[Risk of transfusional-transmitted infections]

Although each donated unit of blood is tested for evidence of infection by specific agents, there are at least four potential reasons why transmission of these agents may still occur: a) the donor has negative laboratory test results during the early stages of infection, known as the window period, b) the existence of a chronic carrier state in which a clinically asymptomatic donor will persistently test negative on a screening assay, c) donors harbouring a mutant or atypical variant and d) laboratory errors when performing the screening tests. Measures to assure the safety of blood and blood components include use of voluntary donors, donor selection and questioning, laboratory testing for serological markers of infections, maintenance of registries of disqualified donors and, more recently, the introduction of direct testing for viral nucleic acids. All these measures must be accompanied by rigorous quality control systems. The potential risk of transfusion-transmitted infectious diseases can be estimated by reviewing the records of blood donations, the screening procedures and determining the prevalence of the serologic markers of infectious diseases. Accurate estimates of the risk of transfusion-transmitted infections are needed in order to monitor the safety of the blood supply and evaluate the yield and cost effectiveness of alternatives to allogeneic transfusion. Genomic screening for infectious agents, especially viruses, became possible with the development of various nucleic acid amplification techniques. They combine the advantages of direct detection of the organism with a sensitivity several orders of magnitude higher than that of traditional methods.