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Leucoreduction for preventing parasite transfusion‐transmission: an overlooked strategy

Dear Editor, We would like to make a brief contribution in response to the interesting article by Leiby et al. entitled ‘International survey on the impact of parasitic infections: frequency of transmission and current mitigation strategies’, which was recently published in Vox Sanguinis (Vox Sang. 2019; 114: 17-27). The authors describe the results of an international survey on the impact of parasitic infections, focusing on the frequency of transmission and the approaches currently implemented to reduce the transfusion-transmission risk of babesiosis, Chagas, leishmaniasis and malaria diseases. The diverse mitigation efforts reported by Leiby et al. are based mainly on riskbased questionnaires, deferral policies and donor testing, either selective or universal. We would like to highlight that another approach to prevent Chagas, leishmaniasis and malaria transfusion-transmission is leucoreduction by filtration of whole blood (WB) and/or red blood cells (RBC), used for decades in many countries, yet perhaps overlooked as a preventive measure. The Leishmania parasite, an intracellular monocyte pathogen, can be effectively removed from infected blood components by leucoreduction filters. Our research group clearly demonstrated the efficacy of RBC leucoreduction filters in the prevention of Leishmania transfusion-transmission, determining the Leishmania parasitemia load by PCR before and after filtration in RBC units collected from asymptomatic L. infantum-infected blood donors [1]. We have also shown that RBC and WB leucoreduction by filtration reduces T. cruzi concentrations by 99% and consequently can potentially decrease Chagas disease transfusion-transmission risk [2, 3]. Moreover, Cardo et al. [4] have reported the adherence of malaria-infected RBC to WB filters by at least three different mechanisms, suggesting that the unexplained decline in the incidence of transfusion-transmitted malaria in the last decades could be due to the increasing use of leucoreduction filters. The effectiveness of leucoreduction against other parasites, such as Babesia sp., remains to be demonstrated. Another useful strategy for preventing parasite transfusion-transmission is the use of pathogen reduction technologies (PRT), not only in plasma and platelet components but also WB [3, 5]. As mentioned by Leiby et al., the high cost of PRT implementation may be prohibitive in poor countries where parasitic infections are endemic. In contrast, leucoreduction by filtration, although it cannot completely eliminate parasitic transmission risk, can represent a suitable and inexpensive alternative for reducing leishmaniasis, malaria and Chagas transfusion-transmission risk, not only where they are endemic but also in non-endemic countries with a high rate of immigration from Latin America and Africa.