Prevention of posttransfusion hepatitis B and C by screening for antibody to hepatitis C virus and antibody to HBcAg.
Screening of blood donors by testing for antibody to HBcAg and antibody to hepatitis C virus is commonly done. However, the applicability of these screening tests may vary depending on the prevalence of hepatitis B virus and hepatitis C virus infection in various populations. We have therefore prospectively evaluated 158 adult patients who received blood or blood products during open-heart surgery in Hong Kong to compare the efficacy of various serological screening tests in the prevention of posttransfusion hepatitis. Serum from five (0.5%) donors was positive for antibody to hepatitis C virus by second-generation enzyme immunoassay; in two, optical-density readings in enzyme immunoassay were greater than 2.0, but only one was positive for hepatitis C virus RNA by reverse transcription-polymerase chain reaction. The latter donor was also positive for antibody to HBcAg and had elevated serum ALT activity. The recipient of a unit of this donor's blood was the only one in whom posttransfusion hepatitis C developed (0.1% per unit transfused). Screening with antibody to hepatitis C virus was more specific than that with antibody to HBcAg or ALT in excluding donors from transmitting hepatitis C (99.6%, 79.4% and 98.8%, respectively). Both the sensitivity and negative predictive value of screening for antibody to hepatitis C virus were 100%, but the positive predictive value was only 20%. Forty-five blood recipients were considered susceptible to hepatitis B virus infection because testing for hepatitis B serology in serum (HBsAg, antibody to HBsAg and antibody to HBcAg) was negative before being transfused. Asymptomatic hepatitis B seroconversion developed in three (6.7%) recipients (1.1% per unit transfused).(ABSTRACT TRUNCATED AT 250 WORDS)
Chung
H T
HT
Department of Medicine, University of Hong Kong, Queen Mary Hospital.
Lee
J S
JS
Lok
A S
AS
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001782:Blood Donors; D004279:DNA, Viral / Q000032:analysis; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology*; D006508:Hepatitis Antibodies / Q000032:analysis*; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000032:analysis*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006526:Hepatitis C / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D018937:Hepatitis C Antibodies; D006801:Humans; D007124:Immunoenzyme Techniques; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D012680:Sensitivity and Specificity; D065227:Transfusion Reaction
D004279:DNA, Viral; D006508:Hepatitis Antibodies; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D000410:Alanine Transaminase