Research Article| Volume 12, ISSUE 4, P701-710, December 1992

Safety in Transfusion Practices: Preventing Infectious Complications

  • Herbert F. Polesky
    Address reprint requests to: Herbert F. Polesky, MD, Memorial Blood Center of Minneapolis, 2304 Park Avenue, Minneapolis, MN 55404
    From the Memorial Blood Center of Minneapolis; and Department of Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, Minnesota
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.
      The benefits of transfusion therapy must always be weighed against the unavoidable chance of an infectious complication. Strategies to minimize the infectious risks inherent in the use of human blood and blood components can be categorized under four general headings: donor selection, testing, appropriate use, and follow-up and reporting of complications. The application of these strategies in the context of their role in the prevention of some of the infectious complications of transfusion therapy is discussed in this article.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Clinics in Laboratory Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Aach R.D.
        • Szmuness W.
        • Mosely J.W.
        • et al.
        Serum alanine aminotransferase of donors in relation to the risk of non-A, non-B hepatitis in recipients: The Transfusion- Transmitted Virus Study.
        N Engl J Med. 1981; 304: 989-994
      1. Acting Director, Center of Biologics Evaluation and Research, Food and Drug Administration: Revised recommendations for the prevention of human immunodeficiency virus (HIV) transmission by blood and blood products—section I, parts A and B only.
        FDA, Bethesda1990 (December 5)
        • Allain J.P.
        • Laurian Y.
        • Paul D.A.
        • et al.
        Serological markers in early stages of human immunodeficiency virus infection in haemophiliacs.
        Lancet. 1986; 2: 1233-1236
        • Alter H.J.
        • Epstein J.S.
        • Swenson S.G.
        • et al.
        Prevalence of human immunodeficiency virus type 1 p24 antigen in US blood donors—an assessment of the efficacy of testing in donor screening.
        N Engl J Med. 1990; 323: 1312-1317
        • American Association of Blood Banks: Recommendations regarding reducing the possible risk of transmission of Leishmania tropica by transfusion
        Memorandum, 1991 (November 21)
        • Bäcker U.
        • Weinauer F.
        • Gathof G.
        • et al.
        HIV antigen screening in blood donors.
        Lancet. 1987; 2: 1213
        • Bang N.U.
        • Ruegsegger P.
        • Ley A.B.
        • et al.
        Selection of hepatitis carriers by serum oxalacetic transaminase activity.
        JAMA. 1959; 171: 2303-2306
        • Bove J.R.
        • Rigney R.
        • Kehoe P.M.
        • et al.
        Look-back: Preliminary experience of AABB members.
        Transfusion. 1987; 27: 201-202
        • Brookmeyer R.
        Reconstruction and future trends of the AIDS epidemic in the United States.
        Science. 1991; 253: 37-42
        • Busch M.P.
        Let’s look at human immunodeficiency virus look-back before leaping into hepatitis C virus look-back.
        Transfusion. 1991; 31: 655-661
        • Centers for Disease Control
        Bacterial contamination of platelet pools—Ohio, 1991.
        MMWR. 1992; 41: 36-37
        • Centers for Disease Control
        Possible transfusion-associated acquired immune deficiency syndrome (AIDS)—California.
        MMWR. 1982; 31: 652-654
        • Centers for Disease Control
        Prevention of acquired immune deficiency syndrome (AIDS): Report of interagency recommendations.
        MMWR. 1983; 32: 101-104
        • Check W.A.
        Preventing AIDS transmission: Should blood donors be screened?.
        JAMA. 1983; 249: 567-570
      2. Code of Federal Regulations.
        US Government Printing Office, Washington, DC1992 (Current edition. 21 Food and Drugs, 606.160(e))
        • Cumming P.D.
        • Wallace E.L.
        • Schorr J.B.
        • et al.
        Exposure of patients to human immunodeficiency virus through transfusion of blood components that test antibody negative.
        N Engl J Med. 1989; 321: 941-946
      3. Director, Office of Biologics Research and Review, Food and Drug Administration: Recommendations concerning persons at risk of HIV-1 and HIV-2 infection.
        Memorandum to all registered blood establishments. 1988; (April 6)
      4. Director, Office of Biologics Research and Review, Food and Drug Administration: Revised definition of high risk groups with respect to acquired immunodeficiency syndrome (AIDS) transmission from blood and plasma donors.
