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Francis T, Delk A, Gammon RR. CMV screening of group-specific orders-good stewardship of the blood supply. Transfusion 2021; 62:151-156. [PMID: 34873703 DOI: 10.1111/trf.16742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/23/2021] [Accepted: 10/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND In addition to antigen-negative red blood cells (RBC), Immunohematology Reference Laboratories (IRL) must provide RBCs that are cytomegalovirus (CMV) seronegative. Due to high percentage of CMV seropositive individuals, it is challenging to find CMV and antigen-negative RBC. The IRL selects predominantly group O donors tested for CMV, and these RBC are sometimes needed to fill orders for nongroup O patients. This study evaluated units sent that were out of group to fulfill CMV-seronegative requests. STUDY DESIGN AND METHODS Requests for CMV-seronegative and antigen-negative RBCs were divided into Period 1 (January 1, 2019-February 29, 2020) before intervention and Period 2 (March 1, 2020-May 31, 2020) post intervention. ABO Rh units requested were compared to ABO Rh units provided. RESULTS Period 1: 537 CMV-seronegative RBC units were provided. 99/188(52.66%) B-positive requests were fulfilled using O RBCs. 58/504 (11.51%) of D-negative units were sent to D-positive patients. Period 2: 119 CMV-seronegative RBC units were provided. 18/51 (35.29%) B positive requests were fulfilled using O RBCs. Only 7/113 (6.19%) D-negative units were sent to D-positive patients. DISCUSSION For 239/656 (36.43%) CMV-seronegative antigen orders requested for B-positive patients, more than half of these orders were filled with O RBCs. To decrease group O usage for nongroup O patients, the IRL practice has changed to increase CMV testing for group B donors. Since the change in algorithm, there was a 17.37% decrease group O usage for group B patients.
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Affiliation(s)
- Tara Francis
- OneBlood, Immunohematology Reference Laboratory, Orlando, Florida, USA
| | - Alexander Delk
- OneBlood, Immunohematology Reference Laboratory, Fort Lauderdale, Florida, USA
| | - Richard R Gammon
- OneBlood, Scientific, Medical, Technical Direction, Orlando, Florida, USA
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2
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Sarker T, Katz LM, Bloch EM, Goel R. Blood Product (Donor) Noninfectious and Infectious Testing and Modification. Clin Lab Med 2021; 41:579-598. [PMID: 34689966 DOI: 10.1016/j.cll.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Blood transfusion begins with safe donor selection and testing. In the United States, the blood supply and transfusion are highly regulated. Blood transfusion safety is multifaceted, whereby each of the elements of the blood safety value chain, spanning donor recruitment and qualification, to collection, blood processing, testing, transfusion practice, and posttransfusion surveillance, must be optimized to minimize risk. Pathogen inactivation is a promising approach to decrease bacterial contamination of platelets, inactivate parasites and viruses, and decrease risks associated with emerging and unidentified pathogens. This article offers an overview of blood donor infectious and noninfectious testing in the United States.
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Affiliation(s)
- Tania Sarker
- Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Louis M Katz
- Mississippi Valley Regional Blood Center, Davenport, IA, USA; Carver College of Medicine, UIHC, Iowa City, IA, USA
| | - Evan M Bloch
- Department of Pathology, Transfusion Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street/Carnegie 446 D1, Baltimore, MD 21287, USA
| | - Ruchika Goel
- Mississippi Valley Regional Blood Center, Davenport, IA, USA; Division of Hematology/Oncology, Simmons Cancer Institute at SIU SOM; Division of Transfusion Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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3
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Byrne M, Langston AA, Booth GS. Cytomegalovirus immunoglobulin G: passive transfer or prior infection? Br J Haematol 2021; 195:11-12. [PMID: 34402043 DOI: 10.1111/bjh.17755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Michael Byrne
- Division of Hematology and Medical Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amelia A Langston
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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4
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Kim KY, Kim EK, Park SH, Kim YJ, Shin SH, Kim HS. Disseminated Postnatal Cytomegalovirus Infection in a Preterm Neonate: Autopsy Case Report. NEONATAL MEDICINE 2021. [DOI: 10.5385/nm.2021.28.2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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5
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Zhou X, Jin N, Chen B. Human cytomegalovirus infection: A considerable issue following allogeneic hematopoietic stem cell transplantation. Oncol Lett 2021; 21:318. [PMID: 33692850 PMCID: PMC7933754 DOI: 10.3892/ol.2021.12579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Abstract
Cytomegalovirus (CMV) is an opportunistic virus, whereby recipients are most susceptible following allogeneic hematopoietic stem cell transplantation (allo-HSCT). With the development of novel immunosuppressive agents and antiviral drugs, accompanied with the widespread application of prophylaxis and preemptive treatment, significant developments have been made in transplant recipients with human (H)CMV infection. However, HCMV remains an important cause of short- and long-term morbidity and mortality in transplant recipients. The present review summarizes the molecular mechanism and risk factors of HCMV reactivation following allo-HSCT, the diagnosis of CMV infection following allo-HSCT, prophylaxis and treatment of HCMV infection, and future perspectives. All relevant literature were retrieved from PubMed and have been reviewed.
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Affiliation(s)
- Xinyi Zhou
- Department of Hematology and Oncology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Nan Jin
- Department of Hematology and Oncology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Baoan Chen
- Department of Hematology and Oncology, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu 210009, P.R. China
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6
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Zerra PE, Josephson CD. Transfusion in Neonatal Patients: Review of Evidence-Based Guidelines. Clin Lab Med 2020; 41:15-34. [PMID: 33494882 DOI: 10.1016/j.cll.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Transfusion of red blood cells, platelets, and fresh frozen plasma in neonatal patients has not been well characterized in the literature, with guidelines varying greatly between institutions. However, anemia and thrombocytopenia are highly prevalent, especially in preterm neonates. When transfusing a neonatal patient, clinicians must take into consideration physiologic differences, gestational and postnatal age, congenital disorders, and maternal factors while weighing the risks and benefits of transfusion. This review of existing literature summarizes current evidence-based neonatal transfusion guidelines and highlights areas of current ongoing research and those in need of future studies.
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Affiliation(s)
- Patricia E Zerra
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Egleston Hospital, 1405 Clifton Rd, Atlanta, GA 30322, USA
| | - Cassandra D Josephson
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Egleston Hospital, 1405 Clifton Rd, Atlanta, GA 30322, USA.
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7
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Mabilangan C, Burton C, Nahirniak S, O'Brien S, Preiksaitis J. Transfusion-transmitted and community-acquired cytomegalovirus infection in seronegative solid organ transplant recipients receiving seronegative donor organs. Am J Transplant 2020; 20:3509-3519. [PMID: 32428296 DOI: 10.1111/ajt.16066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/19/2020] [Accepted: 05/03/2020] [Indexed: 01/25/2023]
Abstract
Solid organ transplant (SOT) recipients who are cytomegalovirus (CMV) seronegative (R-) and receive seronegative donor (D-) organs have a small but currently unquantified risk of both transfusion-transmitted CMV (TT-CMV) and community-acquired CMV (CA-CMV). We retrospectively studied the incidence and clinical symptoms of TT-CMV (infection <1 year posttransplant) and CA-CMV (infection >1 year posttransplant) in a cohort of D-/R- adult and pediatric SOT recipients receiving leukoreduced blood products not screened for CMV seronegativity transplanted at our center between 2000 and 2011. CMV infection was defined as IgG seroconversion or detectable CMV antigenemia/DNAemia. Among 536 consecutive D-/R- recipients, 398 (81.8%) had adequate follow-up, and 231 (58%) received cellular blood products (total: 1626 red blood cell units, 470 platelet units) 30 days pretransplant to 90 days posttransplant. We observed no confirmed TT-CMV cases, but 14 CA-CMV cases (64% symptomatic) were seen. The estimated incidence rate of CA-CMV was higher in children (3.0/100 patient years) than adults (0.46/100 patient years, incident rate ratio of 6.52). The absence of TT-CMV over 11 years suggests neither seronegative blood products nor CMV DNA blood donor screening would provide significant incremental safety when blood is already leukoreduced. D-/R- SOT recipients, particularly children, have a significantly higher and ongoing risk of CA-CMV.
