Transfusion safety: realigning efforts with risks

ver the last decade, the efforts of numerous research groups have been directed at decreasing the risk of transmission of viruses through transfusion.Accelerated by the appearance of human immunodeficiency virus (HN) in the blood supply in the early part of the 1980s, these efforts-reducing viral risks through expansion of donor history screening, improvements in infectious disease marker testing, and development of virus inactivation-have led to unqualified successes for the field of transfusion medicine (Fig. 11.' Quantifiable infectious risks remain; however, the current incidence of transfusion-transmitted infection suggests that the pursuit of additional improvements, while still important, is likely to be more difficult, and questions regarding cost-effectiveness are surfacing2We believe that some of the energy devoted to avoiding transfusion-transmitted viral diseases should now be focused on additional ways to make transfusions safer.In this commentary, we identify three broad areas of transfusion risk that are in need of substantial and coordinated research attention, each of which has different scientific and practical ramifications.One problem, ABO-related transfusion fatalities, has plagued transfusion practice since its beginning.The incidence and impact of the second problem, bacterial contamination of blood components, have probably been underestimated until recently.Finally, the risks and consequences of the third problem, immune modulation following allogeneic blood transfusion, are significant, not only because of the clinical impact on blood ABBREVIATIONS: FDA = Food and Drug