Status:
Ready to upload
Record number:
1456
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Case report
Time to detection:
18 days
Alerting signals, symptoms, evidence of occurrence:
Three days following granulocyte donations, the donor was found to be positive for WNV. Eighteen days following these granulocyte transfusions due to Candida endocarditis and neutropenia, the patient developed sudden onset of confusion with extremity weakness. A lumbar puncture revealed no malignant cells. CSF was WNV-NAT– and IgM-positive.
Demonstration of imputability or root cause:
WNV RNA, WNV IgM and WNV IgG testing of a retention sample and follow- up from the donor demonstrated WNV reactivity. The infecting unit had a high viral load sufficient for detection by minpool-nucleic acid testing however testing was not completed in time to interdict the transfusion of granulocytes.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
WNV, West Nile Virus, NAY, PCR, IgM, IgG, granulocytes, extremity weakness, confusion, lumbar puncture, CNS
Reference attachment:
Suggest references:
Meny GM, Santos-Zabala L, Szallasi A, Stramer SL. (2011). West Nile virus infection transmitted by granulocyte transfusion. Blood 117(21): 5778-9.
Expert comments for publication:
Granulocytes must be transfused as soon as possible after collection and thus transfused before completion of infectious-disease testing. This case illustrates the need to evaluate the benefits of granulocyte transfusion for critically ill, neutropenic patients in the face of the rare possibility of WNV transmission during epidemic periods.