Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: REVIEW
The SARS-CoV-2 Disease and the Risk of Transfusion Transmission: A Narrative Review
SARS-CoV-2 Hastalığı ve Kan Transfüzyonuyla Bulaş Riski: Bir Literatür Derlemesi
Ülkü Ceren KÖKSOYa, Gizem KAHRAMANb, Güle ÇINARc
aDepartment of Anesthesiology and Reanimation, Ufuk University Faculty of Medicine, Ankara, TURKEY
bDepartment of Anesthesiology and Reanimation, Ankara University Faculty of Medicine, Ankara, TURKEY
cDepartment of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, TURKEY
Turkiye Klinikleri J Anest Reanim. 2021;19(2):94-9
doi: 10.5336/anesthe.2020-80725
Article Language: EN
Full Text
ABSTRACT
 Emerging infection outbreaks have a deteriorating effect for the blood supply by limiting resources and compromising the safety of transfusion of blood products. The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) which leads to a self-limited upper respiratory disease emerged from China and turned into a pandemic in January 2020. Symptomatic, asymptomatic and recuperative patients can be reservoirs for transmission but their viral load in plasma, serum, or lymphocytes in the incubation period is not known, thus their rate of infectivity remains uncertain. Even though transmission by blood is not detected yet, a solitary case has reported a neonate born to a mother with coronavirus disease-2019 (COVID-19) with elevated antibody levels and abnormal cytokine test results 2 hours after birth, pointing at the possibility of vertical transmission. With the pandemic spreading wider, the number of blood donations from asymptomatic patients keeps rising, resulting in blood transfusions from COVID-19 patients to SARS-CoV-2 free recipients. It is stated that if all the blood donations were tested for SARS-CoV-2 RNA up to 15% of donors in the incubation phase would have to be excluded for carrying viral RNA. Although data suggest that it is not transmissible through transfusion with no confirmed cases of transfusion transmission, presence of SARS-CoV-2 RNA in the donated plasma of asymptomatic patients is still considered to constitute a risk for blood safety for both healthcare personnel and the recipients. Therefore, blood centers and banks are advised to take measure for protection from SARS-COV-2 and to avoid the risk of transmission through transfusion.

Keywords: Severe acute respiratory syndrome-coronavirus-2; blood transfusion
ÖZET
 Yeni ortaya çıkan enfeksiyonlara bağlı gelişen salgınlar, kaynakları sınırlandırarak ve kan ürünlerinin transfüzyonunun güvenliğini tehlikeye atarak kan tedarikini bozan bir etkiye sahiptir. Kendini sınırlayan bir üst solunum yolu hastalığına yol açan şiddetli akut solunum yolu sendromu koronavirüs-2 [severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)], Çin'den ortaya çıktı ve Ocak 2020'de pandemiye dönüştü. Semptomatik, asemptomatik ve iyileşen hastalar bulaş için rezervuar olabilirler ancak inkübasyon periyodunda plazma, serum veya lenfositlerindeki viral yük bilinmemektedir, bu nedenle bu hastaların enfektivite oranları belirsizliğini korumaktadır. Kan yoluyla bulaşma henüz tespit edilmemiş olsa da bir vaka sunumunda, koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] olan bir anneden doğan ve doğumdan 2 saat sonra yüksek antikor seviyeleri ve anormal sitokin testi sonuçları olan bir yenidoğan bildirilmiş ve dikey bulaş olasılığına işaret etmiştir. Pandeminin yayılmasıyla birlikte, asemptomatik hastalardan kan bağışı sayısı artmaya devam etmekte ve bu da COVID19 hastalarından SARS-CoV-2 bulaşı olmayan alıcılara kan transfüzyonu yapılması ile sonuçlanmaktadır. Tüm kan bağışlarının SARSCoV-2 RNA için test edilmesi durumunda, inkübasyon aşamasındaki donörlerin %15'inin viral RNA taşıdıkları için dışlanmaları gerekeceği belirtilmiştir. Veriler transfüzyon yoluyla bulaş olmayacağını gösterse de ve doğrulanmış bir transfüzyona bağlı bulaş vakası gösterilmemiş olsa da asemptomatik hastaların bağışlanan plazmalarındaki SARS-CoV-2 RNA varlığının, hem sağlık personeli hem de alıcılar için kan güvenliği açısından bir risk oluşturduğu düşünülmektedir. Bu nedenle, kan merkezleri ve bankalara SARS-COV-2'den korunmak için önlem almaları ve transfüzyon yoluyla bulaşma riskinden kaçınmaları önerilir.

