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© 2010 American Association for Clinical Chemistry, Inc.
Clinical Case Study |
Commentary
Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA.
Address correspondence to the author at: Beth Israel Deaconess Hospital YA-309, 330 Brookline Ave, Boston, MA, 02215. Fax 617-667-4533; e-mail luhl{at}bidmc.harvard.edu.
In the wake of the recognition of transfusion-transmitted HIV, the blood-banking community introduced more extensive donor screening, improved donor testing, and postdonation product modification to improve blood supply safety and reduce the risk for transfusion transmitted infection (TTI). In addition to multiple predonation screening questions, in developed countries collected units are subjected to extensive laboratory screening, including nucleic acid testing for HIV/hepatitis C virus, and more recently hepatitis B virus and West Nile virus. Consequently, the risk for TTI has been reduced to levels ranging from 1/200 000 to 1/1–2 million transfusion episodes.
Despite these decreases in risk, ongoing surveillance for emerging infectious diseases potentially transmissible through blood transfusion is necessary (1). As noted by Tang et al., the arbovirus agent responsible for dengue fever is widely endemic in equatorial regions and there is accumulating evidence for the risk of transfusion transmitted dengue infection. Currently, however, no good screening questions have been formulated to identify donors at high risk for dengue-associated TTI, nor is there an acceptable donor-screening test that can be practically applied(1). Consequently, postdonation communication by a blood donor of a febrile illness within 7 days of donation is critical, as evidenced by this case report. Once the blood collection facility is presented with this information, it is incumbent on them to determine the risk for TTI, despite the low specificity of fever for a potential TTI. In most cases, blood collection facilities follow the precautionary principle and attempt to interdict release of blood components by initiating a market recall or withdrawal, often via a telephone call to the transfusion service that received the blood components in question(2). In response, the transfusion service screens its inventory to determine the disposition of the implicated blood product. If still in inventory, the blood product is immediately quarantined until further information from the collection facility is available regarding the safety for distribution. If the product has been released for transfusion, it is the responsibility of the transfusion service to alert the recipient’s physician regarding the risk for TTI and work with the physician to develop an action plan for further assessment and patient management. This case report illustrates the importance of coordinated teamwork between the blood collection facility, the department of laboratory medicine, and the clinical service in assessing the risk of TTI associated with a blood component for which concern was raised.
Acknowledgments
Author Contributions: All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article.
Authors’ Disclosures of Potential Conflicts of Interest: No authors declared any potential conflicts of interest.
Role of Sponsor: The funding organizations played no role in the design of study, choice of enrolled patients, review and interpretation of data, or preparation or approval of manuscript.
References
- Stramer SL, Hollinger FB, Katz LM, Kleinman S, Metzel PS, Gregory KR, Dodd RY. Emerging infectious disease agents and their potential threat to transfusion safety. Transfusion 2009;49:1S-29S.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
- Ramsey G. Managing recalls and withdrawals of blood components. Transfus Med Rev 2004;18:36-45.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
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