Prevention of transfusion‐transmitted cytomegalovirus infection

Pamphilon,; Rider,; Барбара,; Williamson,

doi:10.1046/j.1365-3148.1999.00193.x

Cited by 99 publications

(66 citation statements)

References 54 publications

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“…Since CMV infection was significantly associated with poor response to platelet transfusion, the use of PCs from seronegative donors and/or leukocyte depletion of PCs are strongly recommended in seronegative HSCT donor/recipient pairs. 31 Our study clearly shows that alloimmunization greatly reduced the efficacy of platelet transfusions. On this basis, measures effective in preventing alloimmunization, such as the reduction of leukocytes by filtration and ultraviolet irradiation of PCs, 3 are mandatory in this clinical setting.…”

Section: Leukemiamentioning

confidence: 59%

Factors influencing post-transfusional platelet increment in pediatric patients given hematopoietic stem cell transplantation

Salvaneschi

Klersy

et al. 2001

Leukemia

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Patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) always require platelet transfusions, but the increase in platelet count is often less than expected. Since factors responsible for poor response to platelet transfusions in this clinical setting are largely unknown, we performed a prospective study in 87 consecutive children transplanted in a single institution. The mean 16-h corrected count increment (CCI) of 598 platelet transfusions was 5.76 ± 8.32 × 10 9 /l. Both before and after HSCT, 13.8% of patients had antibodies against HLA and/or platelet-specific antigens. Univariate analysis identified 12 factors significantly associated with a lower post-transfusion CCI, but only four reached statistical significance in the multivariate analysis. These four factors were concomitant therapy with vancomycin, alloimmunization, use of an Autopheresis cell separator for preparation of platelet concentrates and cytomegalovirus infection. We, therefore, suggest that a better response to platelet transfusions could be obtained by choosing a suitable cell separator, by avoiding the use of vancomycin and by adopting measures that reduce alloimmunization and CMV infection. Moreover, screening patients for HLA and platelet-specific antibodies before HSCT would identify the majority of subjects who will develop alloimmune refractoriness after transplantation and would allow the search for a compatible donor in advance. Leukemia (2001) 15, 1885-1891.

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Section: Leukemiamentioning

confidence: 59%

Factors influencing post-transfusional platelet increment in pediatric patients given hematopoietic stem cell transplantation

Salvaneschi

Klersy

et al. 2001

Leukemia

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“…[61][62][63][64] However, some centers give only CMV-negative blood products for patients undergoing HSCT where both the patient and donor are CMV-negative. 65 The indications for fresh-frozen plasma in AA patients are the same as those in the general transfusion guidelines. 53 …”

Section: Transfusion Therapymentioning

confidence: 99%

Supportive care in severe and very severe aplastic anemia

Höchsmann

Moicean

Risitano

et al. 2012

Bone Marrow Transplant

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for the EBMT Working Party on Aplastic AnemiaOptimal management of aplastic anemia (AA) is not confined to immediate diagnosis, early decision making and timely initiation of major treatment strategies (immunosuppression or SCT) but also involves supportive treatment as a crucial part of patient care. Patients are threatened by complications of cytopenia. Here, we summarize current recommendations for prevention and early treatment of fungal, bacterial and viral infections, transfusion strategy and iron chelation and assess the evidence basis. In fact, many recommendations for patients with AA are not based on randomized studies in AA itself, but they are deduced from other conditions with similar severity of cytopenia. Prevention and treatment of complications like hemorrhage, bacterial and fungal infections and of secondary events like alloimmunization to blood products and iron overload have a significant impact on the prognosis of AA patients and need to be carefully observed in daily practice. More controlled studies on supportive care should be performed in this rare disease.Bone Marrow Transplantation (2013) 48, 168-173; doi:10.1038/bmt.2012.220; published online 3 December 2012Keywords: aplastic anemia; supportive treatment; infection; transfusion; hematopoietic growth factors INTRODUCTION Survival of patients with aplastic anemia (AA) after both immunosuppression and allogeneic BMT improved substantially over the past 30 years. 1 For patients who received immunosuppression, this improvement was not restricted to patients who responded to the specific treatment. 2 Remarkably, the prognosis of non-responders to initial immunosuppression also improved substantially over time. 2 This is most likely due to the impact of supportive treatment on the overall survival of patients. The individual risk of a patient is mainly determined by the neutrophil, and monocyte counts. 2-8 During the past two decades, infection-related mortality and invasive fungal infections decreased. 2 However, infections are still the major threat for patients with severe or very severe AA. In the most recently published large clinical trials in AA, the most prevalent complications and the major causes of death still were bacterial and fungal infections. [3][4][5] In the following sections, we will summarize recommendations on the major aspects of supportive treatment in AA, that is, prophylaxis and early treatment of infections, transfusion strategy and treatment of iron overload.

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“…The source of CMV in these cases is unclear. Primary CMV infection is unlikely to account for all these cases, since the annual incidence of new infection is around 1% in adults, 20 and because all patients were restricted in their social interactions.…”

Section: Discussionmentioning

confidence: 99%

“…26 It has been suggested that leucodepletion at source may substitute for CMV-negative blood products for BMT recipients (reviewed in Ref. 20), although this is yet to be tested in a prospective trial. It will therefore be interesting to see the impact of leucodepletion at source on the incidence of CMV DNA positivity following allografting.…”

Section: Discussionmentioning

confidence: 99%

High frequency of positive surveillance for cytomegalovirus (CMV) by PCR in allograft recipients at low risk of CMV

Butt

Clark

2001

Bone Marrow Transplant

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Summary:Cytomegalovirus (CMV) causes significant morbidity and mortality following allogeneic haemopoietic stem cell transplantation. A pre-emptive strategy for ganciclovir therapy is widely used, whereby treatment is commenced on finding positive evidence of CMV replication. Surveillance by PCR has increased the sensitivity for CMV detection, but it is not known whether this may detect cases with evidence of CMV DNAemia who have a low probability of CMV disease. We reviewed our experience of CMV infection and disease since introducing CMV surveillance by PCR. All 30 allografts received bedside leucodepleted CMV-negative blood products. Seven of 10 CMV-positive recipients of a CMV-positive graft developed CMV DNAemia, with three developing clinical disease requiring ganciclovir treatment. In contrast, of 11 low risk patients (CMVnegative recipients of CMV-negative grafts), six developed evidence of CMV DNAemia although only one had clinical evidence of CMV disease requiring ganciclovir. Transfusion records confirmed that four of these had received exclusively CMV-negative blood products. The aetiology of the CMV DNAemia in these cases is unclear. It is suggested that before commencing ganciclovir therapy, confirmatory CMV antigenaemia testing is carried out on samples which test positive for CMV DNA, unless there is high clinical suspicion of CMV disease. Bone Marrow Transplantation (2001) 27, 615-619.

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Prevention of transfusion‐transmitted cytomegalovirus infection

Cited by 99 publications

References 54 publications

Factors influencing post-transfusional platelet increment in pediatric patients given hematopoietic stem cell transplantation

Factors influencing post-transfusional platelet increment in pediatric patients given hematopoietic stem cell transplantation

Supportive care in severe and very severe aplastic anemia

High frequency of positive surveillance for cytomegalovirus (CMV) by PCR in allograft recipients at low risk of CMV

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