Antibody responses to the Epstein-Barr virus and cytomegaloviruses after open-heart and other surgery

Post-transfusion hepatitis in a London hospital: results of a two-year prospective study

Seven hundred and sixty-eight patients were seen and tested at frequent intervals after transfusion of whole blood. Eight patients were judged to have developed icteric or anicteric post-transfusion viral hepatitis, an incidence of 1%. Five were icteric and four of these were hepatitis B antigen (HB Ag) positive; two of these four died. One of the fatal cases and one non-fatal HB Ag positive case had received HB Ag positive blood. Two other antigen-positive patients had received blood or plasma or both which had not been tested for antigen.

Thirty-five patients showed conspicuous or sustained elevations of alanine transaminase without clinical features of hepatitis.

Four were positive for HB Ag but had not received antigen positive blood.

Two who had received antigen positive blood remained antigen negative, but one developed hepatitis B antibody (HB Ab).

Two other patients were also transfused with plasma.

Five had serological evidence of cytomegalovirus (CMV) infection accompanying the enzyme changes.

One patient who had received HB Ag positive blood remained antigen-negative and showed no abnormalities.

Five patients who became HB Ag positive, although they had been given antigen-negative blood, remained clinically and biochemically well.

Cytomegalovirus primary infection or reactivation occurred in another 32 patients; five had isolated, transient enzyme rises, one other was associated with a drug-induced focal liver necrosis and 26 showed no enzyme changes. Epstein–Barr virus infections, one of which was associated with a transient upset of enzyme activity, were detected in five patients. There were no cases of post-perfusion syndrome.

Primary cytomegalovirus infection following open heart surgery

Among 674 patients undergoing open heart surgery in 1981-82, 86 (13%) were cytomegalovirus (CMV) antibody-negative when tested by an enzyme-linked immunosorbent assay prior to operation. At follow-up, 54 (67%) of 80 patients restudied had seroconverted after the operation, and 35 of the 54 seroconvertants had been ill with fever and elevated liver enzymes. Among the latter 35 patients, 26 demonstrated a significant rise in CMV antibody titre, most often detected in the third week following the onset of illness. The older patients were more susceptible to illness and seroconversion, and there was a positive correlation between age and the number of blood units given. Thus, at least one third of the seronegative patients developed symptomatic CMV illness after open heart surgery. This is a much higher incidence than earlier reported.

The Role of Photochemical Treatment With Amotosalen and UV-A Light in the Prevention of Transfusion-Transmitted Cytomegalovirus Infections

Primary cytomegalovirus (CMV) infection is usually asymptomatic in immunocompetent patients but can cause serious life-threatening complications in immunocompromised CMV-seronegative patients, including patients receiving a bone marrow or peripheral blood stem cell transplant, recipients of some solid-organ transplants, and low-birth-weight neonates. Current recommendations for preventing transfusion-transmitted CMV (TT-CMV) infection in these patients include exclusive use of CMV-seronegative and/or leukoreduced cellular blood components (red blood cells and platelets) for transfusion. However, breakthrough cases of TT-CMV still occur. Despite improving the safety of blood components, testing remains a reactive approach to blood safety. In contrast, pathogen inactivation technologies offer a proactive approach with the potential to further improve blood safety. To reduce the risks associated with platelet transfusions, a photochemical treatment (PCT) process using a combination of the psoralen amotosalen HCl and long-wavelength UV light has been developed and introduced into clinical practice in Europe. PCT has been shown to result in greater than 5.9-log reductions in infectivity of human CMV in platelet concentrates and to prevent the transfusion transmission of murine CMV in a mouse transfusion model. Thus, PCT pathogen inactivation may play a role in further reducing the incidence of TT-CMV infection in patients who are at risk for serious CMV disease. Because PCT is a technology that targets nucleic acids, it also offers a proactive process for the inactivation of a broad range of viral, bacterial, and protozoan pathogens in addition to CMV.

Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient

OBJECTIVE

To determine whether critically ill patients who receive allogenic packed red blood cell transfusions are at increased risk of developing nosocomial infections during hospitalization.

DESIGN

Retrospective database study utilizing Project IMPACT.

SETTING

A 40-bed medical-surgical-trauma intensive care unit in an 825-bed tertiary referral teaching hospital.

PATIENTS

One thousand seven hundred and seventeen patients admitted to the medical-surgical-trauma intensive care unit.

MEASUREMENTS AND MAIN RESULTS

Data were collected by using the Project IMPACT database. Nosocomial infection rates were compared among three groups: the entire cohort, the transfusion group, and the nontransfusion group. We determined the nosocomial infection rates in these groups while adjusting for probability of survival by using Mortality Prediction Model (MPM-0) scores, age, gender, and number of units of packed red blood cells transfused. The average number of units transfused per patient was 4.0. The nosocomial infection rate for the entire cohort was 5.94%. The nosocomial infection rates for the transfusion group (n = 416) and the nontransfusion group (n = 1301) were 15.38% and 2.92%, respectively (p <.005 chi-square). Transfusion of packed red blood cells was related to the occurrence of nosocomial infection, and there was a dose-response pattern (the more units of packed red blood cells transfused, the greater the chance of nosocomial infection; p< 0.0001 chi-square). The transfusion group was six times more likely to develop nosocomial infection compared with the nontransfusion group. In addition, for each unit of packed red blood cells transfused, the odds of developing nosocomial infection were increased by a factor of 1.5. A subgroup analysis of nosocomial infection rates adjusted for probability of survival by using MPM-0 scores showed nosocomial infection to occur at consistently higher rates in transfused patients vs. nontransfused patients. A second subgroup analysis adjusted for patient age showed a statistically significant increase in rates of nosocomial infection for transfused patients regardless of age.

CONCLUSIONS

Transfusion of packed red blood cells is associated with nosocomial infection. This association continues to exist when adjusted for probability of survival and age. In addition, mortality rates and length of intensive care unit and hospital stay are significantly increased in transfused patients.

Effect of hepatitis C antibody screening in blood donors on post-transfusion hepatitis in Taiwan

A national screening programme for antibody to hepatitis C virus (HCV) in blood donors in Taiwan began in July 1992 using a second-generation immunoassay. To study the impact of this screening on post-transfusion hepatitis in Taiwan, a prospective study on post-transfusion hepatitis, that was started in 1987, was continued. As of June 1994, 245 patients who received a blood transfusion after July 1992 had completed a follow-up period for more than 6 months post-transfusion. Of them, seven (2.8%) recipients developed acute post-transfusion hepatitis. The hepatitis in six cases could not be attributed to infection by hepatitis A, B, C, D, E viruses or cytomegalovirus (CMV) or Epstein-Barr virus (EBV). The remaining patient seroconverted to both IgG and IgM anti-CMV. All seven patients recovered in 6 months without development of chronicity, and the mean peak alanine aminotransferase level was lower compared with that of the cases before anti-HCV screening (i.e. pre-July 1992). These results indicate that the current anti-HCV screening has effectively interrupted HCV transmission through blood transfusion in Taiwan.

The incidence and consequences of cytomegalovirus transmission via blood transfusion to low birth weight, premature infants in north east Scotland

In a 2-year study involving 133 premature low birth weight (less than 1,500 g) infants, the impact of CMV infection via blood transfusion was assessed. 8.4% (7 out of 83) of transfused infants and 10% (7 out of 70) of those exposed to seropositive blood acquired CMV. In those less than 1,250 g the infection rate rose to 13.2% (7 out of 46). Seropositive infants were at a higher risk of acquiring CMV infection than seronegative ones. CMV infection did not give rise to specific immediate morbidity, and no deaths were attributed to CMV. The only source of nosocomial CMV infection was the transfused seropositive blood. Based on these findings, it was possible to formulate a CMV transfusion policy to premature infants in our region.

