2006 Volume 52 Issue 5 Pages 599-606
In October 2004, a case of Hepatitis B infection was reported to the Kanagawa Red Cross Blood Center. Individual nucleic amplification testing (ID-NAT) was perfomed to study 33 preserved blood samples of donors whose blood had been transfused to the patient. One donor, a 54-year-old male who had donated 78 times during the past 11 years, was found to be positive by ID-NAT. We had previously received reports from different hospitals of three patients with hepatitis. At that time, although a retrospective study was performed using ID-NAT, all the preserved blood samples were negative. Surprisingly, all three patients had received apheresis platelet concentrates derived from the propositus donor. DNA sequence analysis of the HBV of this donor and of three of the four patients revealed 99.8-9% homology and all were genotype C conclusively confirming that the hepatitis B was transmitted from this donor. We have succeeded in following-up the 12 patients for at least six months after transfusion. All had hematological malignancies and had been transfused during chemotherapy. Four patients did not show any change in serological markers where as four were positive, with transmission confirmed by changes in serological markers.
To our knowledge, this case is the first to demonstrate that it is not possible to detect all occult HBV carriers, even by the use of ID-NAT. Furthermore, this case demonstrates that even when a sample is ID-NAT-negative, blood from an occult HBV carrier is a possible source of HBV infection for immunocompromised patients.
