COVID-19 transmission and blood transfusion: A case report

Abstract

The recent outbreak of the novel coronavirus disease 2019 (COVID-19) has been labelled as a pandemic by the World Health Organization. Although person-to-person transmission of the etiologic agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been confirmed, it is not known whether COVID-19 may be transmitted by blood transfusion. Notwithstanding the urgent requirement of blood, it is critical to know whether the SARS-CoV-2 virus can be transmitted by blood transfusion because many individuals may be asymptomatic carriers and may donate blood. Several cases in which specific viral RNA could be detected in the serum from patients with COVID-19 have already been reported; these findings suggest that blood donation may be an unexplored route of transmission. However, the American Association of Blood Banks and Centers for Disease Control and Prevention have not recommended any specific SARS-CoV-2-related actions to be taken at blood collection centres at this time. In this report, we describe a case of a 21-year-old man with very severe aplastic anaemia who received apheresis platelet transfusion from an individual who was subsequently diagnosed with COVID-19. Our patient tested negative for COVID-19 and is awaiting allogeneic stem cell transplantation.

Introduction

Beginning in late December 2019, there were numerous cases emerging from Wuhan, Hubei Province, China, of a new type of severe pneumonia of unknown etiology [1,2]. The etiologic pathogen has since been identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); this virus has since spread rapidly to many countries throughout the world [3]. The SARS-CoV-2 outbreak has currently been labelled as a pandemic by the World Health Organization.

Person-to-person transmission of SARS-CoV-2 has already been confirmed [4]. Contact with respiratory secretions from virus-infected individuals is currently known to be the main route of transmission, although there are reports of virus transmission via aerosol droplets and physical contact [5]. However, it is not known whether the novel coronavirus disease 2019 (COVID-19) can also be transmitted by blood transfusion. Patients with haematologic diseases such as aplastic anaemia may require frequent blood transfusions; as such, it is critical to ensure that all donations are from clearly healthy people as few people are ready to donate blood currently. Notwithstanding the urgent requirement of blood, it is critical to know whether the SARS-CoV-2 virus can be transmitted by blood transfusion because many individuals may be asymptomatic carriers and may donate blood. Although SARS-CoV-2 RNA has been detected in serum or plasma from infected patients, there are no data or cases suggesting the risk of transmission of SARS-CoV-2 via blood transfusion [6].

Here, we report the case of a 21-year-old man with severe aplastic anaemia who received platelet transfusion from an individual who was infected with SARS-CoV-2.

Case

A 21-year-old Korean male was diagnosed with very severe aplastic anaemia in November 2019. His bone marrow was pan-cytopenic at presentation (10% of normal); his condition did not improve in response to immunosuppressive therapy with anti-thymocyte globulin and cyclosporin. He underwent multiple transfusions in preparation for an allogeneic haematopoietic stem cell transplantation. In February 2020, he presented at an outpatient clinic with petechiae and epistaxis. He was admitted to the haematology department for platelet transfusion and supportive care. At the time of admission, his vital signs were stable and he had no fever; his general condition was good, and he presented with no evidence of infection and was classified as having an Eastern Cooperative Oncology Group performance status of 1. His initial complete blood count included a WBC count of 270/mm³ (absolute neutrophil count, 30/mm³), Hb of 8.1 g/dl and a platelet count of 7,000/mm³. Immediately upon admission, he was transfused with apheresis platelets from a presumably healthy donor.

One day after the platelet transfusion, the blood bank notified our department that the platelet donor had been subsequently diagnosed with COVID-19. The blood products were collected 2 days before the platelet transfusion took place; the donor was perceived to be healthy and had no fever or respiratory symptoms at that time. The platelet recipient was tested for SARS-CoV-2 using real-time reverse transcription (RT)-PCR; the result was negative. The patient did not show any symptoms of infection, and there was no evidence of pneumonia on chest computed tomography. Three more tests for SARS-CoV-2 were performed; all of the results were negative (Fig. 1 ). The patient has remained stable and is now being prepared for the scheduled allogeneic haematopoietic stem cell transplantation.

Fig. 1.

Timeline of the platelet donor and recipient.

Discussion

COVID-19 can be transmitted from asymptomatic individuals; this feature may play a critical role in this pandemic status [7]. Furthermore, the mean incubation period for SARS-CoV-2 infection has been reported to be from 0 to 14 days. In this case, transfusion of blood products obtained from infected individuals who had not yet developed signs and symptoms of COVID-19 did not result in disease transmission, even though, the platelet recipient was diagnosed with very severe aplastic anaemia and was taking immunosuppressive drugs.

Interestingly, there are existing pathogen inactivation technologies that might minimise the risk of transmission of SARS-CoV-2 via blood transfusion; coronaviruses are highly susceptible to heat inactivation and/or denaturation at acidic or basic pH [8], although there is concern that these methodologies might damage blood components. The American Association of Blood Banks (AABB) and Centers for Disease Control and Prevention (CDC) currently do not recommend any specific SARS-CoV-2-related actions by blood collection establishments [6]. Meanwhile, the European Center for Disease Prevention and Control (ECDC) suggests a precautionary deferral from donation of blood for 21 days after any possible exposure to confirmed patients [9]. Additionally, those recovering from COVID-19 should avoid donating blood for at least 28 days after symptom resolution and completion of therapy [9].

SARS-CoV-2 infection can result in a spectrum of diseases, from mild respiratory symptoms to severe, life-threatening pneumonia. Therefore, it is critical to consider the potential for transmission of this infection by blood transfusion.

Funding

No funding sources.

Competing interests

None declared.

Ethical approval

Not required.