Original Article Transfus Med Hemother 2014;41:172–175 DOI: 10.1159/000363205
Received: March 11, 2014 Accepted: April 28, 2014 Published online: May 12, 2014
Role of Riboflavin- and UV Light-Treated Plasma in Prevention of Transfusion-Related Acute Lung Injury Teresa Jimenez-Marcoa,b Daniel Ruiz-Aldertona Antonia M. Bautista-Gilia Enrique Girona-Lloberaa,b a b
Fundació Banc de Sang i Teixits de les Illes Balears, Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Palma de Mallorca. Spain
Keywords Riboflavin · UV light · Plasma · TRALI Summary Introduction: Risk reduction strategies for transfusionrelated acute lung injury (TRALI) include the preferential use of male donors to provide fresh frozen plasma (FFP). Implementing this measure based on FFP quarantine program is a very complex process. To improve FFP inventory management and the availability of FFP from male donors, the Mirasol Pathogen Reduction Technology® (PRT) system for FFP using riboflavin and UV light was adopted in our region in 2012. Methods: The percentage of male/female FFP units issued and TRALI cases in patients receiving FFP in the period before implementing riboflavin and UV light (2010–2011) was compared with the period post implementation of riboflavin and UV light (2012–2013). Results: In 2010 and 2011, there was one FFP transfusion-related TRALI case reported per year, when the proportion of male/female FFP distributed to the hospitals was 60/40. During 2012 and 2013, there have been no FFP transfusion-related TRALI cases, when the proportion of male/female FFP distributed to the hospitals was around 97/3. Mirasol PRT allows quick availability (24 h from collection) compared to quarantined FFP (*3 months from collection). Conclusion: Thanks to its readiness, simplicity and feasibility, riboflavin- and UV light-treated FFP implementation can facilitate the preferential use of FFP from male donors as a TRALI prevention strategy.
© 2014 S. Karger GmbH, Freiburg 1660-3796/14/0413-0172$39.50/0 Fax +49 761 4 52 07 14 [email protected] www.karger.com
Accessible online at: www.karger.com/tmh
Introduction The Mirasol Pathogen Reduction Technology® (PRT) system for platelets (PLTs) and plasma uses riboflavin and UV light in order to oxidize nucleic acids (DNA or RNA) through electron transfer reactions, resulting in the inhibition of pathogen genome and leukocyte replication which leads to inactivation [1, 2]. Since riboflavin is an essential nutritive ingredient that is normally present in the human body and as its photo-products are non-toxic, there is no need for their removal from inactivated blood components [3, 4]. Since 1995, the Balearic Islands Blood Bank (BIBB) has maintained a fresh frozen plasma (FFP) quarantine program to provide plasma for transfusion therapy of patients within our community. Basically, the system consists in releasing the plasma unit once a donor has been retested by NAT for HIV, HBV HCV, with negative results after a period of at least 3 months [5]. In 2011, the National Committee for Blood Safety established a recommendation for the preferential use of male donors to provide FFP as a strategy to prevent transfusion-related acute lung injury (TRALI). Selecting FFP from male donors to be quarantined is a very complex process due to multiple manual steps in the quarantine program. In addition, the plasma units are usually unavailable for issue for at least 3 months. As a result, in 2012, the BIBB initiated the routine use of FFP derived from whole blood donations prepared using riboflavin and UV light for the transfusion support of patients with congenital and acquired coagulopathies. However, the quarantine program for plasmapheresis donations was still maintained to provide plasma transfusion support to patients with thrombotic thrombocytopenic purpura (TTP) since the superior efficacy of quarantined FFP (qFFP) compared to inactivated plasma has previously been demonstrated for TTP treatment, and specifically with plasma treated with methylene blue [6.7].