        Memorandum to all registered blood establishments. 1985; (September 3)
        • Esber E.C.
        Recommendations for the management of donors and units that are initially reactive for hepatitis B surface antigen (HBsAg).
        FDA OBRR Memo. 1987 (December 2)
      5. Food and Drug Administration (OBRR, Center for Drugs and Biologies): Revision of donor reentry algorithm for HIV.
        Communication to Blood Products Advisory Committee, 1989 (October 31)
        • Goldfield M.
        • Bill J.
        • Black H.
        • et al.
        The consequences of administering blood pretested for HBsAg by third generation techniques: A progress report.
        Am J Med Sci. 1975; 270: 335-342
        • Hanson M.
        • Polesky H.F.
        A method for calculating the risk of donors implicated in transfusion associated hepatitis.
        in: Hopkins R. Field S. Proceedings of the International Hepatitis Workshop. Nuclear Enterprises, Edinburgh, Scotland1982: 99-100
        • Haseltine W.A.
        Silent HIV infection.
        N Engl J Med. 1989; 320: 1487-1489
        • Hollinger F.B.
        Specific and surrogate screening tests for hepatitis.
        in: Insalaco S.J. Menitove J.E. Transfusion-Transmitted Viruses: Epidemiology and Pathology. American Association of Blood Banks, Arlington, VA1987: 69-86
        • Hoofnagle J.H.
        Posttransfusion hepatitis B.
        Transfusion. 1990; 30: 384-386
        • Imagawa D.
        • Detels R.
        HIV-1 in seronegative homosexual men.
        N Engl J Med. 1991; 325: 1250-1251
        • Imagawa D.T.
        • Lee M.H.
        • Wolinsky S.M.
        • et al.
        Human immunodeficiency virus type 1 in homosexual men who remain seronegative for prolonged periods.
        N Engl J Med. 1989; 320: 1458-1462
        • Kerndt P.R.
        • Waskin H.A.
        • Kirchhoff L.V.
        • et al.
        Prevalence of antibody to Trypanosoma cruzi among blood donors in Los Angeles, California.
        Transfusion. 1991; 31: 814-818
        • Koziol D.E.
        • Holland P.V.
        • Alling D.W.
        • et al.
        Antibody to hepatitis B core antigen as a paradoxical marker for non-A, non-B hepatitis agents in donated blood.
        Ann Intern Med. 1986; 104: 488-495
        • Ladd D.J.
        • Hillis A.
        A new method for evaluating the hepatitis risk of the multiply- implicated donor.
        Transfusion. 1984; 24: 80-82
        • Lui K.J.
        • Lawrence D.N.
        • Morgan W.M.
        • et al.
        A model-based approach for estimating the mean incubation period of transfusion-associated acquired immunodeficiency syndrome.
        Proc Natl Acad Sci. 1987; 83: 3051-3055
        • Mayo D.J.
        • Rose A.M.
        • Matchett S.E.
        • et al.
        Screening potential blood donors at risk for human immunodeficiency virus.
        Transfusion. 1991; 31: 466-474
        • Medley G.F.
        • Anderson R.M.
        • Cox D.R.
        • et al.
        Incubation period of AIDS in patients infected via blood transfusion.
        Nature. 1987; 328: 719-721
        • Norris R.F.
        • Potter H.P.
        • Reinhold J.G.
        Present status of hepatitis function tests in the detection of carriers of viral hepatitis.
        Transfusion. 1963; 3: 202-210
        • Nusbacher J.
        • Chiavetta J.
        • Nauman R.
        • et al.
        Evaluation of a confidential method of excluding donors exposed to human immunodeficiency virus.
        Transfusion. 1986; 26: 539-541
        • Overby L.
        Comments on hepatitis B markers and update on non-A, non-B.
        in: Polesky H.F. Walker R.H. Safety in Transfusion Practices. College of American Pathologists, Skokie, IL1982: 28-31
        • Perkins H.A.
        • Sampson S.
        • Busch M.P.
        How well has self-exclusion worked?.
        Transfusion. 1988; 28: 601-602
        • Perkins H.A.
        • Sampson S.
        • Garner J.
        • et al.
        Risk of AIDS for recipients of blood components from donors who subsequently developed AIDS.