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Affiliation(s)
- Curtis Mabilangan
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine Burton
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Nahirniak
- Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jutta Preiksaitis
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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8
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Bianchi M, Orlando N, Valentini CG, Papacci P, Vento G, Teofili L. Infectious complications in neonatal transfusion: Narrative review and personal contribution. Transfus Apher Sci 2020; 59:102951. [PMID: 32972859 PMCID: PMC7492833 DOI: 10.1016/j.transci.2020.102951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neonates and prematures are among the most transfused categories of patients. Adverse reactions due to transfusions, such as transfusion-transmitted infections, can affect the rest of their lives. In this systematic review, we revised the literature concerning transfusion-transmitted infection in neonates. We reported case-reports and case-series previously published and we integrated these data with our experience at local neonatal intensive care unit. Moreover, we illustrated strategies for mitigating transfusion-transmitted infections, including donor selection and testing, pathogen inactivation technologies and combined approaches, as for Cytomegalovirus infection, integrating leukoreduction and identification of seronegative donors.
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Affiliation(s)
- Maria Bianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Nicoletta Orlando
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Caterina Giovanna Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Patrizia Papacci
- Dipartimento di Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Sezione di Pediatria, Dipartimento di Scienze della salute della donna, del bambino e di sanità pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanni Vento
- Dipartimento di Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Sezione di Pediatria, Dipartimento di Scienze della salute della donna, del bambino e di sanità pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luciana Teofili
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy.
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9
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Transfusion-transmitted cytomegalovirus: behaviour of cell-free virus during blood component processing. A study on the safety of labile blood components in Switzerland. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:446-453. [PMID: 32203012 DOI: 10.2450/2020.0241-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/15/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nowadays, most blood products are leukocyte-reduced. After this procedure, the residual risk for transfusion transmitted cytomegalovirus (TT-CMV) is mostly attributed to cell-free viruses in the plasma of blood donors following primary infection or viral reactivation. Here, objectives are: 1) to study the behaviour of cell-free CMV through the blood component processing; 2) to determine the anti-CMV seroprevalence, the level of viremia, the window-period in blood donor population; and 3) to identify cases of TT-CMV in bone marrow transplant (BMT) recipients. MATERIALS AND METHODS Cell-free CMV was injected into blood bags originating from regular donors. Blood components were processed according to either the CompoSelect® or the CompoFlow® (Fresenius Kabi AG) techniques. Samples were analysed at each step for presence of virus DNA using quantitative polymerase chain reaction (PCR). The anti-CMV seroprevalence in our donor population was taken from our donor data system. The viremia was assessed in pooled plasmas samples from routine donations by quantitative PCR. Medical charts of 165 BMT anti-CMV seronegative recipients/anti-CMV seronegative donors who received CMV-unscreened blood products were reviewed. RESULTS Cell-free CMV passes without any decrease in viral load through all stages of blood processing. The anti-CMV seroprevalence was 46.13%. Four DNA positive samples out of 42,240 individual blood donations were identified (0.009%); all had low levels of viremia (range 11-255 IU/mL). No window-period donation was identified. No TT-CMV was found. DISCUSSION Cell-free CMV remains a concern with current blood component processing as it passes through all the processes. However, since low levels of CMV DNA were identified in the donations tested, and no BMT recipients had TT-CMV, the residual threat of TT-CMV after leukocyte reduction appears to be very low.
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10
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Jebakumar D, Bryant P, Linz W. Risk of cytomegalovirus transmission by blood products after solid organ transplantation. Proc (Bayl Univ Med Cent) 2019; 32:222-226. [PMID: 31191133 DOI: 10.1080/08998280.2019.1582932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 01/14/2023] Open
Abstract
Cytomegalovirus (CMV) infection and CMV disease are significant contributors to increased morbidity, mortality, and cost for immunocompromised solid organ transplant recipients. Although the most significant risk for CMV transmission is the CMV serological status of the transplant donor and recipient, exposure to blood products is another potential risk factor. Before the era of leukocyte reduction, CMV seronegative products were issued to reduce the risk of CMV transmission, thus rendering the products CMV safe. This approach requires maintenance of two inventories of blood products and continuous donor testing. Leukocyte-reduced cellular transfusion products are also considered CMV safe and are essentially universally available. To minimize the risk of CMV infection in transplant recipients, strategies include use of seronegative blood products or prestorage leukocyte reduction. However, no recent randomized prospective controlled trial directly compares the two CMV safety approaches for transplant recipients. Hence, current policy relies on historic trials and more recent observational studies. As a consequence, though generally considered equivalent approaches, preferred practice varies between centers. This review provides guidance to inform an acceptable practice approach.
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Affiliation(s)
- Deborah Jebakumar
- Department of Pathology and Laboratory Medicine, Baylor Scott and White Medical Center-Temple and Texas A&M College of MedicineTempleTexas
| | - Patti Bryant
- Department of Pathology and Laboratory Medicine, Baylor Scott and White Medical Center-Temple and Texas A&M College of MedicineTempleTexas
| | - Walter Linz
- Department of Pathology and Laboratory Medicine, Baylor Scott and White Medical Center-Temple and Texas A&M College of MedicineTempleTexas
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11
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Prevention of transfusion-transmitted infections. Blood 2019; 133:1854-1864. [PMID: 30808637 DOI: 10.1182/blood-2018-11-833996] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/03/2019] [Indexed: 01/10/2023] Open
Abstract
Since the 1970s, introduction of serological assays targeting virus-specific antibodies and antigens has been effective in identifying blood donations infected with the classic transfusion-transmitted infectious agents (TTIs; hepatitis B virus [HBV], HIV, human T-cell lymphotropic virus types I and II, hepatitis C virus [HCV]). Subsequently, progressive implementation of nucleic acid-amplification technology (NAT) screening for HIV, HCV, and HBV has reduced the residual risk of infectious-window-period donations, such that per unit risks are <1 in 1 000 000 in the United States, other high-income countries, and in high-incidence regions performing NAT. NAT screening has emerged as the preferred option for detection of newer TTIs including West Nile virus, Zika virus (ZIKV), and Babesia microti Although there is continual need to monitor current risks due to established TTI, ongoing challenges in blood safety relate primarily to surveillance for emerging agents coupled with development of rapid response mechanisms when such agents are identified. Recent progress in development and implementation of pathogen-reduction technologies (PRTs) provide the opportunity for proactive rather than reactive response to blood-safety threats. Risk-based decision-making tools and cost-effectiveness models have proved useful to quantify infectious risks and place new interventions in context. However, as evidenced by the 2015 to 2017 ZIKV pandemic, a level of tolerable risk has yet to be defined in such a way that conflicting factors (eg, theoretical recipient risk, blood availability, cost, and commercial interests) can be reconciled. A unified approach to TTIs is needed, whereby novel tests and PRTs replace, rather than add to, existing interventions, thereby ameliorating cost and logistical burden to blood centers and hospitals.