Dr. Teresa Jimenez-Marco Fundació Banc de Sang i Teixits de les Illes Balears C/ Rosselló i Caçador, 20, 07004 Palma de Mallorca, Spain [email protected]
Table 1. Percentage of qFFP and PRTFFP units distributed to the hospitals from 2010 to 2013
Total FFP PRT-FFP* qFFP
Pre-riboflavin and UV light FFP period
Post-riboflavin and UV light FFP period
2010
2011
2012
2013
5,583 167 (3%) 5,416 (97%)
4,803 144 (3%) 4,659 (97%)
5,584 1,563 (28%) 4,021 (72%)
5,538 1,548 (28%) 3,990 (72%)
p value
0.223
Received: March 11, 2014 Accepted: April 28, 2014 Published online: May 12, 2014
Role of Riboflavin- and UV Light-Treated Plasma in Prevention of Transfusion-Related Acute Lung Injury Teresa Jimenez-Marcoa,b Daniel Ruiz-Aldertona Antonia M. Bautista-Gilia Enrique Girona-Lloberaa,b a b
Fundació Banc de Sang i Teixits de les Illes Balears, Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Palma de Mallorca. Spain
Keywords Riboflavin · UV light · Plasma · TRALI Summary Introduction: Risk reduction strategies for transfusionrelated acute lung injury (TRALI) include the preferential use of male donors to provide fresh frozen plasma (FFP). Implementing this measure based on FFP quarantine program is a very complex process. To improve FFP inventory management and the availability of FFP from male donors, the Mirasol Pathogen Reduction Technology® (PRT) system for FFP using riboflavin and UV light was adopted in our region in 2012. Methods: The percentage of male/female FFP units issued and TRALI cases in patients receiving FFP in the period before implementing riboflavin and UV light (2010–2011) was compared with the period post implementation of riboflavin and UV light (2012–2013). Results: In 2010 and 2011, there was one FFP transfusion-related TRALI case reported per year, when the proportion of male/female FFP distributed to the hospitals was 60/40. During 2012 and 2013, there have been no FFP transfusion-related TRALI cases, when the proportion of male/female FFP distributed to the hospitals was around 97/3. Mirasol PRT allows quick availability (24 h from collection) compared to quarantined FFP (*3 months from collection). Conclusion: Thanks to its readiness, simplicity and feasibility, riboflavin- and UV light-treated FFP implementation can facilitate the preferential use of FFP from male donors as a TRALI prevention strategy.
© 2014 S. Karger GmbH, Freiburg 1660-3796/14/0413-0172$39.50/0 Fax +49 761 4 52 07 14 [email protected] www.karger.com
Accessible online at: www.karger.com/tmh
Introduction The Mirasol Pathogen Reduction Technology® (PRT) system for platelets (PLTs) and plasma uses riboflavin and UV light in order to oxidize nucleic acids (DNA or RNA) through electron transfer reactions, resulting in the inhibition of pathogen genome and leukocyte replication which leads to inactivation [1, 2]. Since riboflavin is an essential nutritive ingredient that is normally present in the human body and as its photo-products are non-toxic, there is no need for their removal from inactivated blood components [3, 4]. Since 1995, the Balearic Islands Blood Bank (BIBB) has maintained a fresh frozen plasma (FFP) quarantine program to provide plasma for transfusion therapy of patients within our community. Basically, the system consists in releasing the plasma unit once a donor has been retested by NAT for HIV, HBV HCV, with negative results after a period of at least 3 months [5]. In 2011, the National Committee for Blood Safety established a recommendation for the preferential use of male donors to provide FFP as a strategy to prevent transfusion-related acute lung injury (TRALI). Selecting FFP from male donors to be quarantined is a very complex process due to multiple manual steps in the quarantine program. In addition, the plasma units are usually unavailable for issue for at least 3 months. As a result, in 2012, the BIBB initiated the routine use of FFP derived from whole blood donations prepared using riboflavin and UV light for the transfusion support of patients with congenital and acquired coagulopathies. However, the quarantine program for plasmapheresis donations was still maintained to provide plasma transfusion support to patients with thrombotic thrombocytopenic purpura (TTP) since the superior efficacy of quarantined FFP (qFFP) compared to inactivated plasma has previously been demonstrated for TTP treatment, and specifically with plasma treated with methylene blue [6.7].
Dr. Teresa Jimenez-Marco Fundació Banc de Sang i Teixits de les Illes Balears C/ Rosselló i Caçador, 20, 07004 Palma de Mallorca, Spain [email protected]
Table 1. Percentage of qFFP and PRTFFP units distributed to the hospitals from 2010 to 2013
Total FFP PRT-FFP* qFFP
Pre-riboflavin and UV light FFP period
Post-riboflavin and UV light FFP period
2010
2011
2012
2013
5,583 167 (3%) 5,416 (97%)
4,803 144 (3%) 4,659 (97%)
5,584 1,563 (28%) 4,021 (72%)
5,538 1,548 (28%) 3,990 (72%)
p value
0.223
