Condition

Tuberculosis (Mycobacterium tuberculosis complex)

Individual at risk

Recipient

Guidance at RECRUITMENT

Defer enrolment until two (2) years after completed successful treatment.

Guidance at CT/WORK-UP

Defer donor if within two (2) years of completed successful treatment.

Justification for guidance

There are no documented case reports of tuberculosis (TB) transmission via blood transfusion or HPC transplantation. However, TB is one of the most common bacterial infections transmitted via solid organ transplantation.

There is also a known risk of reactivating pre-existing latent infection in HPC transplant recipients, which is mainly seen in countries with an indigenous risk of TB.

The lack of reports of TB transmission via blood despite the known blood phase of TB infection and the worldwide prevalence of TB suggests that the risk of blood transmission – if it exists – must be extremely low. Extrapolating this assumption to HPC, however, should be done with caution because TB can infect bone and has been detected in bone marrow biopsies of infected patients. A recent study even suggests that bone marrow stem cells are an important reservoir of latent infection.

In this context, the precautionary stance of the current 2-year deferral period following successful treatment of infection seems justified, and is consistent with widely-utilised blood donor selection guidelines (eg the Council of Europe Guide to the preparation, use and quality assurance of blood components).

References

1. Fitzgerald D and Haas DW. Mycobacterium tuberculosis. In: Mandell GL, Bennett JE and Dolin R, ed. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, 6th ed. Philadelphia: Elsevier Churchill Livingstone, 2005. Vol 2:2852-2886.

2. Ahmad S. Pathogenesis, immunology, and diagnosis of latent Mycobacterium tuberculosis infection. Clin Dev Immunol 2011; Article ID 814943.

3. Golden MP and Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Phys 2005; 72:1761-1768.

4. World Health Organisation. Global Tuberculosis Report 2012.

5. NHS. National Institute for Health and Clinical excellence. Tuberculosis: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control. Issue date: March 2011.

6. Morris MI, Daly JS, Blumberg E, Kumar D, Sester M, Schluger N, Kim S-H, Schwartz BS, Ison MG, Humar A, Singh N, Michaels M, Orlowski JP, Delmonico F, Pruett T, John GT & Kotton CN. Diagnosis and Management of Tuberculosis in Transplant Donors: A Donor-Derived Infections Consensus Conference Report. American Journal of Transplantation 2012; 12: 2288-2300

7. Ip MSM, Yuen KY, Woo PCY, Luk WK, Tsang KWT, Lam WK & Liang RHS. Risk factors for pulmonary tuberculosis in bone marrow transplant recipients. American Journal of Respiratory and Critical Care Medicine 1998; 158: 1173–1177.

8. Das B, Kashino SS, Pulu I, Kalita D, Swami V, Yeger H, Felsher DW & Campos-Neto A. CD271+ bone marrow mesenchymal stem cells may provide a niche for dormant Mycobacterium tuberculosis. Science Translational Medicine, 5:170ra13, 2013.

9. Council of Europe Guide to the preparation, use and quality assurance of blood components, 16th edition (2010).