Vol 52, No 4 (2021)
Review article
Published online: 2021-08-31

open access

Page views 669
Article views/downloads 758
Get Citation

Connect on Social Media

Connect on Social Media

Methods of pathogen inactivation in whole blood and red blood cells: current state of knowledge

Elżbieta Lachert1
Acta Haematol Pol 2021;52(4):406-411.

Abstract

Although pathogen reduction technology was implemented for platelet concentrates and plasma, the risk of pathogen transmission has not been completely eliminated as no inactivation procedures were implemented for red blood cells and whole blood. Research was therefore focused on developing methods for effective pathogen inactivation in red blood cell components. Attempts were made to apply either chemical compounds (porphyrins and Sylsense compounds) or photosensitizers such as methylene blue (Theraflex MB Plasma System) and amotosalen hydrochloride (Intercept System) already in use for pathogen inactivation in plasma. None proved effective for pathogen inactivation in red blood cells.

Approval was recently given to pathogen inactivation methods based on S-303 compound (for red blood cells) and with riboflavin (for whole blood). Clinical trials are ongoing. Pilot studies have shown that during storage of packed red blood cells subjected to pathogen inactivation with S-303 demonstrated slight loss of red blood cells, decrease in hemoglobin concentration, significantly lower lactate concentration, and lower pH. Pathogen inactivated whole blood stored at room temperature for up to seven days showed slight hemolysis (within the normal range).

This paper presents several pilot clinical trials with pathogen inactivated red blood cells or whole blood. It focuses primarily on the recovery of red blood cells in the recipient's organism and on hemoglobin concentration.

Article available in PDF format

View PDF Download PDF file

References

  1. Marietta M, Franchini M, Bindi ML, et al. Is solvent/detergent plasma better than standard fresh-frozen plasma? A systematic review and an expert consensus document. Blood Transfus. 2016; 14(4): 277–286.
  2. Prowse CV. Component pathogen inactivation: a critical review. Vox Sang. 2013; 104(3): 183–199.
  3. Schlenke P. Pathogen inactivation technologies for cellular blood components: an update. Transfus Med Hemother. 2014; 41(4): 309–325.
  4. Heiden M, Seitz R. Pathogen inactivation — regulators aspects. Vox Sang. 2010; 5: 279–281.
  5. Wagner SJ. Developing pathogen reduction technologies for RBC suspensions. Vox Sang. 2011; 100(1): 112–121.
  6. Council of Europe Expert Committee in Blood Transfusion Study Group on Pathogen Inactivation of Labile Blood Components. Pathogen inactivation of labile blood products. Transfus Med. 2001; 11(3): 149–175.
  7. Ben-Hur E, Rywkin S, Rosenthal I, et al. Virus inactivation in red cell concentrates by photosensitization with phthalocyanines: protection of red cells but not of vesicular stomatitis virus with a water-soluble analogue of vitamin E. Transfusion. 1995; 35: 401–406.
  8. O'Brien JM, Gaffney DK, Wang TP, et al. Merocyanine 540-sensitized photoinactivation of enveloped viruses in blood products: site and mechanism of phototoxicity. Blood. 1992; 80(1): 277–285.
  9. Benjamin RJ. Pathogen inactivation of labile blood products. Transfusion. 2003; 43(10): 1498.
  10. Benjamin RJ. Red blood cell pathogen reduction: in search of serological agnosticism. ISBT Science Series. 2006; 1(1): 222–226.
  11. North AK, Castro G, Erickson A, et al. Characterization of antibodies to red cells prepared with S-303 pathogen inactivation treatment. Vox Sang. 2007; 93(Suppl 1): 167–168.
  12. Winter KM, Johnson L, Kwok M, et al. Red blood cell in vitro quality and function is maintained after S-303 pathogen inactivation treatment. Transfusion. 2014; 54(7): 1798–1807.
  13. Henschler R, Janetzko K, Erterek B, et al. Characterization of red cell concentrates treated with the S–303 pathogen inactivation system and stored in saline adenine glucose-mannitol (SAGM). Vox Sang. 2010; 99(Suppl 1): 38.
  14. Kleinman S, Stassinopoulos A. Risks associated with red blood cell transfusions: potential benefits from application of pathogen inactivation. Transfusion. 2015; 55: 2983–3000.
  15. Reddy H, Marschner S, Doane S, et al. Room temperature storage of whole blood treated with the Mirasol System. Vox Sang. 2010; 99: 243.
  16. Marschner S, Goodrich R. Pathogen reduction technology treatment of platelets, plasma and whole blood using riboflavin and UV light. Transf Med Hemother. 2011; 38(1): 8–18.
  17. Reddy H, Doane S, Spotts C, et al. In vitro assessments of platelet function in whole blood treated with the Mirasol System and stored at room temperature. Vox Sang. 2010; 99: 243.
  18. Cancelas JA, Rugg N, Dumont LJ, et al. Comprehensive evaluation of a new process for S-303 pathogen-inactivation of red blood cells. Transfusion. 2010; 50(Suppl): 9A.
  19. Cancelas JA, Dumont LJ, Rugg N, et al. Stored red blood cell viability is maintained after treatment with a second–generation S–303 pathogen inactivation process. Transfusion. 2011; 51(11): 2367–2376.
  20. Cancelas JA, Gottschall JL, Rugg N, et al. Red blood cell concentrates treated with the amustaline (S-303) pathogen reduction system and stored for 35 days retain post-transfusion viability: results of a two-centre study. Vox Sang. 2017; 112(3): 210–218.
  21. Cancelas JA, Slichter SJ, Rugg N, et al. Red blood cells derived from whole blood treated with riboflavin and ultraviolet light maintain adequate survival in vivo after 21 days of storage. Transfusion. 2017; 57(5): 1218–1225.
  22. Allain JP, Owusu-Ofori A, Assennato S, et al. Effect of Plasmodium inactivation in whole blood on the incidence of blood transfusion-transmitted malaria in endemic regions: the African Investigation of the Mirasol System (AIMS) randomised controlled trial. Lancet. 2016; 387(10029): 1753–1761.
  23. Brixner V, Kiessling AH, Madlener K, et al. Red blood cells treated with the amustaline (S-303) pathogen reduction system: a transfusion study in cardiac surgery. Transfusion. 2018; 58(4): 905–916.
  24. Trakhtman P, Kumukova I, Starostin N, et al. The pathogen-reduced red blood cell suspension: single centre study of clinical safety and efficacy in children with oncological and hematological diseases. 2019; 114(3): 223–231.
  25. Aydinok Y, Piga A, Origa R, et al. Amustaline‐glutathione pathogen‐reduced red blood cell concentrates for transfusion‐dependent thalassaemia. Br J Haematol. 2019; 186: 625–36.