Platelet transfusion associated risks and improvement of platelet transfusion safety with Amotosalen/UVA pathogen inactivation technology

Abstract

Despite the introduction of multiple measures to minimize the risk of transfusion-transmitted infections, there is still a residual risk of platelet transfusions, especially but not only for bacterial sepsis. Recently, the importance of a reliable hemovigilance system has been underlined and an up to 10-fold difference in the reporting of bacterial transmissions between active and passive reporting has been demonstrated. Another reason for a misjudging of the blood safety may derive from the fact that some pathogens cause obvious damage to critically ill and/or immunocompromised patients only and asymptomatic infections in immuno-competent recipients and thus are not being reported. Pathogen inactivation for platelets, a proactive approach not only broadly inactivating pathogens, but also white blood cells, could minimize the risk of transfusion transmitted infections and graft versus host disease due to residual leukocytes. Only the INTERCEPT technology has received approvals from the regulatory agencies in France, Germany and Switzerland, United States and Canada. That technology utilizes photoactive methods to modify nucleic acids. Long-term routine clinical experience, also with children and neonates, shows the safety and efficacy of INTERCEPT platelet transfusions. The national hemovigilance data of Switzerland, France and Belgium as well as single-center routine use studies show an improved clinical outcome in the acute as well as in the prophylactic setting with a significant decrease in septic and other non-hemolytic transfusion reactions, as well as prevention of graft-versus-host disease.