Transfusion and Apheresis Science xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci
Seroprevalence of cytomegalovirus antibodies among blood donors and Multitransfused recipients – A study from north India Bankim Das a, Gagandeep Kaur b,⇑, Sabita Basu b a b
Department of Transfusion Medicine, Gian Sagar Medical College, Rajpura, India Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India
a r t i c l e
i n f o
Article history: Received 3 December 2013 Received in revised form 4 February 2014 Accepted 24 February 2014 Available online xxxx Keywords: Cytomegalovirus antibodies Seroprevalence Blood donors Multitransfused recipients
a b s t r a c t Background and objectives: Primary Cytomegalovirus infection caused by transfusion is a major problem for immunocompromised CMV seronegative patients. Documentation of the status of antibodies to cytomegalovirus in the blood donor pool population is vital to the understanding of the potential likelihood of transmission through donor blood and for determining the best transfusion practices to prevent TT-CMV infection. The present study was conducted to determine the prevalence of CMV infection among blood donors and Multitransfused recipients of north Indian population. Material and methods: A prospective study was done on 2100 donors’ samples and 200 patients sample for CMV antibodies using the ELISA technique. Results: Out of 2100 donors recruited, 93.8% males and 6.2% females. 98.6% were positive for anti CMV IgG antibodies and only one donor was positive for anti CMV IgM antibody. In Multitransfused patients, out of 200 patients, seroprevalence for anti CMV IgG antibodies was in 100% patients and only one patient was positive for anti CMV IgM antibody. Conclusion: The study did not demonstrate statistical significant influence of age and gender on prevalence of anti CMV IgG and IgM antibodies. Other preventive strategies such as universal leucodepletion may be implemented to prevent transmission of CMV in immunocompromised patients. Ó 2014 Elsevier Ltd. All rights reserved.
1. Introduction Cytomegalovirus (CMV) is a ubiquitous, DNA-containing herpes virus belonging to the family of beta herpes viridae [1]. It is usually spread through personal contact with people who excrete the virus in the body fluids including saliva, tears, breast milk, urine, stool, and semen [2]. Besides these, blood transfusion also plays an important ⇑ Corresponding author. Address: Department of Transfusion Medicine, Government Medical College, Sector 32, Chandigarh 160030, India. Tel.: +91 9646121576. E-mail address: [email protected] (G. Kaur).
role in CMV transmission [3]. CMV infection is asymptomatic in immunocompetent individuals. Seronegative patients at risk for developing significant morbidity from CMV include pregnant women, low birth infants ( 0.05). Galea et al. also did not find any relation between CMV serpositivity and gender [21]. However, study by Gargouri et al. [20] and Matos et al. [22] found a higher seroprevalence in females than in men. The likely explanation was that infected infants and children, in particular those under 30 months old excrete the virus in their saliva and urine. Thus, females have more contact with children resulting in higher seroprevalence of CMV in females [23]. Our study showed that the seroprevalence of CMV antibody varied with age ranging from 98.8% in 18–25 years age group to 100% in the 51–60 year age group. Donors are more likely to have antibody to CMV with increasing age suggesting a steady rate of seroconversion. However, difference in serpositivity of CMV based on distribution of age was not statistically significant. Studies by Kothari et al. [13] and Matos et al. [22] also did not find any relationship of CMV antibody prevalence and age. Galea et al. observed a significantly increased positivity with increasing age of blood donors [21]. This may be due to earlier acquisition of CMV infection in India in childhood compared to the western populations, leading to higher seroprevalence even in younger adults. The information
Please cite this article in press as: Das B et al. Seroprevalence of cytomegalovirus antibodies among blood donors and Multitransfused recipients – A study from north India. Transf Apheres Sci (2014), http://dx.doi.org/10.1016/j.transci.2014.02.022
