Advances in pathogen reduction technologies: enhancing safety and functionality of blood products

Abstract Blood transfusion is indispensable in the management of hematological malignancies, trauma, obstetric complications, and congenital bleeding disorders. Despite rigorous donor screening and nucleic acid testing, residual risks of transfusion-transmitted infections (TTIs) remain, particularly with emerging and re-emerging pathogens and bacterial contamination of platelets. These challenges underscore the need for proactive safety strategies. Pathogen reduction technologies (PRTs) provide a universal and complementary safeguard by inactivating viruses, bacteria, parasites, and leukocytes, thereby preventing transfusion-associated graft-versus-host disease (TA-GvHD). Four major PRT platforms are currently in use or advanced development: INTERCEPT (amotosalen/UVA), MIRASOL (riboflavin/UV), THERAFLEX-UVC (short-wavelength UVC), and methylene blue plasma. Clinical studies confirm the safety and efficacy of this product, despite some storage limitations. During outbreaks and in endemic settings, PRT has been used as an adjunct mitigation strategy to maintain transfusion support when pathogen-specific testing or donor deferrals were insufficient or not immediately available. Challenges to widespread adoption include cost and infrastructure requirements, but efforts aim to expand RBC coverage, integrate cold-stored platelets, and automate for broader accessibility. PRTs represent a paradigm shift in transfusion medicine, moving from reactive detection to proactive, broad-spectrum protection. Their broader implementation will be essential for advancing global blood safety and ensuring preparedness against emerging infectious threats.