Pathogen reduction technology – is it time?

Abstract

With the application of stringent donor selection criteria and screening tests, the risk of the so‐called traditional transfusion‐transmitted infections has dramatically decreased. However, breakthrough cases are still being reported. Known pathogens that are not screened for and emerging pathogens represent a constant threat. Moreover, bacterial contamination remains the major infectious risk in blood transfusion. Pathogen reduction (PR) technology represents a proactive approach to our blood safety paradigm. PR technology for platelets and plasma has been approved in Europe for more than 10 years. Although PR efficacy against non‐enveloped viruses and spore forming bacteria is less satisfactory, these technologies show a robust PR capability for a broad spectrum of pathogens. According to current data, transfusion reactions after transfusion of treated platelets are comparable to that of non‐treated platelets and transfusion of treated platelets does not increase bleeding. Since PR technologies target nucleic acids, they inactivate leucocytes, thereby preventing non‐infectious risks like transfusion‐associated graft‐versus‐host disease and febrile non‐haemolytic transfusion reactions. Despite the multiple risks averted through pathogen reduction, the cost to implement these technologies remains a major issue. On the other hand, pathogen reduction could be an alternative to bacterial screening and gamma irradiation. Furthermore, cessation of some of the current screening items and modification of some donor exclusion criteria might be possible, especially when PR technology for red blood cells or whole blood becomes available. Therefore, if we consider all correlated efforts involved to make blood transfusion safe, the introduction of the PR technology might prove to be beneficial.