4
B. Das et al. / Transfusion and Apheresis Science xxx (2014) xxx–xxx
Table 3 Seroprevalence of CMV in different countries. Authors
Country
IgG antibodies (%)
IgM antibodies
Present study Adjei et al. [17] Mutlu et al. [18] Alao et al. [19] Gargouri et al. [20] Galea et al. [21] Matos et al. [22]
India Ghana Turkey Nigeria Tunisia Scotland Brazil
98.5 93.2 97.2 92 97.11 45 87.9
One donor Nil – Nil Nil 5.7% Nil
regarding CMV seroprevalence in population may be useful in selectively choosing donors of a specific age group to provide the highest yield CMV seronegative blood donations. Majority of our donor population was negative for IgM antibodies indicating absence of primary infection. Kumar et al. reported only four donors were positive of 5600 donors tested for anti-IgM CMV [24]. Kothari et al. found none of the 200 donors tested positive for anti-IgM CMV [13]. Our study revealed a high seroprevalence of anti CMV IgG antibodies (100%) in Multitransfused patients, which was statistically not significant to controls (p > 0.05). Koracakova et al. reported lower (80%) seropositivity for CMV antibody in multitransfused patients as compared to our study [25]. Njeru et al. [26] found 93% prevalence of CMV antibody and Jahan et al. [27] from Bangladesh also demonstrated 100% seropositivity for CMV antibody in multitransfused patients. The high seroprevalence for anti CMV IgG antibodies indicate past exposure, which can be due to closer contact or through blood transfusion. Presence of IgM CMV antibody indicates either primary infection or reactivation of latent infection. In our study, only one patient of 100 Multitransfused was positive for IgM CMV infection. Korcakova et al. [25] found only one of 30 haemodialysis patients to be positive for CMV IgM antibodies. Ocak et al. noted in one of 255 haemodialysis patients tested for anti CMV IgM antibodies [28]. The presence of IgM CMV antibodies in Multitransfused patients might indicate primary infection and reactivation or reinfection which occurs frequently in Multitransfused patients. There was high seroprevalence of cytomegalovirus antibodies among blood donors, with virtually all donors having being exposed to the virus. Universal screening of donor blood for CMV may not be cost-effective as very few seronegative blood units would be available for transfusion. Thus, focus should be on other preventive measures such as leucoreduction of red cells and platelet units, antiviral drugs and immunoglobulin administration [29]. While last two options are still under research, the use of third generation leucoreduction filters is being increasingly recommended to minimize TT-CMV. American Association of Blood Banks (AABB) have also recommended the use of deglycerolized frozen RBC when transfusion is required for seronegative preterm infant [30]. Further studies are necessary to determine the age of seroconversion of CMV and also high risk groups who have been transfused be evaluated to determine if they may have acquired TT-CMV.
References [1] Mocarski Jr ES. Biology and replication of cytomegalovirus. Transfus Med Rev 1988;2(4):229–34. [2] Gunter KC, Luban NLC. Transfusion transmitted cytomegalovirus and Epstein–Barr virus diseases. In: Rossi EC, Simon TL, Moss GS, Gould SA, editors. Principles of transfusion medicine. Baltimore: Williams & Wilkins; 1996. p. 717–32. [3] Adler SP. Cytomegalovirus and transfusions. Transfus Med Rev 1988;2(4):235–44. [4] Yeager AS, Grumet FC, Hafleigh EB, Arvin AM, Bradley JS, Prober CG. Prevention of transfusion-acquired cytomegalovirus infections in newborn infants. J Pediatr 1981;98(2):281–7. [5] Adler SP, Chandrika T, Lawrence L, Baggett J. Cytomegalovirus infections in neonates acquired by blood transfusions. Pediatr Infect Dis 1983;2(2):114–8. [6] Murphy MF, Grint PC, Hardiman AE, Lister TA, Waters AH. Use of leukocyte-poor blood components to prevent primary cytomegalovirus (CMV) infection in patients with acute leukaemia. Br J Haematol 1988;70:253–4. [7] Germenis A, Politis C. Thalassemic patients are at high risk for transfusion-transmitted Cytomegalovirus infections. Acta Haematol 1989;82:57–60. [8] Glenn J. Cytomegalovirus