A 35-year-old nurse suffered a sudden heart attack and needed a special life-support machine called ECMO to survive. During treatment, she received blood transfusions that accidentally gave her hepatitis E, a liver infection. Doctors and nurses worked together using careful monitoring, special diet, and medicines to help her liver heal. After 49 days in the hospital, her liver recovered completely, and she was able to have heart surgery. This case shows how important teamwork and close monitoring are when patients need emergency blood transfusions.

The Quick Take

  • What they studied: How nurses and doctors can best care for someone who gets a liver infection from a blood transfusion after needing emergency heart support
  • Who participated: One 35-year-old female nurse who had a sudden, unexpected heart rhythm problem and needed emergency life support
  • Key finding: With careful daily monitoring of liver health, special nutrition, gut-friendly medicines, and coordinated team care, the patient’s liver completely healed in 49 days, and she recovered well enough for follow-up heart surgery
  • What it means for you: If you or someone you know needs emergency blood transfusions, doctors should watch closely for signs of liver problems like yellowing skin or fever. This case suggests that careful monitoring and teamwork between different medical specialists can help patients recover from serious complications

The Research Details

This is a case report, which means doctors documented the story of one patient’s experience in detail. The patient was a 35-year-old nurse who had a sudden, life-threatening heart rhythm problem. She received emergency treatment using ECMO, a machine that does the work of the heart and lungs while the body heals. During this treatment, she needed blood transfusions to replace blood lost during the procedure. About two weeks after the transfusions, she developed signs of a liver infection caused by hepatitis E virus, which was confirmed through advanced genetic testing.

The doctors and nurses created a detailed care plan that included checking her liver health every single day, giving her special medicines to help her gut bacteria stay healthy, providing a carefully planned diet low in fat but high in special proteins, and monitoring her blood’s ability to clot. They also carefully timed when to do her heart surgery (implanting a device to prevent future heart problems) until after her liver had fully recovered.

This approach combined multiple strategies working together rather than treating each problem separately. The team included nurses, doctors, nutrition specialists, and heart surgeons all communicating and coordinating care.

This research matters because hepatitis E from blood transfusions is becoming more common, especially in emergency situations where there’s no time for routine screening. Most doctors and nurses don’t have clear guidelines for managing this specific complication after emergency heart support. By documenting exactly what worked for this patient, the case provides a roadmap that other hospitals can follow when facing similar situations.

This is a single case report, which means it describes one person’s experience rather than comparing many patients. While case reports are less powerful than studies with many patients, they are valuable for describing rare complications and new treatment approaches. The strength of this case is that it includes detailed daily measurements and a long follow-up period (6 months), showing that the patient truly recovered. The diagnosis was confirmed with advanced genetic testing, making it reliable. However, because it’s only one patient, we can’t be certain these exact strategies will work the same way for everyone.

What the Results Show

The patient developed signs of liver infection 15 days after receiving blood transfusions during heart support treatment. Her liver enzymes (markers of liver damage) were very high, her skin and eyes turned yellow, she had a low fever, and her blood wasn’t clotting normally. Advanced genetic testing confirmed she had hepatitis E virus infection.

The medical team implemented a comprehensive care plan with four main parts: (1) Daily monitoring of liver function, blood clotting, and symptoms like yellowing skin; (2) Special medicines to keep her gut bacteria healthy and help with bowel movements; (3) A carefully designed diet that was low in fat but provided enough calories and special proteins her liver needed; and (4) Careful planning of her heart surgery to happen only after her liver had recovered.

After 49 days in the hospital, her liver function completely returned to normal. Her bilirubin (the substance causing yellowing) went back to healthy levels, her blood clotting improved, and the yellow color in her skin disappeared. She was then able to have her planned heart surgery. At three months, she showed no signs of lasting liver damage, and at six months, tests showed the virus was completely gone. She had no heart rhythm problems during the follow-up period.

