Dreier Jens, Knabbe Cornelius, Vollmer Tanja
Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein- Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Front Med (Lausanne). 2018 Feb 1;5:5. doi: 10.3389/fmed.2018.00005. eCollection 2018.
The risk and importance of transfusion-transmitted hepatitis E virus (TT-HEV) infections by contaminated blood products is currently a controversial discussed topic in transfusion medicine. The infectious dose, in particular, remains an unknown quantity. In the present study, we illuminate and review this aspect seen from the viewpoint of a blood donation service with more than 2 years of experience in routine HEV blood donor screening. We systematically review the actual status of presently known cases of TT-HEV infections and available routine NAT-screening assays. The review of the literature revealed a significant variation regarding the infectious dose causing hepatitis E. We also present the outcome of six cases confronted with HEV-contaminated blood products, identified by routine HEV RNA screening of minipools using the highly sensitive RealStar HEV RT-PCR Kit (95% LOD: 4.7 IU/mL). Finally, the distribution of viral RNA in different blood components [plasma, red blood cell concentrate (RBC), platelet concentrates (PC)] was quantified using the first WHO international standard for HEV RNA for NAT-based assays. None of the six patients receiving an HEV-contaminated blood product from five different donors (donor 1: RBC, donor 2-5: APC) developed an acute hepatitis E infection, most likely due to low viral load in donor plasma (<100 IU/mL). Of note, the distribution of viral RNA in blood components depends on the plasma content of the component; nonetheless, HEV RNA could be detected in RBCs even when low viral plasma loads of 100-1,000 IU/mL are present. Comprehensive retrospective studies of TT-HEV infection offered further insights into the infectivity of HEV RNA-positive blood products. Minipool HEV NAT screening (96 samples) of blood donations should be adequate as a routine screening assay to identify high viremic donors and will cover at least a large part of viremic phases.
受污染血液制品传播戊型肝炎病毒（TT-HEV）感染的风险和重要性，目前是输血医学中一个备受争议的讨论话题。尤其是感染剂量，仍然是一个未知数。在本研究中，我们从一家在戊型肝炎病毒献血者常规筛查方面有超过两年经验的血液服务机构的角度，阐明并回顾了这一方面。我们系统地回顾了目前已知的TT-HEV感染病例的实际情况以及可用的常规核酸检测筛查方法。文献综述显示，导致戊型肝炎的感染剂量存在显著差异。我们还介绍了6例接触到戊型肝炎病毒污染血液制品的病例结果，这些病例是通过使用高灵敏度的RealStar HEV RT-PCR试剂盒（95%最低检测限：4.7 IU/mL）对混合样本进行常规戊型肝炎病毒RNA筛查确定的。最后，使用世界卫生组织首个基于核酸检测的戊型肝炎病毒RNA国际标准，对不同血液成分[血浆、红细胞浓缩物（RBC）、血小板浓缩物（PC）]中的病毒RNA分布进行了定量。从5名不同献血者（献血者1：RBC，献血者2 - 5：APC）接受了戊型肝炎病毒污染血液制品的6名患者中，没有一人发生急性戊型肝炎感染，这很可能是由于献血者血浆中病毒载量较低（<100 IU/mL）。值得注意的是，病毒RNA在血液成分中的分布取决于该成分的血浆含量；尽管如此，即使血浆病毒载量低至100 - 1000 IU/mL，在红细胞中也能检测到戊型肝炎病毒RNA。对TT-HEV感染的全面回顾性研究，为戊型肝炎病毒RNA阳性血液制品的传染性提供了进一步的见解。对献血进行混合样本戊型肝炎病毒核酸检测筛查（96份样本）作为常规筛查方法，应足以识别高病毒血症献血者，并且至少能覆盖大部分病毒血症阶段。
