Persistent symptomatic parvovirus B19 infection with severe thrombocytopenia transmitted by red blood cell transfusion containing low parvovirus B19 DNA levels

Nagaharu, Keiki; Sugimoto, Yuka; Hoshi, Yuji; Yokota, Takanori; Ito, Ryugo; Matsubayashi, Keiji; Kawakami, Keiki; Ohishi, Kohshi

doi:10.1111/trf.14088

Cited by 16 publications

(13 citation statements)

References 18 publications

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“…In the latest report of a TT-B19V infection, a red blood cell concentrate taken from a donor with a B19V DNA concentration of 1.1 × 10 4 B19V DNA/ml plasma was the probable source of the infection. The B19V infection of the recipient has been accompanied by an immune thrombocytopenia ( 69 ).…”

Section: Transfusion-transmitted (Tt-) B19v Infection By Blood Producmentioning

confidence: 99%

Parvovirus B19: What Is the Relevance in Transfusion Medicine?

Juhl¹,

Hennig²

2018

Front. Med.

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Parvovirus B19 (B19V) has been discovered in 1975. The association with a disease was unclear in the first time after the discovery of B19V, but meanwhile, the usually droplet transmitted B19V is known as the infectious agent of the “fifth disease,” a rather harmless children’s illness. But B19V infects erythrocyte progenitor cells and thus, acute B19V infection in patients with a high erythrocyte turnover may lead to a life-threatening aplastic crisis, and acutely infected pregnant women can transmit B19V to their unborn child, resulting in a hydrops fetalis and fetal death. However, in many adults, B19V infection goes unnoticed and thus many blood donors donate blood despite the infection. The B19V infection does not impair the blood cell counts in healthy blood donors, but after the acute infection with extremely high DNA concentrations exceeding 1010 IU B19V DNA/ml plasma is resolved, B19V DNA persists in the plasma of blood donors at low levels for several years. That way, many consecutive donations that contain B19V DNA can be taken from a single donor, but the majority of blood products from donors with detectable B19V DNA seem not to be infectious for the recipients from several reasons: first, many recipients had undergone a B19V infection in the past and have formed protective antibodies. Second, B19V DNA concentration in the blood product is often too low to infect the recipient. Third, after the acute infection, the presence of B19V DNA in the donor is accompanied by presumably neutralizing antibodies which are protective also for the recipient of his blood products. Thus, transfusion-transmitted (TT-) B19V infections are very rarely reported. Moreover, in most blood donors, B19V DNA concentration is below 1,000 IU/ml plasma, and no TT-B19V infections have been found by such low-viremic donations. Cutoff for an assay for B19V DNA blood donor screening should, therefore, be approximately 1,000 IU/ml plasma, if a general screening of blood donors for single donation blood components is considered at all: for the overwhelming majority of transfusion recipients, B19V infection is not relevant as well as for the blood donors. B19V DNA screening of vulnerable patients after transfusion seems to be a more reasonable approach than general blood donor screening.

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Section: Transfusion-transmitted (Tt-) B19v Infection By Blood Producmentioning

confidence: 99%

Parvovirus B19: What Is the Relevance in Transfusion Medicine?

Juhl¹,

Hennig²

2018

Front. Med.

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“…Cases of transfusion‐transmitted B19V infection that are reported show that B19V transmission does not occur with a viral load below 10 IU/mL and that transmissibility also depends on the immune status of the donor and the immune status of the recipient . In the current model, a transmissibility of 100% was assumed for donations with a high viral load (B19V DNA >10 4 IU/mL) if the donor is both immunoglobulin M (IgM) and IgG negative, or IgM positive and IgG negative.…”

Section: Resultsmentioning

confidence: 99%

An assessment of the risk, cost‐effectiveness, and perceived benefits of anti‐parvovirus B19 tested blood products

et al. 2019

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BACKGROUND: Parvovirus B19 (B19V) can cause severe anemia, hydrops foetalis, and even death in vulnerable patients. To prevent transfusion-transmitted B19V infection of at-risk patients, B19V antibody screening of blood donors was implemented. The costeffectiveness of this intervention is unclear, as the likelihood of transmission through blood and subsequent complications for recipients are unknown. This study estimates the cost-effectiveness of anti-B19V donor screening in the Netherlands.ABBREVIATIONS: Anti-B19V tested products = red blood cell and platelet products testing positive for B19V antibodies; B19V = parvovirus B19; CER = cost-effectiveness ratio; CI = confidence interval; RBC = red blood cell products; IgG = immunoglobulin G; IgM = immunoglobulin M; IUT = intra-uterine transfusion; IU/ml = international unit per milliliter; IVIG = immunoglobulin therapy (intravenous immunoglobulin); NAT = nucleic acid testing; PI = prediction interval; SCT = stem cell transplant; SD = standard deviation; PLT = platelet products.From the

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“…Cellular blood products are found to have B19V DNA in about 1% and RBC transfusion has been associated with the transmission of B19V primarily with high-level titers of >10 7 IU/mL [89]. However, a recent report from Japan described persistent symptomatic B19V infection with severe thrombocytopenia transmitted by RBC transfusion low levels of B19V DNA [1.0 × 10 4 IU/mL] [90]. Fortunately, most patients with TT-B19V are asymptomatic but the extent of clinical disease from transfusion transmission is unknown.…”

Section: Other Virusesmentioning

confidence: 99%

Blood Transfusion-Associated Infections in the Twenty-First Century: New Challenges

Fong

2020

Current Trends and Concerns in Infectious Diseases

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Persistent symptomatic parvovirus B19 infection with severe thrombocytopenia transmitted by red blood cell transfusion containing low parvovirus B19 DNA levels

Cited by 16 publications

References 18 publications

Parvovirus B19: What Is the Relevance in Transfusion Medicine?

Parvovirus B19: What Is the Relevance in Transfusion Medicine?

An assessment of the risk, cost‐effectiveness, and perceived benefits of anti‐parvovirus B19 tested blood products

Blood Transfusion-Associated Infections in the Twenty-First Century: New Challenges

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