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SB_CPS Statements (Pediatrics Royal College 2018) > Transfusion and risk of infection in Canada: Update 2012 > Flashcards

Transfusion and risk of infection in Canada: Update 2012 Flashcards

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1
Q

What are the steps to prevent infections from blood transfusions?

A
  1. Restrictive transfusion policies and effective blood conservation programs
  2. Evidence based effective policies for donor selection, screening, product collection, testing, and infusion
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2
Q

What steps are taken in Canada to minimize infection risks of transfusion?

A
  1. Blood collection from volunteer, unpaid donors
  2. Donor interview and selection protocols
  3. Careful aseptic technique procedures for collection and infusion
  4. Diversion of the first 40mL of blood collected into a diversion pouch
  5. Donor screening by serological and other tests including bacterial detection in platelets
  6. Viral inactivation procedures used in manufacturing plasma-derived products
  7. Leukocyte reduction techniques to reduce the transmission risk of white-cell associated viruses i.e. CMV
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3
Q

What are blood donors tested for?

A
  1. HIV type 1-2 and subtype O (Antibody/NAT)
  2. HBV (HbsAg, Anti-HBc, NAT)
  3. HTLV type I/II (Antibody)
  4. Syphilis (Treponemal test/PK-TP)
  5. HCV (Antibody/NAT)
  6. WNV (NAT all units year round at CBS, all units tested during the summer plus testing donors with travel risk of WNV in the winter at HQ)
  7. Other: CMV antibody on selected units only, Trypanosoma cruzi (Chagas) antibody on at risk fonors)
  8. Bacteria: bacterial culture on platelets
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4
Q

What specific manufacturing procedures are available for virus inactivation or removal?

A
  1. Inactivation by heat: CMV, HAV, HBV, HCV, HIV, WNV, Parvovirus B19
  2. Inactivation by solvent/detergent: CMV, HBV, HCV, HIV, WNV. Not inactivated: HAV, Parvovirus B19, enteroviruses
  3. Ultrafiltration using 35nm and 15nm filters: removes even small viruses but also macromolecules (i.e. FVIII)
  4. Leukocyte depletion: CMV, HTLV type I/II, not inactivated: non-WBC associated viruses
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5
Q

Which blood product has the highest risk of bacterial contamination and why?

A

Platelets as they are stored at room temperature

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6
Q

What are the manufacturing steps to decrease infectious risks for cryoprecipitate?

A
  1. Virus risk pre-inactivation process

2. Pools screened for HIV, HCV, HBV, HTLV type I/II

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7
Q

What are the manufacturing steps to decrease infectious risks for Factor VII?

A
  1. Virus risk pre-inactivation process
  2. Pools screened for HIV, HCV, HBV, HTLV type I/II
  3. AI(OH)3 +/- nanofiltration +/-vapour heat treatment
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8
Q

What are the manufacturing steps to decrease infectious risks for Factor VIII?

A
  1. Virus risk pre-inactivation process
  2. Pools screened for HIV, HCV, HBV, HTLV type I/II
  3. Pasteurization process
  4. Solvent/detergent +/- dry heat treatment
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9
Q

What are the manufacturing steps to decrease infectious risks for Factor IX?

A
  1. Virus risk pre-inactivation process
  2. Pools screened for HIV, HCV, HBV, HTLV type I/II
  3. Vapour heating
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10
Q

What are the manufacturing steps to decrease infectious risks for antithrombin concentrates?

A
  1. Virus risk pre-inactivation process
  2. Pools screened for HIV, HCV, HBV, HTLV type I/II
  3. Sephadex A-50
  4. Solvent/detergent +/- DEAE
  5. Sepharose FF chromatography +/- nanofiltration
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11
Q

What are the manufacturing steps to decrease infectious risks for albumin?

A
  1. Virus risk pre-inactivation process
  2. Pools screened for HIV, HCV, HBV, HTLV type I/II
  3. Isolation of filtrate +/- isolation of filtrate IV +/- isolation of filtrate d +/- pasteurization +/- cold ethanol fractionation +/- heat treated
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12
Q

What are the manufacturing steps to decrease infectious risks for IVIG products?

A
  1. Virus risk pre-inactivation process
  2. Pools screened for HIV, HCV, HBV, HTLV type I/II
  3. Cold ethanol fractionation
  4. Solvent/detergent +/- caprylate +/- column chromatography +/- low pH treatment +/- nanofiltration +/- heat treatment +/- octanoic acid fractionation +/- depth filtration +/- virus filtration
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13
Q

What are the manufacturing steps to decrease infectious risks for IMIG?