infections following renal transplantation. Rev Infect Dis 1981;3(6):1151–78. [9] Meyers JD, Ljungman P, Fisher LD. Cytomegalovirus excretion as a predictor of cytomegalovirus disease after bone marrow transplantation: importance of cytomegalovirus viremia. J Infect Dis 1990;162:373–80. [10] Alford CA, Stagno S, Pass RF, Britt WJ. Congenital and Perinatal cytomegalovirus infections. Rev Infect Dis 1990;12(7). p. S745–53. [11] Kaplan CS, Petersen EA, Icenogle TB, Copeland JG, Villar HV, Sampliner R, et al. Gastrointestinal cytomegalovirus infection in heart and heart-lung transplant recipients. Arch Intern Med 1989;149(9):2095–100. [12] Blood transfusion transmitted diseases. In: 2nd ed. Saran RK, editor. Transfusion medicine. New Delhi: Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India; 2003. p. 153-7. [13] Kothari A, Ramachandran VG, Gupta P, Singh B, Talwar V. Seroprevalence of Cytomegalovirus among Voluntary Blood Donors in Delhi, India. J Health, Populat Nutr 2011;20(4):348–51. [14] Pal SR, Chitkara NL, Krech U. Sero-epidemiology of cytomegalovirus infection in and around Chandigarh (Northern India). Indian J Med Res 1972 Jul;60(7):973–8. [15] Madhavan HN, Prakash K, Agarwal SC. Cytomegalovirus infection in Pondicherry (South India) – a serological survey. Indian J Med Res 1974;62(2):297–300. [16] Mukundan P, Jadhav M, John TJ. Prevalence of cytomegalovirus antibody in young children in Vellore. Indian J Med Res 1977;65(5):589–92. [17] Adjei AA, Armah H, Narter-Olaga EG. Seroprevalence of cytomegalovirus among some voluntary blood donors at the 37 military hospitals, Accra. Ghana Ghana Med J 2006;40(3):99–104. [18] Mutlu B, Günlemez A, Türker G, Gökalp AS, Willke A. Is serologic screening necessary in the donor bloods for cytomegalovirus seronegative blood transfusion to risky patients? Mikrobiyol Bul 2008;42(2):337–41. [19] Alao OO, Joseph DE, Mamman A, Banwat EB. The seroprevalence of cytomegalovirus antibodies among prospective blood donors in Jos. Niger J Med 2008;17(2):198–200. [20] Gargouri J, Elleuch H, Karray H, Rekik H, Hammami A. Prevalence of anti-CMV antibodies in blood donors in the Sfax region (value in blood transfusion). Tunis Med 2000;78(8–9):512–7.
Please cite this article in press as: Das B et al. Seroprevalence of cytomegalovirus antibodies among blood donors and Multitransfused recipients – A study from north India. Transf Apheres Sci (2014), http://dx.doi.org/10.1016/j.transci.2014.02.022
B. Das et al. / Transfusion and Apheresis Science xxx (2014) xxx–xxx [21] Galea G, Urbaniak SJ. Cytomegalovirus Studies on Blood Donors in North–East Scotland and a review of UK Data. Vox Sang 2009;64(1):24–30. [22] Matos SB, Meyer R, Lima FWM. Seroprevalence of cytomegalovirus infection among healthy blood donors in Bahia State. Brazil Rev Bras Hematol Hemoter 2010;32(1):45–9. [23] Harvey J, Dennis C-L. Hygiene interventions for prevention of cytomegalovirus infection among childbearing women: systematic review. J Adv Nurs 2008;63(5):440–50. [24] Kumar H, Gupta PK, Kumar S, Sarkar RS. Is seroprevalence of antiIGM CMV among blood donors relevant in India? Indian J Pathol Microbiol 2008;51(3):351–2. [25] Korcáková L, Kaslík J, Svobodová J, Kaslíková J, Bláha J, Sedlácková E, et al. CMV infection in patients with chronic renal failure and in those following transplantation. Czech Med 1988;11(3):131–6.
5
[26] Njeru DG, Mwanda WO, Kitonyi GW, Njagi EC. Prevalence of cytomegalovirus antibodies in blood donors at the National Blood Transfusion Centre. Nairobi East Afr Med J 2009;86(12). p. S58–61. [27] Jahan M, Tabassum S, Aziz A, Ahmed M, Islam MN. Transfusion associated CMV infection: transfusion strategies for high risk patients. Bangladesh J Med Microbiol 2012;4(2):24–7. [28] Ocak S, Duran N, Eskiocak AF. Seroprevalence of cytomegalovirus antibodies in haemodialysis patients. Turk J Med Sci 2006;36(3):155. [29] Stagno S. Cytomegalovirus. In: 3rd ed., Remington JS, Klein JO, editors. Diseases of fetus and newborn infant. Philadelphia, W.B. Saunders; 1990. p. 241–81. [30] Holland PV, Schmitt PJ. Standards for blood banks and transfusion services. In: 12th ed. Arlington, Va., Committee on Standards. American Association of Blood Banks, 1987. p. 30–1.
