Transfusion-associated Anaplasma phagocytophilum infection in a pregnant patient with thalassemia trait: a case report.
BACKGROUND
Human granulocytic anaplasmosis (HGA) is an acute nonspecific febrile illness caused by the bacterium Anaplasma phagocytophilum. Although usually transmitted via tick bite, HGA may rarely also be acquired through transfusion. HGA during pregnancy may pose significant gestational risks due to altered maternal immune status and the potential for perinatal transmission.


METHODS
A pregnant 34-year-old Massachusetts woman with β-thalassemia trait was diagnosed at 32 weeks of gestation with transfusion-associated HGA (TAHGA) after receiving nine leukoreduced red blood cell transfusions. She was successfully treated with rifampin therapy and gave birth to a healthy child who tested negative for HGA after delivery. An implicated blood donor was subsequently identified through physician collaboration with the regional American Red Cross and Massachusetts Department of Public Health.


CONCLUSIONS
This is the 11th reported case of HGA in pregnancy and is at least the sixth known case in which leukoreduction did not prevent TAHGA. As seen in this case, nonspecific symptomatology of variable onset can impede diagnosis and treatment. This may increase risk of poor outcomes in maternal HGA patients. Cases of TAHGA, although currently uncommon, may increase as the incidence of HGA in certain parts of the country increases.


CONCLUSIONS
Heightened cross-institutional awareness of the potential risk of TAHGA is warranted. Clinicians need to consider transfusion-associated infections when fever occurs in a transfusion recipient. This case provides additional evidence that leukoreduction does not obviate risk of A. phagocytophilum contamination of donated blood components.
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.|Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Kelsey
K
Shields
Division of Epidemiology and Immunization, Massachusetts Department of Public Health, Boston, Massachusetts.
Melissa
M
Cumming
Massachusetts Region of the American Red Cross Blood Services, Dedham, Massachusetts.
Jorge
J
Rios
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Michael T
MT
Wong
Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Jeffrey I
JI
Zwicker
American Red Cross, Gaithersburg, Maryland.
Susan L
SL
Stramer
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Carolyn D
CD
Alonso
D041081:Anaplasma phagocytophilum / Q000276:immunology / Q000302:isolation & purification*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000635:transmission*; D001782:Blood Donors; D058731:Blood Safety; D057210:Delayed Diagnosis; D016873:Ehrlichiosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007231:Infant, Newborn; D047589:Leukocyte Reduction Procedures; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy*; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012293:Rifampin / Q000627:therapeutic use; D017086:beta-Thalassemia / Q000150:complications / Q000628:therapy*
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D012293:Rifampin