Blood-borne Infections Associated with Transfusion

The epidemic of acquired immunodeficiency syndrome (AIDS) and the realization that transmission of human immunodeficiency virus is caused by homologous blood transfusion have changed the way physicians and their patients view the safety of hemotherapy. Considering that nearly four million patients receive the lifesaving benefits of blood transfusions every year in the United States, we need to recognize and reduce the inherent biological complications of this therapy. Currently, a major concern is the transmission of blood-borne infectious agents and the establishment of persistent infection in transfusion recipients, which is apparently facilitated by suppression of the recipient's hematopoietic and immune systems. Education of blood donors, patients, and attending physicians regarding infectious complications of transfusion is essential and remains the most effective procedure for making rational decisions. Before giving blood transfusions, astute physicians should calculate a risk/benefit ratio and communicate it to the patient or family. Potential recipients of transfusions can be assured that the blood supply is safer now than at any time in the past, although there is still a very small risk for the transmission of infectious agents that cause chronic diseases, such as hepatitis, AIDS, neuropathies, and leukemias. It is essential that everyone understands that the goal of a zero-risk blood supply is not attainable. Recent developments in molecular biology and biotechnology, however, provide opportunities for further reduction of infectious complications of blood transfusions.

Transfusion-acquired cytomegalovirus infection in children in a hyperendemic area

Thirty-nine children without previous cytomegalovirus (CMV) infection received blood transfusion in the National Taiwan University Hospital. The overall transfusion-acquired CMV infection rate was 36% (14/39). Donor CMV seropositive rate was 70%. None of the nine children who had received seronegative blood became infected, in contrast to 14 of the 21 children (67%) who had received seropositive blood (P = 0.002). Another significant risk factor associated with CMV infection was the use of fresh blood: 13 of 15 (87%) with fresh seropositive blood were infected, in contrast to one of six (17%) with "old" seropositive blood (P = 0.01). Most of the fresh blood was used within 24 hours. This blood processing method was shown to account for the extremely high rate of CMV infection in those who had received fresh seropositive blood. The results indicated that the incidence of CMV infection can be reduced by avoiding the use of fresh blood, especially blood less than 24 hours old. For such a population in Taiwan with high prevalence of positive CMV antibody, this approach was more applicable than screening donor blood for CMV antibody.

Epidemiological evidence is crucial as proof of causation in cytomegalovirus disease

This review analyses the methods available to establish proof of causation in cytomegalovirus (CMV) disease. The clinical spectrum of CMV disease is discussed in the light of the crucial role of longitudinal epidemiological studies in proving causation in such disease.

Pathogenesis of acute graft-versus-host disease after open heart surgery

Acute Graft-versus-Host disease (GVHD) generally occurs after allogenic bone marrow transplantation and in immunocompromised patients who have received blood products containing viable lymphocytes. A recently recognized association is that of acute GVHD in the transfused post-open heart surgery patient. The factors that converge after open heart surgery that allow the engraftment and proliferation of donor lymphocytes are discussed and a hypothesis is developed to link the acute GVHD and open heart surgery.

Incidence and morbidity of cytomegaloviral infection in patients with mediastinitis following cardiac surgery

To determine the incidence and morbidity of infections with CMV associated with mediastinitis after conventional cardiac surgery, 115 consecutive adult patients with mediastinitis were evaluated with viral cultures of blood and urine. Shedding of CMV was seen in 29 patients (25 percent) within a mean period of 37 +/- 22 days after cardiopulmonary bypass. Viremia was documented in 79 percent (23) of these 29 patients. Acute renal failure and enzymatic abnormalities (AST and LDH) were significantly more common in patients with virologically proven infection with CMV (p less than 0.05). In patients who survived the initial period of bacterial infection, major differences in their clinical course were observed according to their virologic status. After the 15th day of hospitalization following the débridement, the persistence of local infection was more frequent (p less than 0.05) and the mortality was higher (p less than 0.01) in CMV-infected patients. Moreover, the mean duration of hospitalization in the ICU for survivors was 69 +/- 36 days in viral shedders, compared with 48 +/- 27 days in nonshedders (p less than 0.05). Infection with CMV in mediastinitis occurs frequently and is associated with persistence of local infection, prolonged hospitalization, and increased late mortality.