        Blood. 1987; 70: 1604-1610
        • Pindyk J.
        • Waldman A.
        • Zang E.
        • et al.
        Measures to decrease the risk of acquired immunodeficiency syndrome transmission by blood transfusion.
        Transfusion. 1985; 25: 3-9
        • Public Health Service Inter-Agency Guidelines for Screening Donors of Blood, Plasma, Organs, Tissues and Semen for Evidence of Hepatitis B and Heptatitis C
        MMWR. 1991; 40 (RR-4): 1-17
        • Quinnan G.V.
        FDA recommendations concerning testing for antibody to hepatitis B core antigen (anti-HBc).
        Center for Biologics Evaluation and Research of FDA, Bethesda, MD1991 (September 10)
        • Rhame F.S.
        • McCullough J.
        Nosocomial Pseudomonas cepacia infection.
        MMWR. 1979; 28: 409
        • Rutter P.
        • Herman A.
        • Killroy Forman P.
        Confidential unit exclusion and other infectious disease markers in the donor population.
        Transfusion. 1988; 28: 29S
        • Sazama K.
        Reports of 355 transfusion-associated deaths: 1976 through 1985.
        Transfusion. 1990; 30: 583-590
        • Schmunis G.A.
        Trypanosoma cruzi, the etiologic agent of Chagas’ disease: Status in the blood supply in endemic and nonendemic countries.
        Transfusion. 1991; 31: 547-557
        • Sherman L.A.
        Guidelines for notification and counseling of recipients of HTLV-I/II positive blood.
        Memo to AABB Institutional Members, 1989 (May 26)
        • Stevens C.E.
        • Taylor P.E.
        • Pindyck J.
        • et al.
        Epidemiology of hepatitis C virus: A preliminary study in volunteer blood donors.
        JAMA. 1990; 263: 49-53
        • Stramer S.L.
        • Heller J.S.
        • Coombs R.W.
        • et al.
        Markers of HIV infection prior to IgG antibody seropositivity.
        JAMA. 1989; 262: 64-69
        • Taswell H.F.
        Directed, paid, and self donors, part III.
        in: Clark G.M. Competition in Blood Services. American Association of Blood Banks, Arlington, VA1987: 137-148
        • Tipple M.A.
        • Bland L.A.
        • Murphy J.J.
        • et al.
        Sepsis associated with transfusion of red cells contaminated with Yersinia enterocolitica.
        Transfusion. 1990; 30: 207-213
        • van der Poel C.L.
        • Reesink H.W.
        • Lelie P.N.
        • et al.
        Anti-hepatitis C antibodies and non- A, non-B post transfusion hepatitis in the Netherlands.
        Lancet. 1989; 2: 297-298
        • Walsh J.H.
        • Purcell R.H.
        • Morrow A.G.
        • et al.
        Post-transfusion hepatitis after open-heart operations: Incidence after administration of blood from commercial and volunteer donor populations.
        JAMA. 1970; 211: 261-265
        • Ward J.W.
        • Holmberg S.D.
        • Allen J.R.
        • et al.
        Transmission of human immunodeficiency virus (HIV) by blood transfusions screened as negative for HIV antibody.
        N Engl J Med. 1988; 318: 473-478
        • Ward J.W.
        • Kleinman S.H.
        • Douglas D.K.
        • et al.
        Epidemiologic characteristics of blood donors with antibody to human immunodeficiency virus.
        Transfusion. 1988; 28: 288-301
        • Westphal R.
        Transfusion-transmitted malarial infections.
        in: Smith D.M. Dodd R.Y. Transfusion-Transmitted Infections. ASCP Press, Chicago, IL1991: 167-180
      6. Widmann F.K. Standards for Blood Banks and Transfusion Services. American Association of Blood Banks, Arlington, VA1991: 14-17 (B1.261)
      7. Widmann F.K. Standards for Blood Banks and Transfusion Services. American Association of Blood Banks, Arlington, VA1991: 10-14 (B1.330)
      8. Widmann F.K. Standards for Blood Banks and Transfusion Services. American Association of Blood Banks, Arlington, VA1991: 14-43 (K3.211)
        • Zuck T.F.
        Greetings: A final look back with comments about a policy of zero-risk blood supply.
        Transfusion. 1987; 27: 447-448