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Gawad AA, Hashish M, Abaza A, El-Kayal A. Cytomegalovirus Immunoglobulin G Avidity Index among Blood Donors in Alexandria, Egypt. Cent Eur J Public Health 2017; 24:314-320. [PMID: 28095288 DOI: 10.21101/cejph.a4157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 10/13/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIM Transfusion transmitted diseases (TTD) are a major challenge to transfusion services all over the world. Cytomegalovirus (CMV) is considered one of the main viruses associated with blood transfusion. As CMV screening is not included in routine screening tests done for donated blood in blood banks in Egypt, the detection of CMV Immunoglobulin G (IgG) avidity needs to be tested for being a useful tool to diagnose recent infection among blood donors. The aim of this work was to study CMV IgG avidity index (AI) among blood donors. METHODS A total of 88 blood samples were collected from the non-remunerated volunteer blood donors who attended the Alexandria Regional Blood Transfusion Centre. A quantitative enzyme linked immunosorbent assay for the avidity detection of the specific IgG antibodies to CMV in human serum samples was used. RESULTS Eighty five studied blood donors (96.6%) were positive for CMV IgG. Eighty one donors (95.3%) showed high avidity (>45.0%). Regarding the remaining four CMV IgG positive donors; three had medium avidity (<45.0%) and only one had a low avidity of <25.0%. A moderate agreement of 42.4% was found between IgG concentration and avidity. CONCLUSIONS CMV seroprevalence was found to be high among volunteer blood donors, where age and gender were statistically significant factors associated with CMV IgG concentration. The use of the avidity assay as a screening tool for CMV among blood donors is highly suggested. The exclusion of the low and medium AI units will ensure the availability of a safe stock of blood units, hence eliminating the risk of CMV transmission to vulnerable groups.
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Affiliation(s)
- Aleya Abdel Gawad
- Microbiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Mona Hashish
- Microbiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Amani Abaza
- Microbiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Aisha El-Kayal
- Alexandria Regional Blood Transfusion Centre, Alexandria, Egypt
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Effect of Blood Donor Characteristics on Transfusion Outcomes: A Systematic Review and Meta-Analysis. Transfus Med Rev 2016; 30:69-80. [PMID: 26920039 DOI: 10.1016/j.tmrv.2016.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/30/2015] [Accepted: 01/09/2016] [Indexed: 01/12/2023]
Abstract
Optimal selection of blood donors is critical for ensuring the safety of blood products. The current selection process is concerned principally with the safety of the blood donor at the time of donation and of the recipient at the time of transfusion. Recent evidence suggests that the characteristics of the donor may affect short- and long-term transfusion outcomes for the transfused recipient. We conducted a systematic review with the primary objective of assessing the association between blood donor characteristics and red blood cell (RBC) transfusion outcomes. We searched MEDLINE, EMBASE, and Cochrane Central databases and performed manual searches of top transfusion journals for all available prospective and retrospective studies. We described study characteristics, methodological quality, and risk of bias and provided study-level effect estimates and, when appropriate, pooled estimates with 95% confidence intervals using the Mantel-Haenszel or inverse variance approach. The overall quality of the evidence was graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. From 6121 citations identified by our literature search, 59 studies met our eligibility criteria (50 observational, 9 interventional). We identified the evaluation of association of 17 donor characteristics on RBC transfusion outcome. The risk of bias and confounding of the included studies was high. The quality of evidence was graded as very low to low for all 17 donor characteristics. Potential associations were observed for donor sex with reduced survival at 90 days and 6 months in male recipients that receive donated blood from females (hazard ratio 2.60 [1.09, 6.20] and hazard ratio 2.40 [1.10, 5.24], respectively; n = 1), Human Leukocyte Antigen - antigen D Related (HLA-DR) selected transfusions (odds ratio [OR] 0.39 [0.15, 0.99] for the risk of transplant alloimmunization, n = 9), presence of antileukocyte antibodies (OR 5.84 [1.66, 20.59] for risk of transfusion-related acute lung injury, n = 4), and donor RBC antigens selection (OR 0.20 [0.08, 0.52] for risk of alloimmunization, n = 4). Based on poor quality evidence, positive antileukocyte antibodies, female donor to male recipients, HLA-DR selected RBC transfusion, or donor RBC antigen selection may affect RBC transfusion outcome. Our findings that donor characteristics may be associated with transfusion outcomes warrant establishing vein-to-vein data infrastructure to allow for large robust evaluations. PROSPERO registration number: CRD42013006726.
