Retrospective analysis of blood transfusion recipients: evidence for post-transfusion hepatitis E.
OBJECTIVE
Of 200 volunteer blood donors we had screened earlier for hepatitis E virus (HEV) RNA, using reverse-transcription polymerase chain reaction, 3 were positive, raising the possibility of transfusion-associated hepatitis E in areas endemic for this virus. This retrospective study was to reassess the extent of post-transfusion hepatitis E among transfusion recipients, investigated in 1982.


METHODS
We re-evaluated 56 recipients followed biweekly for 3 months after transfusion. The controls were 51 normal, healthy persons who gave blood at a 2-month interval, as well as 412 blood donors from whom blood was taken once in 1982.


RESULTS
Of the 56 transfusion recipients, 19 were positive for IgG antibodies against HEV (anti-HEV) in the pretransfusion sample. Two of the 37 IgG anti-HEV-negative recipients seroconverted to IgM and IgG anti-HEV 5 and 4 weeks after transfusion, 1 with raised serum alanine aminotransferase levels. None showed symptoms of hepatitis. Attempts to detect HEV RNA in transfused blood, from aliquot units stored at -20 degrees C for over 17 years, were not successful. Of the controls, 17 out of 51 were IgG anti-HEV positive in the initial sample itself. None of the 34 IgG anti-HEV-negative controls seroconverted during the 2-month follow-up. Of the blood donors, 154 out of 412 were IgG anti-HEV positive. None of the 412 donors had circulating IgM anti-HEV antibodies. A significantly higher (p<0.03) proportion of susceptible transfusion recipients were IgM anti-HEV positive as compared with susceptible blood donors.


CONCLUSIONS
The results suggest that, in countries where HEV is endemic, the transmission of hepatitis E may be associated with blood transfusion.
Arankalle
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Hepatitis Division, National Institute of Virology, Indian Council of Medical Research, Pune, India. aarankalle@hotmail.com
Chobe
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D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D001782:Blood Donors; D005260:Female; D016751:Hepatitis E / Q000235:genetics / Q000276:immunology / Q000635:transmission*; D016752:Hepatitis E virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007194:India / Q000453:epidemiology; D008297:Male; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D065227:Transfusion Reaction
D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral; D000410:Alanine Transaminase