Please cite this article in press as: Das B et al. Seroprevalence of cytomegalovirus antibodies among blood donors and Multitransfused recipients – A study from north India. Transf Apheres Sci (2014), http://dx.doi.org/10.1016/j.transci.2014.02.022
Contents lists available at ScienceDirect
Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci
Seroprevalence of cytomegalovirus antibodies among blood donors and Multitransfused recipients – A study from north India Bankim Das a, Gagandeep Kaur b,⇑, Sabita Basu b a b
Department of Transfusion Medicine, Gian Sagar Medical College, Rajpura, India Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India
a r t i c l e
i n f o
Article history: Received 3 December 2013 Received in revised form 4 February 2014 Accepted 24 February 2014 Available online xxxx Keywords: Cytomegalovirus antibodies Seroprevalence Blood donors Multitransfused recipients
a b s t r a c t Background and objectives: Primary Cytomegalovirus infection caused by transfusion is a major problem for immunocompromised CMV seronegative patients. Documentation of the status of antibodies to cytomegalovirus in the blood donor pool population is vital to the understanding of the potential likelihood of transmission through donor blood and for determining the best transfusion practices to prevent TT-CMV infection. The present study was conducted to determine the prevalence of CMV infection among blood donors and Multitransfused recipients of north Indian population. Material and methods: A prospective study was done on 2100 donors’ samples and 200 patients sample for CMV antibodies using the ELISA technique. Results: Out of 2100 donors recruited, 93.8% males and 6.2% females. 98.6% were positive for anti CMV IgG antibodies and only one donor was positive for anti CMV IgM antibody. In Multitransfused patients, out of 200 patients, seroprevalence for anti CMV IgG antibodies was in 100% patients and only one patient was positive for anti CMV IgM antibody. Conclusion: The study did not demonstrate statistical significant influence of age and gender on prevalence of anti CMV IgG and IgM antibodies. Other preventive strategies such as universal leucodepletion may be implemented to prevent transmission of CMV in immunocompromised patients. Ó 2014 Elsevier Ltd. All rights reserved.
1. Introduction Cytomegalovirus (CMV) is a ubiquitous, DNA-containing herpes virus belonging to the family of beta herpes viridae [1]. It is usually spread through personal contact with people who excrete the virus in the body fluids including saliva, tears, breast milk, urine, stool, and semen [2]. Besides these, blood transfusion also plays an important ⇑ Corresponding author. Address: Department of Transfusion Medicine, Government Medical College, Sector 32, Chandigarh 160030, India. Tel.: +91 9646121576. E-mail address: [email protected] (G. Kaur).
role in CMV transmission [3]. CMV infection is asymptomatic in immunocompetent individuals. Seronegative patients at risk for developing significant morbidity from CMV include pregnant women, low birth infants ( 0.05). Galea et al. also did not find any relation between CMV serpositivity and gender [21]. However, study by Gargouri et al. [20] and Matos et al. [22] found a higher seroprevalence in females than in men. The likely explanation was that infected infants and children, in particular those under 30 months old excrete the virus in their saliva and urine. Thus, females have more contact with children resulting in higher seroprevalence of CMV in females [23]. Our study showed that the seroprevalence of CMV antibody varied with age ranging from 98.8% in 18–25 years age group to 100% in the 51–60 year age group. Donors are more likely to have antibody to CMV with increasing age suggesting a steady rate of seroconversion. However, difference in serpositivity of CMV based on distribution of age was not statistically significant. Studies by Kothari et al. [13] and Matos et al. [22] also did not find any relationship of CMV antibody prevalence and age. Galea et al. observed a significantly increased positivity with increasing age of blood donors [21]. This may be due to earlier acquisition of CMV infection in India in childhood compared to the western populations, leading to higher seroprevalence even in younger adults. The information
