Pediatric Clinics of North America - CIPERJ

442 FASANO & LUBAN
[55,56]. This is attributed to an increase in antileukocyte and anti-HLA antibodies
present in multiparous women. Although the United Kingdom has
adopted a policy of minimizing transfusion of high-volume plasma products
from female donors and subsequently has seen a dramatic decrease in the
incidence of TRALI, somewhat different procedures have been adopted in
the United States [55]. These include use of male-only, high-volume plasma
products or the use of male and female donor products after selecting for
donors who have a low likelihood of having been alloimmunized by pregnancy
or transfusions. Performing leukocyte antibody testing on female-donor,
high-volume plasma products is a suggested alternative measure [57].
Future directions
Since the advent of transfusion medicine, many technologic advances
have made the collection of blood products safer and more efficient. Ongoing
research, however, is underway to improve several aspects of blood component
collection and administration. Advances in DNA technology are
changing the understanding of blood group antigens and HLA serotypes
and allowing blood centers to solve compatibility problems among alloimmunized/refractory
patients. The implications of DNA-based RBC and
HLA genotyping are only beginning to become apparent in clinical practice.
Nucleic acid amplification testing is beginning to replace serologic testing
for several blood-borne infectious agents in blood products, and ongoing research
involving multipathogen microarray technology for donor screening
may reform the current infectious disease donor screening interventions.
Pathogen inactivation is successful in eliminating enveloped virus transmission
in plasma derivatives. Considerable effort continues to be invested in
the development of universal pathogen inactivation techniques using nucleic
acid inactivating agents, given that no single technique has proved effective
for all blood components, and their effect on the final blood product is not
fully known.
As a result of dramatic developments in apheresis technology, separation
of every blood component, including HPCs, can be accomplished from a single
donor. HPC transplantation increasingly is used in place of bone marrow
transplantation in childhood malignancies and other diseases because
of the increased safety and availability of this technique of stem cell collection.
In addition, the use of umbilical cord blood as a source of HPCs,
whose collection and processing parallels that of peripheral blood stem
cell techniques, rapidly is expanding the inventory of viable graft options
for children and adults who have these disorders. Refinements in bioengineering
and apheresis technology are expanding the ability to grow, proliferate,
and collect many bone marrow–derived cells, which may show
promise in cellular immunotherapy.