TRANSFUSION-TRANSMITTED DISEASES
Viruses
Cytomegalovirus (CMV)
Cytomegalovirus (CMV) is a virus belonging to the herpes group that is rarely transmitted by blood transfusion. According to the Centers for Disease Control and Prevention (CDC), about 50 to 85 percent of adults in the United States are infected with CMV by the age of 40. CMV infection is usually mild, but it may be serious or fatal in those who are immunocompromised. Particularly at risk are low-birth weight infants and bone marrow and organ transplant patients. If a patient is at high risk of getting CMV diseases, blood that tests negative for CMV can be transfused. Alternatively, blood that has been filtered to decrease the number of white blood cells — the cells that carry CMV — will protect patients from getting a CMV infection from transfusion.
Hepatitis
Hepatitis was the first documented transfusion-transmitted disease. Many of the current practices for diminishing risk in transfusion medicine are based on the experiences of controlling the transmission of hepatitis.
Hepatitis viruses, which infect the liver, fall primarily into two groups: viruses with a chronic course that can readily be transmitted by blood transfusion (hepatitis B and C) and viruses that cause only acute disease and are rarely transmitted by transfusion (hepatitis A and E).
Hepatitis A Virus (HAV)
Hepatitis A (HAV) infection is rarely transmitted through blood transfusion; it is usually spread by contaminated food and water. About 23,000 cases are reported annually in the US, but epidemiologists estimate that the virus infects 150,000 Americans each year. Hepatitis A is very prevalent in the developing world, including Mexico and parts of the Caribbean. Because HAV antibodies are present in approximately 20 percent of the population, many with no history of hepatitis, it is assumed that many people experience unrecognized infection. There have been occasional reports in the US of transfusion-transmitted HAV, but little can be done to prevent this rare occurrence. A vaccine recently developed for HAV has replaced immune globulin as a pre-exposure prophylactic measure for people at a high risk for acquiring this infection, although the latter remains useful after exposure.
Hepatitis B Virus (HBV)
Transmission of hepatitis B virus (HBV) is rare because of routine testing of blood for the HBsAg and hepatitis B core antibody, donor screening and deferral for risk of HBV infection, and the use of only altruistic volunteer blood donors. HBV is a major cause of acute and chronic hepatitis. Each year in the US, an estimated 300,000 persons are infected with HBV. More than 10,000 patients require hospitalization, and an average of 350 die from the disease. There is an estimated pool of 750,000–1,000,000 chronically infected HBV carriers in the US. Approximately 25 percent of carriers have active hepatitis that can progress to cirrhosis of the liver. An estimated 4,000 people die each year from hepatitis B-related cirrhosis, and more than 800 die from hepatitis B-related liver cancer. The number of HBV infections in the US is falling because hepatitis B vaccinations of health care professionals and school-age children has become nearly universal.
Screening blood donors for HBV began in 1969 and became mandatory in 1972. By the mid-1970s, testing and an all-volunteer blood donor supply reduced the rate of post-transfusion hepatitis B to between 0.3 and 0.9 percent. From 1982 to 1985, an average of 3.0 percent of hepatitis B cases in the US were related to blood transfusion. During the period from 1986 to 1988, the percentage of reported cases related to blood transfusion declined to 1.0 percent, possibly as a consequence of the donor screening questions that were instituted to identify persons at increased risk for HIV infection. In 2000, the frequency of post-transfusion hepatitis B developing after a blood transfusion was estimated at perhaps 1 in 137,000 screened units of blood.
Hepatitis C Virus (HCV)
Hepatitis C, formerly known as non-A, non-B hepatitis, was discovered in the late 1980s, and all blood donations have been screened for it since 1990. Acute hepatitis C virus (HCV) is a relatively mild infection, and most people are unaware they have become infected; however, HCV becomes chronic in 80 percent of those infected. In the general population, 1.8 percent of the population has some evidence of HCV-infection. While the rate of new HCV infections is falling rapidly due to behavior changes and blood screening, HCV is an important source of serious chronic liver disease, which often develops decades after the initial exposure to the virus.
Antibody screening was started in 1990, and the test has undergone significant improvement since. In 1999, NAT testing was added in the US. After more than 10 years of testing for HCV, the risk of HCV transmission through transfusion is less than 1 per 1,000,000-screened units of blood.