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12
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Shanmugha Priya RA, Krishnamoorthy R, Panicker VK, Ninan B. Transfusion support in preterm neonates <1500 g and/or <32 weeks in a tertiary care center: A descriptive study. Asian J Transfus Sci 2018; 12:34-41. [PMID: 29563673 PMCID: PMC5850695 DOI: 10.4103/ajts.ajts_148_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Lack of recent studies focusing on indications, pattern, and benefits of transfusions in low birth weight (B.Wt) and low gestational age (GA) preterm neonates prompted us to undertake this study. AIM: To estimate the transfusion requirements and outcomes in preterm neonates <1500 g and/or <32 weeks. SETTINGS AND DESIGN: This is a cross-sectional study conducted over a period of 2 years in a tertiary care center. MATERIALS AND METHODS: This study was conducted with 101 preterm neonates <1500 g and/or <32 weeks who received blood transfusions in the Neonatal Intensive Care Unit. Restrictive pattern of transfusion was followed. Demographic details and antenatal, neonatal, laboratory, and transfusion parameters were collected. STATISTICAL ANALYSIS USED: Statistical analyses were performed using SPSS 16. RESULTS: The study participants received 311 transfusions. Transfusion requirements decreased with increasing GA and B.Wt. Majority of blood transfusions occurred during the first 2 weeks of life. Packed red blood cells (PRBCs) were the most frequent blood components transfused. Ninety-six percent of the study population had an uneventful transfusion. Mean hemoglobin improvement after PRBC transfusions was 2.3 ± 2.1 g/dl. Improvement in apnea occurred in 76% PRBC transfusions. Infants with sepsis, patent ductus arteriosus, bronchopulmonary dysplasia, disseminated intravascular coagulation, and dyselectrolytemia received more number of transfusions. CONCLUSION: This study would serve as an audit for neonatal blood transfusion therapy. Close adherence to neonatal transfusion policy and restrictive transfusion guidelines helps reduce inappropriate use of blood products and adverse transfusion reactions.
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Affiliation(s)
- R A Shanmugha Priya
- Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - R Krishnamoorthy
- Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Vinod Kumar Panicker
- Department of Transfusion Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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13
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Jacquot C, Delaney M. Efforts Toward Elimination of Infectious Agents in Blood Products. J Intensive Care Med 2018; 33:543-550. [PMID: 29562814 DOI: 10.1177/0885066618756589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The US blood supply has never been safer. This level of safety depends on a multifaceted approach including blood donor screening, sensitive infectious disease testing, and good manufacturing practice. However, risks remain for transfusion-transmitted infections due to bacterial contamination of platelets and emerging diseases. Thus, ongoing improvements in screening and testing are required. Newer pathogen reduction technologies have shown promise in further ameliorating the safety of the blood supply.
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Affiliation(s)
- Cyril Jacquot
- 1 Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,2 Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,3 Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,4 Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Meghan Delaney
- 1 Division of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,2 Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Sheikh Zayed Campus for Advanced Children's Medicine, Washington, DC, USA.,3 Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,4 Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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14
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Schiffer CA, Bohlke K, Delaney M, Hume H, Magdalinski AJ, McCullough JJ, Omel JL, Rainey JM, Rebulla P, Rowley SD, Troner MB, Anderson KC. Platelet Transfusion for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2018; 36:283-299. [DOI: 10.1200/jco.2017.76.1734] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose To provide evidence-based guidance on the use of platelet transfusion in people with cancer. This guideline updates and replaces the previous ASCO platelet transfusion guideline published initially in 2001. Methods ASCO convened an Expert Panel and conducted a systematic review of the medical literature published from September 1, 2014, through October 26, 2016. This review builds on two 2015 systematic reviews that were conducted by the AABB and the International Collaboration for Transfusion Medicine Guidelines. For clinical questions that were not addressed by the AABB and the International Collaboration for Transfusion Medicine Guidelines (the use of leukoreduction and platelet transfusion in solid tumors or chronic, stable severe thrombocytopenia) or that were addressed partially (invasive procedures), the ASCO search extended back to January 2000. Results The updated ASCO review included 24 more recent publications: three clinical practice guidelines, eight systematic reviews, and 13 observational studies. Recommendations The most substantial change to a previous recommendation involved platelet transfusion in the setting of hematopoietic stem-cell transplantation. Based on data from randomized controlled trials, adult patients who undergo autologous stem-cell transplantation at experienced centers may receive a platelet transfusion at the first sign of bleeding, rather than prophylactically. Prophylactic platelet transfusion at defined platelet count thresholds is still recommended for pediatric patients undergoing autologous stem-cell transplantation and for adult and pediatric patients undergoing allogeneic stem-cell transplantation. Other recommendations address platelet transfusion in patients with hematologic malignancies or solid tumors or in those who undergo invasive procedures. Guidance is also provided regarding the production of platelet products, prevention of Rh alloimmunization, and management of refractoriness to platelet transfusion ( www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki ).
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Affiliation(s)
- Charles A. Schiffer
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Kari Bohlke
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Meghan Delaney
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Heather Hume
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Anthony J. Magdalinski
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Jeffrey J. McCullough
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - James L. Omel
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - John M. Rainey
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Paolo Rebulla
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Scott D. Rowley
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Michael B. Troner
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Kenneth C. Anderson
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
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15
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Humanes Cytomegalievirus (HCMV). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:116-128. [DOI: 10.1007/s00103-017-2661-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Pediatric Transfusion Medicine. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Pelletier JPR. Infectious Complications of Transfusion of Blood Components. CLINICAL PRINCIPLES OF TRANSFUSION MEDICINE 2018. [PMCID: PMC7151915 DOI: 10.1016/b978-0-323-54458-0.00008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Transfusions are lifesaving but are not without some risks. During the middle of the last century, infectious complications were common from transfusions. By the mid 1980s the risk of transfusion transmission of infections became much lower. With the advent of emerging diseases, however, infectious risks became more prominent for a period of time. Now we live in a time where death from transfusion transmission is 10%–15% of all transfusion-associated deaths and is the lowest in history. As the risks are identified and new screens or processes are put in place, the associated transfusion transmission of infection will continue to have reducing risks and blood supply will continue to be safer still.
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Hassani H, Khoshdel A, Sharifzadeh SR, Heydari MF, Alizadeh S, Noroozi Aghideh A. TNF-α and TGF-ß level after intraoperative allogeneic red blood cell transfusion in orthopedic operation patients. Turk J Med Sci 2017; 47:1813-1818. [PMID: 29306243 DOI: 10.3906/sag-1508-36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background/aim: Blood transfusion is associated with immunosuppression, referred to as transfusion-related immunomodulation (TRIM). In this study, for the first time, changes in the concentration of TGF-ß and TNF-α were measured postoperatively in orthopedic patients with intraoperational allogeneic red blood cell transfusion. Considering the use of packed cell units with different ages, it is possible to suggest the more appropriate product for clinical applications.Materials and methods: Two groups of 35 orthopedic surgery patients (with or without transfusion as case and control groups, respectively) were involved. Serum levels of TNF-α and TGF-ß were measured by ELISA.Results: The data suggested significant differences in age (P = 0.0001), lowered hemoglobin (P = 0.003), and hematocrit (P = 0.003) between the control and case groups. Pre- and postoperation levels of TNF-α and TGF- ßwere not significantly different, but the results showed significant increases in levels of both cytokines after the operation (P = 0.0001) in both groups.Conclusion: Increased levels of TNF-α and TGF-ß are probably related to surgery and packed cell transfusion, respectively. Further studies using more packed cell units or other blood products and assessment of more cytokines are needed to have better understanding about this issue.
