Editing Blood transfusion (section)

=== Processing and testing ===
[[File:FreshFrozenPlasma.JPG|thumb|alt=photograph of a bag containing one unit of fresh frozen plasma|A bag containing one unit of fresh frozen plasma]]

Donated blood is usually subjected to processing after it is collected, to make it suitable for use in specific patient populations. Collected blood is then separated into blood components by centrifugation: [[red blood cell]]s, [[blood plasma|plasma]], and [[platelet]]s.  Plasma can be further processed to manufacture [[human serum albumin|albumin]] [[protein]], clotting factor concentrates, [[cryoprecipitate]], [[fibrinogen]] concentrate, and [[immunoglobulin]]s ([[antibody|antibodies]]). Red cells, plasma and platelets can also be donated individually via a more complex process called [[apheresis]].
* [[File:Vidro para transfusão de sangue, Centro de Memórias do Curso de Enfermagem da UFES (2).jpg|thumb|Glass used in an antiquated method of blood transfusion]]The [[World Health Organization]] (WHO) recommends that all donated blood be tested for transfusion-transmissible infections. These include [[HIV]], [[hepatitis B]], [[hepatitis C]], ''[[Treponema pallidum]]'' ([[syphilis]]) and, where relevant, other infections that pose a risk to the safety of the blood supply, such as ''[[Trypanosoma cruzi]]'' ([[Chagas disease]]) and ''[[Plasmodium]]'' species ([[malaria]]).<ref>{{cite book|title=Screening donated blood for transfusion-transmissible infections: recommendations|date=2009|publisher=World Health Organization|isbn=978-92-4-154788-8|url=http://apps.who.int/iris/bitstream/10665/44202/1/9789241547888_eng.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://apps.who.int/iris/bitstream/10665/44202/1/9789241547888_eng.pdf |archive-date=2022-10-09 |url-status=live}}</ref> According to the WHO, 10 countries are not able to screen all donated blood for one or more of: [[HIV]], hepatitis B, hepatitis C, or syphilis.<ref name=":0">{{cite web|title=Blood safety and availability Fact sheet 279|url=https://www.who.int/mediacentre/factsheets/fs279/en/|publisher=World Health Organization|access-date=21 January 2016|archive-date=29 June 2008|archive-url=https://web.archive.org/web/20080629085919/http://www.who.int/mediacentre/factsheets/fs279/en/|url-status=live}}</ref> One of the main reasons for this is because testing kits are not always available.<ref name=":0" /> However the prevalence of transfusion-transmitted infections is much higher in low income countries compared to middle and high income countries.<ref name=":0" />
* All donated blood should also be tested for the [[ABO blood group system]] and [[Rh blood group system]] to ensure that the patient is receiving compatible blood.<ref>{{cite web|title=Testing of donated blood|url=https://www.who.int/bloodsafety/donation_testing/en/|archive-url=https://web.archive.org/web/20110318122653/http://www.who.int/bloodsafety/donation_testing/en/|url-status=dead|archive-date=March 18, 2011|website=World Health Organization|access-date=21 January 2016}}</ref>
* In addition, in some countries platelet products are also tested for bacterial infections due to its higher inclination for contamination due to storage at room temperature.<ref>{{cite web|title=Bacterial Detection Testing by Blood and Blood Collection Establishments and Transfusion Services to Enhance the Safety and Availability of Platelets for Transfusion|url=https://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/ucm426310.htm|archive-url=https://web.archive.org/web/20150306105828/http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/ucm426310.htm|url-status=dead|archive-date=March 6, 2015|website=FDA U.S. Food and Drug Administration|access-date=21 January 2016}}</ref><ref>{{cite journal | vauthors = Benjamin RJ, McDonald CP | title = The international experience of bacterial screen testing of platelet components with an automated microbial detection system: a need for consensus testing and reporting guidelines | journal = Transfusion Medicine Reviews | volume = 28 | issue = 2 | pages = 61–71 | date = April 2014 | pmid = 24636779 | doi = 10.1016/j.tmrv.2014.01.001 | author3 = ISBT Transfusion Transmitted Infectious Disease Bacterial Workgroup }}</ref>