HIV (Human Immunodeficiency Virus)
Transfusion transmission of HIV, the virus that causes AIDS, has been almost completely eradicated, since blood banks began interviewing donors about at-risk behaviors and a blood test became available in early 1985. The HIV antibody tests, used on every blood donation since then, have undergone continuous improvement. Starting in 1999 nucleic acid amplification testing (NAT) has been used to directly detect the genetic material of the HIV virus in blood, and current estimates are that fewer than 1 in 1,900,000 blood components is capable of transmitting HIV. Transfusion medicine specialists are continually researching new technologies to further reduce the transmission of HIV. Examples of technologies on the horizon include methods to kill viruses in donated blood (called viral inactivation) and blood component substitutes.
Human T Lymphotropic Virus I, -II (HTLV-I, -II)
HTLV-I and -II are viruses that are not related to HIV. HTLV-I is found mainly in Southwestern Japan and Caribbean islands. The viruses can cause blood or nervous system diseases in a small number of infected people (less than 5 percent lifetime risk). HTLV-II is endemic in the Americas (including the US), and also may infrequently cause slightly increased susceptibility to infections. Both of these viruses, although rare, were found in the US blood donor population in the 1980s. Few people have gotten HTLV as a result of transfusion, but because of the small transfusion risk that existed in the 1980s, tests to detect HTLV-I antibodies were developed and quickly implemented; these tests also detected many, but not all, HTLV-II infections. Tests specifically designed to detect both viruses are now available and are used by blood centers to screen every donation.
West Nile virus (WNV)
West Nile virus (WNV) is spread by the bite of an infected mosquito. The virus can infect people, horses, many types of birds, and some other animals.
WNV was first detected in the United States in 1999 and has since been detected in many parts of the US. The first documented cases of WNV transmission through organ transplantation and transfusion were noted in 2002. The most common symptoms of transfusion-transmitted cases of WNV were fever and headache.
The preclinical incubation period is thought to range from 2 to14 days following a bite from an infected mosquito. Approximately 80% of people infected with WNV remain without symptoms, while 20% develop mild symptoms, including fever, headache, eye pain, body aches, gastrointestinal complaints, and occasionally a generalized rash or swollen lymph nodes. One in 150 to 200 persons infected with WNV develops a more severe form of the disease that may be fatal.
FDA is allowing national deployment of investigational nucleic acid tests (NAT) to screen blood for West Nile virus (WNV), until FDA-licensed tests become available. Blood centers have implemented precautionary measures to protect the blood supply from WNV, including stockpiling frozen blood components before the start of mosquito season.
Although there are limited data on the natural course of WNV infection, the deferral periods recommended are based on the longest known viremic period (the length of time a virus remains in the blood stream), with an extra safety margin added.
Who will be deferred?
A potential donor who has been diagnosed with WNV infection (including diagnoses based on symptoms and laboratory results) will be deferred for 120 days.
A donor whose blood or components potentially were associated with a transfusion-related WNV transmission will be deferred for 120 days from the date of the implicated donation.
Donors are encouraged to report unexplained post-donation febrile illness with headache or other symptoms suggestive of WNV infection that occur within one week after blood donation.
The following CDC Web site may be helpful: www.cdc.gov/ncidod/dvbid/westnile/city_states.htm.
Parasitic Infections
Babesiosis
Babesiosis is a parasitic infection carried by the white-footed mouse and transmitted by tick bites. It appears primarily in the northeastern US, in coastal areas that are home to the white-footed mouse. Cases also have been identified in the Upper Midwest and Pacific Northwest. About 30 transfusion-associated cases have been reported in the US. While babesiosis is often quite mild, some patients, including those without a spleen, the elderly, or the immunocompromised, may be at risk of serious illness. There are no useful tests available for screening blood donors, although testing strategies are being developed and discussed. The AABB requires that all donors be asked if they have a history of babesiosis. Those individuals with a history of the disease are permanently deferred from donating blood.
