Modern Blood Banking & Transfusion Practices

6th Edition

Chapter 18

Transfusion-Transmitted Diseases

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Donor Testing
 Required serologic testing is performed on all donor units, including
 Hepatitis B surface antigen (HBsAg)
 Antibody to Hepatitis B core antigen (anti-HBc)
 Antibody to Hepatitis C virus (anti-HCV)
 Antibodies to HIV (anti-HIV 1/2)
 Antibodies to HTLV (anti-HTLV-I/II
 Syphilis
 HCV RNA
 WNV RNA
 HIV-1 RNA

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Donor Testing (cont’d)

 Confirmatory tests are used to detect false-
positives.
 Tests vary by the disease, including
 Polymerase Chain Reaction (PCR)
 Western Blot (WB)
 Radioimmunoprecipitin Assay (RIPA)
 Recombinant Immunoblot Assay (RIBA)

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Donor Testing (cont’d)

 Many other organisms may be transfusion-
transmitted; however, tests for them are not
routinely performed in the blood screening
process.

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Transfusion-Associated Hepatitis
 Hepatitis is inflammation of the liver.
 Symptoms include jaundice, dark urine,
hepatomegaly, anorexia, malaise, fever, nausea,
abdominal pain, and vomiting.
 Hepatitis A (HAV) and Hepatitis E (HEV) are mainly
transmitted through the fecal/oral route.
 Hepatitis B (HBV), Hepatitis C (HCV), Hepatitis D
(HDV), and Hepatitis G (HB-C/HGV) are primarily
transmitted parenterally.
Copyright © 2012 F.A. Davis Company
Modern Blood Banking & Transfusion Practices
6th Edition

Hepatitis A (HAV)
 Belongs to the Picornaviridae family of
viruses and is a small, nonenveloped, single-
stranded enterovirus RNA virus
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Hepatitis B (HBV)
 A partially double-stranded circular DNA virus
of the Hepadnaviridae family
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Hepatitis C (HCV)
 A member of the Flaviviridae virus family and
a virus with an RNA genome
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Hepatitis D (HDV)
 A defective, single-stranded RNA virus that is
found only in patients with HBV infection
 HDV requires HBsAg in order to synthesize an
envelope protein and replicate.
 If HBV and HDV are contracted concurrently, this
co-infection, as compared with HBV alone,
appears to cause a more severe acute disease,
with a higher risk of fulminant hepatitis (2% to
20%) but a lesser risk of developing chronic
hepatitis.
Copyright © 2012 F.A. Davis Company
Modern Blood Banking & Transfusion Practices
6th Edition

Hepatitis D (HDV) (cont’d)

 HDV is detected by testing for IgM and/or IgG
anti-HDV and/or HDAg and HDV RNA in the
serum.
 HDV cannot exist without HBV, so testing for
HBV will eliminate any infections with HDV.
 If a donor has HBV, the unit will not be used for
transfusion.

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Hepatitis E (HEV)
 A member of the Calciviridae family of
nonenveloped RNA viruses
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Hepatitis G Virus (GBV-C)

and (HGV)
 Two genotypes of the same enveloped RNA
virus in the Flaviviridae family
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

HIV Types 1 and 2

(HIV-1 and HIV-2)
 Etiologic agents of AIDS
 Retrovirus with an envelope of glycoproteins,
core proteins, and an inner core of viral RNA
and reverse transcriptase
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment
Copyright © 2012 F.A. Davis Company
Modern Blood Banking & Transfusion Practices
6th Edition

Human T-Cell Lymphotropic Viruses

Types I and II (HTLV-I and HTLV-II)
 RNA retroviruses
 HTLV-I causes a T-cell proliferation with
persistent infection
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

West Nile Virus (WNV)

 A member of the Flavivirus family
 Is a human, avian, and equine neuropathogen
 A single-stranded RNA lipid-enveloped virion
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Cytomegalovirus (CMV)
 A member of the herpes virus group
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Epstein-Barr Virus (EBV)

 A ubiquitous member of the herpes virus
family
 There are a few cases in the literature of
transfusion-associated EBV.
 EBV is not detected by current practices and
could cause severe consequences in
immunocompromised patients, particularly
organ transplant patients.

