Sir,
In India, screening the donated blood for infections is mandatory for human immunodeficiency virus, hepatitis B, hepatitis C, malaria, and syphilis, but not for cytomegalovirus (CMV). Studies have shown a high seroprevalence of CMV (up to 95%) in India and CMV can cause severe morbidity in susceptible individuals such as immunosuppressed patients and neonates.[1] Hence, providing a CMV-negative blood unit by screening for CMV and having a donor database of seronegative donors assumes importance in this setting.
Our center being a tertiary care hospital has all the facilities required for organ transplants. We undertook this cross-sectional study to know the seroprevalence of CMV among our donor population and also to know the feasibility of maintaining a seronegative database for providing CMV-negative blood to such patients.
We screened 1475 samples (as per sample size calculation) collected randomly from the donors at our institute by using “E-CVG-K01” IgG ELISA test kit by Ratio Diagnostics. Among the 1475 samples tested for CMV, 1329 were seropositive and 146 samples gave a negative reaction. Hence, the seroprevalence of CMV among our donor population was 90%.
This was matching the seroprevalence noted in a study from Jordan.[2] A study by Kothari et al. from Delhi also showed an almost similar result around 95%.[3]
Due to the high seroprevalence of CMV in our region (90%) and also the logistics involved, maintenance of a seronegative database is a painful endeavor which is not rewarding. Another problem which is encountered in the maintenance of a CMV seronegative database is that there is a high rate of seroconversion among previously seronegative individuals.[4] Hence, frequent screening and updating of data will be required.
Considering the prevalence of 90%, testing 100 samples would yield 10 CMV negatives, amounting to an approximate expenditure of INR 30,000/- (by ELISA with five calibrators and each sample run in duplicate). In the blood of CMV-seropositive individuals, viral DNA may be present in peripheral leukocytes, and this can cause transfusion-associated infection. Leukoreduction using standard filters will help to decrease this risk.[5] Leukofiltering 10 bags will cost only Rs. 10,000 (commercially available filters cost around 800–1400 rupees), i.e., one-third of the expense for testing for CMV. Thus, a more economical and practical idea would be to implement leukoreduction for the bags to be transfused to CMV susceptible individuals.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
I am deeply indebted to Dr. Debdatta Basu, Head of the Department of Transfusion Medicine for all his valuable inputs. I would also like to thank my colleague, Dr. Sujitha Kannan, who helped me immensely with the technical aspects of the tests.
References
- 1.Saha S, Muddegowda PH, Ramachandran T, Jeyakumar MJ, Datla P. Transfusion transmitted infection-an update in India. Natl J Lab Med. 2015;4:77–82. [Google Scholar]
- 2.Hani A. Seroprevalence of cytomegalovirus in healthy voluntary blood donors in renowned Jordanian hospital. Inj J Biol Med Res. 2012;3:2193–5. [Google Scholar]
- 3.Kothari A, Ramachandran VG, Gupta P, Singh B, Talwar V. Seroprevalence of cytomegalovirus among voluntary blood donors in Delhi, India. J Health Popul Nutr. 2002;20:348–51. [PubMed] [Google Scholar]
- 4.Hecker M, Qiu D, Marquardt K, Bein G, Hackstein H. Continuous cytomegalovirus seroconversion in a large group of healthy blood donors. Vox Sang. 2004;86:41–4. doi: 10.1111/j.0042-9007.2004.00388.x. [DOI] [PubMed] [Google Scholar]
- 5.Pamphilon DH, Rider JR, Barbara JA, Williamson LM. Prevention of transfusion-transmitted cytomegalovirus infection. Transfus Med. 1999;9:115–23. doi: 10.1046/j.1365-3148.1999.00193.x. [DOI] [PubMed] [Google Scholar]