title: A Rare Case of Transfusion Transmission of Hepatitis A Virus to Two Patients with Haematological Disease.
abstract: BACKGROUND
  This paper describes the transmission of hepatitis A virus (HAV) to two blood recipients from a healthy donor that later presented to the blood bank with jaundice.
  
  
  METHODS
  The RNA of HAV was detected by qualitative nested reverse transcription polymerase chain reaction (nested RT-PCR) and quantified by real-time RT-PCR. HAV RNA samples were genotyped by direct sequencing of PCR products. A sequence from a fragment of 168 bp from the VP1/2A HAV region was used to construct a phylogenetic tree.
  
  
  METHODS
  A 31-year-old male donor accepted for donation of a whole blood unit returned to the blood bank with clinical jaundice 20 days after donation. His serological and NAT tests were negative for HBV and HCV. Serological tests for HAV IgM and IgG were negative on donation sample but positive on follow-up sample, confirming donor's HAV acute infection. Both recipients of red blood cells (R1) and platelet concentrate (R2) from the same implicated donation were HAV IgM-negative and IgG-positive. Qualitative PCR was positive on samples from all three individuals and phylogenetic analysis of viruses proved HAV transmission to the two recipients of blood products. HAV viral load on donor follow-up sample and the platelet recipient was 1.3 and 1.5 × 10(3) IU/ml, respectively. The RBC recipient, also infected by HCV, was undergoing bone marrow transplantation and died from fulminant hepatitis, 26 days after the implicated HAV transfusion.
  
  
  CONCLUSIONS
  The blood donor, a garbage collector, spontaneously returned to the blood bank when developing jaundice. This highlights the importance of donor education to immediately report to blood banks of any signs and symptoms related to infectious disease developed after blood donation. The fact that one immunocompromised patient with HCV infection died from fulminant hepatitis after receiving a HAV-contaminated platelet transfusion underpins the importance of a HAV vaccination program for these group of patients.
authors.affiliation: Serviço de Hemoterapia, HC1, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: Suely Gonçalves Cordeiro
authors.initials: SG
authors.lastname: da Silva
authors.affiliation: Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Luciane Almeida Amado
authors.initials: LA
authors.lastname: Leon
authors.affiliation: Coordenação de Pesquisa, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: Gilda
authors.initials: G
authors.lastname: Alves
authors.affiliation: Serviço de Hemoterapia, HC1, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: Selma Magalhães
authors.initials: SM
authors.lastname: Brito
authors.affiliation: Serviço de Hemoterapia, HC1, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: Valcieny de Souza
authors.initials: Vde S
authors.lastname: Sandes
authors.affiliation: Serviço de Hemoterapia, HC1, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: Magda Maria Adorno Ferreira
authors.initials: MM
authors.lastname: Lima
authors.affiliation: Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Marta Colares
authors.initials: MC
authors.lastname: Nogueira
authors.affiliation: Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Rita de Cássia Barbosa da Silva
authors.initials: Rde C
authors.lastname: Tavares
authors.affiliation: Serviço de Hematologia, HC1, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: Jane
authors.initials: J
authors.lastname: Dobbin
authors.affiliation: Coordenação de Pesquisa, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Apa
authors.affiliation: Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Vanessa Salete
authors.initials: VS
authors.lastname: de Paula
authors.affiliation: Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Jaqueline Mendes de Oliveira
authors.initials: JM
authors.lastname: Oliveira
authors.affiliation: Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Marcelo Alves
authors.initials: MA
authors.lastname: Pinto
authors.affiliation: Laboratório de Virologia Molecular, Instituto de Biologia da Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil.
authors.forename: Orlando da Costa
authors.initials: Oda C
authors.lastname: Ferreira
authors.affiliation: Serviço de Hemoterapia, HC1, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
authors.forename: Iara de Jesus Ferreira
authors.initials: Ide J
authors.lastname: Motta
keywords: Blood donor; Blood transfusion; Hepatitis A; Immunosuppression; Window period