Fatal outcome of a hepatitis B virus transfusion-transmitted infection

Background and Objectives In 2008, hepatitis B virus (HBV) DNA testing was not yet mandatory for the screening of blood donations in Switzerland. At that time, HBsAg was the only specific mandatory marker for HBV. The importance of high sensitivity for HBV NAT screening is shown. Materials and Methods Donor and recipient of a transfusion-transmitted HBV infection were followed up. Multiple samples were tested for HBV serological and molecular markers. Results At donation, the donor appeared healthy, HBsAg was negative and had a normal ALAT level. Ten weeks later, clinical symptoms suggested acute HBV infection as was confirmed with positive HBsAg, HBeAg, anti-HBc IgG, anti-HBc IgM and anti-HBe. The archived sample from the original donation was negative for anti-HBc, but positive for HBV DNA (17 IU/ml). A recipient transfused with the red cell concentrate was HBV DNA positive (3100 IU/ml) 3 months post-transfusion. After five months, HBsAg, HBeAg, anti-HBc and HBV DNA (1 center dot 1 x 1011 IU/ml) were positive. Two weeks later, the patient died from complications associated with HBV infection and his underlying bone marrow disease. Conclusions The present case illustrates the importance of introducing highly sensitive HBV NAT screening strategy to prevent possible HBV transfusion-transmitted infections from donors with low viral load.