• Improvements in public health have reduced the risk of transfusion infection. Today, the risk of transfusion infections is much less than that of transfusion reactions.
• Bacterial infection remains the most frequent infectious complication, while viral and parasitic infections are also possible. Additionally, a more mobile donor population has increased the variety of infections found in the blood supply.

• Donor population
• Technique of blood collection
• Storage conditions

• CMV. Usually asymptomatic; those who develop symptoms may experience an illness resembling infectious mononucleosis (fever, swollen glands, fatigue). In compromised immune systems, serious illness involving fever, pneumonia, liver infection, anemia, and retinitis. Symptomatic babies can develop nervous system damage and developmental disabilities.
• Enterovirus. 66 human enterovirus serotypes have been identified (e.g., polioviruses, Coxsackie A viruses, Coxsackie B viruses, and echoviruses). Symptoms can range from mild respiratory illness (common cold), GI infection, "hand, foot and mouth" disease, pleurodynia, acute hemorrhagic conjunctivitis, herpangina, aseptic meningitis, myocarditis, severe neonatal sepsis-like disease, to acute flaccid paralysis.
• EBV (herpes virus HHV-4). Can cause infectious mononucleosis 35–50% of the time. It increases the risk of developing Burkitt's lymphoma, nasopharyngeal carcinoma, and B-cell lymphoma in the immunocompromised patients.
• Hepatitis A is self-limited and without chronic manifestations; not tested by the blood bank.
• Hepatitis B is an acute infection that can cause fulminant hepatitis. 6–10% of infected patients become chronic carriers. Chronic HBV infection can lead to cirrhosis and hepatocellular carcinoma.
• Hepatitis C. 80% of infected people are asymptomatic. Acute infection can cause flu-like symptoms, jaundice, abdominal pain, fatigue, and decreased appetite. Chronic infections can lead to cirrhosis and hepatocellular carcinoma.
• HIV. Many infected people may show little or no symptoms until years later. Within the first few weeks of infection, one may have flu-like symptoms. Years later, lymphadenopathy, diarrhea, weight loss, fever, cough, shortness of breath, and progression to AIDS can result. In addition, they may experience soaking night sweats, chills, fever >38°C for several weeks, persistent lesions in the mouth, headaches, blurred vision, and skin lesions.
• Human parvovirus B19 causes mild symptoms in healthy patients (slapped cheeks in children, limited arthritis, cold-like symptoms in adults). Parvovirus can cause aplastic anemia in AIDS patients, aplastic crisis in patients with sickle cell anemia and hereditary spherocytosis, and hydrops fetalis due to severe fetal anemia resulting in miscarriage or stillbirth in pregnant women.
• HTLV is associated with the development of acute T-cell leukemia/lymphoma.
• WNV. 80% of infected people are asymptomatic. Of those who show symptoms, most have flu-like symptoms. 1 in 150 will develop severe illness ranging from high fever and neck stiffness to stupor, disorientation, coma, tremors, convulsions, and paralysis. Symptoms may last for weeks, and neurological effects may be permanent.
• Bacteremia signs and symptoms can include high fever, high white cell count (if the patient is not neutropenic), tachypnea, tachycardia, hypotension, to GI symptoms such as nausea, vomiting or abdominal pain. Escherichia coli: Diarrhea, usually bloody, and can lead to kidney failure. Klebsiella oxytoca: Pneumonia, diarrhea. Klebsiella pneumonia: Pneumonia, empyema. Pseudomonas aeruginosa: Endocarditis, meningitis, brain abscess, osteomyelitis, malignant otitis externa, characteristic skin lesions called ecthyma gangrenosum. Serratia marcescens: Pneumonia, meningitis, and cerebral abscess, osteomyelitis, skin ulcers. Staphylococcus aureus: Endocarditis, pneumonia. Staphylococcus lugdunensis: Endocarditis.
  • Syphilis (Treponema pallidum): 4 stages of syphilis with different presentations. Stage 1 or primary syphilis – skin lesion (chancre); stage 2 or secondary syphilis – rash on palms of hands and bottoms of feet and mucus lesions, sometimes accompanied by lymphadenopathy; Stage 3 or latent syphilis – asymptomatic but can infect others; Stage 4 or tertiary syphilis – can affect multiple organs with gummata, cardiovascular syphilis, neurosyphilis.
  • Yersinia spp.: Abscess in liver, kidney, spleen, lungs, cellulitis, pyomyositis, pneumonia, meningitis, panophthalmitis, endocarditis, osteomyelitis, infected mycotic aneurysm
• Parasitic infections
  • Babesiosis: Tick-borne malaria-like illness caused by species of the intraerythrocytic protozoan Babesia. Symptoms include fever, hemolytic anemia, and hemoglobinuria.
  • Chagas disease: Acute stage symptoms can include flu-like symptoms, myocarditis, and mengoencephalitis. Chronic disease affects the nervous system (encephalopathy, dementia, motor deficits), digestive system (megacolon and megaesophagus), and heart (cardiomyopathy).
  • Malaria: Ranging from flu-like symptoms to anemia, jaundice, convulsion, and coma.
• Other. vCJD is a rapidly progressive dementia accompanied by physical and speech impairment as well as seizures.

