Post-transfusion hepatitis. Sudden drop of its incidence associated with hyperbilirubinemic donors disqualification.
The lacking impact of various precautions on the incidence of post-transfusion hepatitis (PTH) in the last 15 years is presented. In 1984, however, PTH dropped from 0.12 to 0.04%. This PTH drop did not coincide with the disqualification of HBsAg carriers, nor with that of high ALT, nor with the introduction of complete voluntary donorship in 1982, but with the systematic exclusion of hyperbilirubinemic donors. Circulating immune complexes (CIC) were found in 28.9% of PTH compromised donors, and CIC are therefore supposed to be a marker of PTH risk even if HBsAg was not demonstrable. Re-examining donors compromised in 120 PTH found 12.4% HBsAg carriers who had not been detected by CIEP prior to the transfusions. Accumulation of more than one HBsAg positive transfusion in 56.5% of the PTH patients suggests a cumulative effect. The inability of specific tests to identify sources of infection in 50% of PTH suggests that doubts must be raised as to their post-transfusional origin. This thesis is also supported by the relative increase of this group after the considerable drop of PTH. The importance of viral sources non-B and B undetectable by sensitive specific methods must be emphasized. The latter is in accordance with the observed PTH drop due to a non-specific marker effect. The bilirubin level screening in each donor before stored blood collection is recommended by means of the described extended AST screening test and, besides HBsAg screening, this is supposed to be the most effective precaution for preventing PTH.
D001663:Bilirubin / Q000097:blood; D001782:Blood Donors; D003378:Counterimmunoelectrophoresis; D003604:Czechoslovakia; D004797:Enzyme-Linked Immunosorbent Assay; D006509:Hepatitis B / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control / Q000635:transmission; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006801:Humans; D011863:Radioimmunoassay; D065227:Transfusion Reaction
D006514:Hepatitis B Surface Antigens; D001663:Bilirubin