Читать книгу Transfusion Medicine - Jeffrey McCullough - Страница 156

Two different approaches are under development for inactivation of transfusion‐transmissible pathogens in RBC components. These involve riboflavin [147] and an alkylating agent [148]. The methods involve selective damage to nucleic acid strands, thus inactivating contaminating pathogens while sparing red cells [122]. The methods are effective against most common bacteria, viruses, and protozoa that would be of concern in blood transfusion [122].

Red cells treated with S303 for pathogen inactivation had in vitro properties similar to paired untreated controls for hemolysis, glucose consumption and potassium release, lower lactate levels and pH, and higher ATP, with significant loss of 2,3‐DPG. Thus, in vitro studies of S303 red cells are essentially not significantly different from untreated red cells [148–151].

A clinical trial in cardiovascular surgery was successful, except that two patients developed clinically nonsignificant antibodies to the treated red cells [152]. That method has been revised, and the clinical trial of the revised method in chronically transfused patients with thalassemia reported no difference in efficacy and safety between the control and study groups [153, 154]. The riboflavin method also results in satisfactory red cells [155], and a clinical trial of that WB product prevented transfusion‐transmitted malaria [156].

Inactivation of viruses and bacteria in cellular components, a strategy almost unthinkable a decade ago, is also showing exciting promise with a platelet and two plasma products now FDA approved in the United States. If a WB/red cell technology becomes available, there will certainly be a major impact on the blood supply system and the nature of blood centers producing these components. See Chapter 16 for more details on pathogen inactivation technology.