Transmission of symptomatic parvovirus B19 infection by fibrin sealant used during surgery

Abstract

Summary. Human parvovirus B19 infection has been shown to be transmissible by blood and blood products and to result in transient aplastic crisis in patients with rapid red cell turnover. We report three cases of iatrogenic parvovirus B19 infection resulting from the use of the same batch of ®brin sealant under operation. Fibrin sealant, which is a typical haemostatic agent produced from blood, has been used during surgery. Human parvovirus is resistant to existing virusinactivating techniques, suggesting that infection may occur from blood products contaminated with it. Use of recombinant products for these proteins may thus be necessary.Keywords: parvovirus B19, aplastic crisis, ®brin sealant, surgery.Infection with human parvovirus B19, which is the smallest DNA-containing virus, usually causes a minor, febrile illness or is asymptomatic (Cossart et al, 1975;Shneerson et al, 1980;Anderson, 1990). Blood group P antigen is the cellular receptor for this virus, which can only replicate in proliferating and differentiating erythroid precursor cells (Brown et al, 1993). Transient aplastic crisis as a result of maturation arrest within the erythroid lineage occurs in patients with chronic haemolytic anaemia. Aplastic crisis also occurs in patients who have rapid red cell turnover, such as those with acute blood loss. Transmission of this virus is by respiratory secretions, transplacentally and by transfusion of blood and blood products. We report here three cases of iatrogenic symptomatic human parvovirus B19 infection, resulting from the use of the same batch of ®brin sealant during surgery. CASE REPORTSBetween March 1998 and May 1998, three patients were infected with human parvovirus B19 during surgery in the gynaecology ward of our hospital. The clinical characteristics of the three patients are shown in Table I. One of the three cases has been described previously (Hino et al, 1999). All patients had blood group P2 phenotype (P1 antigen negative/P antigen positive). P antigen is the cellular receptor for parvovirus B19. In all three patients, fever and leucopenia were observed between days 6 and 11 after the operation. The lowest white blood cell counts were 1´11 0 9 /l to 1´4´10 9 /l. Bone marrow examination revealed severe erythroblastopenia (0´8%±1´8% of total nucleated cells) with giant proerythroblasts, suggesting recent human parvovirus B19 infection. Reticulocytopenia and anaemia developed subsequently. The lowest haemoglobin levels were 7´7±8´1 g/dl. Haematological ®ndings spontaneously improved within 10 days in all three patients. Anti-human parvovirus B19 IgM and IgG were detected in serum, and human parvovirus B19 DNA was detected by polymerase chain reaction (PCR) in all three patients (Sevall, 1990). Autologous bone marrow cultures revealed a high degree of inhibition of BFU-E-and CFU-E-derived colony growth by the patients' acute-phase serum, whereas CFU-GM-derived colony formation was normal. Human parvovirus B19-induced aplastic crisis was diagnosed in each of these three patients. Only one pa...

Parvovirus B19 transmitted by bone marrow

“…Parvovirus B19 may infrequently be transmitted by other blood-derived products such as platelets, intravenous immunoglobulin, fibrin products and clottingfactor preparations (Cohen et al, 1997;Erdman et al, 1997;Hino et al, 2000).…”

Tissue adhesives in ocular surgery

“…Risks of viral transmissions are well documented [137]. Hino et al reported three cases of parvovirus B19 transmission from the use of commercial fibrin sealants [138]. This demonstrated that dry heat viral inactivation was not an effective means to eradicate the parvovirus.…”

Renal Injury and the Application of Polysaccharide Hemospheres: A Laparoscopic Experimental Model

“…18,19 Human thrombin has generally replaced bovine sources in these preparations, because in 126 cases since 1955, patients exposed to bovine thrombin have acquired thrombin antibodies. [20][21][22] In addition, Hino and coworkers 23 reported three cases of iatrogenic parvovirus B19 transmission associated with commercial sealants.…”