Anahtar Kelimeler: Şiddetli akut solunum sendromu-koronavirüs-2; kan transfüzyonu
REFERENCES:
  1. World Health Organization [Internet]. ©2021 [Date accessed: 14 March 2021]. Coronavirus disease (COVID-19) pandemic. Access link: [Link] 
  2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. Erratum in: Lancet. 2020: [Crossref]  [PubMed]  [PMC] 
  3. COVID-19 Bilgilendirme Platformu [Internet]. T.C. Sağlık Bakanlığı ©2021 [Date accessed: 14 March 2021]. Access link: [Link] 
  4. Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genome structure, replication, and pathogenesis. J Med Virol. 2020;92(4):418-23. Erratum in: J Med Virol. 2020;92(10):2249. [Crossref]  [PubMed]  [PMC] 
  5. Perlman S. Another decade, another coronavirus. N Engl J Med. 2020;382(8):760-2. [Crossref]  [PubMed]  [PMC] 
  6. Hui DS, Azhar EI, Kim YJ, Memish ZA, Oh MD, Zumla A. Middle East respiratory syndrome coronavirus: risk factors and determinants of primary, household, and nosocomial transmission. Lancet Infect Dis. 2018;18(8):e217-e27. [Crossref]  [PubMed]  [PMC] 
  7. Chang L, Yan Y, Wang L. Coronavirus Disease 2019: Coronaviruses and Blood Safety. Transfus Med Rev. 2020;34(2):75-80. [Crossref]  [PubMed]  [PMC] 
  8. Ding Y, Wang H, Shen H, Li Z, Geng J, Han H, et al. The clinical pathology of severe acute respiratory syndrome (SARS): a report from China. J Pathol. 2003;200(3):282-9. [Crossref]  [PubMed]  [PMC] 
  9. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al; China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. [Crossref]  [PubMed]  [PMC] 
  10. Leblanc JF, Germain M, Delage G, OʼBrien S, Drews SJ, Lewin A. Risk of transmission of severe acute respiratory syndrome coronavirus 2 by transfusion: A literature review. Transfusion. 2020;60(12):3046-54. [Crossref]  [PubMed]  [PMC] 
  11. Zeouk I, Bekhti K, Lorenzo-Morales J. From Wuhan to COVID-19 Pandemic: An Up-to-Date Review of Its Pathogenesis, Potential Therapeutics, and Recent Advances. Microorganisms. 2020;8(6):850. [Crossref]  [PubMed]  [PMC] 
  12. Wu D, Wu T, Liu Q, Yang Z. The SARS-CoV-2 outbreak: What we know. Int J Infect Dis. 2020;94:44-8. [Crossref]  [PubMed]  [PMC] 
  13. Tindale LC, Stockdale JE, Coombe M, Garlock ES, Lau WYV, Saraswat M, et al. Evidence for transmission of COVID-19 prior to symptom onset. Elife. 2020;9:e57149. [Crossref]  [PubMed]  [PMC] 
  14. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514-23. [Crossref]  [PubMed]  [PMC] 
  15. Dong L, Tian J, He S, Zhu C, Wang J, Liu C, et al. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA. 2020;323(18):1846-8. [Crossref]  [PubMed]  [PMC] 
  16. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809-15. Erratum in: Lancet. 2020;395(10229):1038. Erratum in: Lancet. 2020;395(10229):1038. [Crossref]  [PubMed]  [PMC] 
  17. Yuan Z, Chen D, Chen X, Wei Y. Estimation of the number of blood donors during the COVID-19 incubation period across China and analysis of prevention and control measures for blood transfusion transmission. Transfusion. 2020;60(8):1778-84. [Crossref]  [PubMed]  [PMC] 