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Stratta RJ, Pietrangeli C, Baillie GM. Defining the risks for cytomegalovirus infection and disease after solid organ transplantation. Pharmacotherapy 2010; 30:144-57. [PMID: 20099989 DOI: 10.1592/phco.30.2.144] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cytomegalovirus continues to be one of the most clinically significant infections after solid organ transplantation. Classic definitions of patients at high risk for infection and tissue-invasive disease are focused on recipient-donor serostatus, type of organ transplanted, and overall level of immunosuppression. However, recent trends in clinical practice call for a reevaluation of cytomegalovirus infection risks after solid organ transplantation. Indeed, whereas early-onset cytomegalovirus infection is usually controlled by antiviral prophylaxis with ganciclovir and derivatives, delayed- and late-onset cytomegalovirus infection can develop after the completion of a course of preventive therapy. In addition, indirect effects of cytomegalovirus infection may occur as a result of persistent low-level viremia. Suboptimal dosing of antiviral drugs due to specific drug toxicities may result in the development of ganciclovir-resistant cytomegalovirus disease. The relationship between organ allograft rejection and cytomegalovirus infection and disease has been recognized for some time. Transplantation of increasing numbers of extended-criteria donor organs increases the risk of delayed graft function and acute rejection, prompting the use of more intensive immunosuppression. In addition, the trend to spare long-term exposure to calcineurin inhibitors has contributed to a resurgence in the use of polyclonal T-cell induction immunosuppressive agents, which may reduce host anticytomegalovirus immunity. We discuss the current trends in solid organ transplantation that provide a foundation for defining risks for cytomegalovirus infection and disease, including identification of patients who would benefit from more aggressive cytomegalovirus monitoring and prevention strategies.
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Affiliation(s)
- Robert J Stratta
- Department of General Surgery, Section of Transplantation, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
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Roback JD, Su L, Zimring JC, Hillyer CD. Transfusion-Transmitted Cytomegalovirus: Lessons From a Murine Model. Transfus Med Rev 2007; 21:26-36. [PMID: 17174218 DOI: 10.1016/j.tmrv.2006.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Transfusion-transmitted cytomegalovirus (CMV) infection (TT-CMV) continues to complicate blood transfusion therapy, which can lead to severe morbidity or mortality in immunocompromised or immuno-immature recipients. The biological mechanisms that underlie TT-CMV (eg, viral latency in donor monocytes or stimulatory signals in the transfusion recipient leading to cytomegalovirus reactivation) are difficult to study in humans, but can be addressed in animal models. In this review, we discuss a mouse blood transfusion model, which can be used to investigate these issues as well as to validate methods to prevent TT-CMV in at-risk patients.
