Status:
Ready to upload
Record number:
1423
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Sixty-two patients with undiagnosed hepatitis from a single centre in Japan ( 1990- 2005) were retrospectively tested for HEV antibodies and RNA. Among those, there were 52 cases of acute hepatitis, 4 cases of chronic hepatitis and 12 cases of cirrhosis. Two of the patients with acute hepatitis were found to be HEV RNA positive.
Time to detection:
Not possible to ascertain, as this was a retrospective study with limited sample availability.
Alerting signals, symptoms, evidence of occurrence:
A 21-year-old Japanese male with T-cell lymphoma, admitted for 2nd cycle of chemotherapy, suffered from continuous pancytopaenia and required multiple transfusions of 44 RBC and 40 platelet units, with a total of 84 donor exposures. Elevation of serum ALT and AST was observed from day 66 after the first transfusion, but the fluctuation of liver function tests could have been for different reasons.
Demonstration of imputability or root cause:
Serum samples collected from 68 patients with a presumptive diagnosis of viral hepatitis were tested for viral Hepatitis A, B, C, and E. Two of them were found positive for hepatitis E viral RNA. While the clinical course of one patient (patient 1) was typical of acute hepatitis E, with rapid viral clearance, another patient (patient 2) was persistently infected with HEV. Patient 2 was infected through transfusion of blood products received during chemotherapy for T-cell lymphoma. Full viral genome sequence was obtained from the donor of the implicated blood product; the infecting strain was identical to that from the serum of patient 2 obtained on day 170 after the transfusion of the implicated RBC unit, confirming the transmission of HEV by transfusion. The recipient remained negative for anti-HEV antibodies for the duration of the follow-up period of six months.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
T cell lymphoma
chemotherapy
red blood cells
chronic HEV
immunosuppression
transfusion-associated
Reference attachment:
Suggest references:
- Tamura A, Shimizu YK, Tanaka T, Kuroda K, Arakawa Y, Takahashi K, et al. Persistent infection of hepatitis E virus transmitted by blood transfusion in a patient with T-cell lymphoma. Hepatology research : the official journal of the Japan Society of Hepatology. 2007;37(2):113-20.
- Kimura Y, Gotoh A, Katagiri S, et al. Transfusion-transmitted hepatitis E in a patient with myelodysplastic syndromes. Blood Transfus. 2014 Jan;12(1):103-6
Expert comments for publication:
High exposure to blood products might have increased risk of transfusion-acquired HEV infection. Profound lymphopaenia as a result of disease and chemotherapy facilitated establishment of HEV chronicity, as chronic HEV infection is usually seen in situations of profound and continued immunosuppression.