Service and Central Laboratory of Haematology, Lausanne University Hospital, Lausanne, Switzerland.
Faculty of Biology and Medicine, Lausanne University Hospital, Lausanne, Switzerland.
Blood Transfus. 2020 Nov;18(6):446-453. doi: 10.2450/2020.0241-19. Epub 2020 Feb 28.
Nowadays, most blood products are leukocyte-reduced. After this procedure, the residual risk for transfusion transmitted cytomegalovirus (TT-CMV) is mostly attributed to cell-free viruses in the plasma of blood donors following primary infection or viral reactivation. Here, objectives are: 1) to study the behaviour of cell-free CMV through the blood component processing; 2) to determine the anti-CMV seroprevalence, the level of viremia, the window-period in blood donor population; and 3) to identify cases of TT-CMV in bone marrow transplant (BMT) recipients.
Cell-free CMV was injected into blood bags originating from regular donors. Blood components were processed according to either the CompoSelect or the CompoFlow (Fresenius Kabi AG) techniques. Samples were analysed at each step for presence of virus DNA using quantitative polymerase chain reaction (PCR). The anti-CMV seroprevalence in our donor population was taken from our donor data system. The viremia was assessed in pooled plasmas samples from routine donations by quantitative PCR. Medical charts of 165 BMT anti-CMV seronegative recipients/anti-CMV seronegative donors who received CMV-unscreened blood products were reviewed.
Cell-free CMV passes without any decrease in viral load through all stages of blood processing. The anti-CMV seroprevalence was 46.13%. Four DNA positive samples out of 42,240 individual blood donations were identified (0.009%); all had low levels of viremia (range 11-255 IU/mL). No window-period donation was identified. No TT-CMV was found.
Cell-free CMV remains a concern with current blood component processing as it passes through all the processes. However, since low levels of CMV DNA were identified in the donations tested, and no BMT recipients had TT-CMV, the residual threat of TT-CMV after leukocyte reduction appears to be very low.
如今，大多数血液制品都经过白细胞减少处理。在这个过程之后，输血传播巨细胞病毒（TT-CMV）的残余风险主要归因于初次感染或病毒再激活后供体血浆中的无细胞病毒。在此，目标是：1）研究血液成分处理过程中无细胞 CMV 的行为；2）确定供体人群中的抗 CMV 血清流行率、病毒血症水平和窗口期；3）确定骨髓移植（BMT）受者中 TT-CMV 的病例。
将无细胞 CMV 注入来自常规供体的血袋中。根据 CompoSelect 或 CompoFlow（Fresenius Kabi AG）技术对血液成分进行处理。使用定量聚合酶链反应（PCR）在每个步骤分析样本中病毒 DNA 的存在情况。从我们的供体数据系统中获取我们供体人群中的抗 CMV 血清流行率。通过定量 PCR 评估常规捐赠的混合血浆样本中的病毒血症。回顾了 165 名抗 CMV 阴性/抗 CMV 阴性供体的 BMT 抗 CMV 阴性受者接受 CMV 未筛选血液制品的医疗图表。
无细胞 CMV 在血液处理的所有阶段都不会降低病毒载量。抗 CMV 血清流行率为 46.13%。在 42240 份个体血液供体中，有 4 份 DNA 阳性样本（0.009%）被鉴定出来（所有样本的病毒血症水平均较低（范围 11-255 IU/mL）。未鉴定到窗口期供体。未发现 TT-CMV。
由于目前的血液成分处理方法可以使无细胞 CMV 通过所有处理阶段，因此它仍然是一个令人关注的问题。然而，由于在检测的供体中仅鉴定到低水平的 CMV DNA，并且没有 BMT 受者出现 TT-CMV，因此白细胞减少处理后 TT-CMV 的残余威胁似乎非常低。
