Transfusion Safety Decisions in the 1990s: Reactions to the Past

  • S. Kleinman
Part of the Developments in Hematology and Immunology book series (DIHI, volume 34)


The current process of blood safety related decision-making has been strongly influenced by events of the mid to late 1980s. Retrospective analyses of these events has been undertaken by governmental bodies in developed countries throughout the world [1,2]. These analyses have applied the current state of knowledge about the magnitude and severity of transfusion-transmitted AIDS and non-A non-B hepatitis to decisions made in the 1980s. This has resulted in criticism of national blood service organisations, some appropriate and some inappropriate, for various activities during this time frame including: failure to communicate accurate information about transfusion risks to the public, failure to directly question donors about male to male sexual activity, failure to implement anti-HBc testing as a surrogate for AIDS carrier state, unnecessary delays in implementing HIV antibody assays, delays in abandoning the use of blood derivative products that had not undergone viral inactivation, failure to implement surrogate testing for non-A non-B hepatitis and delays in implementing HCV antibody assays. These official criticisms have been influenced and exacerbated by stories in the print and broadcast media, by plaintiff driven litigation and even by criminal prosecution [2].


Nucleic Acid Testing Blood Safety Blood Service Transfusion Recipient Transfusion Risk 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Committee to study HIV transmission through blood and blood products, Division of Health Promotion and Diseases Prevention, Institute of Medicine. HIV and the blood supply: an analysis of crisis decision making, ed. by Leveton LB, Sox HC, and Soto MA. National Academy Press, Washington DC, 1995.Google Scholar
  2. 2.
    Krever, H. Commission of Inquiry on the Blood System in Canada. Final Report. Canadian Government Publishing. Ottawa, Canada, 1997.Google Scholar
  3. 3.
    Blajchman MA, Klein HG. Looking back in anger: Retrospection in the face of a paradigm shift.,Trans Med Rev 1997; 11:1–5.CrossRefGoogle Scholar
  4. 4.
    Busch M, Chamberland M, Epstein J, Kleinman S, Khabbaz R, and Nemo, G. Oversight and monitoring of the blood supply in the United States. Vox Sang In press.Google Scholar
  5. 5.
    Zuck TF. Current good manufacturing practices. Transfusion 1995;35:955–66.PubMedCrossRefGoogle Scholar
  6. 6.
    Menitove JE. Haemovigilance in the United States of America. Vox Sang 1998;74 (Suppl. 2):447–55.PubMedCrossRefGoogle Scholar
  7. 7.
    McClelland B, UK SHOT Project, Love E, Scott S, Williamson LM. Haemovigilance: Concept, Europe and UK initiatives. Vox Sang 1998;74 (Suppl. 2):431–39PubMedCrossRefGoogle Scholar
  8. 8.
    Zuck TF, Thomson RA, Schreiber GB, Gilcher RO, Kleinman SH et al. The Retrovirus Epidemiology Donor Study (REDS): Rationale and Methods. Transfusion 1995;35:944–51.PubMedCrossRefGoogle Scholar
  9. 9.
    Centers for Disease Control and Prevention. Red blood cell transfusions contaminated with Yersinia enterocolitica - United States, 1991–1996, and initiation of a national study to detect bacteria associated transfusion reactions. MMWR 1997;46: 553–55.Google Scholar
  10. 10.
    Perkins HA. The safety of the blood supply: Making decisions in transfusion medicine. In Nance SJ ed. Blood Safety: Current Challenges American Association of Blood Banks. Bethesda, MD. 1992:125–50.Google Scholar
  11. 11.
    Dodd RY, Sullivan MT. Creutzfeldt-Jacob disease and transfusion safety: tilting at icebergs? (Editorial) Transfusion 1998;38:221–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Kleinman S. Donor screening procedures and their role in enhancing transfusion safety in Transfusion Transmitted Infections, ed. by Smith D and Dodd RY. American Society of Clinical Pathologists, Chicago, IL, 1.991;207–42.Google Scholar
  13. 13.
    Somerville MA. Ethical issues and challenges in implementing a new blood system. Trans Med Rev 1998;12:162–74.CrossRefGoogle Scholar
  14. 14.
    Busch MP. To thy (reactive) donors be true! (editorial) Transfusion 1997;37:117–20.PubMedGoogle Scholar
  15. 15.
    Allain JP. Emerging Viruses in Blood Transfusion. Vox Sang 1998;74(Suppl. 2): 125–29.PubMedCrossRefGoogle Scholar
  16. 16.
    Alter HJ. G-pers creepers, where’d you get those papers? A reassessment of the literature on the Hepatitis G virus (editorial). Transfusion 1997;37:569–72.PubMedCrossRefGoogle Scholar
  17. 17.
    Menitove JE. Perception of risk. In Nance SJ ed. Blood Supply: Risks, perceptions, and prospects for the future. American Association of Blood Banks. Bethesda, MD. 1994:45–59.Google Scholar
  18. 18.
    Zuck TF. Greetings - A final look back, with comments about a policy of a zero risk blood supply, (editorial) Transfusion 1987;27:447–48.PubMedCrossRefGoogle Scholar
  19. 19.
    AuBuchon JP, Birkmeyer JD, Busch MP. Safety of the blood supply in the United States: Opportunities and controversies. Annals of hit Med 1997; 127:904 -09.CrossRefGoogle Scholar
  20. 20.
    Dodd RY. Adverse consequences of blood transfusion: Quantitative risk estimates. In Nance SJ ed. Blood Supply: Risks, perceptions, and prospects for the future. American Association of Blood Banks. Bethesda, MD. 1994:1–24.Google Scholar
  21. 21.
    Holland PV. Viral infections and the blood supply. (Editorial) N Engl J Med 1996; 334:1734–35.PubMedCrossRefGoogle Scholar
  22. 22.
    NIH Consensus Development Panel on Infectious Disease Testing for Blood Transfusions. Infectious diseases testing for blood transfusions. JAMA 1995;274: 1374–79.CrossRefGoogle Scholar
  23. 23.
    Kleinman S, Busch MP, Korelitz JJ, Schreiber GB. The Incidence/window period model and its use to assess the risk of transfusion transmitted HIV and HCV infection. Trans Med Rev 1997;11:155–72.CrossRefGoogle Scholar
  24. 24.
    AuBuchon JP, Birkmeyer JD, Busch MP. Cost effectiveness of expanded HIV test protocols for donated blood. Transfusion 1997;37:45–51.PubMedCrossRefGoogle Scholar
  25. 25.
    Seitz R, Burger R. Science, lawyers, and the Europeans”: testing requirements in transfusion medicine.(letter) Transfusion 1998;38:506.PubMedCrossRefGoogle Scholar
  26. 26.
    Busch MP, Stramer SL, Kleinman SH. Evolving applications of nucleic acid amplification assays for prevention of viral transmission by blood components and derivatives. In Garratty, G, ed. Applications of molecular biology to blood transfusion medicine. American Association of Blood Banks. Bethesda, MD. 1997:123–76.Google Scholar
  27. 27.
    Brown P. B lymphocytes and neuroinvasion (news; comments) Nature 1997;390: 662–63.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1999

Authors and Affiliations

  • S. Kleinman
    • 1
  1. 1.University of Britsh ColumbiaVancouverCanada

Personalised recommendations