Retrospective Analysis of Blood Transfusion Recipients: Evidence for Post‐Transfusion Hepatitis E

Background and Objectives: Of 200 volunteer blood donors we had screened earlier for hepatitis E virus (HEV) RNA, using reverse‐transcription polymerase chain reaction, 3 were positive, raising the possibility of transfusion‐associated hepatitis E in areas endemic for this virus. This retrospective study was to reassess the extent of post‐transfusion hepatitis E among transfusion recipients, investigated in 1982. Materials and Methods: We re‐evaluated 56 recipients followed biweekly for 3 months after transfusion. The controls were 51 normal, healthy persons who gave blood at a 2‐month interval, as well as 412 blood donors from whom blood was taken once in 1982. Results: Of the 56 transfusion recipients, 19 were positive for lgG antibodies against HEV (anti‐HEV) in the pretransfusion sample. Two of the 37 lgG anti‐HEV‐negative recipients seroconverted to lgM and lgG anti‐HEV 5 and 4 weeks after transfusion, 1 with raised serum alanine aminotransferase levels. None showed symptoms of hepatitis. Attempts to detect HEV RNA in transfused blood, from aliquot units stored at −20°C for over 17 years, were not successful. Of the controls, 17 out of 51 were lgG anti‐HEV positive in the initial sample itself. None of the 34 lgG anti‐HEV‐negative controls seroconverted during the 2‐month follow‐up. Of the blood donors, 154 out of 412 were lgG anti‐HEV positive. None of the 412 donors had circulating lgM anti‐HEV antibodies. A significantly higher (p<0.03) proportion of susceptible transfusion recipients were lgM anti‐HEV positive as compared with susceptible blood donors. Conclusion: The results suggest that, in countries where HEV is endemic, the transmission of hepatitis E may be associated with blood transfusion.