Transfusion safety: Where are we today?

Over the past decades, the incidence of clinically significant transfusion-transmitted diseases has been dramatically reduced. These reductions have occurred because of a multifocal approach to the collection, processing, and release of blood and blood components. Research has focused on characterizing specific pathogens and their infectious patterns, especially the early viremic phase. Donor motivation and characteristics have been investigated, and restrictive eligibility criteria have been established. Regulatory oversight has been strengthened in the United States and hemovigilance systems established in many countries of the European Union, Canada, and Japan to identify new and emerging infectious and noninfectious transfusion risks. Such systems are required because many emerging pathogens will elude the stringent and sensitive donor testing already in place which, unfortunately, requires advanced technologies. Despite the remarkable progress, the processes of delivering a transfusion to a patient provide additional opportunity for risk, but have been less- well studied and the solutions have been less-well defined. Specific areas of concern include the collection and correct identification of patient samples, selection of modified or unique products, blood administration process, and establishment of specific indications for transfusion. In this chapter, we review the status of transfusion safety in the United States and discuss some emerging infectious and noninfectious risks of transfusion that will become future areas for basic and translational research. The disparities that exist in blood safety in developing countries' red cell alloimmunization and autoimmunity will not be covered.