*Donors may be tested for [[cytomegalovirus]] (CMV) because of the risk of transmission to certain immunocompromised recipients, such as those with stem cell transplant or T cell diseases. However, testing is not universally mandated, because leukoreduced blood is generally considered safe from CMV transmission; also, most donors (and recipients) are seropositive for CMV, and are not actively viremic. CMV seropositive donors are still eligible to donate.<ref>{{cite journal | vauthors = Ziemann M, Hennig H | title = Prevention of Transfusion-Transmitted Cytomegalovirus Infections: Which is the Optimal Strategy? | journal = Transfusion Medicine and Hemotherapy | volume = 41 | issue = 1 | pages = 40–44 | date = February 2014 | pmid = 24659946 | pmc = 3949610 | doi = 10.1159/000357102 }}</ref>
* Leukocyte reduction is the removal of white blood cells by filtration. Leukoreduced blood products are less likely to cause HLA [[alloimmunization]] (development of antibodies against specific blood types), [[febrile non-hemolytic transfusion reaction]], [[cytomegalovirus infection]], and [[platelet-transfusion refractoriness]].<ref name=":3">{{cite journal | vauthors = Bassuni WY, Blajchman MA, Al-Moshary MA | title = Why implement universal leukoreduction? | journal = Hematology/Oncology and Stem Cell Therapy | volume = 1 | issue = 2 | pages = 106–123 | year = 2008 | pmid = 20063539 | doi = 10.1016/s1658-3876(08)50042-2 | doi-access = free }}</ref>
* Pathogen reduction treatment that involves, for example, the addition of [[riboflavin]] with subsequent exposure to [[UV light]] has been shown to be effective in inactivating pathogens (viruses, bacteria, parasites and white blood cells) in blood products.<ref>{{cite journal | vauthors = Hardwick CC, Herivel TR, Hernandez SC, Ruane PH, Goodrich RP | title = Separation, identification and quantification of riboflavin and its photoproducts in blood products using high-performance liquid chromatography with fluorescence detection: a method to support pathogen reduction technology | journal = Photochemistry and Photobiology | volume = 80 | issue = 3 | pages = 609–615 | year = 2004 | pmid = 15382964 | doi = 10.1562/0031-8655(2004)080<0609:TNSIAQ>2.0.CO;2 | s2cid = 198154059 }}</ref><ref>{{cite journal | title = A randomized controlled clinical trial evaluating the performance and safety of platelets treated with MIRASOL pathogen reduction technology | journal = Transfusion | volume = 50 | issue = 11 | pages = 2362–75 | date = November 2010 | pmid = 20492615 | doi = 10.1111/j.1537-2995.2010.02694.x | s2cid = 28186229 | first23 = J. | first22 = R.P. | first20 = P. | first26 = B. | first25 = R.J. | first19 = Gines | first18 = Paolo | first12 = D. | first13 = R. | first24 = C. | first16 = T. | first17 = J. | first14 = J.-D. | first15 = L. }}</ref><ref>{{cite journal | vauthors = Goodrich RP, Edrich RA, Li J, Seghatchian J | title = The Mirasol PRT system for pathogen reduction of platelets and plasma: an overview of current status and future trends | journal = Transfusion and Apheresis Science | volume = 35 | issue = 1 | pages = 5–17 | date = August 2006 | pmid = 16935562 | doi = 10.1016/j.transci.2006.01.007 }}</ref> By inactivating white blood cells in donated blood products, [[Pathogen Reduction Using Riboflavin and UV Light|riboflavin and UV light treatment]] can also replace gamma-irradiation as a method to prevent [[graft-versus-host disease]] ([[TA-GvHD]]).<ref>{{cite journal | vauthors = Fast LD, DiLeone G, Cardarelli G, Li J, Goodrich R | title = Mirasol PRT treatment of donor white blood cells prevents the development of xenogeneic graft-versus-host disease in Rag2-/-gamma c-/- double knockout mice | journal = Transfusion | volume = 46 | issue = 9 | pages = 1553–60 | date = September 2006 | pmid = 16965583 | doi = 10.1111/j.1537-2995.2006.00939.x | s2cid = 13065820 }}</ref><ref>{{cite journal | vauthors = Fast LD, DiLeone G, Marschner S | title = Inactivation of human white blood cells in platelet products after pathogen reduction technology treatment in comparison to gamma irradiation | journal = Transfusion | volume = 51 | issue = 7 | pages = 1397–1404 | date = July 2011 | pmid = 21155832 | doi = 10.1111/j.1537-2995.2010.02984.x | s2cid = 34154946 }}</ref><ref>{{cite journal | vauthors = Reddy HL, Dayan AD, Cavagnaro J, Gad S, Li J, Goodrich RP | title = Toxicity testing of a novel riboflavin-based technology for pathogen reduction and white blood cell inactivation | journal = Transfusion Medicine Reviews | volume = 22 | issue = 2 | pages = 133–153 | date = April 2008 | pmid = 18353253 | doi = 10.1016/j.tmrv.2007.12.003 }}</ref>