key: cord-0723839-4ltzjani
authors: Essa, Mohammed F.; Elbashir, Enas; Batarfi, Khalid; Alharbi, Musaed
title: Lack of transmission of SARS‐CoV‐2 by platelet transfusion from a COVID‐19‐positive donor in a hematopoietic stem cell transplantation patient
date: 2020-08-19
journal: Pediatr Blood Cancer
DOI: 10.1002/pbc.28658
sha: f80eb8ee6c8cde2717c04987572939138a2cd759
doc_id: 723839
cord_uid: 4ltzjani

nan

To the Editor:

The corona virus disease 2019 (COVID-19) is caused by an enveloped, single-stranded positive-sense RNA virus, severe acute respiratory coronavirus 2 (SARS-CoV-2). 1 The pathogenesis, variability of symptoms, and mode of transmission are poorly understood. However, the confirmed mode of transmission is by respiratory droplets. 2, 3 The detection of SARS-CoV-2 RNA has been reported in blood from infected patients. 4 No reports have confirmed the possibility of viral transmission via blood products or feco-oral route despite detection of the virus in blood and stool. 2, 3 We report a 22-month-old boy diagnosed with acute pre-B lymphoblastic leukemia (ALL) who underwent matched related donor hematopoietic stem cell transplant (HSCT) for persistent disease. Universal SARS-CoV-2 blood PCR testing for donors is not widely available compared to available nasal swabs/aspirates. Many centers use NAAT and RT-PCR assay for screening. Although the performance of NAAT in SARS-CoV-2 has not been thoroughly evaluated, it is considered a highly specific test. 7 The sensitivity of testing depends on many factors, including the duration of illness and exposure as well as the type and quality of the specimen obtained. 4 Pathogen-inactivating treatment, which involves photochemical treatment of blood products, could be done. This might be challenging due to platelets' short half-life, unavailability of agents, biochemical changes, lack of enough evidence of efficiency against emerging pathogens, and the additional costs. 8, 9 In pediatric immunosuppressed patients, current reports suggest milder COVID-19 disease compared to adults, especially in developing cytokine release syndrome and thrombotic events. 11, 12 This patient had other features of hyperimmune response, including fever and VOD (platelet refractoriness and high liver enzymes with imaging findings) and negative bacterial cultures. The patient had received defibrotide, low-dose steroids, cyclosporine, and broad-spectrum antibiotics.

Despite repeated negative SARS-CoV-2 testing, many reports suggest that the above suppressants may contribute to COVID-19 complications. It is unlikely that our case is related to COVID-19 and could be seen in other HSCT patients with VOD. 

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