AABB Chapter 08

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Infectious Disease Screening 䊱 Eberhard W. Fiebig, MD, and Michael P. Busch, MD, PhD

H E P A S T T W O decades have seen tremendous improvement in infectious disease screening of blood donations, which has resulted in a measurably safer blood supply.1 However, the ultimate goal of eliminating infectious disease transmission by transfusion has not yet been achieved, and concerns remain about residual risks from “classical” transfusion-transmitted pathogens such as human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV), as well as other viruses, bacteria, and parasites. In addition, a growing list of so-called emerging infectious threats to the blood supply, including West Nile virus, (WNV) Chagas’ disease, and variant Creutzfeldt-Jakob disease (vCJD), are also of concern. This chapter briefly describes the types of infectious pathogens that are known or have the potential to be transmissible by transfusion. Discussion then focuses on the systems and practices designed to prevent these agents from entering blood components and plasma derivatives. Also addressed are supplemental testing for donor counseling, look-back, in-

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fectious risk of plasma derivatives, and pathogen reduction and inactivation methods for blood components and derivatives.2 TR A N SF USI O N-TR A N SM IS SI BL E PA TH O GE N S Viruses Table 8-1 lists profiles of common pathogens and agents that have the potential to be transmitted by infusible blood products. For ease of discussion, these pathogens are grouped according to taxonomic classifications and properties related to transmissibility by transfusion. Classical Transfusion-Transmitted Viruses Viruses included in this group are the bloodborne pathogens HIV types 1 and 2 (HIV-1, HIV-2), HBV, and HCV. Certain features of these viruses place them in a category of special concern for recipients of blood and infusible blood products: 1) perennial low-level prevalence among potential blood donors

Eberhard W. Fiebig, MD, Associate Professor of Clinical Laboratory Medicine, University of California, San Francisco (UCSF), Chief, Laboratory Medicine Service, San Francisco General Hospital, and Michael P. Busch, MD, PhD, Professor of Laboratory Medicine, UCSF, and Vice President, Research, Blood Systems Research Institute, San Francisco, California The authors have disclosed no conflicts of interest.

241 Copyright © 2008 by the AABB. All rights reserved.

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