Status:
Ready to upload
Record number:
1869
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Rare - only few published cases from platelet transfusion.
Time to detection:
5-10 days post transfusion
Alerting signals, symptoms, evidence of occurrence:
Fever was present in both cases reported in the literature; additional signs and symptoms include pancytopenia, elevated liver function tests, and elevated creatinine. Additionally, peripheral blood smear revealed morulae.
Demonstration of imputability or root cause:
The source blood center evaluated the whole blood of the donors who contributed to the pooled platelets. One donor had a positive PCR testing for Anapslama phagocytophilum, as well as ELISA IgM and IgG for Anaplasma. With regards to the recipient, her peripheral smear from the index hospitalization (during which she received platelets) was reviewed and did not show morulae. During the hospitalization for anaplasmosis, she had morulae on her peripheral smear. Additionally, during her anaplosmosis hospitalization her admission testing was positive via PCR for Anasplasma and negative for IFA serology for A. phagocytophilum. Retesting of IFA two weeks after hospitalization resulted as positive, indicating seroconversion.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Suggest new keywords:
Anaplasma
Anaplasmosis
A. phagocytophilum
Reference attachment:
Suggest references:
Antonella B. Fine, et al. Transfusion-transmitted anaplasmosis from a leukoreduced platelet pool. Transfusion. 2016 Mar;56(3):699-704
Expert comments for publication:
A low innoculum is required for infection, estimated to be 2000-3000 neutrophils, and thus leukoreduction of platelets does not prevent transmission. During periods of increased tick activity (spring, summer and fall), the presence of sudden pancytopenia, fevers, elevated liver function tests and elevated creatinine should raise concerns for possible transfusion related anaplasmosis -- especially if it rapidly progresses to hypoxic respiratory failure and shock.
Anaplasma is spread via Ixodes ticks, specificaly Ixodes scapularis and Ixodes pacificus in the United States (Northeast, Upper Midwest, and West Coast) and Ixodes ricinus in Europe (Scandinavia and Central Europe). Cases have emerged in China, Japan, and Korea.