Clinical guidance for use of
Hepatitis E virus (HEV) negative blood components
HEV negative blood components are indicated in:
• Patients awaiting solid organ transplant (SOT) – from 3 months prior to date of planned elective SOT or from the
date of listing for a solid organ transplant.
• Patients who have had SOT – for as long as the patient is taking immunosuppressants.
• Patients with acute leukaemia – from diagnosis (unless/until decision made not to proceed with stem cell transplant).
• Patients awaiting allogeneic stem cell transplant – from 3 months prior to the date of planned transplant and up to
6 months following transplant, or for as long as the patient is immunosuppressed.
• Extra corporeal procedures – only included if within above indications.
Indicate requirement on the patient record both in the clinical area and transfusion laboratory.
Inform the transfusion laboratory
if your patient requires HEV
negative blood components
If HEV components are not available,
the laboratory staff will contact you to
discuss the urgency.
Can your patient wait for HEV negative
blood components?
Yes.
Laboratory staff will order component
from NHS Blood and Transplant
and notify you when it is available
No
Transfuse a component that
has not been tested for HEV
Management in the transplant patient:
• Confirm persistence by re-sampling for PCR
and serology at one month.
• Seek advice from virology/liver teams to assess
liver morphology and fibrosis.
• Consider immunosuppressant reduction as it is
associated with improved chances of viral
clearance.
• If no clearance within 3 months, consider a 3
month course of Ribavirin (note: this use is off
license).
• If you suspect HEV transmission via stem cell
transplant or blood component transfusion
inform NHS Blood and Transplant immediately.
Monitor the patient for features of hepatitis:
Jaundice; Darkened urine; Tiredness;
Nausea and vomiting; Abdominal pain;
Rise in ALT or bilirubin
NHS Blood and Transplant Patient Blood Management Team
Version 1.1, March 2016
If clinical features present, send Hep E
serology and PCR and if suggestive of
active infection follow the guidance for
management in the transplant patient