Postnatal cytomegalovirus infection: a pilot comparative effectiveness study of transfusion safety using leukoreduced-only transfusion strategy

• Authors: Meghan Delaney, University of Washington; Dennis Mayock, University of Washington; Andrea Knezevic, Emory University; Colette Norby-Slycord, University of Washington; Elizabeth Kleine, Seattle Children's Hospital; Ravi Mangal Patel, Emory University; Kirk Easley, Emory University; Cassandra D Josephson, Emory University
• Journal Title: Transfusion
• Volume: Volume 56, Number 8
• Publisher: Wiley: 12 months | 2016-08-01, Pages 1945-1950
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/trf.13605
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health; Biology, Biostatistics
• Keywords: Science & Technology; Life Sciences & Biomedicine; Hematology; BLOOD-DONORS; NEWBORN-INFANTS; TRANSMISSION; PREVENTION; METAANALYSIS; PRODUCTS

Abstract

The optimal mitigation strategy to prevent transfusion transmission of cytomegalovirus (TT-CMV) in preterm very low birthweight infants remains debated. Hospitals caring for this patient population have varied practices. STUDY DESIGN AND METHODS: A prospective observational comparative effectiveness pilot study was conducted to determine the feasibility for a larger study. The pilot was carried out at hospitals using a leukoreduction (LR)-only transfusion strategy. Specimen and data collection for this study was performed in a similar approach to a study completed at Emory University that employed the CMV-seronegative plus LR approach. All testing was performed at one laboratory. The rates of TT-CMV using the two transfusion strategies were compared. RESULTS: Zero incidence of TT-CMV was detected in infants (n = 20) transfused with LR-only blood (0/8; 95% confidence interval [CI], 0-25.3%) and is consistent with the previously reported zero incidence of TT-CMV finding in a cohort of infants transfused with CMV-negative plus LR blood (0/310; 95% CI, 0%-0.9%). The seroprevalence rate among enrolled mothers (n = 17) was 60%. Forty percent of those infants (8/20) received 43 transfusions; five were transfused with one or more CMV-seropositive blood components. One infant had tested positive for CMV before receiving blood transfusions; the infant's mother was CMV immunoglobulin (Ig)G positive and IgM negative. CONCLUSIONS: Using the LR-only transfusion approach, zero cases of TT-CMV were detected in this pilot study. A larger study is needed to reliably determine the most effective strategy for prevention of TT-CMV in this population.