• The Abbreviated Donor History Questionnaire (ADHQ) focuses on querying donors about factors that best predict recent infection.
  • Today: "Are you feeling well and healthy today?"
  • In the past 12 months have you: "Had a blood transfusion?" "Had a transplant such as organ, tissue, or bone marrow?" "Had a graft such as bone or skin?" "Come into contact with someone else's blood?" "Had an accidental needle-stick?" "Had sexual contact with anyone who has HIV/AIDS or has had a positive test for the HIV/AIDS virus?" "Had sexual contact with a prostitute or anyone else who takes money or drugs or other payment for sex?" "Had sexual contact with anyone who has ever used needles to take drugs or steroids, or anything not prescribed by their doctor?" "Had sexual contact with anyone who has hemophilia or has used clotting factor concentrates?" "Had sexual contact with a person who has hepatitis?" "Had a tattoo?" "Had ear or body piercing?" "Had or been treated for syphilis or gonorrhea?" "Been in juvenile detention, lockup, jail, or prison for more than 72 hours?" Female donors: "Had sexual contact with a male who has ever had sexual contact with another male?"
  • In the past three years have you: "Been outside the United States or Canada?"
  • From 1980 to the present, did you: "Spend time that adds up to five years or more in Europe?" "Receive a blood transfusion in the United Kingdom?"
  • From 1977 to the present, have you: "Received money, drugs, or other payments for sex?" Male donors: "Had sexual contact with another male, even once?"
  • Have you ever: "Had a positive test for the HIV/AIDS virus?" "Used needles to take drugs, steroids, or anything not prescribed by your doctor?" "Used clotting factor concentrates?" "Had hepatitis?" "Had malaria?" "Had Chagas’ disease?" "Had babesiosis?" "Received a dura mater (or brain covering) graft?" "Had sexual contact with anyone who was born in or lived in Africa?" "Been in Africa?" "Have any of your relatives had Creutzfeldt-Jakob disease?"
• Proper collection technique at donation involves sterilizing the donor's skin prior to phlebotomy and diverting the first 10–30 cc of blood collected into an integral pouch separate from the collection bag.
• Cold storage inhibits infectious growth; syphilis disappears
• Preferential use of apheresis platelets reduces donor exposure
• Leukoreduction of donor units is indicated in immunocompromised and immunologically naïve patients for CMV (reduces the risk of infection), enterovirus (risk of infection negligible), EBV, Chagas disease.
• Pathogen reduction methods or pathogen inactivation/reduction technologies (PRTs) (6) involves the use of heat treatment, solvent/detergent (S/D) treatment, and filtration methods for fractionated plasma-derived therapeutics. Other methods used in Europe but not yet adopted in the US include methylene blue treated FFP, use of the helix/intercept system or intercept platelet system (which prevents DNA replication), and use of riboflavin and light treatment for platelets
• Use of viral and bacterial detection methods (NATs, serology tests, and antibody binding)
  • CMV: Particle agglutination and enzyme-linked immunosorbent assay (ELISA) test
  • Viral screening of blood units: NAT (nucleic acid testing or nucleic acid amplification technique) HBV DNA NAT, HCV RNA NAT, HIV RNA NAT, WNV NAT
  • HTLVl/ll: Antil-HTLVI and anti-HTLVll
  • Syphilis: Treponemal test
  • T. cruzi antibody screening

• Blood transfusion reaction
• Infection from other sources

• Infectious Disease in Healthcare Workers
• Platelets
• Transfusion-Related Lung Injury (TRALI)
• Postoperative Jaundice
• Hepatitis C

999.34 Acute infection following transfusion, infusion, or injection of blood and blood products

T80.22XA Acute infct fol tranfs,infusn,inject blood/products, init

Anh-Thuy Nguyen , MD