Thursday, December 11, 2014

Transfusion-associated Anaplasma phagocytophilum infection in a pregnant patient

*Transfusion-associated /Anaplasma phagocytophilum/ 
infection in a pregnant patient with thalassemia trait: a
case report. *
Shields K, Cumming M, Rios J, Wong MT, Zwicker JI, Stramer
SL, Alonso CD.
/Transfusion/, online before print, 2014 Nov 11.

Human granulocytic anaplasmosis (HGA) is an acute
nonspecific febrile illness caused by the bacterium
/Anaplasma phagocytophilum/. Although usually transmitted
via tick bite, HGA may rarely also be acquired through
transfusion. HGA during pregnancy may pose significant
gestational risks due to altered maternal immune status and
the potential for perinatal transmission.

*Case Report*
A pregnant 34-year-old Massachusetts woman with
β-thalassemia trait was diagnosed at 32 weeks of gestation
with transfusion-associated HGA (TAHGA) after receiving nine
leukoreduced red blood cell transfusions. She was
successfully treated with rifampin therapy and gave birth to
a healthy child who tested negative for HGA after delivery.
An implicated blood donor was subsequently identified
through physician collaboration with the regional American
Red Cross and Massachusetts Department of Public Health.

This is the 11th reported case of HGA in pregnancy and is at
least the sixth known case in which leukoreduction did not
prevent TAHGA. As seen in this case, nonspecific
symptomatology of variable onset can impede diagnosis and
treatment. This may increase risk of poor outcomes in
maternal HGA patients. Cases of TAHGA, although currently
uncommon, may increase as the incidence of HGA in certain
parts of the country increases.

Heightened cross-institutional awareness of the potential
risk of TAHGA is warranted. Clinicians need to consider
transfusion-associated infections when fever occurs in a
transfusion recipient. This case provides additional
evidence that leukoreduction does not obviate risk of /A. 
phagocytophilum/ contamination of donated blood components.

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