Cytomegalovirus and blood transfusion

The problem of transfusion-transmitted cytomegalovirus (CMV) infection differs from that for other transfusion-transmitted infections in that only patients who are immunocompromised require CMV-free blood or components. The virus is cell-associated and transmission appears to be due to reactivation of latent virus in white blood cells. As a herpes virus, CMV can be responsible for primary infections, reactivations or reinfections in humans. The use of restriction endonuclease techniques is sometimes necessary to pinpoint the origin of infections. Serological studies have shown that CMV infection is worldwide, but seropositivity rates vary widely being highest in underdeveloped countries, rising both with age and lower socio-economic status. Provision of CMV seronegative blood therefore involves considerable administrative as well as laboratory effort and planning, especially if panels of previously tested, seronegative donors are organized. Serious complications of transfusion-transmitted CMV infection (which can occasionally prove fatal) are only seen with immuno-suppressed patients (commonly low birth weight infants or transplant recipients). Prevention or amelioration of CMV infection with appropriate patients can be attempted by reducing the number of white blood cells present in blood or components by filtration or washing, administration of CMV immune globulin or provision of blood found by serological screening to be CMV-seronegative.

Epstein-Barr virus, cytomegalovirus, and other viral infections in children after liver transplantation

We studied 51 consecutive pediatric patients for the frequency and morbidity of viral infections after liver transplantation. The incidence of primary (67%) and reactivation (48%) Epstein-Barr virus (EBV) infections and reactivation (88%) cytomegalovirus (CMV) infection was comparable to that seen in adult transplant recipients. However, fewer pediatric than adult transplant recipients experienced primary CMV infection (P less than .01). Five (38%) of 13 CMV infections were symptomatic and included hepatitis, pneumonitis, enteritis, and mononucleosis. Two of 14 patients with primary EBV infection subsequently developed, at two months and two years after initial infection, an EBV-associated lymphoproliferative syndrome, and one of 10 patients with reactivated EBV infection developed a possible EBV-associated febrile encephalopathy. Other viruses causing infection in these children included herpes simplex virus, varicella-zoster virus, adenovirus, parainfluenza virus, respiratory syncytial virus, and rotavirus.

Transfusion-transmitted cytomegalovirus infections: significance and control

Cytomegalovirus (CMV) is a herpes virus which can give rise to primary infections, reactivated infections, or reinfections in humans. Seroepidemiologic studies have shown CMV infection to be worldwide with the highest antibody prevalences detected in Third World countries; however, significant regional variations can be seen within a given country. Antibody prevalence varies directly with age and inversely according to socioeconomic status. Numerous prospective studies of blood transfusion recipients carried out since 1966 have shown marked differences in infection rates but relatively little associated disease. Infection rates were highest in seronegative recipients given large amounts of fresh blood. Recently published reports have shown substantially lower infection rates than earlier studies, a change likely to be due to the current practice of transfusing fewer units of older blood. CMV has not been found to play a significant role in the etiology of posttransfusion hepatitis. CMV infections have been found to be an important source of morbidity and mortality in immunocompromised patients. Several studies of transfused, premature infants have shown significant differences in infection rates and disease expression. Seronegative low-birth-weight infants receiving blood from seropositive donors are at greatest risk. Blood from CMV-seronegative donors substantially lowers the risk of infection. Receiving a kidney or heart from a CMV-seropositive donor appears to be a more salient risk factor than blood transfusion in renal and cardiac transplant patients who are also more likely to have symptomatic CMV infections. Leukocyte transfusions have been found to be a significant source of CMV infection and disease in bone marrow transplant patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal cytomegalovirus infections due to blood

