Prion reduction of red-blood-cells
INTERNATIONAL FORUM
Prion reduction of red-blood-cells
J. Coste, C. Prowse, C. Grabmer, H. Schennach, P. Santos Prado Scuracchio,
S. N. Wendel, M. Germain, G. Delage, T. Krusius, S. Ekblom-Kullberg, P.
Tiberghien, J. O’Riordan, W. G. Murphy, Ø. Flesland, M. Turner, L. Williamson,
L. Gregori, J. Epstein, D. Asher, S. Panzer, H. W. Reesink
Article first published online: 20 APR 2012
DOI: 10.1111/j.1423-0410.2012.01597.x
© 2012 The Author(s). Vox Sanguinis
© 2012 International Society of Blood Transfusion
J. Coste, C. Prowse, C. Grabmer, H. Schennach, P. Santos Prado Scuracchio,
S. N. Wendel, M, Germain, G. Delage, T. Krusius, S. Ekblom-Kullberg. P,
Tiberghien, J. O'Riordan, W. G, Murphy, Ø. Flesland, M. Turner, L Williamson, L
Gregori, J. Epstein, D. Asher, S. Panzer, H. W. Reesink
First page of article
It is now very likely that the infectious agent responsible for variant
Creutzfeldt-Jakob disease (vCJD), a fatal disease of the brain, can he passed
from person to person through blood transfusion and that this infectious agent
is present in the blood or affected individuals long before clinical signs of
the disease become apparent. This has led to major concerns that a pool of such
infectious, symptomless indi- viduals could exist and that some of these could
be rou- tinely donating blood leading to further cases or transfusion-related
person-to-person disease transmission. In the UK to date, four instances of
probable transmission of vCJD by blood transfusion have been identified by the
UK Transfusion Medicine Epidemiology Review (TMER), including three clinical
cases of vCJD and one sub- or pre- clinical infection. Recently, a fifth case of
vCJD has been identified with a history of blood transfusion in infancy. The
donors who provided the components transfused could not be identified, but a
blood donor known to have donated blood to another individual who subsequently
developed vCJD could have been a donor to the index case [1]. In February 2009.
it was announced that PrPTSE infection was found in the spleen or a 74-year-old
neurological asymp- tomatic patient with haemophilia, who had received units of
FVIII concentrate prepared from plasma pools known to include donations from a
vCJD donor. He had also received 14 units of red cell concentrates (RCCs) [2].
One method of preventing transfusion-related disease transmission would be
routinely screening all blood donations for the presence of the infectious
agent. Several techniques aim to detect PrPTSE in blood, but none have reached
the licensing stage for human use. However, recently, Edgeworth el al. [3]
reported a new test to identify vCJD-infected blood. The assay was applied on a
coded panel of blood samples. The only samples that were reactive were from
patients in clini- cal stage of vCJD. But work is still needed to develop the
assay into a screening assay with sufficient sensitivity to detect the
presumably lower concentrations that are expected to be present in blood of
asymptomatic carriers. A different approach is to reduce prion infectivity from
blood and blood components. At present, three companies have developed filters
to remove infectious prions from
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RCCs. The MacoPharma P-Capt Prion Capture, which can be connected to any
leucoreduced RCC, is 3 prion-specific filter incorporating PRDT patented ligand
technology for the selective adsorption of prions. The P-Capt Filter was CE
marked in September 2006. lndependent UK evaluations have been performed in
terms of operational use, of quality of filtered components and whether
filtration resulted in any changes to blood group antigens [4]. Pall Corporation
has CE marked in 2009 a Leukotrap Affinity Prion Reduc- tion Filter System that
concurrently reduces leucocytes and infectious prions [5]. Moreover,
Asahi/Fenwal and Pall Corporation have developed a New Combination Filter for
Prion and Leukoreduction. These filters are not CE marked yet. Finally,
manufacturers of pooled plasma and plasma products have been introducing
specific steps to remove infectious prion agents from their products [6].
Such a prion removal method may be implemented in some countries on RCCs in
the near future, It seemed. there- fore, of interest to collect information by
sending the fol- lowing quesuons to expert in the field.
Question 1
Is it likely that a prion removal filter of RCCs will be imple- mented in
your country/centre?
(a) If so, will it concern all RCC or RCCs for only certain groups of
patients
(b) How many filtered RCCs have been transfused and what was the
experience?
(c) Have you noticed any untoward reactions or effects that were going to
the filtration process?
(d) If the product is less potent (e.g. less haemoglobin con- tent) as a
result of processing is this of any concern
Question 2
If a prion removal device of RCCs will probably not be implemented in your
country/centre. what ale the reasons for this decision?
(a) Are there still doubts about the efficacy and the safety
(b) Is it an economic question?
(c) Is it because no vCJD cases have been notified in your country?
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TSS
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