| Strategy* | Approach | Advantages | Disadvantages |
| Passive surveillance | - Relies on clinical reports of acute reactions.
| - Least amount of work and resources.
| - Shown to under-report the incidence of bacterial culture-positive transfusion reactions.
- Likely to miss preventable cases of transfusion-associated sepsis and death.
|
| Donor arm cleaning | - Cleaning the venipuncture site rigorously with approved antiseptic solution prior to collection.
| - Easy and can be standardized.
| - Incomplete efficacy and only removes skin contaminants.
|
| Use of a diversion pouch | - The first 15 to 40 mL of blood are diverted from the donor during collection and not included in the product.
| - Easy and can be standardized.
- Diverted blood can be used for donor testing.
| |
| Primary culture | - Performed at the collection site, with sample taken 24 to 36 hours after collection.
| - Moderately effective at interdicting bacterial contamination.
- Additional work and resources not required for the transfusing facility.
| - Earlier culturing and/or use of a small inoculum may miss units contaminated with a low number of organisms or slow growing organism.
|
| Large volume delayed sampling | - Uses a 16 mL sample taken no sooner than 36 hours after collection.
| - Optimizes detection by compensating for low level of bacteria and/or slow growing organisms.
- If sampling is performed ≥48 hours after collection, the shelf-life of the unit can be extended to 7 days.
| - Adds cost.
- May delay release of the unit to the transfusing facility.
|
| Point-of-release testing | - Uses assays for bacterial products such as LPS, performed at the transfusing facility within 24 hours of transfusion.
| - Occurs closer in time to release of the unit.
- Can be done rapidly (in 30 to 60 minutes) without waiting for culture results.
| - Adds cost.
- Additional work and resources required at the transfusing facility.
|
| Pathogen inactivation | - Treatment is applied to the unit shortly after collection (within a few hours).
| - Very effective. Broadly inactivates numerous microorganisms including viruses, fungi, parasites, and bacteria.
- May have ancillary benefits such as prevention of TA-GVHD.
| - Adds significant cost.
- Reduced yield of platelets relative to untreated units.
|
| Investigational approaches | - Cold storage.
- Assaying the unit for bacterial DNA.
| - Cold storage would increase shelf-life.
- DNA testing would be very sensitive and likely to identify low numbers of organisms or slow growing organisms.
| - Further study of cold storage is required to demonstrate efficacy.
- DNA testing would require a panel of markers for multiple organisms and would miss any organisms not on the panel.
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