Please cite this article in press as: Das B et al. Seroprevalence of cytomegalovirus antibodies among blood donors and Multitransfused recipients – A study from north India. Transf Apheres Sci (2014), http://dx.doi.org/10.1016/j.transci.2014.02.022
4
B. Das et al. / Transfusion and Apheresis Science xxx (2014) xxx–xxx
Table 3 Seroprevalence of CMV in different countries. Authors
Country
IgG antibodies (%)
IgM antibodies
Present study Adjei et al. [17] Mutlu et al. [18] Alao et al. [19] Gargouri et al. [20] Galea et al. [21] Matos et al. [22]
India Ghana Turkey Nigeria Tunisia Scotland Brazil
98.5 93.2 97.2 92 97.11 45 87.9
One donor Nil – Nil Nil 5.7% Nil
regarding CMV seroprevalence in population may be useful in selectively choosing donors of a specific age group to provide the highest yield CMV seronegative blood donations. Majority of our donor population was negative for IgM antibodies indicating absence of primary infection. Kumar et al. reported only four donors were positive of 5600 donors tested for anti-IgM CMV [24]. Kothari et al. found none of the 200 donors tested positive for anti-IgM CMV [13]. Our study revealed a high seroprevalence of anti CMV IgG antibodies (100%) in Multitransfused patients, which was statistically not significant to controls (p > 0.05). Koracakova et al. reported lower (80%) seropositivity for CMV antibody in multitransfused patients as compared to our study [25]. Njeru et al. [26] found 93% prevalence of CMV antibody and Jahan et al. [27] from Bangladesh also demonstrated 100% seropositivity for CMV antibody in multitransfused patients. The high seroprevalence for anti CMV IgG antibodies indicate past exposure, which can be due to closer contact or through blood transfusion. Presence of IgM CMV antibody indicates either primary infection or reactivation of latent infection. In our study, only one patient of 100 Multitransfused was positive for IgM CMV infection. Korcakova et al. [25] found only one of 30 haemodialysis patients to be positive for CMV IgM antibodies. Ocak et al. noted in one of 255 haemodialysis patients tested for anti CMV IgM antibodies [28]. The presence of IgM CMV antibodies in Multitransfused patients might indicate primary infection and reactivation or reinfection which occurs frequently in Multitransfused patients. There was high seroprevalence of cytomegalovirus antibodies among blood donors, with virtually all donors having being exposed to the virus. Universal screening of donor blood for CMV may not be cost-effective as very few seronegative blood units would be available for transfusion. Thus, focus should be on other preventive measures such as leucoreduction of red cells and platelet units, antiviral drugs and immunoglobulin administration [29]. While last two options are still under research, the use of third generation leucoreduction filters is being increasingly recommended to minimize TT-CMV. American Association of Blood Banks (AABB) have also recommended the use of deglycerolized frozen RBC when transfusion is required for seronegative preterm infant [30]. Further studies are necessary to determine the age of seroconversion of CMV and also high risk groups who have been transfused be evaluated to determine if they may have acquired TT-CMV.
References [1] Mocarski Jr ES. Biology and replication of cytomegalovirus. Transfus Med Rev 1988;2(4):229–34. [2] Gunter KC, Luban NLC. Transfusion transmitted cytomegalovirus and Epstein–Barr virus diseases. In: Rossi EC, Simon TL, Moss GS, Gould SA, editors. Principles of transfusion medicine. Baltimore: Williams & Wilkins; 1996. p. 717–32. [3] Adler SP. Cytomegalovirus and transfusions. Transfus Med Rev 1988;2(4):235–44. [4] Yeager AS, Grumet FC, Hafleigh EB, Arvin AM, Bradley JS, Prober CG. Prevention of transfusion-acquired cytomegalovirus infections in newborn infants. J Pediatr 1981;98(2):281–7. [5] Adler SP, Chandrika T, Lawrence L, Baggett J. Cytomegalovirus infections in neonates acquired by blood transfusions. Pediatr Infect Dis 1983;2(2):114–8. [6] Murphy MF, Grint PC, Hardiman AE, Lister TA, Waters AH. Use of leukocyte-poor blood components to prevent primary cytomegalovirus (CMV) infection in patients with acute leukaemia. Br J Haematol 1988;70:253–4. [7] Germenis A, Politis C. Thalassemic patients are at high risk for transfusion-transmitted Cytomegalovirus infections. Acta Haematol 1989;82:57–60. [8] Glenn J. Cytomegalovirus infections following renal transplantation. Rev Infect Dis 