Other Options to Reduce Infectivity

Solvent-Detergent

Plasma from multiple donors is pooled and subjected to a lipid-destroying mixture of a solvent (tri-n-butyl phosphate) and a detergent (Triton X-100) to inactivate lipid-enveloped infectious agents, including HIV, HTLV, hepatitis C virus, and hepatitis B virus.^[144] It has several disadvantages, including the risk of contamination of nonenveloped agents. Recalls can occur after any fraction of a lot has been released. It can be much more expensive than other preparations.

Single-Donor Plasma, Donor Retested

A donation is made, and FFP is prepared. The unit (the first donation) is kept if all history and infectious diseases markers are negative. That unit is not released for use until the same donor donates a second unit at least 3 months after the first donation and again passes all donor-intake and serologic testing. At that time, the first unit is released. The second unit is not released until the donor returns more than 3 months later for a third donation and again passes all the testing. At that time, the second unit can be released for use. This approach has obvious advantages but is administratively complex.

Frequent-Donor Plasma

An inverse relationship exists between the number of donations a person has given and the chance that he or she will become seropositive for a disease. The relationship is independent of the time over which the donations were given. A maximum reduction of the incidence of seropositivity is reached at four or more donations. Predictions are that reduction in seropositivity (and therefore transmission) to one third to one half of the current figures is possible.

These options were presented at the University of California, San Francisco, Transfusion Committee meeting, and indicate that clinicians will have many ways of ensuring safer plasma for patients. With the newer tests of infectivity, the previously described FFP approaches may not be necessary.