title: Safety of the blood supply. Surrogate testing and transmission of hepatitis C in patients after massive transfusion.
abstract: OBJECTIVE
  To define a risk profile for post-transfusion hepatitis C in patients receiving massive transfusion.
  
  
  BACKGROUND
  Hepatitis C accounts for more than 90% of post-transfusion hepatitis.
  
  
  METHODS
  Two-hundred twenty-one of 8,765 consecutive trauma admissions to a Level I trauma center received more than 20 units of erythrocytes. Sixty-nine survivors had positive viral serologic tests at least 1 year after transfusion. Surrogate testing for hepatitis C using alanine aminotransferase (ALT) levels and antibodies to hepatitis B core antigen (Core) began in October 1986 and January 1987, respectively. Donor blood for group 1 (pre-ALT/Core) was transfused before surrogate screening was introduced. Donor blood for group 2 (post-ALT/Core) was transfused after surrogate screening.
  
  
  RESULTS
  Sixty-nine patients received blood products from 4,987 donors (mean, 72.3 units of exposure). No patient tested positive for antibodies to hepatitis B surface antigen, human immunodeficiency virus, or human T-lymphotrophic virus type 1. However 23.2% tested positive for hepatitis C virus (HCV) as measured by a second-generation enzyme immunoassay (HCV 2.0) and a recombinant immunoblot assay (RIBA), and 21.7% tested positive by HCV 1.0. Antibodies to Core were found in 8.7% of patients. The risk for post-transfusion hepatitis C per unit of exposure is estimated to be 1.52% group 1 (pre-ALT/Core) and 0.239% for group 2 (post-ALT/Core).
  
  
  CONCLUSIONS
  The introduction of ALT/Core donor screening by a blood bank reduced the incidence of post-transfusion hepatitis C by 84%. The risk for post-transfusion hepatitis C depends on units of exposure, screening techniques, and prevalence of hepatitis C in the donor population. In our community, the risk for post-transfusion hepatitis C is less than 0.2% per unit of exposure. The population of massively transfused patients may serve as our effective resource for monitoring the safety of the blood supply.
authors.affiliation: Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: J A
authors.initials: JA
authors.lastname: Morris
authors.forename: T R
authors.initials: TR
authors.lastname: Wilcox
authors.forename: G W
authors.initials: GW
authors.lastname: Reed
authors.forename: E B
authors.initials: EB
authors.lastname: Hunter
authors.forename: C H
authors.initials: CH
authors.lastname: Wallas
authors.forename: E A
authors.initials: EA
authors.lastname: Steane
authors.forename: S D
authors.initials: SD
authors.lastname: Shotts
authors.forename: J L
authors.initials: JL
authors.lastname: Vitsky
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001782:Blood Donors; D005260:Female; D006508:Hepatitis Antibodies / Q000032:analysis; D006512:Hepatitis B Core Antigens / Q000032:analysis; D006526:Hepatitis C / Q000517:prevention & control* / Q000635:transmission; D018937:Hepatitis C Antibodies; D006801:Humans; D015151:Immunoblotting; D008297:Male; D012307:Risk Factors; D065227:Transfusion Reaction
chemical_list: D006508:Hepatitis Antibodies; D006512:Hepatitis B Core Antigens; D018937:Hepatitis C Antibodies; D000410:Alanine Transaminase