  18. Chang L, Zhao L, Gong H, Wang L, Wang L. Severe Acute Respiratory Syndrome Coronavirus 2 RNA Detected in Blood Donations. Emerg Infect Dis. 2020;26(7):1631-3. [Crossref]  [PubMed]  [PMC] 
  19. Cho HJ, Koo JW, Roh SK, Kim YK, Suh JS, Moon JH, et al. COVID-19 transmission and blood transfusion: A case report. J Infect Public Health. 2020;13(11):1678-9. [Crossref]  [PubMed]  [PMC] 
  20. Essa MF, Elbashir E, Batarfi K, Alharbi M. Lack of transmission of SARS-CoV-2 by platelet transfusion from a COVID-19-positive donor in a hematopoietic stem cell transplantation patient. Pediatr Blood Cancer. 2021;68(2):e28658. [Crossref]  [PubMed]  [PMC] 
  21. Politis C, Papadaki M, Politi L, Kourti G, Richardson C, Asariotou M, et al. Post-donation information and haemovigilance reporting for COVID-19 in Greece: Information supporting the absence of SARS-CoV-2 possible transmission through blood components. Transfus Clin Biol. 2021;28(1):55-9. [Crossref]  [PubMed]  [PMC] 
  22. Rabenau HF, Cinatl J, Morgenstern B, Bauer G, Preiser W, Doerr HW. Stability and inactivation of SARS coronavirus. Med Microbiol Immunol. 2005;194(1-2):1-6. [Crossref]  [PubMed]  [PMC] 
  23. Darnell ME, Taylor DR. Evaluation of inactivation methods for severe acute respiratory syndrome coronavirus in noncellular blood products. Transfusion. 2006;46(10):1770-7. [Crossref]  [PubMed]  [PMC] 
  24. Yunoki M, Urayama T, Yamamoto I, Abe S, Ikuta K. Heat sensitivity of a SARS-associated coronavirus introduced into plasma products. Vox Sang. 2004;87(4):302-3. [Crossref]  [PubMed]  [PMC] 
  25. Rebulla P. The long and winding road to pathogen reduction of platelets, red blood cells and whole blood. Br J Haematol. 2019;186(5):655-67. [PubMed]  [PMC] 
  26. Seltsam A, Müller TH. Update on the use of pathogen-reduced human plasma and platelet concentrates. Br J Haematol. 2013;162(4):442-54. [Crossref]  [PubMed] 
  27. Kwon SY, Kim EJ, Jung YS, Jang JS, Cho NS. Post-donation COVID-19 identification in blood donors. Vox Sang. 2020;115(8):601-2. [Crossref]  [PubMed] 
  28. Update: impact of 2019 novel coronavirus and blood safety. American Association of Blood Banks; 2020. [Link] 
  29. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348(20):1986-94. [Crossref]  [PubMed] 
  30. European Centre for Disease Prevention and Control. Outbreak of acute respiratory syndrome associated with a novel coronavirus, China: first local transmission in the EU/EEA-third update. 31 January 2020. ECDC: Stockholm; 2020. [Link] 
  31. World Health Organization [Internet]. ©2021 [Date accessed: 14 March 2021]. COVID-19 vaccines. Access link: [Link] 
  32. The Food and Drug Administration [Internet]. ©2021 [Date accessed: 14 March 2021]. Updated information for blood establishments regarding the COVID-19 pandemic and blood donation. Access link: [Link] 

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30.03.2014

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