Chagas’ Disease
A Brazilian doctor, Carlos Chagas, discovered Chagas’ disease almost 100 years ago. This disease is caused by a parasite that infects as many as 18 million people worldwide. Once infection is established, it is life-long. Each year, several thousand South and Central Americans die of heart and digestive problems caused by the disease. Up to 20 percent of infected people never exhibit symptoms. This infection is rare in the US, but because of recent global population shifts, individuals from countries where this disease is common now reside in the US. To date, there have been only five cases of transfusion-transmitted Chagas’ disease reported in North America. The AABB requires that blood centers permanently prohibit blood donation from anyone who has had Chagas’ disease, and tests are being developed and screening strategies discussed.
Lyme Disease
Although transfusion-related cases have not been reported, public health agencies and the AABB are monitoring this disease because of the remote chance that it could affect transfusion safety. Lyme disease is associated with the bite of certain species of the deer tick, and can cause an illness that affects many systems within the body. Donors with a history of Lyme disease can donate, provided they have undergone a full course of antibiotic treatment and no longer have any symptoms.
Malaria
Between 1958 and 1998, the CDC recorded 103 cases of transfusion-transmitted malaria. These cases were most likely caused by donations from people who felt well and were not aware that they were carrying malaria. Although exceedingly rare in the US, malaria can cause serious consequences, including fatalities. There is no practical test available to screen donors so AABB requires blood centers to temporarily defer blood donations from people who have visited malarial areas in the past year or who emigrated from a malarial area within the past three years.
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CREUTZFELDT-JAKOB DISEASE (CJD)
CJD is a rare degenerative and fatal nervous system disorder. It is diagnosed in about one person per million per year in the US and worldwide. There are three forms of CJD that can affect humans: sporadic CJD has no known risk factors and accounts for 85 percent of CJD cases; hereditary CJD occurs only in individuals with a family history of the disease and/or tests positive for specific genetic mutations; and acquired CJD is transmitted by exposure to brain or nervous system tissue. Acquired CJD accounts for less than 1 percent of CJD cases and can occur in individuals who have received injections of human pituitary gland growth hormone, or who have had their brain’s outer lining (dura mater) repaired with dura mater from someone else who had CJD.
Individuals who will develop CJD can remain without symptoms for decades and then progress rapidly to dementia, severe loss of coordination and death. Scientists believe abnormal brain proteins that have undergone a peculiar shape change can cause other brain proteins to do the same and cause CJD.
Currently, there is no screening test for the disease, and while blood transfusions have never been shown to transmit any form of the disease, as a precaution the Food and Drug Administration (FDA) prohibits blood donation by individuals who may be at risk. These include potential donors who have received injections of human-derived pituitary hormone, those with a family history of CJD, or those who have had surgeries that involved transplanted dura mater.
variant Creutzfeldt-Jakob disease (vCJD)
Similar to CJD, vCJD, commonly known as the human form of “mad cow” disease, is a rare degenerative and fatal nervous system disorder. There is reason to believe that vCJD occurs when humans eat beef contaminated with bovine spongiform encephalopathy (BSE or “mad cow”). This new form of CJD has appeared in residents of the United Kingdom (UK) and France, and a single individual in Italy. Cases have occurred in other countries, including one in the United States, that have been tracked to a UK origin. Currently, there is no screening test in humans for the disease.
The UK has reported two presumptive transfusion transmitted cases of vCJD. FDA blood donor deferral policies seek an optimal balance between vCJD risk reduction and blood supply preservation. These policies are are under constant review by FDA as we learn more about vCJD and BSE.
The FDA recommends that the following donors be deferred indefinitely due to vCJD risk:
Donors who spent a total of three months or more in the United Kingdom (UK) from the beginning of 1980 through the end of 1996;
Donors who have spent a total of five years or more in Europe from 1980 to the present;
Current or former US military personnel, civilian military employees and their dependents who resided at US military bases in Northern Europe (Germany, UK, Belgium, and the Netherlands) for a total of six months or more from 1980 through 1990, or elsewhere in Europe (Greece, Turkey, Spain, Portugal, and Italy) from 1980 through 1996.
Donors who have received any blood or blood component transfusions in the UK between 1980 and the present;
Donors who have injected bovine insulin since 1980, unless it is possible to obtain confirmation that the product was not manufactured after 1980 from cattle in the UK.
