Pathogen inactivation of blood components

SUMMARY Blood donations are screened for infectious agents of concern, but this approach is always challenged when a new infection is identified. Ideally, each donation or blood component would be treated to inactivate pathogens, as is now done for fractionated plasma products. Technology that allows this is now being developed for red cell and platelet products, and has been available for some time for whole plasma. For plasma and platelets, clinical trials have been completed and show some loss of potency as a result of treatment to reduce pathogens. Most of the methods developed arte effective against lipid-enveloped viruses and bacteria but less so for non-enveloped viruses. Some European countries have already implemented provision of pathogen-reduced plasma and are in the process of large-scale field evaluations of platelet technologies, now that these are licensed (CE marked) in Europe. As yet there is no licensed technology for pathogen reduction of red cells, and no licenses for component pathogen reduction are in place in the USA. Cost-effectiveness of pathogen reduction is very poor if one bases assessment only on those pathogens for which mandatory screening is already in place, as the residual risks of infection are already very low. However, if other factors such as emerging infections, bacterial contamination or the risk of transfusion-related acute lung injury are also included in the evaluation, the economic case becomes more attractive.