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20
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Morton S, Peniket A, Malladi R, Murphy MF. Provision of cellular blood components to CMV-seronegative patients undergoing allogeneic stem cell transplantation in the UK: survey of UK transplant centres. Transfus Med 2017; 27:444-450. [PMID: 28913908 DOI: 10.1111/tme.12461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/03/2017] [Accepted: 08/16/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify current UK practice with regards to provision of blood components for cytomegalovirus (CMV)-seronegative, potential, allogeneic stem cell recipients of seronegative grafts. BACKGROUND Infection with CMV remains a major cause of morbidity and mortality after allogeneic stem cell transplantation (aSCT). CMV transmission has been a risk associated with the transfusion of blood components from previously exposed donors, but leucocyte reduction has been demonstrated to minimise this risk. In 2012, the UK Advisory Committee for the Safety of Tissues and Organs (SaBTO) recommended that CMV-unselected components could be safely transfused without increased risk of CMV transmission. METHODS We surveyed UK aSCT centres to establish current practice. RESULTS Fifteen adult and seven paediatric centres (75%) responded; 22·7% continue to provide components from CMV-seronegative donors. Reasons cited include the continued perceived risk of CMV transmission by blood transfusion, its associated morbidity and concerns regarding potential for ambiguous CMV serostatus in seronegative potential transplant recipients due to passive antibody transfer from CMV-seropositive blood donors, leading to erroneous donor/recipient CMV matching at transplant. CONCLUSIONS The survey demonstrated a surprisingly high rate (22.7%) of centres continuing to provide blood components from CMV-seronegative donors despite SaBTO guidance.
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Affiliation(s)
- S Morton
- Transfusion Medicine, NHS Blood and Transplant, Birmingham, UK
| | - A Peniket
- Department of Haematology, Oxford University Hospitals, Oxford, UK
| | - R Malladi
- Clinical Haematology, University Hospitals Birmingham, Birmingham, UK
| | - M F Murphy
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
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21
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Favrais G, Wibaut B, Pladys P, Saliba E. Transfusion de culot globulaire chez le nouveau-né grand prématuré : ce qui a changé dans les recommandations françaises depuis 2002. Arch Pediatr 2017; 24:894-901. [DOI: 10.1016/j.arcped.2017.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 05/01/2017] [Accepted: 06/22/2017] [Indexed: 12/17/2022]
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22
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Loftus TJ, Thomas RM, Murphy TW, Nguyen LL, Moore FA, Brakenridge SC, Efron PA, Mohr AM. The effects of red cell transfusion donor age on nosocomial infection among trauma patients. Am J Surg 2017; 214:672-676. [PMID: 28720216 DOI: 10.1016/j.amjsurg.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/08/2017] [Accepted: 07/09/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND We hypothesized that packed red blood cell (PRBC) transfusions from older donors would be associated with fewer nosocomial infections among trauma patients. METHODS We performed a four-year retrospective analysis of 264 consecutive adult trauma patients who received ≥1 PRBC transfusion during admission. The capacity of donor age to predict nosocomial infection was assessed by logistic regression. RESULTS Thirty-three percent of all patients developed a nosocomial infection. Donor age was significantly higher among patients with nosocomial infection (40.3 vs. 37.6 years, p = 0.035), and the incidence of infection was directly proportional to donor age. The association between donor age and infection was strongest among recipients age ≥60 years, and was significant on multivariate regression for this cohort (OR 1.07 (95% CI 1.01-1.13), p = 0.024). CONCLUSIONS Among trauma patients receiving PRBC transfusions, blood from older donors may be associated with increased risk for nosocomial infection.
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Affiliation(s)
- Tyler J Loftus
- University of Florida Health Department of Surgery and Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
| | - Ryan M Thomas
- Malcom Randall Veterans Affairs Medical Center Department of Surgery, Gainesville, FL, USA.
| | - Travis W Murphy
- University of Florida Health Department of Emergency Medicine, Gainesville, FL, USA.
| | - Linda L Nguyen
- University of Florida Health College of Medicine, Gainesville, FL, USA.
| | - Frederick A Moore
- University of Florida Health Department of Surgery and Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
| | - Scott C Brakenridge
- University of Florida Health Department of Surgery and Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
| | - Philip A Efron
- University of Florida Health Department of Surgery and Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
| | - Alicia M Mohr
- University of Florida Health Department of Surgery and Sepsis and Critical Illness Research Center, Gainesville, FL, USA.
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23
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Ziemann M, Thiele T. Transfusion-transmitted CMV infection - current knowledge and future perspectives. Transfus Med 2017. [PMID: 28643867 DOI: 10.1111/tme.12437] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Transmission of human cytomegalovirus (CMV) via transfusion (TT-CMV) may still occur and remains a challenge in the treatment of immunocompromised CMV-seronegative patients, e.g. after stem cell transplantation, and for low birthweight infants. Measures to reduce the risk of TT-CMV have been evaluated in clinical studies, including leucocyte depletion of cellular blood products and/or the selection of CMV-IgG-negative donations. Studies in large blood donor cohorts indicate that donations from newly CMV-IgG-positive donors should bear the highest risk for transmitting CMV infections because they contain the highest levels of CMV-DNA, and early CMV antibodies cannot neutralise CMV. Based on this knowledge, rational strategies to reduce the residual risk of TT-CMV using leucoreduced blood products could be designed. However, there is a lack of evidence that CMV is still transmitted by transfusion of leucoreduced units. In low birthweight infants, most (if not all) CMV infections are caused by breast milk feeding or congenital transmission rather than by transfusion of leucoreduced blood products. For other patients at risk, no definitive data exist about the relative importance of alternative transmission routes of CMV compared to blood transfusion. As a result, only the conduction of well-designed studies addressing strategies to prevent TT-CMV and the thorough examination of presumed cases of TT-CMV will achieve guidance for the best transfusion regimen in patients at risk.
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Affiliation(s)
- M Ziemann
- Institut für Transfusionsmedizin, Universitätsklinikum Schleswig Holstein, Lübeck, Germany
| | - T Thiele
- Institut für Immunologie und Transfusionsmedizin, Abteilung Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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24
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Gniadek TJ, Bachowski G, Gorlin J, Roback JD, Ness PM. Cytomegalovirus-safe blood: the unclear effect of sickle hemoglobin. Transfusion 2017; 57:1582-1583. [PMID: 28594144 DOI: 10.1111/trf.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas J Gniadek
- Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Gary Bachowski
- Mid-American Blood Service Division, American Red Cross North-Central Region, St Paul, Minnesota
| | - Jed Gorlin
- Innovative Blood Resources, Hennepin County Medical Center and Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - John D Roback
- Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Paul M Ness
- Blood Bank, The Johns Hopkins University School of Medicine, Bethesda, Maryland
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25
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Ziemann M, Juhl D, Brockmann C, Görg S, Hennig H. Infectivity of blood products containing cytomegalovirus DNA: results of a lookback study in nonimmunocompromised patients. Transfusion 2017; 57:1691-1698. [DOI: 10.1111/trf.14105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/08/2017] [Accepted: 02/16/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Malte Ziemann
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein; Lübeck Germany
| | - David Juhl
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein; Lübeck Germany
| | - Christian Brockmann
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein; Lübeck Germany
| | - Siegfried Görg
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein; Lübeck Germany
| | - Holger Hennig
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein; Lübeck Germany
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26
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Finlay L, Nippak P, Tiessen J, Isaac W, Callum J, Cserti-Gazdewich C. Survey of Institutional Policies for Provision of "CMV-Safe" Blood in Ontario. Am J Clin Pathol 2016; 146:578-584. [PMID: 28430958 DOI: 10.1093/ajcp/aqw181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Debate continues on whether leukoreduction alone (LR) is sufficiently similar to leukoreduced cellular products drawn from cytomegalovirus (CMV)-seronegative (SN) donors to minimize the risk of transfusion-transmitted CMV (TT-CMV). We sought to determine the policy, inventory, and practice landscape of the province for TT-CMV mitigation. METHODS A web-based survey was distributed to hospitals in Ontario by Canadian Blood Services to collect data on their policies with respect to TT-CMV prevention. RESULTS TT-CMV mitigation practices varied by patient population, hospital size, and region. Smaller institutions remain committed to dual prevention, whereas academic hospitals favor a single-measure approach. Although smaller institutions attempt to align their policies with leadership sites, emulation is often inaccurate. The demands for SN products also appear to be significantly lower than the current screening practices of Canadian Blood Services. CONCLUSIONS Standardization is lacking on practices to prevent TT-CMV. Although there are barriers to harmonizing practices, the apparent shift to policies acknowledging LR as a sufficient protection is likely to continue.
