile blood components is a long-pursued goal in transfusion medicine. While PRT for red blood cells and whole blood are still in an early phase of development, different PRT platforms for plasma and platelets are commercially available and routinely used in several countries. This review describes complementary strategies recommended by the US FDA to mitigate the risk of septic reactions in platelet recipients, including PRT and large-volume delayed sampling, and summarizes the main findings of recent reports discussing economical and organizational issues of platelet PRT implementation. Sophisticated mathematical analytical models are available to determine the impact of PRT on platelet costs, shortages and outdates in different settings. PRT implementation requires careful planning to ensure the availability of sufficient economical, technological and human resources. A phased approach was used in most PRT implementation programs, starting with adult and pediatric immunocompromised patients at higher risk of developing septic platelet transfusion reactions. Overall, the reviewed studies show that significant progress has been made in this area, although additional efforts will be necessary to reduce the storage lesion of PRT platelets and to expand the sustainable applicability of PRT to all labile blood components.
Highlights
The development and general use of pathogen reduction technologies (PRT) for all labile blood components is still a well-recognized and long-pursued goal in transfusion medicine
Scenario 1 simulated a comparison of a 5- to 3–4-day effective shelf life of PRT BCPC, which showed that reductions in PRT platelets’ shelf life resulted in shortages of both BCPC and apheresis platelets; scenario 2 determined the increase in BCPC and apheresis platelets needed to maintain the original (2019) service levels after PRT implementation; scenario 3 was based on the expectation that PRT implementation could determine a 20% increase in platelet demand due to increased per-patient transfusion requirements associated with lower post-transfusion platelet count increments
The two distant study periods were chosen “because in the years 2008–2012 the blood bank temporarily used an alternative PRT to treat platelets”. This analysis showed “a statistically significant increase in platelet usage in neonates transfused with PRT platelets”, the authors acknowledged the limitation associated with the use of data from control neonates transfused 10 years before with platelets stored in 100% plasma and concluded that “a long term follow up in chronically transfused pediatric patients and clinical trials on riboflavin and UV light-PRT and other PRT systems are needed to support the safe use of PRT-treated platelets in children”
Summary
The development and general use of pathogen reduction technologies (PRT) for all labile blood components is still a well-recognized and long-pursued goal in transfusion medicine. The recent COVID-19 pandemic, there have been no reports of transmission of its causative agent SARS-CoV-2 through blood transfusion, offers an opportunity to discuss our preparedness to handle emerging cases of novel transmissible agents [1]. Technical progress in this area has been conditioned by the differential levels of frailty of plasma proteins ( the labile blood coagulation factors and inhibitors) versus the cellular blood components (platelet and red blood cells) and by the need to preserve their clinical efficacy while avoiding unacceptable toxicity to the recipient. The review will include short summaries describing (a) the available platelet PRT platforms, (b) the storage lesion associated with PRT, (c) the clinical safety and efficacy of PRT platelets and (d) risk mitigation strategies alternative or complementary to PRT
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