The residual risk of transfusion‐transmitted cytomegalovirus infection associated with leucodepleted blood components

Abstract

We describe a novel approach to assess the residual risk of LD-only components. This can be applied generally using local data. Our risk estimate for LD-only blood components in Australia is below the threshold of 1 in 1 million, generally considered negligible. This provides a useful indicator of the relative safety of LD-only components to assist clinical decisions when serologically screened inventory is unavailable.

An analysis on the fate of a selection of blood products derived from cytomegalovirus‐seronegative donors at three tertiary referral hospitals in Australia

“…At the Blood Service, national implementation of high‐throughput phenotyping platforms is currently under way. Education on the effectiveness of prestorage leukoreduction in mitigating the risk of transfusion‐transmitted CMV infection could reduce the demand for CMV‐negative products . Differential pricing of CMV‐negative blood products might encourage transfusion laboratories to hold a more mixed CMV serostatus inventory.…”

“…Education on the effectiveness of prestorage leukoreduction in mitigating the risk of transfusion-transmitted CMV infection could reduce the demand for CMV-negative products. 15 Differential pricing of CMV-negative blood products might encourage transfusion laboratories to hold a more mixed CMV serostatus inventory. The results from this study provide a basis for a whole of blood sector approach to easing the demand for CMV-negative product.…”

Current strategies and future directions for the prevention of transfusion-transmitted cytomegalovirus

“…Current methods of prestorage LR are highly reliable, with only rare (0.01%-0.11% of units) instances of failure. 42,43 Because LR also decreases the incidence of febrile nonhemolytic transfusion reactions and human leukocyte antigen alloimmunization, nowadays, the vast majority of blood products are leukoreduced, and universal LR of blood products has been implemented in many countries. 44,45 …”

“…Although there is some evidence that cell-free CMV DNA in plasma may be infectious, this is not certain and a minimum infectious dose has not been characterized. 42,46 This potential risk has led to proposals that LR-only blood products be collected from donors who have been seropositive for at least 1 year or that the donors also be screened for CMV by PCR. 34,45,47 However, it remains to be determined whether the latter would be a cost-effective way to further decrease the risk of TT-CMV infection.…”

Humanes Cytomegalievirus (HCMV)

“…Eine Metaanalyse der wenigen, oft Jahre zurückliegenden Studien zeigte keine Vorteile der HCMVAntikörpertestung gegenüber der Leukozytendepletion oder der Kombination aus beiden Strategien [52,120]. In aktuellen Studien wird das Risiko einer transfusionsassoziierten Infektion nach Gabe von nicht auf HCMV-Antikörper untersuchten, leukozytendepletierten Blutkomponenten mit unter 1: 1.000.000 angegeben [121,122] …”