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Affiliation(s)
- Laura Finlay
- From the Department of Clinical Pathology, Sunnybrook Health Science Centre, Toronto, Canada
- Department of Laboratory Medicine, Michael Garron Hospital, Toronto, Canada
| | | | | | | | - Jeannie Callum
- From the Department of Clinical Pathology, Sunnybrook Health Science Centre, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Christine Cserti-Gazdewich
- Ryerson University, Toronto, Canada
- Department of Laboratory Hematology and Transfusion Medicine, University Health Network, Toronto, Canada
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27
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Jackups R, Savage W. Gaps in Research on Adverse Events to Transfusion in Pediatrics. Transfus Med Rev 2016; 30:209-12. [DOI: 10.1016/j.tmrv.2016.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/15/2016] [Indexed: 01/28/2023]
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28
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Strauss RG. Optimal prevention of transfusion-transmitted cytomegalovirus (TTCMV) infection by modern leukocyte reduction alone: CMV sero/antibody-negative donors needed only for leukocyte products. Transfusion 2016; 56:1921-4. [DOI: 10.1111/trf.13683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ronald G Strauss
- Professor Emeritus of Pathology & Pediatrics; University of Iowa College of Medicine; Iowa City IA
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29
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Coşkun O, Yazici E, Şahiner F, Karakaş A, Kiliç S, Tekin M, Artuk C, Yamanel L, Beşirbellioğlu BA. Cytomegalovirus and Epstein-Barr virus reactivation in the intensive care unit. Med Klin Intensivmed Notfmed 2016; 112:239-245. [PMID: 27435067 DOI: 10.1007/s00063-016-0198-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/07/2016] [Accepted: 06/12/2016] [Indexed: 11/24/2022]
Abstract
AIM The purpose of this work was to evaluate the reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in immunocompetent patients in the intensive care unit (ICU) and to identify risk factors associated with reactivation. MATERIALS AND METHODS In this observational prospective study, 60 adult immunocompetent patients who stayed at least 7 days in an ICU were evaluated. During hospitalization, the viral load was monitored at admission and on day 7 with polymerase chain reaction to detect viral reactivation and weekly thereafter on days 14, 21, and 28 if hospitalization continued. RESULTS The mean age of patients was 63.3 years (±23.4 years) and 34 (56.7 %) of them were male. Mean APACHE II scores for patients was 25 at admission. Of these patients, 28 were hospitalized in the internal ICU and 32 were hospitalized in the anesthesiology ICU. CMV/EBV reactivation was found in 17 individuals (12 for EBV, 3 for CMV, and 2 for both). The median high-sensitive C-reactive protein value in patients with CMV reactivation was significantly higher than in those patients without CMV reactivation (p = 0.037). EBV reactivation was statistically higher in patients with mechanical ventilation compared to patients without mechanical ventilation (p = 0.023). EBV reactivation in patients with fever was found to be statistically higher than in the patients without fever (p = 0.035). CONCLUSION There is a need for extended studies with a larger number of patients from specific groups to better understand the reactivation frequency and identify risk factors. EBV and CMV reactivation should be taken into consideration in critically ill patients with fever, without specific symptoms and unresponsive to the treatment.
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Affiliation(s)
- O Coşkun
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Etlik/Ankara, Turkey
| | - E Yazici
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Etlik/Ankara, Turkey
| | - F Şahiner
- Department of Medical Microbiology, Virology Unit, Gulhane Military Medical Academy, Ankara, Turkey
| | - A Karakaş
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Etlik/Ankara, Turkey.
| | - S Kiliç
- Department of Public Health and Epidemiology, Gulhane Military Medical Academy, Ankara, Turkey
| | - M Tekin
- Department of Anesthesiology and Reanimation, Gulhane Military Medical Academy, Ankara, Turkey
| | - C Artuk
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Etlik/Ankara, Turkey
| | - L Yamanel
- Department of Intensive Care Unit, Gulhane Military Medical Academy, Ankara, Turkey
| | - B A Beşirbellioğlu
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Etlik/Ankara, Turkey
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Delaney M, Mayock D, Knezevic A, Norby-Slycord C, Kleine E, Patel R, Easley K, Josephson C. Postnatal cytomegalovirus infection: a pilot comparative effectiveness study of transfusion safety using leukoreduced-only transfusion strategy. Transfusion 2016; 56:1945-50. [PMID: 27080192 DOI: 10.1111/trf.13605] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/22/2016] [Accepted: 03/02/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal mitigation strategy to prevent transfusion transmission of cytomegalovirus (TT-CMV) in preterm very low birthweight infants remains debated. Hospitals caring for this patient population have varied practices. STUDY DESIGN AND METHODS A prospective observational comparative effectiveness pilot study was conducted to determine the feasibility for a larger study. The pilot was carried out at hospitals using a leukoreduction (LR)-only transfusion strategy. Specimen and data collection for this study was performed in a similar approach to a study completed at Emory University that employed the CMV-seronegative plus LR approach. All testing was performed at one laboratory. The rates of TT-CMV using the two transfusion strategies were compared. RESULTS Zero incidence of TT-CMV was detected in infants (n = 20) transfused with LR-only blood (0/8; 95% confidence interval [CI], 0-25.3%) and is consistent with the previously reported zero incidence of TT-CMV finding in a cohort of infants transfused with CMV-negative plus LR blood (0/310; 95% CI, 0%-0.9%). The seroprevalence rate among enrolled mothers (n = 17) was 60%. Forty percent of those infants (8/20) received 43 transfusions; five were transfused with one or more CMV-seropositive blood components. One infant had tested positive for CMV before receiving blood transfusions; the infant's mother was CMV immunoglobulin (Ig)G positive and IgM negative. CONCLUSIONS Using the LR-only transfusion approach, zero cases of TT-CMV were detected in this pilot study. A larger study is needed to reliably determine the most effective strategy for prevention of TT-CMV in this population.
