Prevalence of antibodies to hepatitis C virus in transfused children with cancer.
OBJECTIVE
Hepatitis C virus (HCV) transmission is a well-documented complication of blood transfusions, although data on transfused children with cancer is sparse. Using a newer assay for anti-HCV antibodies, the prevalence of HCV infection was determined in a population of children with cancer in the United States.


METHODS
Forty-five transfused children with cancer were studied for evidence of HCV infection. Patients had not received chemotherapy for a mean of 2.3 years or transfusions for a mean of 3.1 years before being evaluated. Levels of serum aminotransferases [aspartate aminotransferase and alanine aminotransferase (ALT)], hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and hepatitis B core antibody (HBcAb) were assessed. A second-generation enzyme immunoassay (EIA) was used to screen for anti-HCV antibodies. Positive EIAs were supplemented by a radioimmunoblot assay (RIBA-2).


RESULTS
No patient tested positively for HBsAg, HBsAb, or HBcAb; four of 45 (8.9%) were positive for HCV antibodies by EIA. Three of the four (6.7% of the total) were also positive by RIBA-2 testing. The mean number of donor exposures was not significantly different between HCV-negative versus RIBA-2-positive patients (23.1 vs. 61.7, p = 0.16). ALT levels off therapy and peak ALT levels during therapy were significantly higher in the RIBA-2-positive group versus the HCV-negative group, although 36% of all patients (16 of 45) had at least one elevation in ALT greater than twice the upper limit of normal. All three RIBA-2-positive patients were transfused before institution of universal screening of blood donors for HCV in 1990 and had hepatomegaly noted at least once.


CONCLUSIONS
We have identified a small group of children who may be at high risk for developing chronic active hepatitis and cirrhosis. Testing for HCV should be a routine part of long-term follow-up in children treated for cancer.
Department of Pediatrics, Baystate Medical Center, Springfield, Massachusetts 01199.
P M
PM
Monteleone
C
C
Andrzejewski
J F
JF
Kelleher
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006508:Hepatitis Antibodies / Q000097:blood*; D006526:Hepatitis C / Q000209:etiology / Q000276:immunology*; D006801:Humans; D015151:Immunoblotting; D007124:Immunoenzyme Techniques; D007223:Infant; D009369:Neoplasms / Q000276:immunology / Q000628:therapy*; D015995:Prevalence; D065227:Transfusion Reaction
D006508:Hepatitis Antibodies