Transfusion-Transmitted Hepatitis E: NAT Screening of Blood Donations and Infectious Dose
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 revie...
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doaj-26989c877e6c4af6946f2f41f142b1322020-11-24T23:52:43ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2018-02-01510.3389/fmed.2018.00005323309Transfusion-Transmitted Hepatitis E: NAT Screening of Blood Donations and Infectious DoseJens Dreier0Cornelius Knabbe1Tanja Vollmer2Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein- Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, GermanyInstitut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein- Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, GermanyInstitut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein- Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, GermanyThe 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.http://journal.frontiersin.org/article/10.3389/fmed.2018.00005/fullhepatitis E virusblood donorblood safetyNAT testingtransfusion–transmission |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jens Dreier Cornelius Knabbe Tanja Vollmer |
spellingShingle |
Jens Dreier Cornelius Knabbe Tanja Vollmer Transfusion-Transmitted Hepatitis E: NAT Screening of Blood Donations and Infectious Dose Frontiers in Medicine hepatitis E virus blood donor blood safety NAT testing transfusion–transmission |
author_facet |
Jens Dreier Cornelius Knabbe Tanja Vollmer |
author_sort |
Jens Dreier |
title |
Transfusion-Transmitted Hepatitis E: NAT Screening of Blood Donations and Infectious Dose |
title_short |
Transfusion-Transmitted Hepatitis E: NAT Screening of Blood Donations and Infectious Dose |
title_full |
Transfusion-Transmitted Hepatitis E: NAT Screening of Blood Donations and Infectious Dose |
title_fullStr |
Transfusion-Transmitted Hepatitis E: NAT Screening of Blood Donations and Infectious Dose |
title_full_unstemmed |
Transfusion-Transmitted Hepatitis E: NAT Screening of Blood Donations and Infectious Dose |
title_sort |
transfusion-transmitted hepatitis e: nat screening of blood donations and infectious dose |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Medicine |
issn |
2296-858X |
publishDate |
2018-02-01 |
description |
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. |
topic |
hepatitis E virus blood donor blood safety NAT testing transfusion–transmission |
url |
http://journal.frontiersin.org/article/10.3389/fmed.2018.00005/full |
work_keys_str_mv |
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