Direct assessment of cytomegalovirus transfusion-transmitted risks after universal leukoreduction

Authors

  • Yanyun Wu,

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • Shimian Zou,

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • Ritchard Cable,

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • Kerri Dorsey,

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • Yanlin Tang,

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • Cheryl Anne Hapip,

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • Russell Melmed,

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • Jonathan Trouern-Trend,

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • Jian-Hui Wang,

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • Melanie Champion,

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • Chyang Fang,

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • Roger Dodd

    1. From the Yale University School of Medicine, New Haven, Connecticut; Jerome H. Holland Laboratory, American Red Cross Blood Services, Rockville, Maryland; and The Connecticut Region, American Red Cross Blood Services, Farmington, Connecticut.
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  • The study was supported by the American Red Cross Blood Services.

YanYun Wu, MD, PhD, Associate Professor of Laboratory Medicine, Department of Laboratory Medicine, Yale University School of Medicine, 20 York Street, CB 459, New Haven, CT 06510-3202; e-mail: yan.wu@yale.edu.

Abstract

BACKGROUND: Cytomegalovirus (CMV) transfusion-transmitted disease (TTD) remains a clinical concern. Universal leukoreduction has become one of the main strategies for the prevention of CMV-TTD. Through prospective clinical follow-up and testing of transfusion recipients (TRs), the risk for CMV-TTD was studied.

STUDY DESIGN AND METHODS: Transfused units were all leukoreduced and not prospectively screened for CMV. For TRs with negative baseline CMV testing results (CMV total antibody and DNA), all follow-up TR samples were tested for CMV total antibody and DNA, and retained linked donor serum samples were tested for CMV total antibody. In cases when CMV-TTD was suspected, donor sera were also tested for CMV DNA and selected TR samples were tested for CMV immunoglobulin M antibody. Evaluable transfusion was defined as a transfusion with TR sample(s) collected 14 to 180 days posttransfusion.

RESULTS: Forty-six TRs were negative for CMV at baseline. There were 1316 evaluable cellular blood transfusions to these TRs. Of 1316 evaluable cellular products, 460 (35%) were positive for CMV total antibody tested using linked donor samples. Three cases of probable CMV-TTD were found; however, there was no definitive proof from donor follow-up that they were transfusion associated.

CONCLUSION: Among all 46 baseline seronegative recipients and 1316 evaluable transfusions, the calculated overall CMV-TTD risk was up to 6.5% (95% confidence interval [CI], 1.0%-18.0%) in terms of TRs and up to 0.23% (95% CI, 0.06%-0.62%) in terms of non–CMV-screened leukoreduced cellular products. In summary, after universal leukoreduction, CMV-TTD, while uncommon, may still occur.

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