Several important secondary outcomes support the success of this case. The patient’s albumin level (a protein made by the liver that shows liver health) improved from 31.3 to 35.1 g/L, indicating her liver was making proteins normally again. Her blood clotting time (prothrombin time) returned to normal range, showing her liver was making clotting factors properly. The timing of her heart device implantation on day 50 (after liver recovery) was successful with no complications. During the six-month follow-up, she had no abnormal heart rhythms and no need for the device to deliver therapy. These findings suggest that waiting for liver recovery before doing elective heart surgery was the right decision.

Hepatitis E from blood transfusions is increasingly recognized as a problem, especially in emergency settings, but there are very few published guidelines on how to manage it. Most previous cases of hepatitis E were from contaminated food or water in developing countries. This case is important because it shows that hepatitis E can come from blood transfusions in developed countries and that careful, coordinated nursing and medical care can lead to complete recovery. The multimodal approach (combining monitoring, gut health support, special nutrition, and coordinated specialist care) appears to be more effective than treating each problem separately, which is a shift from how some hospitals have managed similar cases.

This is a single case report about one patient, so we cannot be certain these results would be the same for everyone with this condition. The patient was a healthcare worker who may have had better understanding of her condition and better access to specialized care than some other patients. We don’t know if the same care plan would work as well for patients with other health conditions or complications. The case doesn’t compare this approach to other treatment methods, so we can’t say definitively that this is the best way to manage hepatitis E after heart support. Additionally, because this is so rare, it’s difficult to study in larger groups of patients.

The Bottom Line

For patients receiving emergency blood transfusions during heart support: (1) Doctors should check liver function tests regularly (at least every few days) for the first month after transfusion - this is a moderate-confidence recommendation based on this case; (2) Watch for warning signs like yellowing skin, fever, or dark urine and report them immediately - high-confidence recommendation based on standard medical practice; (3) If hepatitis E is suspected, a coordinated care team including specialists in liver disease, nutrition, and heart care should work together - moderate-confidence recommendation based on this case’s success; (4) Delay non-urgent heart surgery until liver function and blood clotting have returned to normal - moderate-confidence recommendation based on this case.

This information is most relevant for: patients who need emergency heart support machines and blood transfusions; families of these patients; hospital staff including nurses, doctors, and nutritionists caring for critically ill patients; and blood bank professionals. People who have had routine blood transfusions for other reasons should not be overly concerned, as hepatitis E screening in blood banks is improving. However, anyone who develops unexplained yellowing of skin or eyes after a transfusion should see a doctor immediately.

In this case, recovery took about 49 days (7 weeks) for the liver to fully heal. However, this timeline may vary for different patients depending on how severe their infection is and their overall health. The virus was completely cleared from the body by 6 months. Most patients would likely see improvement in liver function within 2-4 weeks with proper care, but complete recovery may take longer.

Want to Apply This Research?

  • If you or a loved one is recovering from emergency heart support and blood transfusions, track daily: (1) Skin and eye color (note any yellowing), (2) Urine color (dark urine is concerning), (3) Body temperature (especially any fever), (4) Energy level and appetite. Use a simple daily checklist in the app with yes/no or color-coded options (green=normal, yellow=slightly concerning, red=needs doctor attention).
  • Users should: (1) Set daily reminders to check for warning signs and log them in the app; (2) Keep a list of all blood products received and dates in the app for doctor reference; (3) Schedule and track all follow-up blood tests for liver function; (4) Log any symptoms like fever, yellowing, or dark urine immediately; (5) Set reminders for any prescribed medications or dietary recommendations.
  • Create a long-term tracking dashboard that shows: (1) Liver function test results over time (if available); (2) Symptom trends (fever, yellowing, appetite); (3) Medication adherence; (4) Follow-up appointment completion. Set alerts if symptoms worsen or if follow-up appointments are missed. Share this data with healthcare providers during visits to support better coordinated care.

This case report describes one patient’s experience and should not be considered medical advice. Hepatitis E from blood transfusions is rare, and most blood transfusions are safe. If you have received a blood transfusion and develop symptoms like yellowing of skin or eyes, fever, or dark urine, contact your doctor immediately. The care strategies described in this case were tailored to one specific patient and may not be appropriate for everyone. Always consult with your healthcare provider about your individual situation, especially if you have received emergency medical treatment or blood transfusions. This information is for educational purposes and does not replace professional medical diagnosis or treatment.