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Leukocyte-reduction to prevent transfusion-transmitted cytomegalovirus infections
1UI DeGowin Blood Center, University of Iowa, College of Medicine, Iowa City 52242-1182, USA. ronald-strauss@uiowa.edu
Abstract:
Certain infectious organisms, including cytomegalovirus, are associated 'exclusively' with blood leukocytes (WBC), and their transmission by transfusion is strikingly diminished by marked WBC-reduction of cellular blood components. Based on several reports of WBC-reduction, it is clear that the risk of CMV is nearly eliminated by consistently removing WBC to a level < 1-5 x 10(6) WBCs/unit (< or = 1 x 10(6) preferred in Europe; < or = 5 x 10(6) in the United States). Alternatively, the rate of CMV infections is reduced by transfusing blood components collected from donors negative for CMV antibody. However, neither technique is perfect, with a failure rate of 1-4%. Although WBC-reduction is favored by many experts, practitioners must choose the method that they believe to be most efficacious--being mindful that data do not exist to establish additive protection by combining WBC-reduction and transfusion of blood components collected from antibody negative donors.
Insights
Reducing white blood cells (WBC) in blood transfusions significantly lowers cytomegalovirus (CMV) transmission risk. While effective, neither WBC reduction nor using CMV-negative donors completely eliminates CMV infection risk.
Area of Science:
- Transfusion Medicine
- Infectious Disease Transmission
- Hematology
Background:
- Certain infectious agents, like cytomegalovirus (CMV), are primarily associated with white blood cells (WBC).
- Transfusion-transmitted CMV poses a risk, particularly to immunocompromised patients.
Purpose of the Study:
- To evaluate the efficacy of white blood cell (WBC) reduction in preventing cytomegalovirus (CMV) transmission via blood transfusion.
- To compare WBC reduction with the use of CMV antibody-negative blood donors.
Main Methods:
- Analysis of existing reports on WBC-reduction techniques for cellular blood components.
- Review of data concerning CMV antibody screening of blood donors.
Main Results:
- Marked WBC reduction to < 1-5 x 10(6) WBCs/unit substantially diminishes CMV transmission.
- CMV antibody-negative donor blood also reduces infection rates, but neither method is fully effective (1-4% failure rate).
Conclusions:
- WBC reduction is a highly effective strategy for minimizing transfusion-associated CMV transmission.
- While WBC reduction is favored, current data do not support combining it with CMV-negative donor screening for additive protection.
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