Asymptomatic chlamydia urinary tract infection (UTI) and donor eligibility
A Japanese physician and donor center medical director reports a case of a male blood donor who appeared to be in excellent health at the time of a May 2003 whole blood donation. The following month, in July 2003, the donor's current girlfriend developed a symptomatic UTI with Chlamydia. As part of her medical assessment, the male donor was tested and discovered to also be infected with Chlamydia. The girlfriend was adamant that she could only have acquired her Chlamydia infection from her male friend. Consequently, a previous girlfriend of the male donor was tested, and she, too, was discovered to be infected with Chlamydia. The male donor denies any symptoms of his infection, and until this situation developed, he did not know that he was infected with Chlamydia. Upon discovering he was infected, he notified the blood center where he donated blood in May, so that the center would have the benefit of this post-donation information. A review of the May 2003 whole blood donation revealed that cellular and acellular blood products were produced, and that the donor testing done in May showed the donor to be HIV, HCV, HBV negative by serology and by a 50 donor pool NAT. The donor was also negative for syphilis and HTLV-I by serology. The donor center initiated a product recall, but some of the blood products from this donation were already used before they could be removed from inventory.
The inquiring colleague is aware of a recent publication by Hedin G et al in Transfusion (May 2003) entitled "A lack of serologic evidence of transmission of Chlamydia pneumoniae by transfusion of buffy coat-depleted RBCs". He wonders if any further action is needed on the part of the donor center or the hospitals that received the products in question.
The following responses were received.
ADDENDA July 30, 2003
- A colleague from the United Kingdom believes that the Chlamydia issue is an important question. He reports that in the UK the incidence of sexually transmitted chlamydia in people presenting to GUM (Genito-Urinary Medicine) clinics has increased rapidly in recent years - from 34,000 in 1996 to 71,000 in 2001. It is now the most common STI in the UK, with a female/male ratio of 4:3, and it is silent in 70% of women and 40% of men. Even though it is silent, sexual transmission to women is a major cause of pelvic inflammatory disease and infertility. He adds that the paper by Hedin G et al indicated that although some macrophages may carry the Chlamydia pneumoniae organism in acutely ill people, evidence of transmission by blood transfusion was not strong. The Chlamydia associated with STI is a different species, more closely related to Chlamydia trachoma, and he is told by specialists that it is probably even less associated with being carried in the blood by macrophages. There seems to be little evidence of Chlamydemia in otherwise healthy-appearing but chronically infected individuals, and if most organisms carried in the blood are in macrophages - even though not many - they would be further reduced by effective leukocyte reduction procedures. He feels that there is likely to be little consequence to the recipient in this Japanese case, even if the blood was not leukocyte-reduced. He concludes by stating that the UK is reviewing donor selection policies in relation to all STI's, and it would be very interesting to know other peoples' opinions on this issue. He reminds the e-network forum that in the UK they follow a universal leukocyte-reduction policy.
- A New York blood bank physician reports that in sexually active populations (including many target donor groups such as students, military, etc.) the infection rate for chlamydia can exceed 10%. Thus, he concludes that right now there are many units from such individuals being transfused. He states (verbatim) "I don't see how a recall can be justified for such a circumstance, except from a scientifically unfounded (but real) concern over legal liabilities. Are we going to start recalling units for every hangnail, boil, pinkeye, or runny nose?"
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