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Affiliation(s)
- John D Roback
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Program, Emory University School of Medicine, Atlanta, GA 30322, USA
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Roback JD, Conlan M, Drew WL, Ljungman P, Nichols WG, Preiksaitis JK. The Role of Photochemical Treatment With Amotosalen and UV-A Light in the Prevention of Transfusion-Transmitted Cytomegalovirus Infections. Transfus Med Rev 2006; 20:45-56. [PMID: 16373187 DOI: 10.1016/j.tmrv.2005.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Vamvakas EC. Is White Blood Cell Reduction Equivalent to Antibody Screening in Preventing Transmission of Cytomegalovirus by Transfusion? A Review of the Literature and Meta-Analysis. Transfus Med Rev 2005; 19:181-99. [PMID: 16010649 DOI: 10.1016/j.tmrv.2005.02.002] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The question whether the use of cytomegalovirus (CMV)-seronegative versus white blood cell (WBC)-reduced blood components is equally efficacious in preventing transfusion-acquired CMV infection remains unresolved. A total of 829 recipients of CMV-seronegative components were followed in 11 studies, and a total of 878 recipients of WBC-reduced components were followed in 12 studies. Twelve (1.45%) of 829 recipients of CMV-seronegative components and 24 (2.73%) of 878 recipients of WBC-reduced components developed CMV infection in these studies. Among bone marrow transplant (BMT) recipients, the risk of CMV infection was, respectively, 1.63% (11/674) and 3.01% (21/697). Four of 7 controlled studies of CMV-seronegative components and 1 of 3 controlled studies of WBC-reduced components indicated benefit from these special components compared with CMV-unscreened/non-WBC-reduced components. One of 3 controlled studies indicated benefit from CMV-seronegative components, as compared with WBC-reduced components. Across a subset of studies whose results were integrated in a meta-analysis, CMV-seronegative or WBC-reduced components were virtually equivalent to each other when they were compared with CMV-unscreened/non-WBC-reduced components. CMV-seronegative components were associated with a 93.1% reduction in the risk of CMV infection; WBC-reduced components were associated with a 92.3% reduction in risk (summary odds ratio [OR] = 0.069; 95% confidence interval [CI], 0.037-0.128; P < .05; and summary OR = 0.077; 95% CI, 0.031-0.190; P < .05, respectively). However, across 3 studies that compared CMV-seronegative and WBC-reduced components to each other, CMV-seronegative components were associated with a 58% reduction in risk (summary OR = 0.42; 95% CI, 0.22-0.79; P < .05). Thus, a meta-analysis of the available controlled studies indicates that CMV-seronegative blood components are more efficacious than WBC-reduced blood components in preventing transfusion-acquired CMV infection.
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Ljungman P. Risk of cytomegalovirus transmission by blood products to immunocompromised patients and means for reduction. Br J Haematol 2004; 125:107-16. [PMID: 15059132 DOI: 10.1111/j.1365-2141.2004.04845.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Per Ljungman
- Department of Hematology, Huddinge University Hospital, Karolinska Institutet, SE-14186 Stockholm, Sweden.
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Abstract
Among the human herpesviruses, cytomegalovirus (CMV) is the only one that has assumed significant importance in blood transfusion. Transfusion transmission of CMV (TT-CMV) to seronegative immunocompromised patients can lead to lethal CMV disease. Studies over the past 30 years have demonstrated that monocytes latently infected with CMV represent the primary vector for TT-CMV, and that TT-CMV can be largely abrogated by transfusing at-risk patients with either seronegative units or blood filtered to remove white blood cells. However, the small number of cases of breakthrough TT-CMV that follow transfusion of either seronegative or filtered blood still produce morbidity and mortality. These circumstances have motivated ongoing efforts to provide improved protection from TT-CMV, including the use of CMV DNA amplification for blood screening, and pathogen inactivation to sterilise all blood components prior to transfusion.
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Affiliation(s)
- John D Roback
- Transfusion Medicine Program, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, WMB 2307, 1639 Pierce Drive, Atlanta, GA 30322, USA.
