Whole Blood Pathogen Reduction: Which Benefit for Blood
Safety in Africa?
Claude
Tayou Tagny, Soraya El Dusouqui, Emmanuel Rigal, Dora Mbanya
Claude
Tayou Tagny, Dora Mbanya, Hematology and Blood Transfusion service, University
Teaching Hospital, Yaound¨¦ Cameroon
Claude Tayou Tagny,
Dora Mbanya, Faculty of
Medicine and Biomedical Sciences, University of Yaound¨¦ I, Cameroon
Soraya El Dusouqui,
Emmanuel Rigal, Hopital
University of Gen¨¨ve, Geneva, Switzerland
Correspondence to: Tagny Claude Tayou,
MD, Hematology and Blood Transfusion
service, University Teaching Hospital, Yaound¨¦ Cameroon.
Email: tayouclaude@yahoo.fr
Telephone: +237-93-06-00-83
Received: November 25,
2014
Revised: March 11, 2015
Accepted: March 21, 2015
Published online: April 30, 2015
© 2015 ACT. All
rights reserved.
Key words: Pathogen reduction; Whole blood; Africa
Tagny CT, El
Dusouqui S, Rigal E, Mbanya D. Whole Blood Pathogen Reduction: Which Benefit
for Blood Safety in Africa?. International Journal
of Hematology Research 2015; 1(1): 27-28
Available from: URL: http://www.ghrnet.org/index.php/ijhr/article/view/997
LETTER TO THE EDITOR
According to WHO, the global burden of disease due to unsafe blood
transfusion can be reduced through an integrated approach for blood safety
based on 4 strategies:
Establishment
of a nationally-coordinated blood transfusion service.
Collection of blood
only from voluntary non-remunerated blood donors from low-risk populations.
Testing of all
donated blood, including screening for transfusion-transmissible infections
(TTIs), blood grouping and compatibility testing.
Reduction in
unnecessary transfusions through the effective clinical use of blood[1].
Each of the 4
strategies is efficient in reducing risks of infection during blood
transfusion. Indeed, African countries with coordinated systems, collecting
blood from voluntary and non-remunerated blood donors, and/or screening TTIs
through quality assured techniques have substantially lower prevalences of TTIs
in blood donors[1]. Such strategies must be based on the five
quality system essentials: Organization, structure and infrastructure;
Standards (references); Documentation (traceability); Education (teaching and
training); Assessment (Monitoring and Evaluation). These essentials and their
implementation in the vein-to-vein transfusion chain should be seriously
considered before attempting to bridge the gaps with advanced and sophisticated
expensive technologies and methodologies.
However,
despite the current effort, residual risk of TTIs is still very high as
reported by the Francophone Africa Blood transfusion research network[2].
Viral detection through nucleic acid testing would certainly be most beneficial
but it is still not feasible in most African countries due to financial and
technical reasons. In addition, the efficacy of screening is limited by many
factors including genetic variations, inappropriate test conditions, absence of
quality assurance in many centers, and the inability to detect recently
infected subjects. Systematic screening of blood donor for endemic and public
health diseases such as malaria is still problematic. Moreover, it is still
impossible to know or reliably predict if and when emerging and re-emerging
pathogens (Chikungunya Virus, Ebola virus, dengue, etc.) will threaten the
safety of the blood supply. Thus it seems logical to assume that any other strategy
to eliminate the risk of infection, or reinforce the above recommendations
without hampering them should be considered.
For many
years, physical and/or chemical treatment of blood products has been only
feasible for platelet concentrates and plasma. However, Whole Blood and Red
Blood Cells are the main products used by a vast majority of clinicians in
sub-Saharan African countries[2]. With recent development of new
possibilities by some researchers, ¡®Inactivation Efficacy of Current Pathogen
Inactivation Technologies (PIT)¡¯ needs to be considered on whole blood. Intercept
Technology is a novel platform technology (2nd generation) that is based on
the addition of the chemical compound, S-303 (0.2 mmol/L) and glutathione (GSH;
20 mmol/L) as a quencher. On the other hand, Mirasol technology uses the same
riboflavin-based PIT which was successfully evaluated for platelets and plasma.
The toxicology profile and pathogen inactivation efficacy have already been
positively reported for both[3]. These technologies are also
accompanied by not inconsiderable costs. However, the use of pathogen
inactivated Whole Blood and convalescent plasma could then These technologies
are also accompanied by not inconsiderable costs.highly help in the emergency
management of epidemic crisis such as the current Ebola virus in West-Africa[4].
The use of
pathogen reduced Whole Blood and convalescent plasma could highly help in the
emergency management of epidemic crisis such as the current Ebola virus in
West-Africa[5].
However, there
is still a need for relevant clinical evaluation and hemovigilance data in
phase III of the evaluation process that will ensure not only safety but also a
reproducible and user-friendly technology for resource-limited settings. Such
technology should be adapted to current recommended blood safety regulations,
affordable and economically sustainable for blood services.
While the
availability of pathogen inactivated Whole Blood remains a challenge in Africa,
nevertheless, the use of pathogen reduction of Whole Blood and Red Blood Cells
is recommendable to Africa, where Whole Blood is predominantly used. Hence,
there is a dire need for researchers, international organizations and
pharmaceutical companies to concentrate efforts towards developing this blood
safety technology in these resource-limited settings.
CONFLICT OF INTERESTS
The authors have no conflicts of interest to declare.
REFERENCES
1
WHO Aide M¨¦moire-Blood safety. Blood
Transfusion Safety Department of Essential Health Technologies World Health
Organization, Geneva, Switzerland.
2
Tapko JB. Status of blood safety in the
WHO African region: ten years after adoption of the regional strategy. Africa
sanguine 2013; 16(1): 2-18
3
Tagny CT, Murphy EL, Lefr¨¨re JJ. The
Francophone Africa Blood Transfusion Research Network: a five-year report
(2007-2012). Transfus Med 2013; 23(6): 442-444
4
Schlenke P.
Pathogen Inactivation Technologies for Cellular Blood Components: an Update. Transfus
Med Hemother 2014; 41: 309-325
5
Wood D on behalf of WHO Ebola Blood and
Plasma group. Convalescent plasma in the context of Ebola infection control
Briefing for the ECBS. World Health Organization, Geneva, Switzerland.
Peer reviewer: Rui-tao wang, MD, PhD,
Associate Professor, Department of Geriatrics, the Second Affiliated Hospital,
Harbin Medical University, NO.246 Xuefu ST, Nangang District, Harbin, 150086,
China.
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