Prevention of Transfusion-Associated Cytomegalovirus Infection:<i>Practice Parameter</i>

Przepiorka, Donna; Leparc, Germán F.; Werch, Jochewed; Lichtiger, Benjamin

doi:10.1093/ajcp/106.2.163

Cited by 22 publications

(9 citation statements)

References 46 publications

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“…Consequently, with the appropriate quality control measures in place, our results will likely be applicable to other institutions and will allow this approach to be used for other populations at high risk for transfusion-associated infections. 10,12 …”

Section: Discussionmentioning

confidence: 99%

Transfusion support using filtered unscreened blood products for cytomegalovirus-negative allogeneic marrow transplant recipients

Narvios

Przepiorka

Tarrand

et al. 1998

Bone Marrow Transplant

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Summary:It has been suggested that leukoreduced unscreened blood products can be used as an alternative to components from cytomegalovirus (CMV)-seronegative donors in order to prevent transmission of CMV from transfusions for CMV-seronegative marrow transplant recipients with CMV-seronegative donors, but confirmatory data are lacking. A retrospective chart review was undertaken for patients undergoing allogeneic transplantation over a 4-year period during which blood products were filtered for CMV-seronegative patients with CMV-seronegative donors when CMVseronegative components were not available. Forty-five CMV-seronegative patient-donor pairs were identified. Only one patient developed CMV disease (pneumonia) and no other patients developed an infection. In this group of patients, the rate of CMV infection was 2.7% (95% CI, 0-8%) by life-table analysis. We conclude that filtered unscreened blood products as partial transfusion support for CMV-seronegative marrow transplant recipients were associated with a low incidence of CMV infection, justifying further evaluation of filtered blood products as total transfusion support for this patient population. However, since CMV infections still occur, continued surveillance by periodic culture or other techniques is warranted. Keywords: cytomegalovirus infections; filtered blood components; bone marrow transplantation Meyers et al 1 reported that 28% of cytomegalovirus (CMV)-seronegative marrow transplant recipients with CMV-seronegative donors developed CMV infections, and these were attributed to transmission of virus by leukocytes in blood components used for transfusions. Although use of blood products solely from CMV-seronegative donors was associated with a reduction in CMV infection to approximately 3% in CMV-seronegative transplant patients, 2,3 the availability of such blood products is limited by the high incidence of CMV infection in the general population. Leukoreduction by filtration has emerged as an alternative means for providing unscreened blood compoCorrespondence: Dr B Lichtiger, The

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Section: Discussionmentioning

confidence: 99%

Transfusion support using filtered unscreened blood products for cytomegalovirus-negative allogeneic marrow transplant recipients

Narvios

Przepiorka

Tarrand

et al. 1998

Bone Marrow Transplant

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“…In contrast, primary infection or reactivation of the latent virus in congenitally infected neonates or immunosuppressed patients, in particular tissue or organ transplant recipients and HIV-infected patients, can lead to serious clinical manifestation. The transmission of HCMV via blood products containing cells should be avoided at all costs by means of appropriate precautions (see 4.2) in the following HCMV-negative patients and in the case of intrauterine transfusions [7,14,23,25]: -HCMV-seronegative pregnant women, -premature infants with a birth weight of less than 1,200 g born to HCMV-seronegative mothers, -HCMV-seronegative potential recipients of allogenic stem cell transplants, -HCMV-seronegative recipients of allogenic stem cell transplants from HCMV-seronegative donors, -HCMV-seronegative recipients of organ transplants from seronegative donors, -HCMV-seronegative AIDS patients. The prevention of HCMV infection from blood products containing cells is also often recommended for the following patient groups: -HCMV-seronegative patients with Hodgkin's disease, -HCMV-seronegative patients receiving immunosuppressive therapy, especially if they have a tendency towards opportunistic infections, -HCMV-seronegative recipients of autologous stem cell transplants, -HCMV-seronegative patients with congenital or acquired deficiencies of cellular immunity.…”