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Affiliation(s)
- Meghan Delaney
- University of Washington.,Bloodworks Northwest, Seattle, Washington
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31
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Mainou M, Alahdab F, Tobian AA, Asi N, Mohammed K, Murad MH, Grossman BJ. Reducing the risk of transfusion-transmitted cytomegalovirus infection: a systematic review and meta-analysis. Transfusion 2016; 56:1569-80. [DOI: 10.1111/trf.13478] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/30/2015] [Accepted: 12/06/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Maria Mainou
- Evidence-Based Practice Center; Mayo Clinic; Rochester Minnesota
| | - Fares Alahdab
- Evidence-Based Practice Center; Mayo Clinic; Rochester Minnesota
| | - Aaron A.R. Tobian
- Division of Transfusion Medicine, Department of Pathology; Johns Hopkins University; Baltimore Maryland
| | - Noor Asi
- Evidence-Based Practice Center; Mayo Clinic; Rochester Minnesota
| | - Khaled Mohammed
- Evidence-Based Practice Center; Mayo Clinic; Rochester Minnesota
| | - M. Hassan Murad
- Evidence-Based Practice Center; Mayo Clinic; Rochester Minnesota
| | - Brenda J. Grossman
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology; Washington University in St Louis; St Louis Missouri
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Lancini DV, Faddy HM, Ismay S, Chesneau S, Hogan C, Flower RL. Cytomegalovirus in Australian blood donors: seroepidemiology and seronegative red blood cell component inventories. Transfusion 2016; 56:1616-21. [DOI: 10.1111/trf.13459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/12/2015] [Accepted: 10/12/2015] [Indexed: 01/26/2023]
Affiliation(s)
- Daniel V. Lancini
- School of Medicine; University of Queensland
- Clinical Services and Research; Australian Red Cross Blood Service; Brisbane Queensland
| | - Helen M. Faddy
- School of Medicine; University of Queensland
- Clinical Services and Research; Australian Red Cross Blood Service; Brisbane Queensland
| | - Sue Ismay
- Manufacturing; Australian Red Cross Blood Service; Brisbane Queensland, Australia
| | - Stuart Chesneau
- Manufacturing; Australian Red Cross Blood Service; Brisbane Queensland, Australia
| | - Chris Hogan
- Clinical Services and Research; Australian Red Cross Blood Service; Melbourne Victoria Australia
| | - Robert L. Flower
- Clinical Services and Research; Australian Red Cross Blood Service; Brisbane Queensland
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Leucoreduction of blood components: an effective way to increase blood safety? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 14:214-27. [PMID: 26710353 DOI: 10.2450/2015.0154-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/31/2015] [Indexed: 02/08/2023]
Abstract
Over the past 30 years, it has been demonstrated that removal of white blood cells from blood components is effective in preventing some adverse reactions such as febrile non-haemolytic transfusion reactions, immunisation against human leucocyte antigens and human platelet antigens, and transmission of cytomegalovirus. In this review we discuss indications for leucoreduction and classify them into three categories: evidence-based indications for which the clinical efficacy is proven, indications based on the analysis of observational clinical studies with very consistent results and indications for which the clinical efficacy is partial or unproven.
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Nickel RS, Josephson CD. Neonatal Transfusion Medicine: Five Major Unanswered Research Questions for the Twenty-First Century. Clin Perinatol 2015; 42:499-513. [PMID: 26250913 DOI: 10.1016/j.clp.2015.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Blood component transfusions are important to the care of preterm neonates; however, their use in clinical practice often is not based on high levels of evidence. Five major questions for neonates are discussed: (1) What is the optimal red blood cell (RBC) transfusion threshold? (2) What is the optimal platelet transfusion threshold? (3) Does the storage age of an RBC unit affect outcomes? (4) Does RBC transfusion contribute to the pathogenesis of necrotizing enterocolitis? and (5) Which new practices should be used to prevent transfusion-transmitted infections? Although definitive answers to these questions do not exist, future research should help answer them.
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Affiliation(s)
- Robert Sheppard Nickel
- Department of Pediatrics, Children's National Health System, The George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue North West, Washington, DC 20010, USA
| | - Cassandra D Josephson
- Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Children's Healthcare of Atlanta, Emory University, 1405 Clifton Road North East, Atlanta, GA 30322, USA.
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35
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Kleinman S, Stassinopoulos A. Risks associated with red blood cell transfusions: potential benefits from application of pathogen inactivation. Transfusion 2015; 55:2983-3000. [PMID: 26303806 PMCID: PMC7169855 DOI: 10.1111/trf.13259] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/02/2015] [Accepted: 06/22/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Red blood cell (RBC) transfusion risks could be reduced if a robust technology for pathogen inactivation of RBC (PI-RBCs) were to be approved. MATERIALS AND METHODS Estimates of per-unit and per-patient aggregate infectious risks for conventional RBCs were calculated; the latter used patient diagnosis as a determinant of estimated lifetime exposure to RBC units. Existing in vitro data for the two technologies under development for producing PI-RBCs and the status of current clinical trials are reviewed. RESULTS Minimum and maximum per-unit risk were calculated as 0.0003% (1 in 323,000) and 0.12% (1 in 831), respectively. The minimum estimate is for known lower-risk pathogens while the maximal estimate also includes an emerging infectious agent (EIA) and endemic area Babesia risk. Minimum and maximum per-patient lifetime risks by diagnosis grouping were estimated as 1.5 and 3.3%, respectively, for stem cell transplantation (which includes additional risk for cytomegalovirus transmission); 1.2 and 3.7%, respectively, for myelodysplastic syndrome; and 0.2 and 44%, respectively, for hemoglobinopathy. DISCUSSION There is potential for PI technologies to reduce infectious RBC risk and to provide additional benefits (e.g., prevention of transfusion-associated graft-versus-host disease and possible reduction of alloimmunization) due to white blood cell inactivation. PI-RBCs should be viewed in the context of having a fully PI-treated blood supply, enabling a blood safety paradigm shift from reactive to proactive. Providing insurance against new EIAs. Further, when approved, the use of PI for all components may catalyze operational changes in blood donor screening, laboratory testing, and component manufacturing.
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Affiliation(s)
- Steve Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
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Abstract
BACKGROUND The transfusion of blood components plays a significant role as supportive therapy in the treatment of patients with cancer. Although blood transfusions help manage complications arising from either the patient's primary condition or associated with therapeutic intervention, their use introduces a new set of risks; therefore, health care professionals must be aware of the potential morbidity introduced by using blood components and endeavor to optimize outcomes by ordering transfusions only when the benefits outweigh the inherent risks. METHODS This article sought to review the published literature, including the epidemiology of diseases transmissible via transfusion, performance characteristics for assays used for blood donor screening, surveillance activities to detect newly emergent pathogens, and biovigilance activities reported by public health authorities. RESULTS Effective measures have been implemented to significantly decrease the risk of transmissible diseases associated with transfusion. Reports of viral disease transmitted via transfusion have been nearly eliminated, particularly since the introduction of molecular-based detection technology. The transmission of bacteria and parasites still represents a threat to the use of cellular blood components. Transfusion-associated human prion disease has not been reported in the United States. Immune-mediated reactions due to donor-recipient incompatibility remain a challenge. CONCLUSIONS Transmissible agents most commonly associated with risks due to transfusion are no longer a major threat; however, a significant challenge remains with regard to addressing the need for quick response mechanisms to manage emerging pathogens with the potential for rapid spread, either unintentionally (eg, globalization) or intentionally (eg, bioterrorism). The use of technology to reduce pathogens holds promise for further increasing the safety profile of blood transfusion.
