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Practices regarding selection of CMV seronegative and/or leukocyte reduced blood products for transfusion of pregnant patients |
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A transfusion medicine physician at an academic center in Maryland wonders what other institutions do with regard to selecting CMV seronegative and/or leukocyte reduced blood products for transfusion therapy of pregnant patients. If either CMV seronegative or leukocyte reduced products are used, are they used for all pregnant women, or just for those women whose CMV serostatus is unknown or seronegative? For institutions that rely on the CMV serostatus of the mother for providing leukoreduced and/or CMV-seronegative blood during pregnancy, is CMV serology routinely obtained during prenatal testing? The following comments have been received. ADDENDA Apr. 24, 2006 1. A colleague who works at an academic medical center in the vicinity of Sacramento reports that her transfusion service policy is to use CMV sero-negative cellular components for all pregnant patients, up to the time of delivery. In the very rare case of massive transfusion, they can (with director notification) switch to CMV untested units that are leukoreduced, if their stock supply is threatened. She adds that because so few pregnant patients are transfused at her institution, they do not require that pregnant women have a CMV serology result on file in the transfusion service laboratory. ADDENDA Apr. 26, 2006 2. A transfusion medicine physician in the Midwest reports that while he concurs with comments about a lack of evidence to support a request for irradiation of blood products for pregnant women, he is supportive of the use of leukoreduced units to lower risk of CMV transmission for that patient group. In his opinion, the study by Boppana entitled Intrauterine transmission of cytomegalovirus to infants of women with preconceptional immunity. N Engl J Med. 2001 May 3;344(18):1366-71 suggests the potential for second strain infection. Hence, in his experience some centers prefer to provide CMV reduced risk products to all pregnant patients and premature infants. |
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Please submit comments to the e-Network Forum. Ira A. Shulman, MD |
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