Relation of Titers of Antibodies to CMV in Blood Donors to the Transmission of Cytomegalovirus Infection

Abstract

Titers of antibody to cytomegalovirus (CMV) of 529 persons whose blood had been supplied to 51 selected patients who underwent open-heart surgery were determined by indirect hemagglutination (IHA) and IgM-specific indirect immunofluorescence (IFA). Twenty-eight patients showed evidence of active CMV infection after transfusion (seroconversion or a fourfold rise in titer by IHA), whereas 23 showed no serological change. Patients with active CMV infections had received, on average, a greater number of blood units (12.9 vs. 7.9), of which more were seropositive (6.9 vs. 3.5), than did patients who showed no serological change. Those seropositive units of blood that had been transfused into the group that showed evidence of active infection, however, had a lower geometric mean titer than did those transfused into the group that showed no serological change (1:654 vs. 1:1,360). Seven (1.3%) of the 529 blood donors had CMV-specific IgM titers (by IFA) of greater than or equal to 1:16; each of the seven recipients of their blood subsequently showed evidence of active CMV infection. This study suggests that donor blood with high IHA titers may prevent transmission of CMV infection, whereas blood from donors with IgM antibody to CMV may transmit CMV.

Development of CMV Antibody Tests and Their Clinical Evaluation

“…These data strongly suggest that screening for anti-CMV IgM only will not prevent transmission of CMV through blood transfusions. This conclusion is supported by data from other investigators [15], who calculated that only half of the posttransfusion CMV infections would have been prevented when IgM anti-CMV-positive blood would have been excluded. The overall prevalence of CMV-specific IgM in healthy blood donors found by us (0.16%) is in agreement with one study [16] and is lower than reported by some other investigators [15,17].…”

“…This conclusion is supported by data from other investigators [15], who calculated that only half of the posttransfusion CMV infections would have been prevented when IgM anti-CMV-positive blood would have been excluded. The overall prevalence of CMV-specific IgM in healthy blood donors found by us (0.16%) is in agreement with one study [16] and is lower than reported by some other investigators [15,17]. How ever, the specificity of some tests used is questionable, whereas the IgM-ELISA used here has a very high speci ficity [18].…”

Evaluation of a prescreening blood donor program for prevention of perinatal transfusion-acquired cytomegalovirus (CMV) infection

“…One of these three infants developed CMV infection which lead to serious morbidity. A recent study suggested that recently infected donors may transmit CMV more efficiently than latent infected donors [5]. We find it prudent that the prescreened blood be retested before its use.…”

Prevention of Transfusion-Transmitted Cytomegalovirus Infections: Which is the Optimal Strategy?

“…Despite early assumptions that donations from only a small subgroup of donors can cause TT-CMV [23,24,25], traditionally all seropositive donors have been regarded as potentially infectious for at-risk patients [26]. To identify potentially infectious donors, testing the donors' urine for CMV has been suggested by Kane and colleagues [23] because CMV viruria is frequent in primarily infected donors, and urine usually contains a higher viral load than peripheral blood.…”

“…To identify potentially infectious donors, testing the donors' urine for CMV has been suggested by Kane and colleagues [23] because CMV viruria is frequent in primarily infected donors, and urine usually contains a higher viral load than peripheral blood. Presumably more feasible for daily practice are the suggestions of testing donors for rising antibody titers or IgM antibodies [24]. Alternatively, CMV-antibody positive, but gB-antibody-negative donors or donors with low-avidity antibodies can be regarded as potentially infectious [3,19].…”