Status:
Ready to upload
Record number:
1843
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Unknown and poorly documented
Time to detection:
2-3 days
Alerting signals, symptoms, evidence of occurrence:
Donation aliquots testing negative by an investigational NS1-Ag ELISA during a dengue epidemic in Puerto Rico were stored frozen and retested retrospectively using a research transcription-mediated amplification assay (TMA) for dengue RNA. Confirmation was performed on RNA reactive samples and recipients were traced back. Extensive work was carried out and 2 recipients of DENV-4 RNA positive units were described. Case 1, a 75-year-old man with lung cancer and coronary heart disease, was admitted for symptomatic anemia and transfused with 3 RBC units. Three days posttransfusion, he developed fever. Blood and urine cultures were negative. He had a course of illness compatible with dengue hemorrhagic fever: at defervescence, he developed leukopenia, thrombocytopenia, melena, hematochezia, and severe plasma leakage with bilateral pleural and pericardial effusions, hypoalbuminemia, and shock. Case 2, an 82-year-old female with pancreatic cancer received one unit of DENV confirmed-positive RBC given for anemia (IgM seroconversion in Donor). She developed fever 2 days posttransfusion; blood cultures were negative and no other cause of fever was found.
Demonstration of imputability or root cause:
Transfusion of DENV RNA positive RBC units into recipients who developed compatible symptoms whilst in hospital, 2 to 3 days post transfusion
Imputability grade:
1 Possible
Groups audience:
Keywords:
Suggest new keywords:
Dengue, Dengue fever, Dengue hemorrhagic shock, NS1 antigen, transcription-mediated amplification assay
leukopenia, thrombocytopenia, melena, pericardial effusion, hypoalbuminemia
Reference attachment:
Suggest references:
Probable and possible transfusion-transmitted dengue associated with NS1 antigen-negative but RNA confirmed-positive red blood cells.
Expert comments for publication:
Dengue virus 1-4 infects hundreds of millions people in tropical areas and even in the absence of specific screening of blood donations, transfusion-transmitted infection are infrequently described. Deferral of symptomatic cases and /or use of pathogen reduction technologies in endemic or epidemic areas and 28 days deferral of asymptomatic donors returning from affected areas contribute to mitigation of risk. TTI is likely to be under recognised and this large study illustrates the difficulty in confirming TTI in endemic areas. It also showed that an NS1-Ag assay detected only 20% of all RNA confirmed-positive donations demonstrating limitations of NS1-Ag ELISA for blood donation screening.