Delaney Meghan, Mayock Dennis, Knezevic Andrea, Norby-Slycord Colette, Kleine Elizabeth, Patel Ravi, Easley Kirk, Josephson Cassandra
University of Washington.
Bloodworks Northwest, Seattle, Washington.
Transfusion. 2016 Aug;56(8):1945-50. doi: 10.1111/trf.13605. Epub 2016 Apr 15.
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.
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.
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.
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.
预防早产儿极低出生体重儿巨细胞病毒输血传播（TT-CMV）的最佳缓解策略仍存在争议。照顾这一患者群体的医院做法各不相同。
进行了一项前瞻性观察性比较有效性试点研究，以确定开展更大规模研究的可行性。该试点在采用仅白细胞滤除（LR）输血策略的医院进行。本研究的样本和数据收集方式与埃默里大学完成的一项采用巨细胞病毒血清阴性加LR方法的研究类似。所有检测均在一个实验室进行。比较了两种输血策略的TT-CMV发生率。
在接受仅LR血液输血的婴儿（n = 20）中未检测到TT-CMV病例（0/8；95%置信区间[CI]，0 - 25.3%），这与先前报道的在接受巨细胞病毒阴性加LR血液输血的一组婴儿中TT-CMV发生率为零（0/310；95%CI，0% - 0.9%）一致。入组母亲（n = 17）中的血清阳性率为60%。这些婴儿中有40%（8/20）接受了43次输血；其中5次输注了一种或多种巨细胞病毒血清阳性血液成分。一名婴儿在接受输血前巨细胞病毒检测呈阳性；该婴儿的母亲巨细胞病毒免疫球蛋白（Ig）G呈阳性而IgM呈阴性。
在这项试点研究中，采用仅LR输血方法未检测到TT-CMV病例。需要开展更大规模的研究，以可靠地确定预防该人群TT-CMV的最有效策略。
