Window period donations during primary cytomegalovirus infection and risk of transfusion‐transmitted infections

Ziemann, Malte; Heuft, Hans‐Gert; Frank, Kerstin; Kraas, Sabine; Görg, Siegfried; Hennig, Holger

doi:10.1111/trf.12074

Cited by 28 publications

(38 citation statements)

References 18 publications

(30 reference statements)

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“…22 However, data by Ziemann et al indicated that only ~25% of donors have evidence of viremia, with low levels of CMV DNA (<30 IU/mL) detectable in their plasma during the window period ( Figure 2). 23 The counterintuitive reality is that the highest concentration of circulating CMV and the highest risk of TT-CMV infection occur shortly after seroconversion, but before neutralizing, high-avidity antibodies are formed. Seroconversion is initially characterized by the production of non-neutralizing IgM and low-avidity IgG antibodies directed against nonstructural immediate early CMV antigens and early CMV Notes: Data from Manicklal et al, 8 Shaiegan et al, 9 Das et al, 10 Furui et al, 11 and Staras et al…”

Section: Seroconversion In Blood Donorsmentioning

confidence: 99%

“…This is accompanied by an increase in the quantity of circulating cell-free CMV DNA in plasma (up to 1,600 IU/mL) in 80% of newly seroconverted donors. 23 In another study, Ziemann et al detected CMV DNA in plasma for a median of 107 days, which was considerably longer than the leukocyte fraction (median =77 days). 24 Clearance of detectable CMV DNA from both white blood cells (WBCs) and plasma required a median of 137 days (range, 0-269 days).…”

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confidence: 99%

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

Harmon¹,

Cooling²

2017

IJCTM

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Cytomegalovirus (CMV) is a pervasive DNA virus that infects a significant portion of individuals worldwide, and may be transmitted through the transfusion of blood products. Although CMV infection is of little consequence in immunocompetent individuals, patients with an impaired immune system are at risk of significant morbidity and mortality. Unlike other blood-borne infectious agents, it is impractical to defer all CMV-positive individuals from blood donation as this would exclude a substantial number of otherwise eligible donors. Other methods such as transfusion of CMV-seronegative and leukoreduced blood products must be employed to prevent the transmission of CMV to at-risk patients. In this study, the widespread use of current strategies for the prevention of transfusion-transmitted CMV (TT-CMV) infection and the evidence to support these methods in various at-risk groups were reviewed. In addition, emerging pathogen inactivation technologies that have the potential to eliminate TT-CMV were also discussed.

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Section: Seroconversion In Blood Donorsmentioning

confidence: 99%

mentioning

confidence: 99%

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

Harmon¹,

Cooling²

2017

IJCTM

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“…In donors with low interdonation intervals (e.g. apheresis donors), CMV DNA can be detected in up to 25% in the last seronegative sample and 83% in the first seropositive sample [18]. …”

Section: Physiology Of CMV Infections In Blood Donorsmentioning

confidence: 99%

Prevention of Transfusion-Transmitted Cytomegalovirus Infections: Which is the Optimal Strategy?

Ziemann¹,

Hennig²

2013

Transfus Med Hemother

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Traditionally, leukoreduction and selection of blood products from seronegative donors have been used as alternative strategies to reduce the risk of transfusion-transmitted cytomegalovirus infections (TT-CMV) in atrisk patients. After the introduction of universal leukoreduction for red blood cell and platelet concentrates in Germany, a controversy evolved as to whether the additional selection of blood products from seronegative donors would reduce or even increase the risk of TT-CMV. This review summarizes the current knowledge about CMV infections in blood donors and the implications of this information on the effect of potential transfusion strategies. Even though there are conflicting data about the incidence of TT-CMV remaining after the introduction of leukodepletion, it has been clearly shown that both prevalence and concentration of CMV DNA in peripheral blood are highest in newly seropositive donors. Therefore, avoidance of blood products from these donors is the most important goal of any transfusion strategy. This goal can be reached by: i) selection of blood products from seronegative donors, ii) provision of CMV DNA-negative blood products, or iii) provision of blood from long-term seropositive donors. In cases of suspected TT-CMV, all implicated donors should be investigated carefully to gather further knowledge on which donors confer the lowest risk for TT-CMV.

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“…In addition, individuals recently infected with CMV may donate blood within the 6-to 8-week window period between onset of CMV viremia and seroconversion, although window-period donations are rare and are not associated with high levels of CMV viremia. 2,13,14 Additional strategies for the prevention of CMV disease are often used for at-risk patient populations, including prophylaxis (eg, administration of antiviral drugs 1 to 4 times daily for 3 to 6 months following transplantation) or viremic monitoring with rapid administration of antiviral medications should the patient demonstrate evidence of viral replication. 15 Since the role of CMV-seronegative products in everyday practice remains unclear, we developed a survey to assess strategies for TT-CMV reduction by using leukoreduction and/or CMV-seronegative blood products, and CMV prophylaxis and monitoring practices for high-risk populations at CAP member institutions.…”

mentioning

confidence: 99%

Survey on Transfusion-Transmitted Cytomegalovirus and Cytomegalovirus Disease Mitigation

Weisberg¹,

Staley²,

Williams³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Cytomegalovirus (CMV) can be transmitted by cellular blood products, leading to severe disease in immunosuppressed patients such as neonates and transplant recipients. To mitigate transfusion-transmitted CMV (TT-CMV), “CMV-safe” blood products (leukoreduced and/or CMV-seronegative) are transfused. Attempts to develop practice guidelines for TT-CMV mitigation have been limited by paucity of high-quality clinical trials. Objective.— To assess current TT-CMV mitigation strategies across medical institutions for specific at-risk populations. Design.— Supplemental questions regarding TT-CMV and CMV disease mitigation were added to a College of American Pathologists Transfusion Medicine (Comprehensive) Participant Survey in 2015, addressing whether a given institution provided CMV-safe products for 6 at-risk patient populations. Results.— Ninety percent (2712 of 3032) of institutions reported providing universally leukoreduced blood products. Among institutions without universal leukoreduction, 92% (295 of 320) provided leukoreduced products on the basis of clinical criteria. Eighty-three percent (2481 of 3004) of respondents reported having availability of CMV-seronegative products; however, wide variation in policies was reported governing CMV-seronegative product use. Among all respondents, less than 5% reported using CMV prophylaxis and monitoring in high-risk patient groups. Transplant centers reported higher rates of CMV prophylaxis (25% [97 of 394] solid organ) and monitoring (15% [59 of 394] solid organ) for CMV-negative transplant recipients. Conclusions.— Universal leukoreduction is the primary strategy for mitigating TT-CMV. While most institutions have both CMV-seronegative and leukoreduced blood products available, consensus is lacking on which patients should receive these products. High-quality studies are needed to determine if CMV-seronegative and leukoreduced blood products are needed in high-risk patient populations.

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Window period donations during primary cytomegalovirus infection and risk of transfusion‐transmitted infections

Cited by 28 publications

References 18 publications

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

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

Prevention of Transfusion-Transmitted Cytomegalovirus Infections: Which is the Optimal Strategy?

Survey on Transfusion-Transmitted Cytomegalovirus and Cytomegalovirus Disease Mitigation

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