Dapatkah COVID 19

Ditularkan Melalui
Transfusi Darah?
Dr. Nova Hippy, MBiomed, MPH
Can it?

 Blood cells don’t have the binding sites Covid-19 looking for.
The virus is focused on attacking the respiratory and digestive systems
 “There is absolutely no evidence of transfusion transmission for COVID-19, or
any other coronavirus” Dr. S. Drews, Associate Director of Microbiology at
Canadian Blood Services
 Also applies to other coronaviruses such as severe acute respiratory syndrome
(SARS), Middle East respiratory syndrome (MERS), and the unrelated influenza
viruses
 Based on very conservative estimates we’ve done, we’re looking at odds of one in
100 million chance of collecting a blood donation containing the virus

https://blood.ca/en/stories/why-you-wont-get-covid-19-from-a-blo
od-transfusion
So?

Zero evidence COVID-19 can be

transmitted by blood, and even so, at this
point the odds of us collecting blood from
an infected individual are at worst one in
100 million

https://blood.ca/en/stories/why-you-wont-get-covid-19-from-a-blo
od-transfusion
But?

There is still a theoretical risk of transmission of coronaviruses through

the transfusion of labile blood products
 Silent Spreader in asymptomatic people
 SARS CoV2 Viremia
 New theory about SARS CoV2 attacking the RBC
Asymptomatic Silent Spreader

Setting Proportion Comment

Diamond Princess
cruise 18%
ship, Yokohama, Most infections occurred before the
(95% credible interval  16%-
Japan  (n=-634 quarantine start.
20%).
tested positive).
[1]
Vo’Euganeo, 50
km west of 50% to 75%—were In an open letter to the authorities in
Venice, asymptomatic the Tuscany region
Italian village  [2]

https://www.cebm.net/covid-19/covid-19-what-proportion-are-asymptomatic/
Asymptomatic Silent Spreader

 WHO
 Q&A: Similarities and differences – COVID-19 and influenza
 17 March 2020 | Q&A
 For COVID-19, data to date suggest that 80% of infections are mild or
asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical
infections, requiring ventilation

https://www.who.int/news-room/q-a-detail/q-a-similarities-and-differences-covid-19-and-influenza
Asymptomatic?

 COVID-19 - virtual press conference - 01 April 2020

Those individuals who are identified as asymptomatic at the time of reporting and go
on to develop symptoms, so 75% of those, are actually pre-symptomatic
 Lauer SA, et al.
101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14
days of active monitoring or quarantine

https://www.who.int/docs/default-source/coronaviruse/transcripts/who- Lauer SA, et al. The incubation period of coronavirus disease 2019
audio-emergencies-coronavirus-press-conference-full-01apr2020-final.pdf? (COVID-19) from publicly reported confirmed cases: estimation and
sfvrsn=573dc140_2 application. Annals of internal medicine. 2020 Mar 10.
How about Blood Donors?

 WHO: Maintaining a safe and adequate blood supply during the pandemic
outbreak of coronavirus disease (COVID-19)
Persons who have fully recovered from confirmed COVID-19, those with possible
direct exposure to COVID-19 from a confirmed case, and those who have travelled
from areas with ongoing community transmission should refrain from blood donation
for at least 28 days.
Viremia in COVID19

Wang W, et al. Detection of SARS-CoV-2 in different types of clinical specimens. Jama. 2020 Mar 11.
Viremia of SARS CoV2

 Chang L, Yan Y, Wang L. Coronavirus disease 2019: coronaviruses and blood

safety. Transfusion Medicine Reviews. 2020 Feb 21
Viral RNA in plasma or serum could be detected in COVID-19 patients on the first 2
or 3 days after onset of symptoms
So, No Virus in the Blood Donors?

 Chang L, et al. Severe acute respiratory syndrome coronavirus 2 RNA detected in

blood donations. Emerg Infect Dis. 2020 Jul
4 blood donors in Wuhan whose plasma samples tested positive for SARS-CoV-2
RNA
 https://www.straitstimes.com/asia/east-asia/six-in-south-korea-donated-blood-
before-testing-positive-later
A total of six people had donated their blood within two weeks before testing positive
Transfusion-transmitted?
Wuhan Case
Transfusion-transmitted?
Korea Case
SARS CoV2 attacking RBC?

 Conserved domain analysis, homology modeling, and molecular docking were

used to compare the biological roles of certain proteins of the novel coronavirus
 The results showed:
The ORF8 and surface glycoprotein could bind to the porphyrin, respectively. At the
same time, ORF1ab, ORF10, and ORF3a proteins could coordinate attack the heme
on the 1-beta chain of hemoglobin to dissociate the iron to form the porphyrin.

Liu W. COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism. ChemRxiv Preprint 2020
Conclusion?

 There is a theoretical risk of transmission

 But, there is no evidence of transfusion transmission for COVID-19
Even after all of that…

 While transfusion of components containing an infectious agent does present a

risk, the possibility of a productive infection in the recipient may be less likely,
if…
 the presence of the infectious agent is below the minimum infectious dose of each
infectious agent
 the infectious agent is not highly infectious
 the recipient has previously been exposed to the infectious agent and has a degree of
immunity

World Health Organization. Protecting the blood supply during infectious disease outbreaks: guidance for national blood services.
And more less likely if…

 Transfuse blood component

Thank You