title: AABB Committee Report: reducing transfusion-transmitted cytomegalovirus infections.
abstract: Transfusion-transmitted cytomegalovirus (TT-CMV) is often asymptomatic, but certain patient populations, such as very low birth weight neonates, fetuses requiring intrauterine transfusion, pregnant women, patients with primary immunodeficiencies, transplant recipients, and patients receiving chemotherapy or transplantation for malignant disease, may be at risk of life-threatening CMV infection. It is unclear whether leukoreduction of cellular blood components is sufficient to reduce TT-CMV or whether CMV serological testing adds additional benefit to leukoreduction. The AABB CMV Prevention Work Group commissioned a systematic review to address these issues and subsequently develop clinical practice guidelines. However, the data were of poor quality, and no studies of significant size have been performed for over a decade. Rather than creating guidelines of questionable utility, the Work Group (with approval of the AABB Board of Directors) voted to prepare this Committee Report. There is wide variation in practices of using leukoreduced components alone or combining CMV-serology and leukoreduction to prevent TT-CMV for at-risk patients. Other approaches may also be feasible to prevent TT-CMV, including plasma nucleic acid testing, pathogen inactivation, and patient blood management programs to reduce the frequency of inappropriate transfusions. It is unlikely that future large-scale clinical trials will be performed to determine whether leukoreduction, CMV-serology, or a combination of both is superior. Consequently, alternative strategies including pragmatic randomized controlled trials, registries, and collaborations for electronic data merging, nontraditional approaches to inform evidence, or development of a systematic approach to inform expert opinion may help to address the issue of CMV-safe blood components.
authors.affiliation: Department of Medicine, McMaster Centre for Transfusion Research.|Canadian Blood Services & Division of Clinical Pathology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Heddle
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, and the University of Washington, Seattle, Washington.
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
authors.affiliation: Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University in St Louis, St Louis, Missouri.
authors.forename: Brenda
authors.initials: B
authors.lastname: Grossman
authors.affiliation: Department of Pathology, Bellevue Hospital Center, New York University School of Medicine, New York, New York.
authors.forename: Jessica
authors.initials: J
authors.lastname: Jacobson
authors.affiliation: University of British Columbia, Victoria, Canada, and Medical Advisor to AABB, Bethesda, Maryland.
authors.forename: Steven
authors.initials: S
authors.lastname: Kleinman
authors.affiliation: Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
authors.affiliation: Canadian Blood Services & Division of Clinical Pathology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Webert
authors.affiliation: Division of Laboratory Medicine, Departments of Pediatrics and Pathology, Children's National Medical Center, George Washington School of Medicine and Health Sciences, Washington, DC.
authors.forename: Edward C C
authors.initials: EC
authors.lastname: Wong
authors.affiliation: Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: John D
authors.initials: JD
authors.lastname: Roback
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D001803:Blood Transfusion / Q000379:methods; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000517:prevention & control / Q000635:transmission*; D005260:Female; D006801:Humans; D047589:Leukocyte Reduction Procedures / Q000592:standards*; D008297:Male; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012698:Serologic Tests; D065227:Transfusion Reaction
chemical_list: D000914:Antibodies, Viral