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Transfusion-related cytomegalovirus infection following noncardiac surgery
Abstract:
Clinically evident cytomegalovirus (CMV) infections developed in five patients after noncardiac surgery. Each of them had received several blood transfusions and had evidence of primary CMV infection. These five cases were identified in a single eight-month period, suggesting that this syndrome must be occurring with greater frequency than is commonly appreciated. Three of five patients had undergone splenectomy, and review of the literature for documented cases of posttransfusion CMV mononucleosis following non-cardiac-bypass surgery disclosed an additional nine patients, five of whom had had splenectomies. This striking association suggests the possibility that the spleen plays a role in controlling the incidence or clinical manifestations of posttransfusion CMV infections. Alternatively, this association may only reflect the frequent requirement for many blood transfusions in this type of surgery.
Insights
Cytomegalovirus (CMV) infections after noncardiac surgery are more common than thought, especially in patients receiving blood transfusions. Splenectomy may increase risk, suggesting a role for the spleen in managing posttransfusion CMV.
Area of Science:
- Infectious Diseases
- Surgical Outcomes
- Transfusion Medicine
Background:
- Cytomegalovirus (CMV) is a common virus that can cause serious infections in immunocompromised individuals.
- Post-transfusion CMV infection is a known complication, particularly in neonates and transplant recipients.
- Non-cardiac surgery involving cardiopulmonary bypass can be associated with significant blood transfusions.
Observation:
- Five cases of clinically evident CMV infections were observed in patients following non-cardiac surgery within an eight-month period.
- All affected patients had received multiple blood transfusions and showed signs of primary CMV infection.
- A literature review identified nine additional cases of post-transfusion CMV mononucleosis after non-cardiac-bypass surgery.
Findings:
- A high proportion of patients (3 out of 5 in the initial series, and 5 out of 9 in the literature review) had undergone splenectomy.
- This suggests a potential link between splenectomy and the development or clinical presentation of post-transfusion CMV infections.
- The frequency of these infections may be underestimated in surgical populations.
Implications:
- The spleen's role in controlling CMV incidence or manifestations warrants further investigation.
- Clinicians should consider CMV screening in patients undergoing non-cardiac surgery with multiple transfusions, especially if splenectomized.
- Enhanced vigilance and potential prophylactic strategies may be necessary to prevent post-transfusion CMV in at-risk surgical patients.