Infants with very low birthweights (less than 1250g) are immunocompromised and have immature hematopoietic systems. They require frequent blood transfusions and have an increased susceptibility to infection. These very low birthweight infants who lack passively acquired antibody against CMV, acquire transfusion-associated CMV infections with a frequency of approximately 30%. These infections are associated with significant morbidity and mortality. The source of these postnatally acquired CMV infections are seropositive blood donors. These infections can be prevented by appropriate donor selection and/or blood processing. Recent but limited data suggests that all infants (regardless of birthweight or the presence of antibody against CMV) should receive CMV seronegative blood products if they are likely to receive multiple transfusions from multiple donors.

Transfusion-associated cytomegalovirus infections in seropositive cardiac surgery patients

To determine whether reinfection with an exogenous strain of cytomegalovirus (CMV) or reactivation of endogenous CMV is responsible for post-transfusion CMV infections in patients previously infected with the virus, seropositive patients were randomised preoperatively to receive red blood-cells (RBCs) from CMV seronegative donors (group A) or from random donors (group B). Each group B patient received at least one seropositive unit. 5 of 46 group A patients and 7 of 48 group B patients had a four-fold or greater increase of IgG antibody to CMV eight to twelve weeks postoperatively. IgG antibody titre did not increase in a third group (group C) of 57 seropositive patients who received no RBCs. 10 of the 12 patients with increased IgG titres also had CMV-specific IgM antibody after transfusion. These results indicate that reactivation accounts for most post-transfusion CMV infections in seropositive adults.

Transfusion-acquired cytomegalovirus infection in cardiac surgery patients

The incidence of transfusion-acquired primary cytomegalovirus (CMV) infection was studied in 483 cardiac surgery patients. Ninety-six patients (20%) were found to lack antibody to CMV [CMV Ab(-)] as measured by radioimmunoassay. Sixty-eight CMV Ab(-) were followed by viral culture and/or serology from eight weeks to one year after transfusion. Transfusion requirements in CMV Ab(-) patients were as follows: whole blood/packed red blood cells, mean 4.7 +/- 2.6 units; platelets (20 patients), 6.9 +/- 3.8 units; fresh frozen plasma (25 patients), mean 3.3 +/- 1.6 units. Forty-nine percent of 235 donor units tested had antibody to CMV. One donor unit (0.4%) had CMV-specific IgM. This was not associated with CMV infection in the recipient. One patient (1.5%) demonstrated evidence of seroconversion to CMV during the follow-up period. This is significantly less than reported in previously published studies (P less than .01). Serological methods used, the age of the transfused blood, the immune status of the transfusion recipient, and the administration of passive antibody in fresh frozen plasma are factors that may be responsible for the low incidence observed.

Identification of patients at risk of symptomatic cytomegalovirus infection after open-heart surgery

In a prospective study, 58 consecutive patients submitted to open-heart surgery were followed from the preoperative period up to 3 months postoperatively with regard to clinical status, cytomegalovirus (CMV) antibodies and signs of enzymatic liver damage. Forty-eight patients (83%) were seropositive prior to operation. Of the ten (17%) preoperatively seronegative patients, five became CMV-seropositive during follow-up. Of the 48 initially seropositive patients, nine showed heightened CMV-antibody titers after the operation. Significant symptomatic CMV illness with protracted fever developed in four patients, all from the group of five with seroconversion. All five of these patients had enzymatic liver damage. The incidence of symptomatic CMV infection after open-heart surgery in CMV-negative patients probably is higher than previously assumed, while CMV-positive patients seem to have complete protection against CMV morbidity.

