A blood draw done in an inappropriate manner - risks for HBV already infected person

Hello,

I am new here. Thank you for accepting me and for creating this place.

As I have a few questions concerning a particular situation I decided to create a separate topic about it. I hope it’s fine.

I was diagnosed with HBV and HCV in June 2020 (I was infected probably at hospital in Poland where I live as a newborn 35 years ago).

I was cured from HCV (therapy with Maviret).

For HBV infection I take Entecavir and for several months now the results of my HBV DNA tests are negative. HBsAg stays positive. HBeAg is negative (it was negative already at the moment when the therapy was started).

A month ago I had a blood draw that in my opinion was done in an inappropriate manner and that keeps warring me.

When I came into the office, the nurse was behind her desk and wearing a pair of gloves. Wearing those gloves she filled in the documentation needed for the procedure. Next the nurse changed her gloves to new ones. She did not wash her hands before putting on new gloves. When I was ready for the procedure, the nurse disinfected my skin. Then she put off one glove, touched my skin with her bare hand to feel the vein, did not disinfect my skin any more and put needle into the vein.

I have several questions concerning this situation.

Is a transmission of an infection in this case possible ? I mean could I have been infected with a blood-born virus in this situation ?

Can I be infected with HBV once again, with its different type / mutation ? In other words, is it possible to have two types of HBV viruses at the same time ? Could it affect my condition / treatment ? Should it be checked in any way ?

In the situation described above, could I get infected with HDV ? Is HDV as easy spread as HBV is (as far as I know it is far easier to get infected with HBV than with HCV or HIV) ? How much time after the exposure can I get tested for HDV antibodies so that the result is reliable ?

Thank you in advance for your help.

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Hi @Magdalena ,

Welcome to the community. One of the experts will answer this question for you as soon as they are able. I am not an expert but my guess is going to be that they will say that the possibility of transmission in this situation is very slight. I could be wrong but I hope not.

Just wanted to say Hi and welcome you.

Happy Holidays!

-Paul

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Hi Magdalena,

Often times palpation with an ungloved finger is essential for locating the most easily accessible part of the vein and is common practice during a blood draw. While the nurse’s technique was not perfectly aseptic (she should have resterilized the area with an alcohol swab after palpation), Paul is right the risk of transmission of HBV or HDV in the situation you have described is very very low.

HDV is much less stable in the environment than HDV and although highly infectious, really requires direct contact of bodily fluids between individuals like HCV or HIV (ie unprotected sex or sharing an infected needle).

Some basic facts will help you understand your infection better:

  1. HBV is very mutable and in every patient, chronic HBV infection develops to a large collection of different “quasispecies” as a result of these mutations and the constant drive to escape the immune system.

  2. Drugs like ETV and TDF/TAF work well against all quasispecies and resistance to these drugs is rare (except for ETV if you previously developed resistance to an older medication called lamivudine (Epivir)).

So hopefully you will see that its not really possible to get infected with a HBV mutant which would not respond to your therapy.

Hope this helps!

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Thank you @PuallyHBV and @availlant for your kind answers. It is a great help and support.

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Hello,

I come back to this topic because I have more and more doubts and I am very scared.
Please excuse me for the length of this post but I try to explain my situation the best I can.
At the end I ask questions for which I cannot find answers.

Dear @availlant : as we already exchanged in this thread (you answer was a great relief to me), could you please look into this new post and try to help me to find new answers ?

On the 9th November 2022 I had blood tests which outcome was very typical for me :
HBV DNA undetectable (treatment with Entecavir) and ALAT 12,5 U/L (normal range 0-55).

On the 15th November 2022 I had blood test with improper behavior of the nurse described in my previous post. Those tests did not concerne my liver so I have no information about it’s condition at that time. In addition when I came back to the nurse’s office two days later to get my results, I noticed that she licked her hand to page thought my results. I am scared that if she has this kind of habit, she could have traces of saliva on her hand when she touched me to feel the vein.

Two weeks from this situation I started to have some discomfort in my right ribs and in the back. It got a little bit worse during next two weeks. I am disabled person (problem with right knee) which often doesn’t let me get right sitting position. So first I thought the discomfort was due to my disability.

At the beginning of the fifth week I got a cold (my father got it from me so I am sure that the next symptoms came from the cold). I got cough, running nose and a very mild fever ( 37 degrees Celsius / 98.60 degrees Fahrenheit).

About 4 days later I lost my appetite and when I was trying to eat I got strong pain below sternum at the right side. I had still pain in the ribs and in my back (at the ribs level and below my right scapula). In two weeks (form the beginning of the cold) I lost 5 kilos and therefore became very weak (the weight dropped to 46 kilos). My urine got darker. I decided to take blood tests to see if the liver was ok.