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Affiliation(s)
- German F Leparc
- OneBlood, 10100 Dr Martin Luther King Jr Steet North, St Petersburg, FL 33716, USA
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Systematic Evaluation of Different Nucleic Acid Amplification Assays for Cytomegalovirus Detection: Feasibility of Blood Donor Screening. J Clin Microbiol 2015. [PMID: 26202109 DOI: 10.1128/jcm.01091-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Acute primary cytomegalovirus (CMV) infections, which commonly occur asymptomatically among blood donors, represent a significant risk for serious morbidity in immunocompromised patients (a major group of transfusion recipients). We implemented a routine CMV pool screening procedure for plasma for the identification of CMV DNA-positive donors, and we evaluated the sensitivities and performance of different CMV DNA amplification systems. Minipools (MPs) of samples from 18,405 individual donors (54,451 donations) were screened for CMV DNA using the RealStar CMV PCR assay (Altona Diagnostic Technologies), with a minimum detection limit of 11.14 IU/ml. DNA was extracted with a high-volume protocol (4.8 ml, Chemagic Viral 5K kit; PerkinElmer) for blood donor pool screening (MP-nucleic acid testing [NAT]) and with the Nuclisens easyMAG system (0.5 ml; bioMérieux) for individual donation (ID)-NAT. In total, six CMV DNA-positive donors (0.03%) were identified by routine CMV screening, with DNA concentrations ranging from 4.35 × 10(2) to 4.30 × 10(3) IU/ml. Five donors already showed seroconversion and detectable IgA, IgM, and/or IgG antibody titers (IgA(+)/IgM(+)/IgG(-) or IgA(+)/IgM(+)/IgG(+)), and one donor showed no CMV-specific antibodies. Comparison of three commercial assays, i.e., the RealStar CMV PCR kit, the Sentosa SA CMV quantitative PCR kit (Vela Diagnostics), and the CMV R-gene PCR kit (bioMérieux), for MP-NAT and ID-NAT showed comparably good analytical sensitivities, ranging from 10.23 to 11.14 IU/ml (MP-NAT) or from 37.66 to 57.94 IU/ml (ID-NAT). The clinical relevance of transfusion-associated CMV infections requires further investigation, and the evaluated methods present powerful basic tools providing sensitive possibilities for viral testing. The application of CMV MP-NAT facilitated the identification of one donor with a window-phase donation during acute primary CMV infection.
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Hall S, Danby R, Osman H, Peniket A, Rocha V, Craddock C, Murphy M, Chaganti S. Transfusion in CMV seronegative T-depleted allogeneic stem cell transplant recipients with CMV-unselected blood components results in zero CMV transmissions in the era of universal leukocyte reduction: a U.K. dual centre experience. Transfus Med 2015; 25:418-23. [PMID: 26114211 DOI: 10.1111/tme.12219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 03/30/2015] [Accepted: 06/03/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To establish rates of cytomegalovirus (CMV) transmission with use of CMV-unselected (CMV-U), leukocyte-reduced blood components transfused to CMV-seronegative patient/CMV-seronegative donor (CMV neg/neg) allogeneic stem cell transplantation (SCT) recipients including those receiving T-depleted grafts. BACKGROUND CMV infection remains a major cause of morbidity following SCT. CMV-seronegative SCT recipients are particularly at risk of transfusion transmitted CMV (TT-CMV) and until recently they have received blood components from CMV-seronegative donors with significant resource implications. Although leukocyte reduction of blood components is reported to minimise risk of TT-CMV, its efficacy in high-risk situations, such as in T-depleted transplant recipients, is unknown. METHODS We retrospectively analysed the incidence of TT-CMV in CMV neg/neg allogeneic SCT recipients transfused with CMV-U, leukocyte-reduced blood components in two transplantation centres in the UK. Patients were monitored for CMV infection by weekly CMV polymerase chain reaction testing. Leukocyte reduction of blood components was in accordance with current UK standards. RESULTS Among 76 patients, including 59 receiving in vivo T-depletion, no episodes of CMV infection were detected. Patients were transfused with 1442 CMV-unselected, leukocyte-reduced components, equating to 1862 donor exposures. CONCLUSIONS Our findings confirm the safety of leukocyte reduction as a strategy in preventing TT-CMV in high-risk allogeneic SCT recipients.
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Affiliation(s)
- S Hall
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - R Danby
- Department of Haematology, Oxford University Hospitals, Oxford, UK
| | - H Osman
- Department of Virology, University Hospitals Birmingham, Birmingham, UK
| | - A Peniket
- Department of Haematology, Oxford University Hospitals, Oxford, UK
| | - V Rocha
- Department of Haematology, Oxford University Hospitals, Oxford, UK
| | - C Craddock
- Department of Clinical Haematology, University Hospitals Birmingham, Birmingham, UK
| | - M Murphy
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - S Chaganti
- Department of Clinical Haematology, University Hospitals Birmingham, Birmingham, UK
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Barone A, Lucarelli A, Onofrillo D, Verzegnassi F, Bonanomi S, Cesaro S, Fioredda F, Iori AP, Ladogana S, Locasciulli A, Longoni D, Lanciotti M, Macaluso A, Mandaglio R, Marra N, Martire B, Maruzzi M, Menna G, Notarangelo LD, Palazzi G, Pillon M, Ramenghi U, Russo G, Svahn J, Timeus F, Tucci F, Cugno C, Zecca M, Farruggia P, Dufour C, Saracco P. Diagnosis and management of acquired aplastic anemia in childhood. Guidelines from the Marrow Failure Study Group of the Pediatric Haemato-Oncology Italian Association (AIEOP). Blood Cells Mol Dis 2015; 55:40-7. [DOI: 10.1016/j.bcmd.2015.03.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/28/2015] [Indexed: 02/03/2023]
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Seed CR, Wong J, Polizzotto MN, Faddy H, Keller AJ, Pink J. The residual risk of transfusion-transmitted cytomegalovirus infection associated with leucodepleted blood components. Vox Sang 2015; 109:11-7. [DOI: 10.1111/vox.12250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 11/26/2022]
Affiliation(s)
- C. R. Seed
- Australian Red Cross Blood Service; Perth WA Australia
| | - J. Wong
- Australian Red Cross Blood Service; Sydney NSW Australia
| | - M. N. Polizzotto
- Department of Clinical Haematology; Monash University; Melbourne Vic. Australia
| | - H. Faddy
- Australian Red Cross Blood Service; Brisbane Qld Australia
| | - A. J. Keller
- Australian Red Cross Blood Service; Perth WA Australia
| | - J. Pink
- Australian Red Cross Blood Service; Brisbane Qld Australia
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Transfusions for anemia in adult and pediatric patients with malignancies. Blood Rev 2015; 29:291-9. [PMID: 25796130 PMCID: PMC7127235 DOI: 10.1016/j.blre.2015.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/20/2015] [Accepted: 02/05/2015] [Indexed: 12/11/2022]
Abstract
Anemia is present in over two-thirds of patients with malignant hematological disorders. The etiology of anemia predominates from ineffective erythropoiesis from marrow infiltration, cytokine related suppression, erythropoietin suppression, and vitamin deficiency; ineffective erythropoiesis is further exacerbated by accelerated clearance due to antibody mediated hemolysis and thrombotic microangiopathy. As the anemia is chronic in nature, symptoms are generally well tolerated and often non-specific. Transfusion of red blood cells (RBCs) is a balance between providing benefit for patients while avoiding risks of transfusion. Conservative/restrictive RBC transfusion practices have shown equivalent patient outcomes compared to liberal transfusion practices, and meta-analysis has shown improved in-hospital mortality, reduced cardiac events, re-bleeding, and bacterial infections. The implications for a lower threshold for transfusion in patients with malignancies are therefore increasingly being scrutinized. Alternative management strategies for anemia with IV iron and erythropoietin stimulating agents (ESAs) should be considered in the appropriate settings.