Natural killer cell activity after open-heart surgery

We studied the effects of elective open-heart surgery with cardiopulmonary bypass on peripheral blood natural killer (NK) cell activity in 12 patients with heart disease. Separated mononuclear cells from patients and control cells taken from healthy volunteers were incubated in microtiter plates for 24 h with 3H-thymidine-labelled K 562 cells as target cells. In this test system, higher counts per minute (cpm) values represent a greater number of surviving target cells and thus weaker NK activity. Results of cultures prepared from blood samples taken preoperatively were compared with those taken 2, 7 and 14 days postoperatively. NK cell activity was depressed (P less than 0.01) for 2 days after surgery. NK cell activity in the control samples did not change significantly. The results show an impairment of NK cell activity immediately after open-heart surgery.

Comparison of an enzyme-linked immunoassay with an indirect hemagglutination assay for the detection of antibodies to cytomegalovirus

Because of the morbidity associated with cytomegalovirus (CMV) infections in neonates, immunosuppressed and transplant patients, there is a need for a rapid, sensitive, and reliable assay for the presence of antibody to CMV. Such an assay would permit the identification of CMV antibody negative blood or plasma for transfusion into these high-risk patients. The indirect hemagglutination assay (IHA) is often employed to detect antibodies to CMV, but results must be interpreted subjectively. Thus, an indirect enzyme immunoassay (EIA) was developed to detect antibodies to CMV, and was compared to IHA. 531 sera from a population of healthy blood donors were assayed by both methods. Compared with IHA the sensitivity of the indirect EIA was 98.5% (267/271) and the specificity was 93.1% (242/260). Antibodies to Epstein-Barr, herpes-zoster, or herpes simplex viruses did not react in the EIA. The EIA and IHA correlated well in the detection of antibodies to CMV in sera from acute CMV infections. The presence of rheumatoid factor did not interfere with the EIA or IHA results. This indirect EIA is a rapid, simple, and reproducible method to identify seronegative sera or plasma.

Screening for hepatitis B virus markers is not justified in West African transfusion centres

62 severely anaemic Gambian children who were transfused with whole blood not screened for hepatitis B surface antigen (HBsAg) were followed for evidence of hepatitis B virus (HBV) infection over six months. 89% of donors and 44% of recipients before their transfusion had at least one HBV marker. Of the 54 recipient children surviving for the follow-up period, only 1 had a transient rise in liver enzymes. In 13 (37%) of 35 previously uninfected children HBV infection developed within twelve weeks of transfusion. Only 1 of these 13 children followed up at one year had become a persistent HBsAg carrier. The rate at which this cohort acquired persistent HBV infection or clinically important hepatitis was no greater than that in a cohort of similarly aged, nontransfused, children not admitted to hospital. In sub-Saharan Black Africa, where 15% of children have persistent HBV infection by the age of 10 years, HBV screening programmes in transfusion centres cannot at present be justified.

Cytomegalovirus hepatitis in normal and immune compromised hosts

Liver biopsies of six previously normal hosts (Group I, NH), with recent or acute CMV infection, and autopsy liver samples of four immunocompromised hosts (Group II, ICH) with overwhelming CMV infection have been studied in an occasional survey. In both groups, portal tract involvement, bile duct inflammation, liver cell degeneration and parenchymal granulomas were present. In Group I, a randomly distributed hepatitis with predominant involvement of the periportal areas was present, including sinusoidal arrays of lymphocytes and lymphohistiocytic aggregates. In contrast, in Group II liver cell damage was more extensive and the inflammatory infiltration only scarce. Intracellular viral inclusion bodies were found only in Group II, both in liver cells and in bile duct epithelium. Morphologically, the presence of viral inclusion bodies correlated well with the immunohistologic demonstration of CMV specific "late" (CMV-LA) or structural antigens. In addition, CMV-specific "early" (CMV-EA) or non-structural antigens were present in liver cell nuclei of 2/6 NH and 2/4 ICH. The possible relations between the inflammation and the lack of structural antigenic viral expression are discussed. It is concluded that ICH with CMV infection have a prominent cytopathogenic effect and widespread lytic viral infection in the liver in the absence of adequate immunologic reactivity, whereas the opposite is found in NH.