Section: Severity and Course Of The Diseasementioning

confidence: 99%

“…Patients who receive polychemotherapy and/or irradiation treatment for an underlying malignant disease often experience a transient disturbance of cellular immunity but which does not usually progress to HCMV disease as a result of a primary or secondary infection [14].…”

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confidence: 99%

Human Cytomegalovirus

2001

Transfus Med Hemother

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1 Current Knowledge about the Pathogen 1.1 Characteristics of HCMV Together with animal cytomegalovirus, human cytomegalovirus (HCMV), also referred to in recent literature as human herpesvirus 5 (HHV-5), belongs to the Herpesviridae family, subfamily Betaherpesvirinae, genus Cytomegalovirus. The name is derived from the fact that it causes enlargement of the infected cell (cytomegaly) and induces characteristic inclusion bodies. The HCMV genome consists of a doublestranded DNA with approximately 230,000 base pairs. The genome is enclosed by an icosahedral capsid (100–110 nm diameter, 162 capsomers). Between the capsid and the virus envelope is a protein layer known as the tegument. The virus envelope is derived from cell membranes. At least eight different viral glycoproteins are embedded in the lipid bilayer. The mature viral particle has a diameter of 150–200 nm (fig. 1). Like all herpesviruses, HCMV is sensitive to low pH, lipiddissolving agents and heat. HCMV has a half-life of approximately 60 min at 37 °C and is relatively unstable at –20 °C. It needs to be stored at at least –70 °C in order to maintain its infectivity. ...

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“…1 Transfused WBCs have been associated with febrile transfusion reactions, alloimmunization and subsequent platelet refractoriness, 2 transmission of cytomegalovirus (CMV) and other infections, 3 up-regulation or reactivation of latent host viruses, 4 and immune suppression of the recipient. 5,6 For many years it has been observed that red blood cell components from allogeneic donors contain WBCs capable of survival and expansion.…”

Section: Introductionmentioning

confidence: 99%

Survival of transfused donor white blood cells in HIV-infected recipients

Kruskall

Lee

Assmann

et al. 2001

Blood

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The appearance and expansion of donor white blood cells in a recipient after transfusion has many potential biologic ramifications. Although patients with HIV infection are ostensibly at high risk for microchimerism, transfusion-associated graft-versus-host disease (TA-GVHD) is rare. The purpose of this study was to search for sustained microchimerism in such patients. Blood samples were collected from 93 HIV-infected women (a subset from the Viral Activation Transfusion Study, an NHLBI multicenter randomized trial comparing leukoreduced versus unmodified red blood cell [RBC] transfusions) before and after transfusions from male donors. Donor lymphocytes were detected in posttransfusion specimens using a quantitative Y-chromosome-specific polymerase chain reaction (PCR) assay, and donor-specific human leukocyte antigen (HLA) alleles were identified with allele-specific PCR primers and probes. Five of 47 subjects randomized to receive nonleukoreduced RBCs had detectable male lymphocytes 1 to 2 weeks after transfusion, but no subject had detectable male cells more than 4 weeks after a transfusion. In 4 subjects studied, donorspecific HLA haplotypes were detected in posttransfusion specimens, consistent with one or more donors' cells. None of 46 subjects randomized to receive leukoreduced RBCs had detectable male lymphocytes in the month after transfusion. Development of sustained microchimerism after transfusion in HIV-infected patients is rare; HIV-infected patients do not appear to be at risk for TA-GVHD. (Blood. 2001;98:272-279)

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Prevention of Transfusion-Associated Cytomegalovirus Infection:Practice Parameter

Cited by 22 publications

References 46 publications

Transfusion support using filtered unscreened blood products for cytomegalovirus-negative allogeneic marrow transplant recipients

Transfusion support using filtered unscreened blood products for cytomegalovirus-negative allogeneic marrow transplant recipients

Human Cytomegalovirus

Survival of transfused donor white blood cells in HIV-infected recipients

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