REACTIVATION OF HEPATITIS B VIRUS (HBV) IN A MULTI-TRANSFUSED PATIENT

—CONFIRMATION BY LOOK-BACK STUDY USING STORED SPECIMENS—

Abstract

Viral infection in the post-transfusion period is not always the result of the transfusion, especially if the patient has occult hepatitis B virus (HBV) infection. The look-back study using stored specimens of patients and blood donors is an effective way of confirming whether the infection occurred through transfusion or reactivation. We experienced a case of HBV reactivation in a multi-transfused patient after chemotherapy and peripheral blood stem cell transplantation (PBSCT), which could be confirmed by testing HBV markers with stored specimens both from the patient and blood donors.
A female patient with multiple myeloma in her 50s received intensive chemotherapy and autologous stem cell transplantation. Between Sep 2003 and Oct 2004, she received 305 units of platelet concentrates derived from 19 donors and 20 units of red cell concentrates derived from 15 donors.
One year after this intensive treatment, HBV was detected in her serum for the first time. Since she was HBsAg-negative at pretransfusion (August 2002), HBV transmission by transfusion was suspected. A pretransfusion specimen in September 2003 and 9 consecutive posttransfusion specimens were HBsAg (-), HBsAb (+), HBcAb (+) and HBV-DNA (-). All the stored specimens of the blood donors were negative for HBV-DNA. HBsAb reactivities of her specimens tended to decline and finally became undetectable in September 2005. Thus, it is highly likely that she had occult HBV infection in the pre-transfusion period and that her HBV was reactivated, probably by the chemotherapy and/or PBSCT.