Pathogen inactivation: emerging indications

To review data about transfusion-transmitted infections so as to assess potential safety benefits of applying pathogen inactivation technology to platelets.

Residual bacterial risk still exists. Multiple arbovirus epidemics continue to occur and challenge blood safety policy makers in nonendemic developed countries. There is new documentation of transfusion transmission of dengue and Ross River viruses, and new or increased concern about chikungunya and Zika viruses. Pathogen inactivation has been shown to inactivate almost all bacterial species and several epidemic arboviruses that pose a transfusion transmission risk. The two available platelet pathogen inactivation technologies show different levels of pathogen inactivation as measured by in-vitro infectivity assays; the clinical significance of this finding is not known.

Pathogen inactivation can mitigate infectious risk and should do so more completely than other interventions such as donor questioning, donor/component recall, or donor testing. However, pathogen inactivation increases the cost of the pathogen-reduced blood component, which is a significant obstacle in the current healthcare environment. This may inhibit the ability to move forward with an effective new paradigm for blood safety that fulfills the implicit public trust in the blood system.