Transfusion and Risk of Infection in Canada: Update 2006

Noni MacDonald

doi:10.1155/2006/298303

Abstract

In Canada and other developed countries, many steps are taken to minimize the risk of infection from transfusion of blood or blood products (1). However, the infection risk can never be zero because these are biological products taken from living donors who are never 'germ free' (2). This is in contrast to drugs that can be manufactured de novo under sterile conditions in a laboratory. The present note provides an update on transfusion infection risks in Canada. It replaces the 2005 note (3) and may be helpful to practitioners in discussions with patients and parents for informed consent before blood or blood product administration. The changes in this note include new Canadian data on risk of adverse transfusion events (ATEs), including risk of bacterial infection. Transfusion-related acute lung injury and major allergic or anaphylactic reactions are more common than serious infections (4).

Highlights

Restrictive transfusion policies and effective blood conservation programs A crucial step in enhancing safety is to carefully assess whether the patient will likely benefit from the administration of the blood or blood product [5]
In Canada, the infectious disease risks associated with transfusion are minimized through multiple steps, including blood collection from unpaid volunteer donors; donor interview and selection procedures; careful aseptic techniques for collection and infusion; diversion of the first 40 mL of blood collected into a diversion pouch [12]; donor screening by serological and other tests, including bacterial detection in platelets (Table 1); viral inactivation procedures included in the manufacturing of plasma-derived products (Table 2) [13,14,15]; and leukocytereduction techniques that reduce the infection transmission risk of white blood cell-associated viruses, such as cytomegalovirus [16]
The solvent or detergent and heat viral inactivation procedures noted in Table 2 cannot be used on red blood cells or platelets because neither can withstand these vigorous processes

Summary

PAEDIATRIC INFECTIOUS DISEASE NOTES

In Canada and other developed countries, many steps are taken to minimize the risk of infection from transfusion of blood or blood products [1]. The infection risk can never be zero because these are biological products taken from living donors who are never ‘germ free’ [2]. This is in contrast to drugs that can be manufactured de novo under sterile conditions in a laboratory. The present note provides an update on transfusion infection risks in Canada. It replaces the 2005 note [3] and may be helpful to practitioners in discussions with patients and parents for informed consent before blood or blood product administration. Transfusion-related acute lung injury and major allergic or anaphylactic reactions are more common than serious infections [4]

STEPS IN THE PREVENTION OF INFECTION WITH BLOOD TRANSFUSION

Leukocyte depletion

Yes Yes Yes Yes Yes Yes

Packed red cells Whole blood Platelets

Plasma platelets

Adverse transfusion event

Yes Yes Yes

Findings

IMPORTANCE OF DOCUMENTATION OF TRANSFUSION