Overview

According to the American Blood Center, approximately 14 million units of blood are transfused in the United States every year. Current screening protocols routinely test for several pathogens, including the Hepatitis B virus, Hepatitis C virus, Human Immunodeficiency Viruses types 1 and 2, Human T-Lymphotropic virus types 1 and 2, and syphilis. Recent headlines indicate that the blood supply may contain other organisms, such as Xenotropic Murine Leukemia Virus-Related Virus (XMRV), that are not currently being identified in these routine screens. At the Pathogens in the Blood Supply symposium held at the New York Academy of Sciences on March 29, 2011, experts from a range of backgrounds came together to discuss the current problems, reveal recent advances in the testing and screening of the blood supply, and explore future directions for the improvement of screening protocols.

After an excellent overview of the rationale for the symposium from Lorrence H. Green from Westbury Diagnostics, the first two speakers outlined the current state of blood banking. Gail Moskowitz, a healthcare consultant, discussed transfusion-transmitted pathogens and strategies currently employed to limit their transmission. She then presented recent examples illustrating the importance of the different strategies. Susan L. Stramer, executive scientific officer at the American Red Cross then provided an extremely comprehensive explanation of the infectious diseases that are relevant to transfusion safety. She covered pathogens that have historically been the focus of blood safety (HIV, Hep C virus, and Hep B virus), and then moved on to pathogens screened for more recently, such as West Nile Virus RNA and Trypanosoma cruzi. Future screens may target Babesia (a blood parasite), Dengue viruses, and the vCJD (Creutzfeltdt–Jakob disease) prion.

W. Ian Lipkin, John Snow Professor and director of the Center for Infection and Immunity at Columbia University's Mailman School of Public Health then reviewed recent advances in nucleic acid diagnostic methods for the diagnosis of infectious diseases. He discussed mechanisms of microbial pathogenesis, routes to proving causation, and a staged strategy for microbe discovery and surveillance. In his evaluation of the strengths and limitations of various analytical platforms, he provided examples that illustrate how each platform can be used to investigate clinical problems. His talk was followed by a presentation from Judy A. Mikovits, the research director of the Whittemore Peterson Institute for Neuro-Immune Disease. She discussed strategies for detecting XMRV in blood as well as recent progress in the development of tests to detect and characterize XMRV variants.

Joining the symposium from the New York Blood Center, Debra Kessler, director of Special Donor and Community Health Services, then took the stage to ask the audience what is next for blood pathogen screening. In her examination of emerging challenges to a safe blood supply, she reviewed testing technologies, including nucleic acid testing for common viruses, which have drastically reduced the risk of transfusion transmission. However, she reported that emerging infections, particularly those transmitted via insects, are increasing in the population, and testing for these infectious agents (including those that cause Dengue fever and babesiosis) is currently not available. She explained several existing approaches for protecting the blood supply from emerging threats. Among others, she considered the creation of pathogen-specific tests and the method of pathogen inactivation. Kessler concluded with her thoughts on "whether we should test everyone for everything."

To conclude the symposium, Sanjai Kumar, a head researcher in the FDA's Division of Emerging and Transfusion transmitted Diseases, continued the examination of the future of defending the blood supply against emerging pathogens. He reported that there are no FDA-approved laboratory tests for many emerging and potentially important pathogens, even for pathogens that are either currently endemic in the U.S., have caused recent outbreaks in the U.S., or are epidemic in other parts of the world. These undetected infectious agents present a serious risk to donors and pose a potential threat to the continued safety and availability of the U.S. blood supply. He addressed threats to the blood supply from a number of infectious agents not yet interdicted by either donor testing or by questionnaires, and he described some of the ongoing efforts in this regard at the FDA's Center for Biologics Evaluation & Research (CBER).

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This event was funded in part by the Life Technologies™ Foundation.

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