Advances in pretransfusion infectious disease testing: ensuring the safety of transfusion therapy

At the dawn of the third millennium, the American blood supply is exquisitely safe. This high level of transfusion safety is the result of a multi-tiered approach to donor evaluation and infectious disease testing, including most recently the application of nucleic acid testing for HIV and Hepatitis C virus. Nonetheless, despite the overall safety of the blood supply, problems and challenges remain. Bacterial contamination, particularly involving platelets, has emerged as the leading infectious complication of transfusion therapy. In addition, the epidemic of mad cow disease and new variant Creuztfeldt-Jakob disease in Europe has elicited new fears about the potential for blood transmissibility of this new type of pathogen. In response to these concerns and the potential emergence of other infectious agents, various strategies for pathogen inactivation are likely to evolve during the next several years as the newest chapter in the quest for transfusion safety.