Transfusion Acquired Infection

What did the FDA and AABB eliminate and how did it help?

What did the FDA and AABB eliminate and how did it help?

- donors motivated by cash
- reduced risk of Hepatitis transmission
- raffle/lotteries now

autologous donation

donation for self re-transfusion for a future use

Allogenic donations

donations for public transfusions (or directed like for someone you know)

Once a donor passes the questionnaire, What diseases do they test for?

Hep B + C, HIV, HTLV, Syph, West nile, T. chagas, zika

Transfusion Associated Hepatitis (definition and symptoms)

- inflammation of the liver
- jaundice, dark urine, hepatomegaly, anorexia, malaise, fever, N/V

Hepatitis A

- oral-fecal (contaminated food/water or person-person)
- IgM anti-HAV for diagnosis
- vaccine available

Hepatitis B

- circular DNA
- bodily fluids
- first Ab to appear is anti-Hbc,
- HBIG prepped from ppl w/ high titer of anti-HBs

What is the clinical course for Hepatitis B?

Incubation (1st window), acute (symptoms, HBsAg + HBeAg, 2nd window), early recovery (anti-HBc IgM declines), recovery

What would be present in a patient that has recovered from a Hep B infection?

Anti-HBc, Anti-HBs, maybe Anti-HBe

What would be present in a patient who has received the Hep B vaccine?

Anti-HBs

What would be present in the window period of Hepatitis B?

DNA

Hepatitis C

- RNA
- transmitted through infected blood
- No vaccine (therapy uses pegylated IFN and ribavirin)

How would you differentiate a false positive and an infection?

RNA presence

Hepatitis D

- RNA (only infects HepB+ pts)
- IV drug users or transmitted sexually
- higher risk of fulminant hepatitis

Why is HDV testing not necessary for blood donors?

HBV is tested for and if there is no B > no D (B + units not used anyway)

Hepatitis E

- more in UK
- fecal oral route (contaminated water, pork, venison, and shellfish)
- chronic HEV in immunocompromised

Hepatitis G

- positive in 1-2% of donors (more common than C)
- transmitted by transfusion (IV drug users)
- treatment: interferon-alpha

What does Hep G do in HIV+ ppl?

slows the progression to AIDS

HIV types 1 and 2

- HIV-1: US HIV-2: Africa
- no definite cure (treatment lengthens life and improves quality)
- if unit +, it is destroy/donor is notified

For HIV 1, what bands are observed for gag, pol, env?

gag: p18, p24, p15 (core)
pol: p51 (reverse transcriptase)
env: gp41 (transmembrane protein)

If a donor unit screen comes up positive, what are the next steps?

a confirmation test is done, ALWAYS destroy the unit if any test is positive (contact the donor)

Human T-Cell Lymphotrophic Viruses I and II

- RNA retroviruses
- T- cell proliferation w/ persistent infection
- can self replicate in DNA (latent for years)

HTLV-I

Adult T-cell leukemia, transmitted vertically sexual or parenterally

HTLV-II

high rates in IV drug users

What could you do to a unit that is HTLV positive in order to transfuse it still?

leukocyte reduction

West Nile

- mosquito-bird life cycle
- infection from blood, organs, pregnancy, breast milk
- causes encephalitis, meningitis, and meningoencephalitis

Zika Virus

- test using NAT for ZIKV RNA
- mosquito
- defer any donor 28 days following travel in a zika country

Chagas disease

- T. cruzi (reduvid bug)
- nodule: chagoma
- central/south america
- transmission: donor, congenital, placenta, organ transplant

CMV

- not required test (important for babies or pregnant)
- transmitted by WBCs (leukocyte reduce)
- most ppl have had it by 40 y/o

EBV

- most ppl exposed by age 40
- infectious mono
- severe transplant rxns if immunocompromised/never exposed

Syphillis

- T. pallidum (spirochete)
- sexual contact or blood transfusions
- test: STS, PCR southern blot
- 12 month deferral period after treatment

Methods of pathogen Inactivation

- Heating inactivation
- Organic solvent and detergents destroy lipid-env viruses
- psoralen activated by UV light