A
  1. Virus risk pre-inactivation process
  2. Pools screened for HIV, HCV, HBV, HTLV type I/II
  3. Cold/ethanol fractionation
  4. Solvent/detergent +/- heat inactivation +/- precipitation filtration +/- ultra filtration +/- dia filtration
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14
Q

What are the manufacturing steps to decrease infectious risks for specific antibody products?

A
  1. Virus risk pre-inactivation process
  2. Pools screened for HIV, HCV, HBV, HTLV type I/II
  3. Cold ethanol fractionation or ion exchange column chromatography
  4. solvent/detergent
  5. virus filtration ± heat inactivation
  6. Anion-exchange column chromatography ± Planova 20N Virus Filter ± solvent/detergent ± cold ethanol fractionation ± heat inactivation ± precipitation filtration ± ultra filtration ± diafiltration
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15
Q

What bacterial agents are associated with acute infection during pRBC transfusion?

A

Storage: 1-6 degrees Celsius x 35-42d

Agents: Yersinia enterocolitica gram-negative, including Pseudomonas species

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16
Q

What bacterial agents are associated with acute infection during whole blood transfusion?

A

Storage: 1-6 degrees Celsius x 35-42d

Agents: Gram-negative, including Pseudomonas species

17
Q

What bacterial agents are associated with acute infection during platelet transfusion?

A

Storage: 20-24 degrees Celsius x 5d

Agents: Skin flora (Staph epidermidis, Strep species, diphtheroids), Salmonella species, E coli, Enterococci species, Clostridium species, Serratia marcescens

18
Q

What bacterial agents are associated with acute infection during plasma transfusion?

A

Storage: Frozen, once thawed can be held
at 1°C to 6°C for 24 h

Agents: S. aureus, Pseudomonas aeruginosa

19
Q

What are adverse reactions to transfusions in Canada?

A
  1. Severe allergic/anaphylactic reaction
  2. Acute hemolytic transfusion reaction
  3. Delayed hemolytic transfusion reaction
  4. Transfusion-associated circulatory overload
  5. Transfusion-related acute lung injury
  6. Possible transfusion-related acute lung injury
  7. Transfusion associated dyspnea
  8. Bacterial contamination
  9. Hypotensive transfusion reaction
  10. Post-transfusion purpura
20
Q

What are the estimated risk of infectious agents for which all blood donors are tested in blood or blood products?

A
  1. HIV 1 in 8-12 million
  2. HCV 1 in 5-7 million
  3. HBV 1 in 1.1-1.7 million
  4. HTLV I or II in 1 in 1.3million
  5. WNV no reported cases
  6. Bacteria: apheresis platelets 1 in 105 000, platelet pools 1 in 47 000
  7. Syphilis <1 in 100 million
21
Q

What are the estimated risk of infectious agents which are tested on occasion in blood or blood products?

A
  1. CMV rare

2. Chagas no new cases in 5 years

22
Q

What are the estimated risk of infectious agents which are not tested in blood or blood products?

A
  1. Parvovirus B19 1 in 5000 to 1 in 20 000
  2. GBV-C 1-2 in 100
  3. TTV 1 in 100
  4. SEN-V 1 in 100
  5. HHV-8 unknown
  6. Malaria no new cases in 10y
  7. Babesiosis 1 case in 2001
  8. vCJD risk unknown (<1 in 10 million)
23
Q

What are the estimated risks of viruses for which all blood donors are tested in manufactured plasma-derived products?

A
  1. HIV <1 in 10 million
  2. HCV <1 in 10 million
  3. HBV <1 in 10 million
  4. HTLV I and II theoretical
24
Q

What are the estimated risks of other viruses in manufactured plasma-derived products?

A
  1. CMV theoretical
  2. Parvovirus B19: theoretical if heat inactivation, 1 in 100 000 to 1 in 1 million otherwise
  3. WNV theoretical
25
Q

What are the estimated risks of parasites in manufactured plasma-derived products?

A

Only a theoretical risk for malaria, chagas, and babesiosis

26
Q

What are the estimated risks of prions in manufactured plasma-derived products?

A

vCJD theoretical risk of <1 in 100 million

SB_CPS Statements (Pediatrics Royal College 2018) (223 decks)

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