Red blood cell transfusion‐transmitted acute hepatitis E in an immunocompetent subject in Europe: a case report

• Published in: Transfusion (Philadelphia, Pa.) Vol. 57; no. 2; pp. 244 - 247
• Main Authors: Riveiro‐Barciela, Mar, Sauleda, Silvia, Quer, Josep, Salvador, Fernando, Gregori, Josep, Pirón, María, Rodríguez‐Frías, Francisco, Buti, Maria
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2017
• Subjects: Acute Disease; Aneurysm, Infected - blood; Aneurysm, Infected - microbiology; Aneurysm, Infected - therapy; Antibodies, Viral - blood; Blood transfusion; Case reports; Drugs; Erythrocyte Transfusion; Erythrocytes; Genotypes; Hepatitis; Hepatitis E - blood; Hepatitis E - etiology; Hepatitis E - genetics; Hepatitis E - transmission; Hepatitis E virus - genetics; Humans; Immunocompetence; Immunoglobulin M; Jaundice; Male; Middle Aged; Mycobacterium bovis; Mycotic aneurysm; Patients; Phylogeny; Ribonucleic acid; Risk analysis; Risk factors; RNA; RNA viruses; RNA, Viral - blood; RNA, Viral - genetics; Transfusion; Tuberculosis - blood; Tuberculosis - microbiology; Tuberculosis - therapy; Viruses; Europe
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.13876

BACKGROUND Acute hepatitis E in industrialized countries is usually related to intake or manipulation of undercooked or raw meat. Cases of transfusion‐transmitted hepatitis E have rarely been documented in immunosuppressed patients, mainly after receiving frozen plasma. STUDY DESIGN AND METHODS A 61‐year‐old man was admitted to hospital for jaundice. His personal history included disseminated bacillus Calmette‐Guerin infection treated with antituberculous drugs. He had received red blood cell (RBC) transfusion 2 months previously, during admission for mycotic aneurysm surgery. Since liver function tests worsened despite stopping antituberculous drugs, other causes of acute hepatitis were explored. RESULTS Acute hepatitis E was diagnosed by the presence of both immunoglobulin M and hepatitis E virus (HEV) RNA. Traceback procedure for the 8 RBC units was carried out, and one of the eight archive plasma samples tested positive for HEV RNA, with an estimated viral load of 75,000 IU/mL. Phylogenetic analysis revealed the same HEV strain Genotype 3 in one of the transfused RBC products and in the patient's serum sample. CONCLUSION Transfusion of RBCs with detectable HEV RNA is a risk factor for acute hepatitis E in immunocompetent patients in Europe.