Parvovirus B19-Infektion nach Transfusion enes Pathogen-inaktiviertes Thrombozytenkonzentrat: eine Fallvorstellung
Solari Daria (Lugano / CH), Serricchio Mauro (Bern / CH), Motta Maddalena (Lugano / CH), Nadja Widmer (Bern / CH), Gowland Peter (Bern / CH), Niederhauser Christoph (Bern / CH; Berne / CH), Fontana Stefano (Lugano / CH; Lausanne / CH)
Parvovirus B19 (B19) is moderately resistant to the inactivation methods used for platelet concentrates. Approximately 30% of donors are seronegative and susceptible for new B19 infections. B19 nucleic acid testing (NAT) is generally not required to release blood products. In Switzerland the Blood Transfusion Centers test B19 NAT for plasma fractionation. Results are normally available after the release of the blood products and, according to the national prescriptions, are handled by post donation information.
We describe the case of a B19 primo-infection transmitted by transfusion of a UVA and Amotosalen-treated pooled platelet concentrate (PC) to a seronegative patient in treatment for aplastic anemia. In donor and patient samples before and after the transfusion we performed B19 NAT viremia, IgG and IgM serologies, and phylogenetic analyses in viremic samples. Additionally, we collected relevant clinical and laboratory data.
At d0 the patient received a pathogen-reduced pooled PC including a B19 NAT-positive donation with a viral load of 9.1E+11 IU/mL, negative IgM, and negative IgG. The donor was a 42-y.o. asymptomatic male without recent history of B19 contact. At d 2 post transfusion B19 was detectable in the recipient, with a viral load of 36201 IU/mL. The highest viral load of 7.94E+09 IU/mL and a IgM seroconversion (9.2, index) were observed at d14. IgG seroconversion was observed at d26 (30, index). With i.v. immunoglobulin treatment at d14-15 the patient remained asymptomatic. At d39 the viral load has dropped to 19"040 IU/mL. Phylogenetic analysis demonstrated identity between the donor"s and patient"s B19 DNA sequences.
This is, at our knowledge, the second case describing a direct transmission of B19 by a PC treated with a pathogen reduction technology, and the first case documenting the development of an infection in the recipient. B19 is not considered as a safety concern in transfusion medicine. However, it should be kept in mind that some pathogens may be transmitted by transfusion of pathogen reduced products, and procedures should be in place to detect these cases and take appropriate measures in the patients.
No conflict of interests related to the present abstract.