Is dengue a threat to the blood supply?

Abstract

Dengue is the most common arthropod-borne infection worldwide, affecting at least 50 million people every year and endemic in more than 100 countries. The dengue virus is a single-stranded RNA virus with four major serotypes. Infection with one serotype confers homotypic immunity but not heterologous immunity, and secondary infection with another serotype may lead to more severe disease. The major route of transmission occurs through the Aedes aegypti mosquito vector, but dengue has also been transmitted through blood transfusion and organ transplantation. Infection results in a spectrum of clinical illness ranging from asymptomatic infection, undifferentiated fever, dengue fever, dengue haemorrhagic fever (DHF) to dengue shock syndrome (DSS). Dengue is spreading rapidly to new areas and with increasing frequency of major outbreaks. A trend has also been observed towards increasing age among infected patients. This will impact blood supply availability as more blood donors are deferred because of dengue infection or exposure to infection. The risk of transmission through transfusion of blood from asymptomatic viraemic donors will also increase. Although screening tests for dengue and effective pathogen reduction processes are now available for the blood supply, the value of implementing these costly measures needs to be carefully considered. Demand for platelets and fresh frozen plasma will rise with increasing number of DHF/DSS. Evidence-based guidelines for the clinical use of these blood components in the management of patients with DHF/DSS have not been well established, and inappropriate use will contribute to the challenges faced by blood services.

Dengue Hemorrhagic Fever in Trinidad and Tobago: A Case for a Conservative Approach to Platelet Transfusion

“…Blood transfusion for dengue is only indicated for patients with significant clinical bleeding. 5 In our two patients, there was no evidence of hemorrhage or decrease in hemoglobin levels, and one of these patients showed an increase in hematocrit 20% from baseline. These patients do not meet the criteria for blood transfusions and represent over-treatment by physicians.…”

“…This vector is highly susceptible to the dengue virus and feeds preferentially on human blood. 4 These mosquitoes are daytime feeders and have crepuscular 5 and nocturnal habits, 6 which further enhance dengue transmission. These nocturnal components expand their feeding duration to periods when persons are at home at night.…”

The Incidence of Bleeding and the Factors That Influence Its Development among Patients Admitted With Dengue Fever

“…There is no significant increase in bleeding in patients who have co-morbidities (p=0.447). A previous study done on adult patients with dengue fever and DHF showed that age above 65 years, history of dengue infection, diabetes mellitus, hypertension and renal insufficiency have been identified as being significantly associated with DHF/DSS 10 . The aforementioned study mentioned that the presence of co-morbidities will increase the risk to develop DHF, but not necessarily bleeding.…”

Detection of Dengue Virus in Department of Bolivar, Colombia, 2012-2013, Real-Time PCR

“…Although viremia in vertebrate hosts has been estimated for dengue between 10 5 and 10 9 RNA copies/mL [30], there are reports of situations with low plasma viremia during early stages of infection, for example, reinfection by DENV-3 with high levels of preexisting neutralizing antibodies [31,32], epidemics with endemic DENV-3 strains associated with low viremia in humans [30], primary infections with a duration of less than five days [33], newborn infected with DENV-2 through a contagious via associated with transfusion [34], and even infections of two genotypes of DENV-2 in a humanized mouse model [35].…”