John D. Roback

A multicenter study on the performance of a fully automated, walk-away high-throughput analyzer for pretransfusion testing in the US population.

Moving to automation is a major focus of transfusion centers. Erytra (Grifols) is a walk‐away analyzer with high‐performance and ‐throughput capacity for pretransfusion testing. Efficiency and performance of Erytra with its cards and reagents were evaluated in comparison to Food and Drug Administration (FDA)‐approved reference methods.

Peritransplantation Red Blood Cell Transfusion Is Associated with Increased Risk of Graft-versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation

More than 90% of allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients receive red blood cell (RBC) or platelet transfusions in the peritransplantation period. We tested the hypothesis that transfusions are associated with the development of severe (grade III-IV) acute graft-versus-host disease (aGVHD) or mortality after allo-HSCT in a retrospective study of 322 consecutive patients receiving an allogeneic bone marrow or granulocyte colony-stimulating factor-mobilized blood stem cell graft for a hematologic malignancy. Counting transfused RBC and platelet units between day -7 pretransplantation and day +27 post-transplantation, but excluding transfusions administered after a diagnosis of aGVHD, yielded medians of 5 RBC units and 2 platelet units transfused. Sixty-three patients (20%) developed a maximal grade III-IV aGVHD with onset up to day +150 post-transplantation (median aGVHD onset of 28 days). HLA mismatch (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2 to 4.7; Pu2009=u2009.01), and transfusion of more than the median number of RBC units (HR, 2.1; 95% CI, 1.1 to 3.7; Pu2009=u2009.02) were independently associated with greater risk of grade III-IV aGVHD in a multivariable analysis model. Disease risk strata (HR, 1.7; 95% CI, 1.2 to 2.4 for high risk versus low risk; Pu2009=u2009.005) and transfusion ofu2009more than the median number of RBC units (HR, 1.4; 95% CI, 1.0 to 2.0; Pu2009=u2009.054) were independently associated with inferior overall survival. These data support our hypothesis that peritransplantation RBC transfusions are associated with the risk of developing severe aGVHD and worse overall survival following allo-HSCT, and suggest that strategies to reduce routine RBC transfusion may favorably reduce the incidence and severity of GVHD.

CMV and Other Virus-Safe Products: Leukoreduction and Virus Inactivation

Publisher Summary The prevention of infectious disease transmission requires additional, complementary approaches to remove or inactivate viral contaminants in blood components prior to transfusion. Filtration of blood components prior to transfusion is currently used clinically to decrease the incidence of cytomegalovirus (CMV) transmission. The chapter discusses the role of leukofiltration as well as several methodologies in preventing infectious disease transmission and maintaining the safety of the blood supply. The blood components have undergone additional screening or processing steps to reduce the risk of viral transmission. Many transfusion services employ CMV serology to maintain an inventory of CMV-seronegative components, which historically have been regarded as the gold standard for reducing the incidence of transfusion-transmitted CMV infections in selected patient populations. Leukoreduction of packed red blood cell and platelet units, usually accomplished by filtration, decreases the incidence of adverse transfusion outcomes, including alloimmunization to human leukocyte antigens, febrile nonhemolytic transfusion reactions, transfusion-mediated immunosuppression, and transmission of leukocyte-associated infectious agents. Solvent/detergent plasma is prepared for treating the pool with the solvent tri(n-butyl)phosphate and detergent Triton X-100 to inactivate any contaminating lipid-enveloped viruses, including human immunodeficiency virus (HIV) and hepatitis C virus. Advances in molecular biological techniques over the past decades allow coagulation factors—such as factor VIII—to be expressed and purified in vitro, virtually eliminating concerns of infectious disease transmission that still plague factor VIII concentrates prepared from human plasma.

Chapter 33 – CMV and Other Herpesviruses

Publisher Summary This chapter discusses human herpesviruses (HHV) with emphasis on those leukocytotropic viruses—primarily cytomegalovirus (CMV)—in which transmission by transfusion or transplantation is associated with significant clinical sequelae. The HHV family is composed of 8 viral species categorized into 3 subfamilies based on similarities in genome structure, nucleic acid sequences of conserved open reading frames (ORFs), and biological properties. HSV-1, spread by contact with virus from oral vesicular fluid, is usually acquired early in life with seropositivity rates reaching 80% whereas HSV-2 is usually acquired during sexual contact from vesicular fluid in the anogenital area. After replicating in epithelial cells at the mucosal surface, HSV is retrogradely transported in peripheral nerves to neuronal cell bodies in the dorsal root ganglia where the viral genome remains in a latent state. There is no evidence that transmission by blood or organ transplantation is of clinical concern. CMV can be shed into body fluids leading to the transmission in case of close person-to-person contact. Healthy seropositive individuals intermittently shed CMV into saliva, and CMV can also be found in breast milk of 30% or more of seropositive women. It is recommended that standard blood components are not appropriate for transfusion of seronegative immunocompromised patients because of the unacceptably high risk of CMV.

Chapter 15 – CMV and Other Virus-Safe Products: Leukoreduction and Virus Inactivation

Publisher Summary The prevention of infectious disease transmission requires additional, complementary approaches to remove or inactivate viral contaminants in blood components prior to transfusion. Filtration of blood components prior to transfusion is currently used clinically to decrease the incidence of cytomegalovirus (CMV) transmission. The chapter discusses the role of leukofiltration as well as several methodologies in preventing infectious disease transmission and maintaining the safety of the blood supply. The blood components have undergone additional screening or processing steps to reduce the risk of viral transmission. Many transfusion services employ CMV serology to maintain an inventory of CMV-seronegative components, which historically have been regarded as the gold standard for reducing the incidence of transfusion-transmitted CMV infections in selected patient populations. Leukoreduction of packed red blood cell and platelet units, usually accomplished by filtration, decreases the incidence of adverse transfusion outcomes, including alloimmunization to human leukocyte antigens, febrile nonhemolytic transfusion reactions, transfusion-mediated immunosuppression, and transmission of leukocyte-associated infectious agents. Solvent/detergent plasma is prepared for treating the pool with the solvent tri(n-butyl)phosphate and detergent Triton X-100 to inactivate any contaminating lipid-enveloped viruses, including human immunodeficiency virus (HIV) and hepatitis C virus. Advances in molecular biological techniques over the past decades allow coagulation factors—such as factor VIII—to be expressed and purified in vitro, virtually eliminating concerns of infectious disease transmission that still plague factor VIII concentrates prepared from human plasma.