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Risk of viral and bacterial infection following transfusion of blood products

Risk of viral and bacterial infection following transfusion of blood products
Components prepared from whole blood*
Hepatitis B virus[1,2] 1:1 million to 1:1.5 million
Hepatitis C virus[1,2] 1:2 million to 1:2.6 million
HTLV[3,4] 1:2.7 million
HIV[1,2] 1:1.6 million to 1:2.3 million
Solvent/detergent-treated plasma products
Hepatitis C virus Inactivated
Hepatitis B virus Inactivated
HIV Inactivated
Hepatitis A virus Not fully inactivated
Parvovirus B19 Not fully inactivated
Hepatitis E virus Not fully inactivated
Platelets
With automated bacterial culturing methods in place prior to 2019, septic transfusion reactions were estimated to occur at a rate of 1:50,000 to 1:80,000 transfused platelet apheresis units in the United States. This is thought to have been an underestimate since it relied on passive surveillance[5]. From 2019 onward, the risk is likely to have been lowered by enhanced bacterial safety methods.
CMV infection
The risk of CMV infection is rare in recipients who are at risk for severe morbidity from CMV due to conditions such as hematopoietic stem cell or solid organ transplantation and who receive CMV reduced-risk products. Two methods to supply CMV reduced-risk products that appear to have equal efficacy are CMV-seronegative cellular components (red blood cells, platelets) or leukoreduced components.
These numbers are estimates; ranges are given for some viruses where different databases and analyses have generated slightly different numbers. In the United States, blood is routinely screened for syphilis, hepatitis B virus, hepatitis C virus, HIV-1, HIV-2, HTLV-I, HTLV-II, West Nile virus, and Trypanosoma cruzi. Babesia microti testing is confined to states where community-acquired babesisos is considered to be of high risk. CMV serology testing is not routine; instead, enough products are tested to provide a sufficient inventory of CMV-negative products. Platelets are tested for bacterial contamination. Refer to UpToDate topics on risks of blood transfusion for further details.

CMV: cytomegalovirus; HIV: human immunodeficiency virus; HTLV: human T-lymphotropic virus.

* These estimates apply to red blood cells, platelets, and plasma, with the exception of HTLV, for which there is no risk from plasma.

¶ Plasma products are tested for parvovirus B19, hepatitis A virus, and hepatitis E virus nucleic acid before being used for further manufacturing into solvent/detergent-treated plasma. Transmission of these agents should not occur (or should be extraordinarily rare) under these conditions.
References:
  1. Steele WR, Dodd RY, Notari EP, et al. HIV, HCV, and HBV incidence and residual risk in US blood donors before and after implementation of the 12-month deferral policy for men who have sex with men. Transfusion 2021; 61:839.
  2. Dodd RY, Crowder LA, Haynes JM, et al. Screening blood donors for HIV, HCV, and HBV at the American Red Cross: 10 year trends in prevalence, incidence, and residual risk, 2007 to 2016. Trans Med Rev 2020: 34(2):81.
  3. Zou S, Stramer SL, Dodd RY. Donor testing and risk: Current prevalence, incidence, and residual risk of transfusion-transmissible agents in US allogeneic donations. Transfus Med Rev 2012; 26:119.
  4. Stramer SL, Notari EP, Zou S, et al. HTLV antibody screening of blood donors: Rates of false positive results and evaluation of a potential donor re-entry algorithm. Transfusion 2011; 51:692.
  5. Kleinman S, Reed W, Stassinopoulos A. A patient-oriented risk-benefit analysis of pathogen-inactivated blood components: Application to apheresis platelets in the United States. Transfusion 2013; 53:1603.
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