On the 28th December (six weeks after „unfortunate blood draw” ) I made the tests. At that time minor symptoms of the cold were still present. The results were as follows :
ALT : 79 U/l ( normal range : 0 - 55) - elevated first time in my life, it is around 10 normally.
AST : 48 U/l (5 - 34)
Bilirubin : 0,72 mg/dl (0 - 1,2)
Alkaline phosphatase: 40 U/l (40 - 150)
GGT 13 U/l (normal range : 0 - 38)
Platelets : 206 thousands/µl (125,3 - 396,2)
Platel Distribution Width - 12,4 (9,8 - 16,2)
White blood cell : 4,8 thousands /µl ( 3,98 - 10,04)
Lymphocytes : 1,3 thousands /µl (1,3 - 3,4)
INR : 1,06 (0,9 - 1,2)
Albumins : 45,46 g/l (35 - 50)

I saw my doctor. She told my to do new tests in 3 weeks and make an ultrasound.
She suggested that the liver enzymes might be higher because of some minor virus. And stated that hdv was very unlikely as it it extremely rare in Poland. At the same time she said that it is never tested. My conclusion is that as it is not tested, it does not exist in the records. My doctor (whom I completely trust if it comes to HBV treatment) added that if the change in my condition were due to the delta virus, I would be already in hospital in a bad state.

Three weeks later (16th January - nine weeks after „unfortunate blood draw” )
my results were as follows :
ALT : 32,6 U/l ( 0 - 55)
AST : 23,8 U/l (5 - 34)
Bilirubin : 0,76 mg/dl (0 - 1,2)
Alkaline phosphatase: 34,00 U/l (40 - 150)
GGT 11,8 U/l (0 - 38)
Platelets : 179,00 thousands/µl (150 - 400)
Platel Distribution Width - 16,7 fl (9,8 - 16,2)
White blood cell : 5,93 thousands /µl (3,98 - 10,04)
Lymphocytes : 1,54 thousands /µl (1 - 3)
INR : 1,06 (0,9 - 1,2)

In addition :
HAV IGG (-), HAV IGM (-)
CMV IGG (+), CMV IGM (-)
EBV IGG (+), EBV IGM (-)
HCV RNA (-)

On 10th January I made an ultrasound - all organs shown were ok, liver was not enlarged, gallbladder and bile ducts ok.

I saw my doctor again : she said that I could have biliary dyskinesia (some of the pain comes after the meal or when I was hungry at night) or peptic ulcer disease - for this she gave my a medication that limits stomach acid secretion. If it comes to the liver, the doctor said that everything was fine. I was told nevertheless to repeat the tests in a month and come back to see her (it will be in 3 weeks).

I am still worried. I can eat better and after most of the products I do not have pain below my sternum at the right side anymore. I saw the pain come back only after eating small amount hazelnuts (3 to be more exact). When it hurts in this area, it hurts even more when I squeeze the painful part.

I still feel discomfort and pain in my ribs and back (it can be throbbing or stabbing or burning pain). Most of the time it is located below my right scapula but it can go to my shoulder and fingers of the right hand and in the lower part of the back - all only on the right side). My urine is still sometimes darker than usually (orange). I don’t know the possible reason of my symptoms nor of the ALT pick at the end of December.

I do not exclude that at least a part of my symptoms comes from the problems with my bad posture and from the extreme stress this health change causes me.

I would like to rule out the delta virus which I am most affrayed of. Therefore I made 3 tests. The problem is that I do not know if I made them in the right time (too soon) and if they are accurate enough.

28th December - six weeks after „unfortunate blood draw” : I made a test for anti-hdv. The result was negative.

16th January - nine weeks after „unfortunate blood draw”: I made two two tests:

  1. anti-hdv - the result was still negative and exactly the same as previous one :

  1. HDV RNA PCR - the result was negative too :

Both tests ware carried out in France, Lyon by Eurofins Biomnis (sent there by my local laboratory).

What concerns me is that :

  1. I cannot find the accurate information when the test for antibody should be taken. In the internet in different articles / laboratory web sites I find a different kind of information. According to different sources, the time after exposure for the test to be reliable varies from 4 to 12 weeks. Could you please tell if my tests (made after 6 and 9 weeks) were made too soon ? Should it be repeated later to be sure that hdv can be ruled out ? When this kind of test is reliable ?

  2. The RNA test seems to be not very sensitive, the limit of detection being 250 iu/ml. I thought that this type of test could be decisive. But the threshold makes me afraid that after 9 weeks the levels of RNA in my blood (if it is there) might be insufficient to be detected with this test. Is my concern legitimate ?

Any other remark/ advice will be appreciated.

Thank you in advance for your help and patience in reading this long post.

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Dear @Magdalena,

First to you and everyone else in the community, we are happy to read these long posts that you take the time to prepare. More information is always better.

Many respiratory infections can also have a mild liver involvement. This was almost certainly the cause of your transient and VERY mild ALT/AST elevation. Not HDV.

Your physician is evaluating your situation correctly based on your symptoms. You may also want to consider diverticulitis (inflammation of the intestines) if you notice the symptoms are worse with grains, seeds or nuts. HDV does not manifest with these kinds of symptoms.

It is very unlikely that you acquired HDV from this blood draw episode. Transmission of HDV occurs from the needle being contaminated with HDV, which would not have been the case in your scenario.

I understand and appreciate your anxiety but I would also strongly encourage you to not worry about this any longer. Your recent HDV RNA tests done in France will be the highest caliber tests available. The result indicates the viral genome was not detected. If HDV RNA was present but below the limit of quantification (< 250 IU/mL) it would have stated viral genome detected. You really have no HDV RNA in your blood.

Do not hesitate with more questions.

With best regards,

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Thank you @availlant for your time and so quick answer. You have given me a peace of mind.
It is a great help to have the opportunity to exchange with you and to benefit from your knowledge and experience. Also it is very helpful to read posts and conversations of other forum members, both experts and people living with the virus. It is a wonderful place and I am very happy to be part of this community.

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