Transcript Patients at Risk for Significant CMV Infection

Salwa Hindawi MSc, FRCPath, CTM
Director of Blood Transfusion Services
kAUH, Jeddah
Saudi Arabia
ESPHO Cairo 2008
Salwa Hindawi

Despite general measures to ensure transfusion
safety, there still an added risk to infants and
children with underlying hematological,
oncologic and immunologic disorders.

Transfusion reaction may be caused by both
infectious or non infectious processes.

Special products are blood components
collected, processed, and selected specifically
to minimize these complications.
Salwa Hindawi

CMV is transmitted by leucocytes.

The use of CMV-seronegative blood components
has been shown to reduce the incidence of CMV
infection to 1-3%.
Salwa Hindawi
Patients with congenital immunodeficiency disorders
 AIDS (human immunodeficiency virus infection) patients
 Hematopoietic progenitor cell transplant recipients
 Organ allograft transplant recipients
 Premature infants during infancy
 Cancer patients undergoing intense chemotherapy
 Recipients of intrauterine transfusions

Salwa Hindawi

Leucocytes in the blood components can lead to
many complications

Universal Leucodepletion verses specific
indications.
Salwa Hindawi

Nonhemolytic transfusion reactions (commonly called
“febrile nonhemolytic transfusion reactions”)

Alloimmunization to HLA Class I antigens

Cytomegalovirus infections

Immune modulation

Graft-vs-host disease
Salwa Hindawi
WHY?
 To Prevent Graft verses Host Disease mediated by T
lymphocytes in units of Packed RBCs, Platelets, and
Granulocytes.

Blood components that contain viable lymphocytes
may be irradiated to prevent proliferation of T
lymphocytes, which is the immediate cause of GVHD.

The standard dose of gamma irradiation is 2500 cGy ,
maximum allowable dose is 5000cGy.
Salwa Hindawi

Patients with congenital immunodeficiency disorders
of cellular immunity.

Intrauterine transfusion and neonatal exchange
transfusion recipients.

Hematopoietic progenitor cell transplant recipients.

Recipients of blood components from 1st & 2nd
degree relatives.
Salwa Hindawi
 Patients
receiving HLA-matched cellular blood
components.
 Patients
with hematologic malignancies and
Cancer patients
undergoing intense chemotherapy or Hodgkin’s
disease receiving fludarabine.
Salwa Hindawi
Sickle cell trait:
Hb A = 60%
Hb S = 40%


Hypoxia and acidosis can lead to sickle crisis.

Can donate blood.
Salwa Hindawi

Define patients populations who should receive red
blood cells known to lack hemoglobin S.
1- infants with small blood volume or massive
transfusion in neonates.
2- Sickle cell patients
Salwa Hindawi
The risk of:
Bacterial contamination
Emerging pathogens
are still a major concerns which lead to the need for
better techniques.
PI for platelet concentrates have been in routine use
since 2002 and for plasma in 2006 (INTERCEPT blood
system).
A noval PI approach to blood safety (the Mirasol PRT
System).

Salwa Hindawi

Nucleic acid targeted pathogen inactivation
technologies offer the potential to protect from
infectious and non infectious processes through
prevention of cell replication and transcription.

To accurately assess the true value of a pathogen
reduction system it is essential to weigh its cost against
the saving it offers in terms of quality of life and
reduced cost to society.
Salwa Hindawi
MIRASOL PRT system for platelets
and plasma – Concept
+
Platelet or
plasma product
+
Riboflavin
(Vitamin B2)
UV Light
Reduction of viruses, bacteria, parasites 
Inactivation of residual white cells 
Salwa Hindawi
The MIRASOL PRT process:
1
2
3
Transfer platelet
product to MIRASOL
Illumination bag
Add 35 mL
Riboflavin Solution
(500 uM)
Illuminate
product for
6-10 min.*
* Illumination time depends on product volume
Salwa Hindawi
 delayed
clamping of the umbilical cord;
 restricting
blood sampling
 using
recombinant human erythropoietin to
stimulate erythropoiesis
 using
iron supplementation or vitamins to
minimize the severity of anemia
Salwa Hindawi
 using
appropriately collected and stored
multipack RBC units
 using
appropriately screened and handled
RBCs from regular or designated donors; and
 collecting
and transfusing umbilical cord
blood (autologous blood transfusion).
Salwa Hindawi

The use of special products is a must for specific
patients in pediatric age group to ensure safety.

The use of PI procedures are recommended to ensure
better safety.

Training for the staff, policies, and guidelines in
pediatric age group are important issues to be
considered.
Salwa Hindawi
Pediatric Transfusion, A Physician’s handbook
 2nd Edition, 2006.
 Prenatal and childhood transfusion, Practical
Transfusion Medicine 2001.
 A novel Approach to blood safety, Gambro BCT 2007.
 Impact of Pathogen activation on platelets utilization
during 3 years of routine use, AABB October 2007.
 Pathogen Inactivation making decisions about new
technologies preliminary reports of a consensus
conference, Vox Sanguinis 2007.

Salwa Hindawi
Salwa Hindawi