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19 - Processing and components: leucodepletion and pathogen reduction
- from Section 2 - Selection and testing
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- By Rebecca Cardigan, Head of Components Development, NHS Blood and Transplant Cambridge, Cambridge, UK, Chris Prowse, Research Director, National Science Laboratory, Scottish National Blood Transfusion Service, Edinburgh, UK, Lorna M. Williamson, Reader in Transfusion Medicine, University of Cambridge; Medical Director, NHS Blood and Transplant, Cambridge, UK
- Edited by John A. J. Barbara, University of the West of England, Bristol, Fiona A. M. Regan, Marcela Contreras, University of the West of England, Bristol
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- Book:
- Transfusion Microbiology
- Published online:
- 12 January 2010
- Print publication:
- 24 April 2008, pp 239-258
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- Chapter
- Export citation
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Summary
Although donor selection and donation screening remain the critical elements of protection from transfusion-transmitted pathogens, there is increasing interest in achieving further safety enhancements by component modification. In the last five years, leucocyte depletion has moved from being a bedside procedure for specific patients to a universal and integral part of component processing. In this context, its potential for removal of leucocyte-associated viruses has been the subject of considerable debate. Over the same time period, techniques for pathogen reduction of fresh frozen plasma and platelets have been developed and, in some cases, licensed for routine use. Pathogen reduction for red cells is proving a more challenging prospect, but in time the current difficulties may be overcome. Such techniques present policy-makers with interesting decisions which must take into account cost-effectiveness, loss of functionality of components, potential toxicity, and the potential impact on current donor selection and screening policies.
Leucocyte depletion (LD)
Many countries now undertake universal LD of all components in blood centres within 1–2 days of collection. The reasons for this practice vary from country to country, but perceived benefits include reduced immunomodulation, fewer febrile reactions, and reduction of cytomegalovirus risk (reviewed in Williamson, 2000). In the UK, the main reason for implementation of universal LD was as a precaution against transmission of variant Creutzfeld-Jacob disease. Leucocyte depletion is achieved either by filtration of either whole blood or processed components, or by centrifugation/elutriation during platelet apheresis.