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Preiksaitis JK, Sandhu J, Strautman M. The risk of transfusion-acquired CMV infection in seronegative solid-organ transplant recipients receiving non-WBC-reduced blood components not screened for CMV antibody (1984 to 1996): experience at a single Canadian center. Transfusion 2002; 42:396-402. [PMID: 12076284 DOI: 10.1046/j.1525-1438.2002.00069.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of CMV-safe cellular blood components has been recommended for CMV-sero- negative recipients of CMV seronegative (R-D-) solid- organ transplants. STUDY DESIGN AND METHODS The incidence of CMV infection in 281 CMV-seronegative patients receiving renal, heart, heart-lung, lung, and liver transplants at our center between January 1984 and October 1996 was studied. The blood components that these patients received were neither WBC reduced nor screened for CMV antibody. RESULTS One hundred thirty-one of 154 (85.1%) patients receiving organs from CMV-seropositive donors (R-D+) developed CMV infection compared with three cases of presumptive transfusion-acquired (TA) CMV infection in 127 R-D- recipients (2.4%) (relative risk, 36.0; 95% CI, 11.8-110.4). The organ-specific incidence of TA CMV infection in R-D- patients was as follows: renal, 0 of 57 (0%); heart, 0 of 29 (0%); heart-lung and/or lung, 1 of 6 (16.7%); and liver, 2 of 20 (10%). There was no significant difference in the transfusion requirements of CMV-infected and -uninfected R-D- patients. False-positive results were often (40%) observed when posttransfusion serum samples were used for determination of the organ donor CMV serostatus. CONCLUSION The low risk of TA CMV infection observed in transplant patients who received standard blood components in our study should be considered when evaluating the efficacy of programs that provide CMV-safe blood components for this population.
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Laupacis A, Brown J, Costello B, Delage G, Freedman J, Hume H, King S, Kleinman S, Mazzulli T, Wells G. Prevention of posttransfusion CMV in the era of universal WBC reduction: a consensus statement. Transfusion 2001; 41:560-9. [PMID: 11316911 DOI: 10.1046/j.1537-2995.2001.41040560.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A Laupacis
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
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Preiksaitis JK. The cytomegalovirus-"safe" blood product: is leukoreduction equivalent to antibody screening? Transfus Med Rev 2000; 14:112-36. [PMID: 10782497 DOI: 10.1016/s0887-7963(00)80003-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J K Preiksaitis
- Department of Medicine, University of Alberta, Edmonton, Canada
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Luban NL, Manno C. Lack of difference in CMV transmission via the transfusion of filtered irradiated and nonfiltered irradiated blood to newborn infants in an endemic area. Transfusion 2000; 40:387-9. [PMID: 10738046 DOI: 10.1046/j.1537-2995.2000.40030387.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hume HA, Preiksaitis JB. Transfusion associated graft-versus-host disease, cytomegalovirus infection and HLA alloimmunization in neonatal and pediatric patients. TRANSFUSION SCIENCE 1999; 21:73-95. [PMID: 10724787 DOI: 10.1016/s0955-3886(99)00067-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Modern transfusion support of pediatric patients requires attention to the necessity to provide specialized or modified blood components to these patients who are often immunocompromised and/or affected by very complex medical and surgical illnesses. In this review we will address three potential complications of transfusion that may require specialized components for their prevention in selected patients namely transfusion-associated graft-versus-host disease, transfusion-transmitted cytomegalovirus infection and HLA alloimmunization, with particular reference to the indications for prevention of these transfusion complications in neonatal and pediatric patients.
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Affiliation(s)
- H A Hume
- Department of Pediatrics, Université de Montréal, Québec, Canada.
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Wagner FF, Flegel WA, Kubanek B. Blood transfusion: influence of transfusion therapy on outcome. Curr Opin Anaesthesiol 1998; 11:167-75. [PMID: 17013215 DOI: 10.1097/00001503-199804000-00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Few studies have addressed the influence of different transfusion therapies on outcome in a convincing way. Proven adverse impact of allogeneic blood on outcome is minimal. Acute mortality has declined to about 1 : 500,000 and the rate of transfusion-transmitted infections is decreasing, too. Data on postoperative infections and non-Hodgkin's lymphoma as possible adverse effects are controversial. Evidence for an increased risk of tumour recurrences is lacking. Alternatives to allogeneic blood may have appreciable risks: perioperative blood recovery had a fatality rate of more than 1 : 40,000. Reduction of allogeneic blood exposure may not be equated with improved outcome.
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Affiliation(s)
- F F Wagner
- Abteilung Transfusionsmedizin, Universität and DRK-Blutspendezentrale Ulm, Ulm, Germany
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