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Adverse Occurrence type:
Transmission of HAV by transfusion is infrequently described.
Time to detection:
13 to 22 days
Alerting signals, symptoms, evidence of occurrence:
Da Silva et al describe the case of a blood donor reported jaundice 20 days post-donation and HAV IgG and IgM seroconversion was demonstrated retrospectively. The recipient of RBC was a 39-year-old man with chronic HCV and myelodysplastic syndrome for which he had received a bone marrow transplant. Twenty two days after transfusion, ALT and total bilirubin serum levels became elevated and he died from fulminant hepatitis 4 days later. The recipient of platelets was a 27-year-old man under chemotherapy for acute myeloid leukemia (AML) who died of causes related to AML, 7 months later. Retrospective testing of recipients sera showed detectable HAV IgG in samples taken around 2 weeks post transfusion of the implicated units. HAV RNA was detected in the donor and both recipients' sera. Gowland et al describe a similar case, where the donor reported a diagnosis of acute HAV 13 days post donation; the recipient of fresh frozen plasma, who had pre-existing HAV IgG detectable in serum, had transient viraemia and no symptoms.
Demonstration of imputability or root cause:
Sequence identity in virus samples from donor and both recipients was demonstrated over a 168 bp fragment from the VP1/2A HAV region; of note, however, the phylogenetic tree shows sequence homology in another branch amongst 3 other unrelated strains. This may indicate that the region sequenced may not be discriminatory enough to separate common circulating strains in a given region or country.
Suggest new keywords:
acute hepatitis; chronic hepatitis; fulminant hepatitis; hepatitis A virus (HAV) ; hepatitis C virus (HCV)
1) Gowland, D., Fontana, S., Niederhauser, C. and Taleghani, B.M. (2004). Molecular and serologic tracing of a transfusion-transmitted hepatitis A virus. Transfusion 44(11): 1555-61. 2) da Silva SG, et al. A Rare Case of Transfusion Transmission of Hepatitis A Virus to Two Patients with Haematological Disease. Transfus Med Hemother. 2016 Mar;43(2):137-41 3) Ishikawa K, et al. A case of posttransfusion hepatitis A. Gastroenterol Jpn. 1984 Jun;19(3):247-50.
No PDF available for Ishikawa et al paper (EP)
Expert comments for publication:
The two cases are of interest because HAV IgG was detected in recipient samples taken 2 to 3 weeks post transfusion. The authors do not discuss the contribution of passively acquired antibodies in addition to pre-existing HAV antibodies. Given the immunocompromised status of the recipients, HAV infection occurred despite presence of detectable antibodies. The authors also note the fact that one immunocompromised patient with chronic HCV infection died from fulminant super imposed acute hepatitis, illustrating the importance of a HAV vaccination program for patients with chronic hepatitis.