Vox sanguinis · 2023
Does cold storage of blood before transfusion prevent the transmission of syphilis? A systematic review and meta-analysis.
МетаанализСистематический обзорСтатьяНазвание и аннотация: Перевод в очереди
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D'aes Tine, Van de Sande Dieter, De Buck Emmy, Zachée Pierre, Compernolle Veerle, Vandekerckhove Philippe
Аннотация
BACKGROUND AND OBJECTIVES: Although screening of donated blood for syphilis is almost universally applied, its cost-effectiveness is questioned because of the low prevalence of transfusion-transmitted syphilis and a widespread belief that the syphilis-causing bacterium Treponema pallidum is very vulnerable to cold storage. Since the latter claim is not yet supported by a systematic review, we investigated whether syphilis can be transmitted via transfusion following prolonged (cold or room temperature) storage of blood products.
MATERIALS AND METHODS: MEDLINE, PMC and NCBI bookshelf (PubMed interface), Cochrane Library, Embase, Web of Science and CINAHL were searched up to 17 January 2023.
RESULTS: Nine experimental animal studies and one observational human study were included. Meta-analysis showed that storing artificially infected human (six studies; risk ratio [RR] = 0.37, 95% confidence interval [CI]: 0.22-0.64, p = 0.0003) or rabbit (two studies; RR = 0.08, 95% CI: 0.01 to 0.55, p = 0.01) blood for more than 72 h before intratesticular injection significantly decreased the number of recipient animals that develop syphilis. Nonetheless, the possibility of syphilis transmission remained for up to 7 days. Differences could not be found for rabbit plasma (p = 0.60) or naturally infected rabbit blood (p = 0.28). There was limited evidence from one study in favour of the storage of artificially infected human platelets for over 72 h at cold temperatures (RR = 0.13, 95% CI: 0.03-0.52, p = 0.004) but not at room temperature (p = 0.12).
CONCLUSION: Even though the infectivity of T. pallidum-spiked blood may decrease after 72 h of cold storage, the possibility for transfusion-transmitted syphilis may remain for several days after. The evidence is very uncertain, and conclusions are hindered by a lack of sufficiently powered studies and studies in humans. In addition, T. pallidum concentrations used in animal studies may be unrealistically high.
MATERIALS AND METHODS: MEDLINE, PMC and NCBI bookshelf (PubMed interface), Cochrane Library, Embase, Web of Science and CINAHL were searched up to 17 January 2023.
RESULTS: Nine experimental animal studies and one observational human study were included. Meta-analysis showed that storing artificially infected human (six studies; risk ratio [RR] = 0.37, 95% confidence interval [CI]: 0.22-0.64, p = 0.0003) or rabbit (two studies; RR = 0.08, 95% CI: 0.01 to 0.55, p = 0.01) blood for more than 72 h before intratesticular injection significantly decreased the number of recipient animals that develop syphilis. Nonetheless, the possibility of syphilis transmission remained for up to 7 days. Differences could not be found for rabbit plasma (p = 0.60) or naturally infected rabbit blood (p = 0.28). There was limited evidence from one study in favour of the storage of artificially infected human platelets for over 72 h at cold temperatures (RR = 0.13, 95% CI: 0.03-0.52, p = 0.004) but not at room temperature (p = 0.12).
CONCLUSION: Even though the infectivity of T. pallidum-spiked blood may decrease after 72 h of cold storage, the possibility for transfusion-transmitted syphilis may remain for several days after. The evidence is very uncertain, and conclusions are hindered by a lack of sufficiently powered studies and studies in humans. In addition, T. pallidum concentrations used in animal studies may be unrealistically high.