Selective transfusion protocols:errors and accidents waiting to happen

Fatal transfusion‐associated graft‐versus‐host disease in an immunocompetent recipient of a volunteer unit of red cells

“…The great majority of the United States uses a selective irradiation policy for patients at known risk for TAGVHD. This case illustrates one of the major problems previously described with a selective transfusion protocol, 9 in this case for irradiated blood components. A selective irradiation policy may miss subtle immune deficiency states that may not be recognized clinically or overt risk factors which are not communicated to the blood bank and will not prevent transfusion of blood components from randomly selected donors who are homozygous for a shared HLA haplotype.…”

Cost‐effectiveness of blood donor screening for Babesia microti in endemic regions of the United States

“…This result is explained by the significant costs associated with Babesia antibody/PCR screening of approximately 30% of the blood supply for transfusion recipients with easily identifiable high‐risk conditions and the likelihood of severe TTB cases occurring in transfusion recipients with other common comorbidities who would be difficult to target through risk‐based algorithms. Furthermore, prior work has documented the logistic and ethical problems associated with selective transfusion protocols designed to prevent transfusion‐related complications . Our model suggests that, in addition to these issues, a risk‐targeted transfusion policy for TTB prevention in endemic regions is unlikely to offer greater value compared to a universal antibody screening strategy.…”

“…Furthermore, prior work has documented the logistic and ethical problems associated with selective transfusion protocols designed to prevent transfusion-related complications. 62,63 Our model suggests that, in addition to these issues, a risk-targeted transfusion policy for TTB prevention in endemic regions is unlikely to offer greater value compared to a universal antibody screening strategy.…”

Cost‐effectiveness of Babesia microti antibody and nucleic acid blood donation screening using results from prospective investigational studies

“…13,15,16 This strategy has many limitations, including difficulty in correctly defining and identifying high-risk patients, additional resources or logistics associated with testing and maintaining two blood product inventories, and resultant increased potential for errors, as well as the liability assumed when transfusing patients who are deemed low risk with untested, infectious units. 32 Simon and colleagues considered this strategy when modeling cost-effectiveness and concluded that "risk-targeted transfusion policy for TTB prevention in endemic regions is unlikely to offer greater value compared to universal Ab screening." 13 Our analyses likewise suggest that a risktargeted strategy performs poorly; it resulted in the lowest number of TTB cases averted and the highest ICER values compared to the status quo, regardless of transmission probability scenario, and was never the most costeffective strategy ( Table 4; Figs.…”