Transfusion-transmitted human T-lymphotropic virus Type I infection in a United States military emergency whole blood transfusion recipient in Afghanistan, 2010

Authors

  • Shilpa Hakre,

    Corresponding author
    1. San Antonio Military Medical Center, San Antonio, Texas
    2. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    3. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
    • Armed Services Blood Program Office, Falls Church, Virginia
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  • Mark M. Manak,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Clinton K. Murray,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Kenneth W. Davis,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Meera Bose,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Aaron J. Harding,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Peter R. Maas,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Linda L. Jagodzinski,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Jerome H. Kim,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Nelson L. Michael,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Francisco J. Rentas,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Sheila A. Peel,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Paul T. Scott,

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • Sodsai Tovanabutra

    1. Armed Services Blood Program Office, Falls Church, Virginia
    2. San Antonio Military Medical Center, San Antonio, Texas
    3. United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
    4. United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
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  • The views expressed are those of the authors and should not be construed to represent the positions of the US Department of Defense.
  • This work was supported by funds from the Armed Services Blood Program and Military Infectious Diseases Research Program.

Address correspondence to: Shilpa Hakre, Epidemiology and Threat Assessment, U.S. Military HIV Research Program, 6720-A Rockledge Drive, Suite 400, Bethesda, MD 20817; e-mail: shakre@hivresearch.org

Abstract

Background

The United States introduced human T-lymphotropic virus Type I (HTLV-I) screening of blood donors in 1988. The US military uses freshly collected blood products for life-threatening injuries when available stored blood components in theater have been exhausted or when these components are unsuccessful for resuscitation. These donors are screened after donation by the Department of Defense (DoD) retrospective testing program. All recipients of blood collected in combat are tested according to policy soon after and at 3, 6, and 12 months after transfusion.

Case Report

A 31-year-old US Army soldier tested positive for HTLV-I 44 days after receipt of emergency blood transfusions for severe improvised explosive device blast injuries. One donor's unit tested HTLV-I positive on the DoD-mandated retrospective testing. Both the donor and the recipient tested reactive with enzyme immunoassay and supplemental confirmation by HTLV-I Western blot. The donor and recipient reported no major risk factors for HTLV-I. Phylogenetic analysis of HTLV-I sequences indicated Cosmopolitan subtype, Subgroup B infections. Comparison of long terminal repeat and env sequences revealed molecular genetic linkage of the viruses from the donor and recipient.

Conclusion

This case is the first report of transfusion transmission of HTLV-I in the US military during combat operations. The emergency fresh whole blood policy enabled both the donor and the recipient to be notified of their HTLV-I infection. While difficult in combat, predonation screening of potential emergency blood donors with Food and Drug Administration–mandated infectious disease testing as stated by the DoD Health Affairs policy should be the goal of every facility engaged with emergency blood collection in theater.

Ancillary