Probable and possible transfusion‐transmitted dengue associated with NS1 antigen–negative but RNA confirmed‐positive red blood cells. Issue 1 (7th September 2015)

• Record Type: Journal Article
• Authors: Matos, Desiree; Tomashek, Kay M.; Perez‐Padilla, Janice; Muñoz‐Jordán, Jorge; Hunsperger, Elizabeth; Horiuchi, Kalanthe; Noyd, David; Winton, Colleen; Foster, Gregory; Lanteri, Marion; Linnen, Jeffrey M.; Stramer, Susan L.
• Is Part Of: Transfusion. Volume 56:Issue 1(2016:Feb.)
• Page Start: 215
• Page End: 222
• Publication Date: 2015-09-07
• Subjects: Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.13288
• Languages: English
• ISSNs: 0041-1132

Abstract

Abstract : BACKGROUND: In the absence of active blood donation screening, dengue viruses (DENV) have been implicated in only a limited number of transfusion transmissions worldwide. This study attempted to identify if blood from donors testing negative by an NS1‐antigen (Ag) enzyme‐linked immunosorbent assay (ELISA) but confirmed positive for DENV RNA caused DENV‐related disease in recipients during the epidemic years of 2010 to 2012 in Puerto Rico. STUDY DESIGN AND METHODS: Donation aliquots testing negative by an investigational NS1‐Ag ELISA were stored frozen and retested retrospectively using a research transcription‐mediated amplification assay (TMA) detecting DENV RNA. All RNA‐reactive donations were subject to confirmatory RNA and antibody testing. Recipient tracing was conducted for all components manufactured from TMA‐reactive components. Medical chart review, recipient interview, and follow‐up sampling occurred for 42 recipients transfused with TMA‐reactive components. RESULTS: Six of 42 recipients developed new‐onset fever in the 2 weeks posttransfusion; three (50%) received RNA confirmed‐positive, NS1‐Ag–negative red blood cell (RBC) units. One recipient of a high‐titer unit (7 × 10 7 DENV‐4 RNA copies/mL) developed severe dengue, and a second recipient had only fever recorded but had a negative sepsis work‐up. New fever attributable to DENV infection in a third recipient was confounded by fever potentially attributable to posttransfusion sepsis. CONCLUSIONS: In our retrospective study, NS1‐Ag detected 20% of all RNA confirmed‐positive donations demonstrating limitations of NS1‐Ag ELISA for blood donation screening. We identified one recipient with a clinical syndrome compatible with severe dengue who had received an NS1‐Ag–negative but RNA confirmed‐positive RBC unit. This investigation illustrates the difficulty in confirming transfusion transmission in dengue‐endemic areas among severely ill transfusion recipients.