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Human B19 Parvovirus (B19)

 A small, single-stranded DNA non-enveloped
virus
 An asymptomatic donor would be capable of
transmitting the virus during this period.
 The viremic stage occurs shortly after infection.
 This is a concern for donor centers because the
rate of seroconversion is high after exposure.

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Human Herpesvirus 6 and Human

Herpesvirus 8 (HHV-6) and (HHV-8)
 Implications for transfusion-transmitted
disease

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Bacterial Contamination
 Although the incidence of transfusion-
associated bacterial sepsis is low, the morbidity
and mortality rates are high.
 Platelets have been the most frequent source
of septic transfusion reactions.
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Syphilis
 Treponema pallidum, the causative agent of syphilis, is a
spirochete.
 The standard serologic tests for syphilis (STS) usually do
not detect a donor in the spirochetemia phase who has
not yet seroconverted.
 The STS is still required for blood donors despite the fact
that in 1978 a federal advisory panel recommended that
this requirement be eliminated.

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Babesia Microti
 Babesiosis, a zoonotic disease, is usually
transmitted by the bite of an infected deer tick.
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Trypanosoma Cruzi
 A flagellate protozoan that is the etiologic agent
of Chagas disease (American trypanosomiasis)
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Malaria (Plasmodium Species)

 Another intraerythrocytic protozoan infection
 May be caused by several species of the
genus Plasmodium (P. malaria, P. falciparum,
P. vivax, and P. ovale)
 Clinical manifestations and pathology
 Epidemiology and transmission
 Laboratory diagnosis
 Prophylaxis and treatment
Copyright © 2012 F.A. Davis Company
Modern Blood Banking & Transfusion Practices
6th Edition

Creutzfeldt-Jakob Disease (CJD)

 One of the transmissible spongiform
encephalopathies (TSE)
 Causative agent of all TSEs believed to be a
“prion”
 Classic CJD: sporadic, inherited, and iatrogenic
 Variant form (vCJD): affects younger individuals;
linked to bovine spongiform encephalopathy
 Considerations for testing and donor deferral

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Pathogen Inactivation: Plasma

Derivatives
 These methods account for residual risks
associated with serologic window periods,
virus variants, laboratory errors, and for
organisms for which testing is not performed
routinely.
 Coagulation factors had a high rate of viral
transmission until the early 1980s.

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Pathogen Inactivation: Plasma

Derivatives (cont’d)
 The lipid-enveloped viruses, HIV, HBV, HCV, HTLV, EBV, CMV,
HHV-6, and HHV-8, are all inactivated by use of organic
solvents and detergents.
 The current risk of enveloped virus transmission is very low
because of the combination of treatments such as heat-
treatment, solvent/detergent treatment, and nanofiltration.
 This process is not effective with non-lipid-enveloped viruses
such as HAV and parvovirus B-19.

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Quarantine and Recipient Tracing

(Look Back)
 All blood banks and transfusion services are required
to have a process to detect, report, and evaluate any
complication of transfusion including recipient
development of HBV, HCV, HIV, and/or HTLV.
 A method to notify donors of any abnormality with
the predonation evaluation, laboratory testing, or
recipient follow-up is required.

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Quarantine and Recipient Tracing

(Look Back) (cont’d)
 Current donations that test positive for HBV, HCV,
HIV, and/or HTLV cannot be used for transfusion.
 All prior donations from these donors become suspect.
 The timeline and standards for using the look-back
procedure differ depending on the disease involved in
each case.

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Quarantine and Recipient Tracing

(Look Back) (cont’d)
 Any prior components still in date must be
quarantined, and the disposition depends on results
of licensed supplemental tests.
 If it is noted that a patient developed HBV, HCV, HIV, or
HTLV after receiving a single unit from one donor, that
donor is permanently deferred.
 If the recipient received donations from several donors,
all donors do not have to be excluded.

Copyright © 2012 F.A. Davis Company

Modern Blood Banking & Transfusion Practices
6th Edition

Quarantine and Recipient Tracing

(Look Back) (cont’d)
 Implicated donors may be called in for retesting.
 Once a donor has been implicated, other recipients
of a component from the suspected donor should be
contacted.
 The donor must be placed on the appropriate donor
deferral list if subsequent tests are positive.
 Donors who have been permanently deferred due to
positive test results must be notified of the fact.
 Reporting requirements must be followed.
Copyright © 2012 F.A. Davis Company