1981;3(6):1151–78. [9] Meyers JD, Ljungman P, Fisher LD. Cytomegalovirus excretion as a predictor of cytomegalovirus disease after bone marrow transplantation: importance of cytomegalovirus viremia. J Infect Dis 1990;162:373–80. [10] Alford CA, Stagno S, Pass RF, Britt WJ. Congenital and Perinatal cytomegalovirus infections. Rev Infect Dis 1990;12(7). p. S745–53. [11] Kaplan CS, Petersen EA, Icenogle TB, Copeland JG, Villar HV, Sampliner R, et al. Gastrointestinal cytomegalovirus infection in heart and heart-lung transplant recipients. Arch Intern Med 1989;149(9):2095–100. [12] Blood transfusion transmitted diseases. In: 2nd ed. Saran RK, editor. Transfusion medicine. New Delhi: Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India; 2003. p. 153-7. [13] Kothari A, Ramachandran VG, Gupta P, Singh B, Talwar V. Seroprevalence of Cytomegalovirus among Voluntary Blood Donors in Delhi, India. J Health, Populat Nutr 2011;20(4):348–51. [14] Pal SR, Chitkara NL, Krech U. Sero-epidemiology of cytomegalovirus infection in and around Chandigarh (Northern India). Indian J Med Res 1972 Jul;60(7):973–8. [15] Madhavan HN, Prakash K, Agarwal SC. Cytomegalovirus infection in Pondicherry (South India) – a serological survey. Indian J Med Res 1974;62(2):297–300. [16] Mukundan P, Jadhav M, John TJ. Prevalence of cytomegalovirus antibody in young children in Vellore. Indian J Med Res 1977;65(5):589–92. [17] Adjei AA, Armah H, Narter-Olaga EG. Seroprevalence of cytomegalovirus among some voluntary blood donors at the 37 military hospitals, Accra. Ghana Ghana Med J 2006;40(3):99–104. [18] Mutlu B, Günlemez A, Türker G, Gökalp AS, Willke A. Is serologic screening necessary in the donor bloods for cytomegalovirus seronegative blood transfusion to risky patients? Mikrobiyol Bul 2008;42(2):337–41. [19] Alao OO, Joseph DE, Mamman A, Banwat EB. The seroprevalence of cytomegalovirus antibodies among prospective blood donors in Jos. Niger J Med 2008;17(2):198–200. [20] Gargouri J, Elleuch H, Karray H, Rekik H, Hammami A. Prevalence of anti-CMV antibodies in blood donors in the Sfax region (value in blood transfusion). Tunis Med 2000;78(8–9):512–7.
Please cite this article in press as: Das B et al. Seroprevalence of cytomegalovirus antibodies among blood donors and Multitransfused recipients – A study from north India. Transf Apheres Sci (2014), http://dx.doi.org/10.1016/j.transci.2014.02.022
B. Das et al. / Transfusion and Apheresis Science xxx (2014) xxx–xxx [21] Galea G, Urbaniak SJ. Cytomegalovirus Studies on Blood Donors in North–East Scotland and a review of UK Data. Vox Sang 2009;64(1):24–30. [22] Matos SB, Meyer R, Lima FWM. Seroprevalence of cytomegalovirus infection among healthy blood donors in Bahia State. Brazil Rev Bras Hematol Hemoter 2010;32(1):45–9. [23] Harvey J, Dennis C-L. Hygiene interventions for prevention of cytomegalovirus infection among childbearing women: systematic review. J Adv Nurs 2008;63(5):440–50. [24] Kumar H, Gupta PK, Kumar S, Sarkar RS. Is seroprevalence of antiIGM CMV among blood donors relevant in India? Indian J Pathol Microbiol 2008;51(3):351–2. [25] Korcáková L, Kaslík J, Svobodová J, Kaslíková J, Bláha J, Sedlácková E, et al. CMV infection in patients with chronic renal failure and in those following transplantation. Czech Med 1988;11(3):131–6.
5
[26] Njeru DG, Mwanda WO, Kitonyi GW, Njagi EC. Prevalence of cytomegalovirus antibodies in blood donors at the National Blood Transfusion Centre. Nairobi East Afr Med J 2009;86(12). p. S58–61. [27] Jahan M, Tabassum S, Aziz A, Ahmed M, Islam MN. Transfusion associated CMV infection: transfusion strategies for high risk patients. Bangladesh J Med Microbiol 2012;4(2):24–7. [28] Ocak S, Duran N, Eskiocak AF. Seroprevalence of cytomegalovirus antibodies in haemodialysis patients. Turk J Med Sci 2006;36(3):155. [29] Stagno S. Cytomegalovirus. In: 3rd ed., Remington JS, Klein JO, editors. Diseases of fetus and newborn infant. Philadelphia, W.B. Saunders; 1990. p. 241–81. [30] Holland PV, Schmitt PJ. Standards for blood banks and transfusion services. In: 12th ed. Arlington, Va., Committee on Standards. American Association of Blood Banks, 1987. p. 30–1.
Please cite this article in press as: Das B et al. Seroprevalence of cytomegalovirus antibodies among blood donors and Multitransfused recipients – A study from north India. Transf Apheres Sci (2014), http://dx.doi.org/10.1016/j.transci.2014.02.022
