Current Risks of Transfusion-Transmitted Agents: A Review

Abstract

Abstract Context.—Infectious disease testing has dramatically improved the safety of blood for transfusion in the United States, especially since the introduction in 1999 of nucleic acid amplification testing. In 2004, methods (primarily culturing) for detecting bacteria in platelets were also added. Objective.—To provide current risk estimates for the likelihood of viral transmission by test-negative blood components and to illustrate the safety improvements since the introduction of bacterial testing of platelets. Data Sources.—Published literature from 1999 through 2006 and unpublished American Red Cross data sources. Conclusions.—The risk of human immunodeficiency virus and hepatitis C virus transmission through blood transfusion since the introduction of nucleic acid amplification testing is approximately 1 in 2 million. Hepatitis B virus risk, for which nucleic acid amplification testing is not performed routinely, remains at 1 in 200 000 to 500 000 using a combination of anti–hepatitis B core and hepatitis B surface antigen testing. Seven cases of transfusion-transmitted West Nile virus have been reported since the introduction of nucleic acid amplification testing in 2003, but none has been reported since system-wide implementation of processes to increase the test sensitivity for use in epidemic areas. The residual risk of receiving a bacterially contaminated platelet component with clinical consequences is estimated at approximately 1 in 75 000, if culture negative and 1 in 33 000 if not tested by culture methods.