Transfusion‐transmitted CMV infection – current knowledge and future perspectives

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Excerpt

Human cytomegalovirus (CMV) was recognised five decades ago as a potential cause for the mononucleosis‐like post‐perfusion syndrome after transfusion of fresh blood throughout cardiac surgery (Kääriäinen et al., 1966). Although transfusion‐transmitted CMV (TT‐CMV) caused mostly mild febrile symptoms in immunocompetent recipients, it was discovered to dramatically worsen the outcome of immunocompromised patients, e.g. after organ transplantation. As a consequence, testing of blood donors for the CMV serostatus and the use of CMV‐seronegative blood was introduced to reduce the risk of TT‐CMV in recipients at risk. Later in the 1990s, Bowden et al., (1995) demonstrated that leucocyte depletion of cellular blood products reduces the risk of TT‐CMV to a similar extent as using blood of CMV‐seronegative donors.
Since the introduction of universal leucoreduction in many western countries, the additional value of using only CMV‐seronegative blood for patients at risk of TT‐CMV is debated. A recent survey in blood centres of 18 countries revealed that most centres still keep dual inventories with blood products from CMV‐seronegative donors for patients at risk (Lieberman et al., 2014), although universal leucoreduction is used in nearly all countries. There is no consensus about which patients are at risk of TT‐CMV. Some sites provide leucoreduced and seronegative blood products only for pregnant women, neonatal and intrauterine transfusions. Other centres also consider patients undergoing stem cell or solid organ transplantation at an increased risk of TT‐CMV and provide them with CMV‐seronegative blood products. Finally, the CMV Prevention Work Group of the American Association of Blood Banks (AABB) voted not to formulate any guidelines for the prevention of TT‐CMV because of insufficient data from current studies (AABB Clinical Transfusion Medicine Committee, 2016).
Here, we review the most recent studies in blood donors and transfusion recipients and provide a comprehensive overview on the residual risk of TT‐CMV. Moreover, we discuss practical implications of the use of blood products either tested or not tested for CMV.
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