Blood-safety interventions over time and current estimates of the rate of potentially infectious units entering the US blood supply despite safety interventions
| Pathogen . | Clinical syndromes . | Blood-safety interventions (approximate year of implementation in US) . | Current per unit risk estimate . |
|---|---|---|---|
| HIV | • Acute seroconversion illness | • HIV-Ab (1985) | 1 in 2 million |
| • AIDS | • MP-NAT (1999) | ||
| HCV | • Acute hepatitis | • HCV-Ab (1990) | 1 in 2 million |
| • Chronic hepatitis | • MP-NAT (1999) | ||
| • Cirrhosis | |||
| HBV | • Acute hepatitis | • HBsAg (1971) | 1 in 2 million |
| • Chronic hepatitis | • HBcAb (1986) | ||
| • Cirrhosis | • MP-NAT (2009) | ||
| • Hepatocellular carcinoma | |||
| HTLV-I/II | • Adult T-cell leukemia/lymphoma | • HTLVI/II-Ab (1988) | 1 in 3 million |
| • HTLV-associated myelopathy/tropical spastic paraparesis | |||
| CMV | • Retinitis | • Selective CMV-Ab (1980s) | <1 in 3 million |
| • Enteritis | • Leukoreduction (∼2000) | ||
| • Disseminated infection | |||
| WNV | • Neuroinvasive disease | • MP-NAT/seasonal ID-NAT (2003) | <1 in 3 million |
| ZIKV | • Congenital Zika syndrome (including microcephaly) | • ID-NAT (2016) | <1 in 3 million* |
| • Guillain Barré | • MP-NAT (2018) | ||
| T pallidum | • Syphilis | • T pallidum Ab (1948) | None but theoretical risk from RT-stored platelets |
| Bacteria | • Sepsis | • Arm disinfection (early) | STR from platelet: 1 in 100 000† |
| • Inlet diversion pouches (early 2000s) | |||
| • Bacterial culture platelets (mid 2000s) | |||
| • Pathogen reduction (∼2016)† | |||
| • Point-of-care testing (∼2016)† | |||
| Plasmodium spp.‡ | • Malaria | • Risk factor based donor deferral (1970s or before) | <1 in 3 million |
| Babesia spp. (B microti) | • Babesiosis | • Selective testing (not mandated) in high-endemicity areas (∼2014) | Not known§,|| |
| T cruzi | • Chagas disease | • T cruzi Ab (2007) | <1 in 3 million |
| vCJD | • Transmissible spongiform encephalopathy | • Risk factor–based donor deferral (2000) | None, but theoretical risk |
| Pathogen . | Clinical syndromes . | Blood-safety interventions (approximate year of implementation in US) . | Current per unit risk estimate . |
|---|---|---|---|
| HIV | • Acute seroconversion illness | • HIV-Ab (1985) | 1 in 2 million |
| • AIDS | • MP-NAT (1999) | ||
| HCV | • Acute hepatitis | • HCV-Ab (1990) | 1 in 2 million |
| • Chronic hepatitis | • MP-NAT (1999) | ||
| • Cirrhosis | |||
| HBV | • Acute hepatitis | • HBsAg (1971) | 1 in 2 million |
| • Chronic hepatitis | • HBcAb (1986) | ||
| • Cirrhosis | • MP-NAT (2009) | ||
| • Hepatocellular carcinoma | |||
| HTLV-I/II | • Adult T-cell leukemia/lymphoma | • HTLVI/II-Ab (1988) | 1 in 3 million |
| • HTLV-associated myelopathy/tropical spastic paraparesis | |||
| CMV | • Retinitis | • Selective CMV-Ab (1980s) | <1 in 3 million |
| • Enteritis | • Leukoreduction (∼2000) | ||
| • Disseminated infection | |||
| WNV | • Neuroinvasive disease | • MP-NAT/seasonal ID-NAT (2003) | <1 in 3 million |
| ZIKV | • Congenital Zika syndrome (including microcephaly) | • ID-NAT (2016) | <1 in 3 million* |
| • Guillain Barré | • MP-NAT (2018) | ||
| T pallidum | • Syphilis | • T pallidum Ab (1948) | None but theoretical risk from RT-stored platelets |
| Bacteria | • Sepsis | • Arm disinfection (early) | STR from platelet: 1 in 100 000† |
| • Inlet diversion pouches (early 2000s) | |||
| • Bacterial culture platelets (mid 2000s) | |||
| • Pathogen reduction (∼2016)† | |||
| • Point-of-care testing (∼2016)† | |||
| Plasmodium spp.‡ | • Malaria | • Risk factor based donor deferral (1970s or before) | <1 in 3 million |
| Babesia spp. (B microti) | • Babesiosis | • Selective testing (not mandated) in high-endemicity areas (∼2014) | Not known§,|| |
| T cruzi | • Chagas disease | • T cruzi Ab (2007) | <1 in 3 million |
| vCJD | • Transmissible spongiform encephalopathy | • Risk factor–based donor deferral (2000) | None, but theoretical risk |
As a worst-case scenario, it can be assumed that any unit containing a pathogen will transmit that infection to a recipient. The estimates for risk of TTIs are for single-unit transfusions; risk will be higher (ie, multiplied by the number of units) for patients who receive multiple units either in single exposures or over a treatment course. See Kleinman and Stassinopoulos14 and Kleinman et al15 for extrapolated risks for large transfusion exposure clinical events (platelets and RBCs) and various chronically transfused recipient populations.14,15
Ab, antibody testing; Ag, antigen testing; ID, individual donation; MP, minipool; RT, room temperature; STR, septic transfusion reaction.
No cases reported in the United States and only 4 possible TT cases reported globally, all in Brazil during the large 2015 to 2016 outbreak.
These interventions have been adopted only by some blood centers or hospitals.
This is the risk for a clinically septic event from a platelet transfusion. The actual rate of transfusing a bacterial contaminated platelet may be much higher (estimate of 1 in ∼2000 U). The risk of an STR from a RBC transfusion is much lower (<1 in 1 million).
These are RBC parasites and risk is from transfusion of packed RBCs.
Because Babesia testing is performed extensively but not universally in highly endemic areas of the United States, it is unclear how much residual risk still remains.