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Transfusion-acquired hepatitis A
1Department of Pediatrics, University of Oklahoma College of Medicine-Tulsa 74136.
Insights
Hepatitis A outbreak linked to blood transfusion in a neonatal unit. Despite screening, infected blood products transmitted the virus, causing illness in some recipients and their contacts.
Area of Science:
- Hepatology
- Infectious Diseases
- Transfusion Medicine
Background:
- Hepatitis A virus (HAV) is a significant cause of acute liver inflammation.
- Blood transfusion is a potential route for pathogen transmission, necessitating rigorous screening protocols.
- Recent implementation of alanine aminotransferase (ALT) testing aims to mitigate transfusion-transmitted infections.
Observation:
- An outbreak of hepatitis A occurred in a neonatal intensive care unit (NICU).
- The outbreak was linked to a single unit of packed red blood cells and platelets from an infected donor.
- Several infants in the NICU received components from the implicated blood unit.
Findings:
- Four infants exposed via transfusion showed serologic evidence of recent hepatitis A infection, though remained asymptomatic.
- Symptomatic hepatitis A developed in several staff and family members exposed to the infants.
- An adult recipient of platelets from the same unit developed elevated liver enzymes, and his wife also showed serologic evidence of infection.
Implications:
- This case highlights the risk of transfusion-transmitted hepatitis A, even with current screening measures like ALT testing.
- It underscores the importance of donor vigilance and potential for occult hepatitis A transmission.
- Further strategies may be needed to enhance the safety of blood products against hepatitis A.
Abstract:
An outbreak of hepatitis A in a neonatal intensive care unit was apparently attributable to blood transfusion. Several infants received aliquots from a single unit of packed red blood cells donated by an individual who subsequently became ill with hepatitis A. Although none of the infants became symptomatic, there was serologic evidence of recent exposure in four. Several staff and family members exposed to these infants became symptomatic. An adult patient who received platelets from this same unit developed elevated liver enzymes and his wife also showed serologic evidence of hepatitis A. These are the first reported cases of hepatitis A associated with a blood transfusion since implementation of alanine aminotransferase testing.