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19 - Processing and components: leucodepletion and pathogen reduction

from Section 2 - Selection and testing

Published online by Cambridge University Press:  12 January 2010

By
Rebecca Cardigan ,
Chris Prowse  and
Lorna M. Williamson
Edited by
John A. J. Barbara ,
Fiona A. M. Regan  and
Marcela Contreras
Rebecca Cardigan
Affiliation:
Head of Components Development, NHS Blood and Transplant Cambridge, Cambridge, UK
Chris Prowse
Affiliation:
Research Director, National Science Laboratory, Scottish National Blood Transfusion Service, Edinburgh, UK
Lorna M. Williamson
Affiliation:
Reader in Transfusion Medicine, University of Cambridge; Medical Director, NHS Blood and Transplant, Cambridge, UK
John A. J. Barbara
Affiliation:
University of the West of England, Bristol
Fiona A. M. Regan
Affiliation:
HNSBT and Hammersmith Hospitals NHS Trust, London
Marcela Contreras
Affiliation:
University of the West of England, Bristol
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Summary

Although donor selection and donation screening remain the critical elements of protection from transfusion-transmitted pathogens, there is increasing interest in achieving further safety enhancements by component modification. In the last five years, leucocyte depletion has moved from being a bedside procedure for specific patients to a universal and integral part of component processing. In this context, its potential for removal of leucocyte-associated viruses has been the subject of considerable debate. Over the same time period, techniques for pathogen reduction of fresh frozen plasma and platelets have been developed and, in some cases, licensed for routine use. Pathogen reduction for red cells is proving a more challenging prospect, but in time the current difficulties may be overcome. Such techniques present policy-makers with interesting decisions which must take into account cost-effectiveness, loss of functionality of components, potential toxicity, and the potential impact on current donor selection and screening policies.

Leucocyte depletion (LD)

Many countries now undertake universal LD of all components in blood centres within 1–2 days of collection. The reasons for this practice vary from country to country, but perceived benefits include reduced immunomodulation, fewer febrile reactions, and reduction of cytomegalovirus risk (reviewed in Williamson, 2000). In the UK, the main reason for implementation of universal LD was as a precaution against transmission of variant Creutzfeld-Jacob disease. Leucocyte depletion is achieved either by filtration of either whole blood or processed components, or by centrifugation/elutriation during platelet apheresis.

Type
Chapter
Information
Transfusion Microbiology , pp. 239 - 258
Publisher: Cambridge University Press
Print publication year: 2008

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