Evaluation and management of prosthetic valve endocarditis

Despite improved operative technique and sophistication in managing patients undergoing cardiac valve replacement, prosthetic valve endocarditis (PVE) remains a source of major morbidity (overall recent incidence approximately 2.1%), and these patients have a high case-fatality rate (58% overall). Early PVE (less than 60 days postoperative) has a worse prognosis (78% case-fatality rate) and is usually caused by staphylococcal species, gram-negative rods, and fungi; whereas the case-fatality rate in late PVE is 46%, owing to the lower fatality of streptococcal species infections that tend to occur late. Risk factors that portend a poor clinical response to medical therapy alone include the presence of congestive heart failure, paravalvular leakage, systemic embolic, early PVE, nonstreptococcal etiology, aortic location in a nonheterograft valve, as well as persistent fever (greater than 10 days). Given the frequently dismal outcomes in the medical management of these patients, the case is made for early surgical intervention in most cases of PVE (except for late streptococcal disease), especially if any of the aforementioned risk factors are present.

Bilateral cytomegalovirus panuveitis after high-dose corticosteroid therapy

A 30-year-old previously healthy woman who recieved immunosuppressive doses of corticosteroids developed an unusual culture-proved cytomegalovirus panuveitis bilaterally. The atypical clinical course was marked by bilateral exudative detachements with minimal evidence of retinitis. Any patient receiving blood transfusions and immunosuppressive doses of corticosteroids is potentially at risk for developing ocular cytomegalovirus infection, and the clinical presentation of the ocular infection may be atypical.

Autologous transfusion in obstetrics and gynecology

Two cases are presented which illustrate the use of autologous blood transfusion for elective surgery in obstetrics and gynecology. The advantages and disadvantages are described and review of the pertinent literature over the past century is summarized.

Cytomegalovirus mononucleosis in a healthy adult: association with hepatitis, secondary Epstein-Barr Virus antibody response and immunosuppression

A 35 year old previously healthy physician had clinical manifestations of a mononucleosis illness complicated by arthralgia, vesicular pharyngitis and hepatitis. Initially, the patient had cytomegalovirus (CMV) viremia (predominantly in polymorphonuclear leukocytes) followed by the presence of CMV in the urine, throat and semen. He also had an antibody response to the Epstein-Barr virus which appeared to be a secondary type. During the acute phase of illness, only 7 per cent of the patient's lymphocytes formed spontaneous T cell rosettes as compared to a normal value of 65 to 70 per cent. Concurrently, evidence of abnormal delayed hypersensitivity was manifested by the loss of reactivity to mumps skin test antigen. All clinical and laboratory abnormalities except for the persistence of CMV in the pharynx, urine and semen returned to normal after resolution of the clinical illness.

Blood as a potential vehicle for the cytomegaloviruses

This study analyzed transfused blood as a potential vehicle for infectious cytomegalovirus (CMV) particles. A total of 207 patients who received a total number of 897 units of blood were monitored. A complement-fixing antibody titer of 1:8, as determined by micro-titer technique, was observed in 14.8 per cent of the blood units. A total of 140 individuals in this study were serosusceptible. Eighty-six serosusceptible individuals did not receive blood containing complement-fixing CMV antibodies. In this patient population three instances of seroconversion were identified. Among the 54 serosusceptible individuals who received at least one unit of blood whose complement-fixing titer to the AD-169 strain of CMV was 1:8 or greater, 13 seroconversions were observed.

Evaluation of a walking-donor blood transfusion program in an intensive care nursery

A prospective study was carried out to identify the immediate and long-range advantages and disadvantages of a walking-donor transfusion program for an intensive care newborn nursery. The effect of heparin on coagulation of blood was evaluated and found to be minimal. There was no evidence of transmission of HBSAg. The prevalence of CMV infection at the time of follow-up was higher in infants who had received blood from donors seropositive for CMV than in infants who had been transfused from seronegative donors. In our experience, a walking-donor program has been a safe and effective method for the provision of small transfusions of blood to sick neonates.