A Rare Case of Transfusion Transmission of Hepatitis A Virus to Two Patients with Haematological Disease

Abstract

Background: This paper describes the transmission of hepatitis A virus (HAV) to two blood recipients from a healthy donor that later presented to the blood bank with jaundice. Methods: The RNA of HAV was detected by qualitative nested reverse transcription polymerase chain reaction (nested RT-PCR) and quantified by real-time RT-PCR. HAV RNA samples were genotyped by direct sequencing of PCR products. A sequence from a fragment of 168 bp from the VP1/2A HAV region was used to construct a phylogenetic tree. Case Report: A 31-year-old male donor accepted for donation of a whole blood unit returned to the blood bank with clinical jaundice 20 days after donation. His serological and NAT tests were negative for HBV and HCV. Serological tests for HAV IgM and IgG were negative on donation sample but positive on follow-up sample, confirming donor's HAV acute infection. Both recipients of red blood cells (R1) and platelet concentrate (R2) from the same implicated donation were HAV IgM-negative and IgG-positive. Qualitative PCR was positive on samples from all three individuals and phylogenetic analysis of viruses proved HAV transmission to the two recipients of blood products. HAV viral load on donor follow-up sample and the platelet recipient was 1.3 and 1.5 × 10³ IU/ml, respectively. The RBC recipient, also infected by HCV, was undergoing bone marrow transplantation and died from fulminant hepatitis, 26 days after the implicated HAV transfusion. Conclusion: The blood donor, a garbage collector, spontaneously returned to the blood bank when developing jaundice. This highlights the importance of donor education to immediately report to blood banks of any signs and symptoms related to infectious disease developed after blood donation. The fact that one immunocompromised patient with HCV infection died from fulminant hepatitis after receiving a HAV-contaminated platelet transfusion underpins the importance of a HAV vaccination program for these group of patients.

Hepatitis A: an epidemiological survey in blood donors, France 2015 to 2017

“…One case of TTHA was detected. TTHA is extremely rare [ 13 - 18 ]. This is likely due to the absence of chronic carriage, the high frequency of symptomatic forms in adults, and anti-HAV immunity in transfusion recipients as well as in blood donors.…”

Ultraviolet C light efficiently inactivates nonenveloped hepatitis A virus and feline calicivirus in platelet concentrates

“…The majority of viruses posing a risk to blood safety are enveloped viruses . Exceptions include B19V, HAV, and HEV, which have been shown to be transmitted by blood components , Whereas HAV and HEV predominantly cause hepatitis, B19V infection is associated with a variety of different conditions, including febrile illness, erythema infectiosum, and transient aplastic crisis.…”

“…31 Exceptions include B19V, HAV, and HEV, which have been shown to be transmitted by blood components. [18][19][20][21][22][23]28,29 Whereas HAV and HEV predominantly cause hepatitis, B19V infection is associated with a variety of different conditions, including febrile illness, erythema infectiosum, and transient aplastic crisis. Although scientific and epidemiologic evidence suggests that these nonenveloped viruses pose little to no risk to blood safety, 31 HEV is increasingly recognized as a problem in developed countries.…”

“…Although there have been sporadic reports of HAV being transmitted via whole blood, fresh-frozen plasma (FFP), PCs, and red blood cells (RBCs), it is mainly transmitted by the fecal-oral route. [18][19][20][21][22][23] HAV and FCV have physicochemical properties similar to those of HEV and have been used as models of HEV to evaluate virus reduction steps in plasma product manufacturing processes. 24…”

“…Various experiments were performed using a clinically relevant virus (HAV) and a nonhuman pathogenic virus (feline calicivirus, FCV) as model viruses. Although there have been sporadic reports of HAV being transmitted via whole blood, fresh‐frozen plasma (FFP), PCs, and red blood cells (RBCs), it is mainly transmitted by the fecal‐oral route . HAV and FCV have physicochemical properties similar to those of HEV and have been used as models of HEV to evaluate virus reduction steps in plasma product manufacturing processes …”