Department of Defense (DoD) has a slightly different policy summarized here:
The DoD implemented its set of donor deferral rules in October 2001. All active-duty military personnel, civil service employees, and these two groups’ family members will be deferred indefinitely due to vCJD risk if they are:
Donors who traveled or resided in the UK for a cumulative total of three months or more at any time from 1980 through the end of 1996;
Donors who have received a blood transfusion in the UK at any time from 1980 to the present;
Donors who have traveled to or resided anywhere in Europe for a cumulative total of six months or more at any time from 1980 through the end of 1996;
Donors who traveled to or resided anywhere in Europe for a cumulative total of five years or more at any time from Jan. 1, 1997, to the present.
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SARS (SEVERE ACUTE RESPIRATORY SYNDROME)
Severe acute respiratory syndrome — or SARS — is a respiratory infection that can develop serious complications. Most of the cases identified have been in Asia, but there have been cases in other countries, including the United States and Canada.
There has been no evidence this infection is transmitted from blood donors to transfusion recipients, but the virus associated with SARS is present in the blood of people who are sick, and it is possible that the virus could be present in blood immediately before a person gets sick, so that an individual with infection but no symptoms possibly could transmit SARS through a blood donation.
To help determine whether or not an individual might be infected with SARS, a blood collection facility will ask a potential donor orally or in writing about any travel to a SARS-affected country or a history of SARS or possible exposure to SARS.
Because the risk of contracting SARS through a blood transfusion theoretically exists, anyone who might be at risk of being infected with SARS is requested not to donate blood for an interval of time called a deferral period. The individual is said to be “deferred.”
Who will be deferred?
Anyone who has traveled or lived in a SARS-affected area*, will be deferred from making a donation for a period of 14 days after arrival in the United States.
Anyone who has had close contact with a person with SARS or suspected SARS, will be deferred for 14 days after the last exposure to that individual. Close contact is defined as having cared for, having lived with, or having had direct contact with respiratory secretions and/or body fluids of a person known to have, or to have had, SARS or suspected of having, or having had, the illness.
Anyone who has been ill with SARS or suspected SARS, will be deferred for 28 days from the last date of treatment AND the last date that the individual had symptoms.
Please note that as long as a donor is and remains well, no other measures are necessary. If a donor becomes ill with fever of 100.4o F accompanied by cough or trouble breathing, that person should see a doctor. Also, any donor who develops a fever in the 14 days after making a donation should call the blood center.
Information about the definition of SARS cases and the identification of SARS-affected areas are updated regularly. This information is posted on the CDC web site http://www.cdc.gov/ncidod/sars/casedefinition.htm or may be obtained by calling the CDC at (888)246-2675, 8 am –11 pm weekdays, 10 am – 8 pm weekends. Information is also posted in the AABB “Pressroom.”
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SMALLPOX
Due to concern that terrorists may have access to the smallpox virus and attempt to use it against the American public, the U.S. Department of Health and Human Services (HHS) has been working, in cooperation with state and local governments, to strengthen our preparedness for bioterror attacks, by expanding the national stockpile of smallpox vaccine. The vaccine, which was routinely administered to Americans until 1972, is a highly effective protection against smallpox when given before or shortly after exposure to the virus. Vaccinia is the live virus used in smallpox vaccinations.
It is possible that until the vaccination scab spontaneously separates from the skin, recipients of the vaccinia virus could inadvertently infect close contacts who touch the vaccination site or dressing. The scabs themselves contain infectious virus. In an effort to ensure that the virus is not transmitted through a blood donation, potential donors will be asked by blood collection facilities about history of vaccination or close contact with anyone who has been vaccinated. A vaccine recipient who has had no complications may donate after the vaccination scab has spontaneously separated, or 21 days after vaccination, whichever is the later date. Some individuals who have received a smallpox vaccination may be requested not to donate for an interval of time called a deferral period. Those persons are said to be “deferred.”
Who will be deferred:
A vaccine recipient whose scab was pulled off or knocked off, and did not spontaneously separate, will be deferred for two months after the date of vaccination.
A vaccine recipient who has experienced complications will be deferred for 14 days after all vaccine complications are completely gone.
