Transfusion practices and infectious risks

ABSTRACT

Transfusion-transmitted infections remain among the most-feared complications of allogeneic blood transfusion. Thanks to several strategies including donor screening and deferral, blood testing and pathogen inactivation, their risks have reached all-time low levels, particularly in developed nations. Nonetheless, new and emerging infections remain a threat that is likely to exacerbate in the coming years with continued globalization and climate change. More effective strategies of pathogen inactivation and more vigilant horizon screening are hoped to abate the risk. Additionally, allogeneic transfusion has repeatedly been shown to be associated with worsening of outcomes in patients, including the documented increased risk of infections (often nosocomial) in recipients of transfusions. The underlying mechanism is likely to be related to immunosuppressive effects of allogeneic blood, iron content, and bacterial contamination. This issue is best addressed by more judicious and evidence-based use of allogeneic blood components to ensure the potential benefits outweigh the risks.

KEYWORDS:

• Transfusion
• infection
• transfusion-transmitted infection
• transfusion complication
• iron
• transfusion-related immunomodulation
• blood testing
• outcomes
• patient blood management
• transfusion strategy

Declaration of interest

A Shander has been a consultant or speaker with honorarium for or received research support from, Masimo, Gauss, and Vifor; He is a founding member of the Society for the Advancement of Blood Management (SABM). M Javidroozi has been a consultant and contractor for SABM and Gauss Surgical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Notes

1 FDA News Release. FDA updates blood donor deferral policy to reflect the most current scientific evidence and continue to ensure the safety of the US blood supply. 21 December 2015. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm478031.htm