Book Review

Transfusion Microbiology

N Engl J Med 2009; 360:739-740February 12, 2009

Article

Transfusion Microbiology
Edited by John A.J. Barbara, Fiona A.M. Regan, and Marcela C. Contreras. 390 pp., illustrated. New York, Cambridge University Press, 2008. $160 (cloth); $128 (e-book). ISBN: 978-0-521-45393-6 (cloth); 978-0-511-42112-9 (e-book).

Since it was first recognized that hepatitis B virus and HIV can be transmitted from donors to recipients by transfusion, physicians and the public alike have been focused on the infectious risks of transfusion. What is surprising, however, is the lack of a prominent textbook of blood banking that is focused solely on infections transmitted by transfusion. This gap has now been filled with the publication of Transfusion Microbiology. There are two questions a potential reader should ask about a textbook like this one. First, does it include all the standard, core material that practitioners refer to on a regular basis; and second, does it have sufficient depth to answer even some of the most esoteric questions in the field? For this book, on almost all counts, the answer is clearly yes.

As expected, all the major infectious agents that can be transmitted by transfusion are included, and the level of detail given for each is at least as great as (and frequently greater than) that given in other leading transfusion textbooks. For example, the authors of one chapter provide an extensive treatment of bacterial contamination in blood components, including the epidemiology of bacterial contamination, the prevention of transmission (including in-depth discussions of all currently commercialized screening assays, as well as many strategies that are still under development), and approaches to the inactivation of bacteria in blood products. Variant Creutzfeldt–Jakob disease (vCJD) also receives thorough coverage. In addition to a detailed analysis of the epidemiology of vCJD cases that supports the contention that vCJD is transmitted by transfusion, the authors of the chapter also include descriptions and characteristics of nine different assays that are currently in development for the detection of vCJD in blood donors. This kind of information, which is occasionally needed by the transfusion specialist, has until now been difficult to find in a readily accessible format.

The chapter on cytomegalovirus and other herpesviruses, one of my areas of interest, is very well written and includes helpful discussions of per-unit risk of cytomegalovirus transmission, the relative safety of seronegative versus leukoreduced units, and other controversies in the area. In addition, several pages of the book are devoted to potentially important emerging viruses, including GB virus C (also called hepatitis G virus), TT virus, and SEN virus. Although there are some omissions — Chikungunya fever virus, for example, is addressed only very briefly — they are rare.

Tests for infectious diseases and other methods of preventing transmission are prominently featured in this book. Topics that can confuse the practitioner as well as the trainee, such as confirmatory testing and donor readmission, are given entire chapters with detailed flow charts and diagrams. The differences between nucleic acid testing in the United States and in the United Kingdom are emphasized, and a chapter is devoted to the approach used in each of the two countries. The chapter on plasma fractionation is one of the most detailed that I have read, with many informative tables and charts that illustrate the efficacy of fractionation procedures for the removal of viral infectivity. Two other interesting topics that are rarely addressed at this level of detail are the investigation of post-transfusion infections in the recipient and the notification of donors who have significant microbiologic test results. These topics are covered in distinct, helpful chapters. Statistical methods for estimating the risk of infectious disease transmission are discussed in a separate chapter.

The layout, artwork, and tables are noteworthy, not only for their clean aesthetic appeal but also for their detailed content. For example, one figure is a seroconversion timeline illustrating the points during hepatitis B virus infection at which 29 distinct hepatitis B surface antigen assays will first detect infection. A similar figure is presented for HIV.

In summary, Transfusion Microbiology is a commendable addition to the field and a reference that many transfusion medicine professionals will want on their bookshelves.

John D. Roback, M.D., Ph.D.
Emory University School of Medicine, Atlanta, GA 30322
jroback@emory.edu