If a potential donor has had close contact (defined as physical intimacy, touching the vaccination site, touching the bandages or covering of the vaccination site, or handling bedding or clothing that had been in contact with an unbandaged vaccination site) with a vaccine recipient and has developed localized skin lesions without any other symptoms or complications, blood collection facility personnel will visually verify the absence of a scab.
If a scab spontaneously separated and is no longer present, there will be no deferral.
If a scab was otherwise removed, the donor will be deferred for three months from the date when the contact (that is the vaccine recipient) was vaccinated.
If the date when the contact received the vaccination is unknown, the potential donor will be deferred for two months from the time of the interview.
If a potential donor has had contact with a vaccine recipient who has had complications, the donor will be deferred for 14 days from the time that all vaccine complications are gone.
If a potential donor has had contact with a vaccine recipient who has had no symptoms, the donor will not be deferred and may make a donation.
The primary concern with the vaccination scab is to ensure that it is healed, not necessarily how it came off. It is possible to contract smallpox from the vaccination site until the scab is fully healed, which generally occurs when the scab spontaneously separates, or drops off, the skin, usually before 21 days have elapsed. Healing is considered complete when there is no scab, oozing or discharge, bleeding, or opening. Healing is evidenced by pink, uninterrupted skin at the inoculation site.
An individual who wants to receive a smallpox vaccination and who also wishes to donate blood may want to consider scheduling the blood donation before the vaccination.
07/05
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HIGHLIGHTS OF TRANSFUSION MEDICINE HISTORY
1628 English physician William Harvey discovers the circulation of blood. Shortly afterward, the earliest known blood transfusion is attempted.
1665 The first recorded successful blood transfusion occurs in England: Physician Richard Lower keeps dogs alive by transfusion of blood from other dogs.
1667 Jean-Baptiste Denis in France and Richard Lower in England separately report successful transfusions from lambs to humans. Within 10 years, transfusing the blood of animals to humans becomes prohibited by law because of reactions.
1795 In Philadelphia, American physician Philip Syng Physick, performs the first human blood transfusion, although he does not publish this information.
1818 James Blundell, a British obstetrician, performs the first successful transfusion of human blood to a patient for the treatment of postpartum hemorrhage. Using the patient's husband as a donor, he extracts approximately four ounces of blood from the husband's arm and, using a syringe, successfully transfuses the wife. Between 1825 and 1830, he performs 10 transfusions, five of which prove beneficial to his patients, and publishes these results. He also devises various instruments for performing transfusions and proposed rational indications.
1840 At St. George's School in London, Samuel Armstrong Lane, aided by consultant Dr. Blundell, performs the first successful whole blood transfusion to treat hemophilia.
1867 English surgeon Joseph Lister uses antiseptics to control infection during transfusions.
1873-1880 US physicians transfuse milk (from cows, goats, and humans).
1884 Saline infusion replaces milk as a “blood substitute” due to the increased frequency of adverse reactions to milk.
1900 Karl Landsteiner, an Austrian physician, discovers the first three human blood groups, A, B, and C. Blood type C was later changed to O. His colleagues Alfred Decastello and Adriano Sturli add AB, the fourth type, in 1902. Landsteiner receives the Nobel Prize for Medicine for this discovery in 1930.
1907 Hektoen suggests that the safety of transfusion might be improved by crossmatching blood between donors and patients to exclude incompatible mixtures. Reuben Ottenberg performs the first blood transfusion using blood typing and crossmatching in New York. Ottenberg also observed the mendelian inheritance of blood groups and recognized the “universal” utility of group O donors.
1908 French surgeon Alexis Carrel devises a way to prevent clotting by sewing the vein of the recipient directly to the artery of the donor. This vein-to-vein or direct method, known as anastomosis, is practiced by a number of physicians, among them J.B. Murphy in Chicago and George Crile in Cleveland. The procedure proves unfeasible for blood transfusions, but paves the way for successful organ transplantation, for which Carrel receives the Nobel Prize in 1912.
1908 Moreschi describes the antiglobulin reaction. The antiglobulin is a direct way of visualizing an antigen-antibody reaction that has taken place but is not directly visible. The antigen and antibody react with each other, then, after washing to remove any unbound antibody, the antiglobulin reagent is added and binds between the antibody molecules that are stuck onto the antigen. This makes the complex big enough to see.
