Transfusion‐transmitted viral infections: building bridges to transfusion medicine to reduce risks and understand epidemiology and pathogenesis

Abstract

ransfusion medicine is a rapidly evolving field that now interfaces with virtually every clinical discipline and with many of the basic medical and social sciences. Transfusion medicine has been heavily influenced by, and has had a major impact on, public health and political, regulatory, and legal systems around the globe. When I was a young resident in pathology and laboratory medicine at the University of California in San Francisco (UCSF) in the early 1980s, I recall first encountering what was then referred to simply as blood banking. I was struck and intrigued by the relatively primitive understanding of the molecular basis of blood groups and by the simple methods used for compatibility and infectious disease testing. At the time, infectious disease concerns were minor and revolved primarily around possible residual risk of viral hepatitis following the recent implementation of hepatitis B surface antigen (HBsAg) screening. I had just completed my MD and PhD degrees at the University of Southern California (USC), where my thesis focused on the role of feline endogenous retroviruses in embryogenesis and lymphoma. Despite large-scale viral discovery studies at UCSF, USC, and elsewhere, no convincing evidence for a human retrovirus existed at that time. Certainly no one suspected that we were already in the early stages of a major global panT demic due to a novel class of retrovirus (lentivirus) that spread efficiently by blood transfusions. And then came acquired immunodeficiency syndrome (AIDS), and blood banking, indeed the entire world, changed forever! Fortunately for me, I was in the right place, at the right time. Thanks to relevant training, supportive mentors, wonderful collaborators, and a home base in the epicenter of the US AIDS epidemic, I was able to participate in the early characterization of transfusion-AIDS and help develop and execute many of the studies that have advanced our understanding of infectious risks associated with blood transfusions over the past 25 years. The theme of this Cooley Lectureship is “building bridges to transfusion medicine,” referring to the success that has been achieved by application of novel approaches and findings from other fields to study transfusion complications, while at the same time deriving insights from investigations of viral infections in blood donors and recipients to develop broader understanding of the epidemiology, diagnosis, and pathogenesis of relevant infections diseases with far reaching implications beyond our field. This lecture traces the history of transfusion risk analysis, demonstrating how thoughtful and creative individuals both in academia and in industry have responded to once unimaginable challenges posed by emerging transfusion-transmitted infections which, unfortunately, we now view as routine.