Pathogen inactivation for safer blood transfusion: What are the limitations?

Several new technologies to reduce pathogen contamination, called pathogen inactivation (PI), have recently been developed and shown to improve transfusion safety. Generally, whole blood donations are separated into components after collection. One of the separation processes used at Canadian Blood Services, called the buffy coat method, results in three components: platelets, red blood cells (RBCs), and plasma. These components can be transfused separately to patients as they are needed. Before transfusion into patients, PI would treat these blood components with ultraviolet (UV) light with or without a chemical called a photosensitizer. UV light damages nucleic acids (DNA and RNA) which contain the cells’ genetic information. When a pathogen’s nucleic acids are damaged they can no longer reproduce and cause illness. PI offers protection against known and ‘emerging’ pathogens and also destroys residual white blood cells which can cause transfusion-related complications. However, blood components contain nucleic acids, and previous studies have shown that PI can damage plasma and platelet components. Very little is known about the effect of PI on RBCs. The researchers examined the UV light/riboflavin PI method. Rather than treating individual blood components with PI, they treated whole blood with PI, separated the blood and investigated the quality of all three components.

• The quality of RBC components produced from PI-treated whole blood decreased more quickly than components produced from untreated blood. At the end of RBC storage (day 42), the average number of burst RBCs (called Collected in November 2014 In brief… Pathogen inactivation is known to improve blood transfusion safety, but also impact quality. More research is needed to determine the best approach to ensure safety and optimize blood component quality. Pathogen inactivation for safer blood transfusion: What are the limitations? ResearchUnit is a knowledge mobilization tool developed by Canadian Blood Services’ Centre for Innovation Available online at www.transfusionmedicine.ca ‘hemolysis’) was greater than 0.8 % in components produced from PI-treated whole blood, exceeding Canadian Standards Association guidelines.
• Plasma components produced from whole blood treated with PI showed a three to 44 % decrease in activity for several clotting factors.
• Platelet components from PI-treated whole blood were of significantly better quality than platelet components treated directly with PI. However, compared to untreated platelet concentrates, the quality of PI-treated platelets was reduced regardless of whether whole blood or the component was treated.

Overall, components produced from PI-treated whole blood did not meet all Canadian Standards Association criteria for quality. However, these standards are based on untreated components, so whether they can be applied to PI-treated products is unclear. PI treatment of platelet concentrates and plasma is known to affect quality parameters, but treatment of these products does not appear to change patient outcomes. Whether the lower quality seen impacts the clinical effectiveness of the RBCs is unknown.

Dr. Dana V. Devine is the Canadian Blood Services chief medical and scientific officer, a Canadian Blood Services’ Centre for Innovation scientist and a professor at the department of pathology and laboratory medicine at the University of British Columbia. This study was conducted in Dr. Devine’s laboratory, led by Dr. Peter Schubert, a Canadian Blood Services’ Centre for Innovation research associate and clinical associate professor in the department of pathology and laboratory medicine at the University of British Columbia. Dr. Katherine Serrano and Dr. Elena Levin are a Canadian Blood Services’ centre for innovation research associate and research assistant, respectively, and are affiliated with the department of pathology and laboratory medicine at the University of British Columbia. Brankica Culibrk, Simrath Karwal and Daniel Bu are members of Dr. Devine’s laboratory. Dr. William P. Sheffield is the associate director of research and a scientist at Canadian Blood Services’ centre for innovation, and a professor of pathology and molecular medicine at McMaster University, Hamilton ON. Varsha Bhakta is a research assistant in Dr. Sheffield’s laboratory at McMaster University. The work was conducted in collaboration with Dr. Raymond P. Goodrich, vice president scientific and clinical affairs, TerumoBCT, Lakewood, CO.