1912 Roger Lee, a visiting physician at the Massachusetts General Hospital, along with Paul Dudley White, develops the Lee-White clotting time. Adding another important discovery to the growing body of knowledge of transfusion medicine, Lee demonstrates that it is safe to give group O blood to patients of any blood group, and that blood from all groups can be given to group AB patients. The terms "universal donor" and "universal recipient" are coined.
1914 Long-term anticoagulants, among them sodium citrate, are developed, allowing longer preservation of blood.
1915 At Mt. Sinai Hospital in New York, Richard Lewisohn uses sodium citrate as an anticoagulant to transform the transfusion procedure from direct to indirect. In addition, Richard Weil demonstrates the feasibility of refrigerated storage of such anticoagulated blood. Although this is a great advance in transfusion medicine, it takes 10 years for sodium citrate use to be accepted.
1916 Francis Rous and J.R.Turner introduce a citrate-glucose solution that permits storage of blood for several days after collection. Allowing for blood to be stored in containers for later transfusion aids the transition from the vein-to-vein method to indirect transfusion. This discovery also allows for the establishment of the first blood depot by the British during World War I. Oswald Robertson, an American Army officer, is credited with creating the blood depots. Robertson received the AABB Landsteiner Award in 1958 as developer of the first blood bank.
1927-1947 The MNSs and P systems are discovered. MNSs and P are two more blood group antigen systems — just as ABO is one system and Rh is another.
1932 The first blood bank is established in a Leningrad hospital.
1937 Bernard Fantus, director of therapeutics at the Cook County Hospital in Chicago, establishes the first hospital blood bank in the United States. In creating a hospital laboratory that can preserve and store donor blood, Fantus originates the term "blood bank." Within a few years, hospital and community blood banks begin to be established across the United States. Some of the earliest are in San Francisco, New York, Miami, and Cincinnati.
1939/40 The Rh blood group system is discovered by Karl Landsteiner, Alex Wiener, Philip Levine, and R.E. Stetson and is soon recognized as the cause of the majority of transfusion reactions. Identification of the Rh factor takes its place next to the discovery of ABO as one of the most important breakthroughs in the field of blood banking.
1940 Edwin Cohn, a professor of biological chemistry at Harvard Medical School, develops cold ethanol fractionation, the process of breaking down plasma into components and products. Albumin, a protein with powerful osmotic properties, plus gamma globulin and fibrinogen are isolated and become available for clinical use. John Elliott develops the first blood container, a vacuum bottle extensively used by the Red Cross.
1940 The United States government establishes a nationwide program for the collection of blood. Charles R. Drew develops the “Plasma for Britain” program — a pilot project to collect blood for shipment to the British Isles. The American Red Cross participates, collecting 13 million units of blood by the end of World War II.
1941 Isodor Ravdin, a prominent surgeon from Philadelphia, effectively treats victims of the Pearl Harbor attack with Cohn's albumin for shock. Injected into the blood stream, albumin absorbs liquid from surrounding tissues, preventing blood vessels from collapsing, a finding associated with shock.
1943 The introduction by J.F. Loutit and Patrick L. Mollison of acid citrate dextrose (ACD) solution, which reduces the volume of anticoagulant, permits transfusions of greater volumes of blood and permits longer term storage.
1943 P. Beeson publishes the classic description of transfusion-transmitted hepatitis.
1945 Coombs, Mourant, and Race describe the use of antihuman globulin (later known as the “Coombs Test”) to identify “incomplete” antibodies.
1947 The American Association of Blood Banks (AABB) is formed to promote common goals among blood banking practitioners and the blood donating public.
1949-1950 The US blood collection system includes 1,500 hospital blood banks, 46 community blood centers, and 31 American Red Cross regional blood centers.
1950 Audrey Smith reports the use of glycerol cryoprotectant for freezing red blood cells.
1950 In one of the single most influential technical developments in blood banking, Carl Walter and W.P. Murphy, Jr., introduce the plastic bag for blood collection. Replacing breakable glass bottles with durable plastic bags allows for the evolution of a collection system capable of safe and easy preparation of multiple blood components from a single unit of whole blood. Development of the refrigerated centrifuge in 1953 further expedites blood component therapy.