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Affiliation(s)
- Radhika Dasararaju
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marisa B. Marques
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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Radia R, Pamphilon D. Transfusion strategies in patients undergoing stem-cell transplantation. Expert Rev Hematol 2014; 4:213-20. [DOI: 10.1586/ehm.11.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ziemann M, Hennig H. Prevention of Transfusion-Transmitted Cytomegalovirus Infections: Which is the Optimal Strategy? ACTA ACUST UNITED AC 2013; 41:40-4. [PMID: 24659946 DOI: 10.1159/000357102] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/16/2013] [Indexed: 11/19/2022]
Abstract
Traditionally, leukoreduction and selection of blood products from seronegative donors have been used as alternative strategies to reduce the risk of transfusion-transmitted cytomegalovirus infections (TT-CMV) in atrisk patients. After the introduction of universal leukoreduction for red blood cell and platelet concentrates in Germany, a controversy evolved as to whether the additional selection of blood products from seronegative donors would reduce or even increase the risk of TT-CMV. This review summarizes the current knowledge about CMV infections in blood donors and the implications of this information on the effect of potential transfusion strategies. Even though there are conflicting data about the incidence of TT-CMV remaining after the introduction of leukodepletion, it has been clearly shown that both prevalence and concentration of CMV DNA in peripheral blood are highest in newly seropositive donors. Therefore, avoidance of blood products from these donors is the most important goal of any transfusion strategy. This goal can be reached by: i) selection of blood products from seronegative donors, ii) provision of CMV DNA-negative blood products, or iii) provision of blood from long-term seropositive donors. In cases of suspected TT-CMV, all implicated donors should be investigated carefully to gather further knowledge on which donors confer the lowest risk for TT-CMV.
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Affiliation(s)
- Malte Ziemann
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Holger Hennig
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
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46
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Roback JD, Josephson CD. New insights for preventing transfusion-transmitted cytomegalovirus and other white blood cell-associated viral infections. Transfusion 2013; 53:2112-6. [DOI: 10.1111/trf.12366] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- John D. Roback
- Center for Transfusion and Cellular Therapies; Emory University School of Medicine; Atlanta GA
| | - Cassandra D. Josephson
- Center for Transfusion and Cellular Therapies; Emory University School of Medicine; Atlanta GA
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47
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Furui Y, Satake M, Hoshi Y, Uchida S, Suzuki K, Tadokoro K. Cytomegalovirus (CMV) seroprevalence in Japanese blood donors and high detection frequency of CMV DNA in elderly donors. Transfusion 2013; 53:2190-7. [PMID: 23968359 DOI: 10.1111/trf.12390] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/18/2013] [Accepted: 07/20/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The current prevalence of cytomegalovirus (CMV) in Japan and the risk of CMV transfusion transmission are unknown in the era of seronegative leukoreduced blood components. STUDY DESIGN AND METHODS We measured CMV-specific immunoglobulin (Ig)M and IgG in 2400 samples of whole blood collected from 12 groups of blood donors categorized by sex and age at 10-year intervals from their teens to their 60s. We also tested for CMV DNA using polymerase chain reaction in the cellular fractions of all samples. RESULTS We found that 76.6% of blood donors were CMV seropositive. The seroprevalences among donors in their 20s and 30s were 58.3 and 73.3%, respectively. We detected CMV DNA in the cellular fraction of 4.3% of samples from donors in their 60s and in 1.0% of samples from donors younger than 60 years. None of the 562 seronegative samples was DNA positive. Furthermore, 14% of DNA-positive samples also contained DNA in the plasma fraction, and two of five such samples were derived from donors in their 60s. Leukoreduced plasma components derived from donations with CMV DNA in plasma samples also contained a relevant amount of CMV DNA. CONCLUSION The seroprevalence of CMV among Japanese blood donors of child-bearing age has not changed over the past 15 years. Latent CMV becomes reactivated more frequently among elderly donors than among younger donors. A proportion of them have free CMV DNA in their plasma fraction, which could not be diminished by leukoreduction. The risk of transfusion-transmitted CMV infection in blood with plasma CMV DNA should be determined.
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Affiliation(s)
- Yasumi Furui
- Blood Service Headquarters, Japanese Red Cross, Tokyo, Japan
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Ziemann M, Juhl D, Görg S, Hennig H. The impact of donor cytomegalovirus DNA on transfusion strategies for at-risk patients. Transfusion 2013; 53:2183-9. [PMID: 23581526 DOI: 10.1111/trf.12199] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/11/2013] [Accepted: 02/28/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) DNA is frequently detected in plasma of newly seropositive donors. Selection of leukoreduced blood products from donors with remote CMV infection could avoid transfusion-transmitted CMV infections (TT-CMV) due to primarily infected donors. However, there are no data about the prevalence of reactivations in long-term seropositive donors compared to the incidence of window period donations in seronegative donors. Therefore, the optimal transfusion strategy for at-risk patients is unclear. STUDY DESIGN AND METHODS Whole blood samples from 22,904 donations were tested for CMV DNA, and CMV DNA-positive donations were categorized as donations from 1) seronegative donors, 2) newly seropositive donors, and 3) long-term seropositive donors. RESULTS Twenty-one donors were reproducibly CMV DNA-positive (0.09%). Frequency of detection and concentration of CMV DNA in whole blood were comparable for seronegative and long-term seropositive donors. Nonreproducibly positive results for CMV DNA in whole blood were more frequent in long-term seropositive donors (0.16% vs. 0.01%, p<0.01). Only low concentrations of CMV DNA in plasma were detectable in two seronegative donors and one long-term seropositive donor. Highest concentrations of CMV DNA in both whole blood and plasma, however, were found in newly seropositive donors. CONCLUSION Prevalences of window period donations among seronegative donors and reactivations among long-term seropositive donors, as well as the CMV DNA concentration in whole blood and plasma samples from these donors, are comparable. Therefore, blood products from both groups could be used for patients at risk for TT-CMV, while those of newly seropositive donors seem to bear an increased risk.
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Affiliation(s)
- Malte Ziemann
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
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Juhl D, Vockel A, Luhm J, Ziemann M, Hennig H, Görg S. Comparison of the two fully automated anti-HCMV IgG assays: Abbott Architect CMV IgG assay and Biotest anti-HCMV recombinant IgG ELISA. Transfus Med 2013; 23:187-94. [DOI: 10.1111/tme.12036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 03/08/2013] [Accepted: 03/12/2013] [Indexed: 11/27/2022]
Affiliation(s)
- D. Juhl
- Institute of Transfusion Medicine; University Hospital of Schleswig-Holstein; Lübeck/Kiel; Germany
| | - A. Vockel
- Abbott GmbH & Co. KG; Wiesbaden; Germany
| | - J. Luhm
- Institute of Transfusion Medicine; University Hospital of Schleswig-Holstein; Lübeck/Kiel; Germany
| | - M. Ziemann
- Institute of Transfusion Medicine; University Hospital of Schleswig-Holstein; Lübeck/Kiel; Germany
| | - H. Hennig
- Institute of Transfusion Medicine; University Hospital of Schleswig-Holstein; Lübeck/Kiel; Germany
| | - S. Görg
- Institute of Transfusion Medicine; University Hospital of Schleswig-Holstein; Lübeck/Kiel; Germany
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50
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Ziemann M, Heuft HG, Frank K, Kraas S, Görg S, Hennig H. Window period donations during primary cytomegalovirus infection and risk of transfusion-transmitted infections. Transfusion 2013; 53:1088-94. [DOI: 10.1111/trf.12074] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 11/30/2022]
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