Vox Sanguinis (2017) SHORT REPORT © 2017 International Society of Blood Transfusion DOI: 10.1111/vox.12572 Hepatitis E in transfusion-dependent thalassaemia patients, in Greece: a single centre experience P. Klonizakis, G. Gioula, M. Exindari, C. Apostolou, A. Kotsiafti & E. Vlachaki School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece Received: 5 March 2017, revised 6 August 2017, accepted 7 August 2017 Hepatitis E is considered an emerging disease that may be a threat in both devel- oping and industrialized countries all over the world. The risk of chronic hepati- tis E virus infection is higher among immunocompromised patients. This study aimed to assess the status of hepatitis E infection in patients with transfusion- dependent thalassaemia from a single centre, in Greece. Our results suggest that the prevalence of hepatitis E infection in this group of patients is low. Key words: beta-thalassaemia, hepatitis E, transmission. Introduction Hepatitis E (HE) has been initially identified in developing countries. The causal agent is a RNA virus, transmitted mainly through the faecal-oral route. Nevertheless, there are additional patterns of transmission, including the transfusion of infected blood products. In fact, HE is nowadays considered an emerging disease that may be a threat in both developing and industrialized countries all over the world [1, 2]. The risk of developing chronic HE infection following transfusion of infected blood-derived products is higher among immunocompromised patients, compared to the general population. Although HE infection usually has a self-limited clinical course in healthy individuals, several cases of chronic HE infection leading to cirrhosis or neu- rological complications have been described in patients after solid organ transplantation, after haemopoietic stem cell transplantation, after chemotherapy, in HIV-infected patients and in patients taking steroids [3]. Patients with transfusion-dependent thalassaemia (TDT) are also immunocompromised, but the data regarding transfusion- transmitted HE infection are limited for this group of patients [2, 4]. Accordingly, there is, as yet, no consensus on whether blood products should be systematically screened for markers of the HE virus [5]. The aim of this study was to assess the HE status in TDT patients followed up in a single Thalassemia Unit, in Northern Greece. The Human Ethics Review Committee of the Aristotle University of Thessaloniki approved the study protocol and informed consent was obtained from each patient. Over a one-month period, we retrospectively evaluated 96 consecutive patients, from a registry of adult TDT patients followed at the Adult Thalassemia Unit, 2nd Department of Internal Medicine, Aristotle University, ‘Hippokration’ General Hospital of Thessaloniki, Greece. This registry is one of the largest in Greece and includes patients with thalassaemia from the area of Northern Greece. The mean age of the study population was 36 – 10 years; 42% were male and 58% female. According to the patients’ blood transfusion history, the participants had been transfused with 47 376 blood units during the last 14 years, whereas during the last year, the same patient population had been transfused with 3 384 blood units. Blood samples were taken from each patient in plastic tubes without anticoagulant and were centrifuged for serum isolation. The serum samples were stored in ali- quots at -70°C. RNA extraction was performed in 96/96 thawed serum samples using a commercial kit (QIAamp Viral RNA Mini kit, Qiagen), according to the manufac- turer’s instructions. The detection of HEV RNA was performed by real-time RT-PCR method (hepatitise2@ ceeramTools kit, Applied Biosystems ABI), according to the instructions. The detection of HEV was based on the identification of the region of ORF2, as described previously [6]. A positive control from a previous Greek hepatitis E-positive patient was included in the PCR test. Correspondence: Philippos Klonizakis, Adults Thalassemia Unit, 2nd Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, 49, Konstantinoupoleos Street, P.C 54642, Thessaloniki, Greece E-mail: philklon@gmail.com 1