da Silva Suely Gonçalves Cordeiro, Leon Luciane Almeida Amado, Alves Gilda, Brito Selma Magalhães, Sandes Valcieny de Souza, Lima Magda Maria Adorno Ferreira, Nogueira Marta Colares, Tavares Rita de Cássia Barbosa da Silva, Dobbin Jane, Apa Alexandre, de Paula Vanessa Salete, Oliveira Jaqueline Mendes de Oliveira, Pinto Marcelo Alves, Ferreira Orlando da Costa, Motta Iara de Jesus Ferreira
Serviço de Hemoterapia, HC1, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.
Transfus Med Hemother. 2016 Mar;43(2):137-41. doi: 10.1159/000441910. Epub 2015 Nov 24.
This paper describes the transmission of hepatitis A virus (HAV) to two blood recipients from a healthy donor that later presented to the blood bank with jaundice.
The RNA of HAV was detected by qualitative nested reverse transcription polymerase chain reaction (nested RT-PCR) and quantified by real-time RT-PCR. HAV RNA samples were genotyped by direct sequencing of PCR products. A sequence from a fragment of 168 bp from the VP1/2A HAV region was used to construct a phylogenetic tree.
A 31-year-old male donor accepted for donation of a whole blood unit returned to the blood bank with clinical jaundice 20 days after donation. His serological and NAT tests were negative for HBV and HCV. Serological tests for HAV IgM and IgG were negative on donation sample but positive on follow-up sample, confirming donor's HAV acute infection. Both recipients of red blood cells (R1) and platelet concentrate (R2) from the same implicated donation were HAV IgM-negative and IgG-positive. Qualitative PCR was positive on samples from all three individuals and phylogenetic analysis of viruses proved HAV transmission to the two recipients of blood products. HAV viral load on donor follow-up sample and the platelet recipient was 1.3 and 1.5 × 10(3) IU/ml, respectively. The RBC recipient, also infected by HCV, was undergoing bone marrow transplantation and died from fulminant hepatitis, 26 days after the implicated HAV transfusion.
The blood donor, a garbage collector, spontaneously returned to the blood bank when developing jaundice. This highlights the importance of donor education to immediately report to blood banks of any signs and symptoms related to infectious disease developed after blood donation. The fact that one immunocompromised patient with HCV infection died from fulminant hepatitis after receiving a HAV-contaminated platelet transfusion underpins the importance of a HAV vaccination program for these group of patients.
本文描述了甲型肝炎病毒（HAV）从一名健康献血者传播给两名输血受者的情况，该献血者后来因黄疸到血库就诊。
采用定性巢式逆转录聚合酶链反应（巢式RT-PCR）检测HAV的RNA，并通过实时RT-PCR进行定量。通过对PCR产物进行直接测序对HAV RNA样本进行基因分型。使用来自HAV VP1/2A区域168 bp片段的序列构建系统发育树。
一名接受全血捐献的31岁男性献血者在献血20天后因临床黄疸回到血库。他的血清学和核酸检测中HBV和HCV均为阴性。献血样本的HAV IgM和IgG血清学检测为阴性，但随访样本为阳性，证实献血者发生了HAV急性感染。来自同一相关献血的红细胞受者（R1）和血小板浓缩液受者（R2）的HAV IgM均为阴性，IgG为阳性。对所有三人的样本进行定性PCR均为阳性，病毒的系统发育分析证明HAV传播给了两名血液制品受者。献血者随访样本和血小板受者的HAV病毒载量分别为1.3和1.5×10(3) IU/ml。红细胞受者也感染了HCV，正在接受骨髓移植，在相关HAV输血后26天死于暴发性肝炎。
该献血者是一名垃圾收集工，但在出现黄疸时主动回到了血库。这凸显了对献血者进行教育的重要性，即要求他们在献血后出现任何与传染病相关的体征和症状时立即向血库报告。一名免疫功能低下的HCV感染患者在接受受HAV污染的血小板输血后死于暴发性肝炎，这一事实强调了对这类患者实施HAV疫苗接种计划的重要性。