1953 The AABB Clearinghouse is established, providing a centralized system for exchanging blood among blood banks. Today, the Clearinghouse is called the National Blood Exchange.
Mid-1950s In response to the heightened demand created by open-heart surgery and advances in trauma care patients, blood use enters its most explosive growth period.
1957 The AABB forms its committee on Inspection and Accreditation to monitor the implementation of standards for blood banking.
1958 The AABB publishes its first edition of Standards for a Blood Transfusion Service (now titled Standards for Blood Banks and Transfusion Services).
1959 Max Perutz of Cambridge University deciphers the molecular structure of hemoglobin, the molecule that transports oxygen and gives red blood cells their color.
1960 The AABB begins publication of TRANSFUSION, the first American journal wholly devoted to the science of blood banking and transfusion technology. In this same year, A. Solomon and J.L. Fahey report the first therapeutic plasmapheresis procedure — a procedure that separates whole blood into plasma and red blood cells.
1961 The role of platelet concentrates in reducing mortality from hemorrhage in cancer patients is recognized.
1962 The first antihemophilic factor (AHF) concentrate to treat coagulation disorders in hemophilia patients is developed through fractionation.
1962 In the US, there were 4,400 hospital blood banks, 123 community blood centers and 55 American Red Cross blood centers, collecting a total of five to six million units of blood per year.
1964 Plasmapheresis is introduced as a means of collecting plasma for fractionation.
1965 Judith G. Pool and Angela E. Shannon report a method for producing Cryoprecipitated AHF for treatment of hemophilia.
1967 Rh immune globulin is commercially introduced to prevent Rh disease in the newborns of Rh-negative women.
1969 S. Murphy and F. Gardner demonstrate the feasibility of storing Platelets at room temperature, revolutionizing platelet transfusion therapy.
1970 Blood banks move toward an all-volunteer blood donor system.
1971 Hepatitis B surface antigen (HBsAg) testing of donated blood begins.
1972 Apheresis is used to extract one cellular component, returning the rest of the blood to the donor.
1979 A new anticoagulant preservative, CPDA-1, extends the shelf life of whole blood and red blood cells to 35 days, increasing the blood supply and facilitating resource sharing among blood banks.
Early 1980s With the growth of component therapy, products for coagulation disorders, and plasma exchange for the treatment of autoimmune disorders, hospital and community blood banks enter the era of transfusion medicine, in which doctors trained specifically in blood transfusion actively participate in patient care.
1981 First Acquired Immune Deficiency Syndrome (AIDS) case reported.
1983 Additive solutions extend the shelf life of red blood cells to 42 days.
1984 Human Immunodeficiency Virus (HIV) identified as cause of AIDS
1985 The first blood-screening test to detect HIV is licensed and quickly implemented by blood banks to protect the blood supply.
1987 Two tests that screen for indirect evidence of hepatitis are developed and implemented, hepatitis B core antibody (anti-HBc) and the alanine aminotransferase test (ALT).
1989 Human-T-Lymphotropic-Virus-I-antibody (anti-HTLV-I) testing of donated blood begins.
1990 Introduction of first specific test for hepatitis C, the major cause of “non-A, non-B” hepatitis.
1992 Testing of donor blood for HIV-1 and HIV-2 antibodies (anti-HIV-1 and anti-HIV-2) is implemented.
1996 HIV p24 antigen testing of donated blood begins. Although the test does not completely close the HIV window, it shortens the window period.
1997 U.S. Government issues two reports suggesting ways to improve blood safety, including regulatory reform.
National Blood Data Resource Center founded by AABB to collect, analyze and distribute data on all aspects of blood banking and transfusion medicine.
1998 HCV lookback campaign — a public health effort to alert anyone who may have been exposed to the hepatitis C virus (HCV) through blood transfusions before July 1992 so they can receive medical counseling and treatment if needed.
1999 Blood community begins implementation of Nucleic Acid Amplification Testing (NAT) under the FDA’s Investigational New Drug (IND) application process. NAT employs a testing technology that directly detects the genetic materials of viruses like HCV and HIV.
2002 West Nile virus identified as transfusion transmissible.
2002 Nucleic acid amplification test (NAT) for HIV and HCV was licensed by the Food and Drug Administration.
