An epidemiological and clinical study of transaminase levels and hepatitis B antibodies in 1,100 blood donors

High prevalence of HBV infectivity in blood donors detected by the dot blot hybridisation assay

Hepatitis B virus (HBV) continues to be a significant cause for post-transfusion hepatitis in India, in spite of the introduction of compulsory hepatitis B surface antigen (HBsAg) screening. To understand the true HBV-infective pool in the blood donor population, HBV DNA was detected by a 32P-labelled dot blot hybridisation assay in 605 donor units that were negative for HBsAg by a third-generation Elisa. Serum alanine aminotransferase (ALT) was estimated in all these samples and correlated with DNA positivity. The frequency of HBV DNA positivity in HBsAg-negative units was very high (9.91%) and correlated well with the elevation in ALT (p < 0.00005). However, the frequency of elevated ALT was high (11.9%), using the locally determined upper limit of normal, and half of the DNA-positive samples had a normal ALT. Thus, ALT is a poor surrogate marker for HBV infectivity and efforts should be made to apply DNA detection systems in blood banks.

Prevalence and consistency of ALT elevation in plasmapheresis donors: implications for the assessment of blood product infectivity

Alanine aminotransferase (ALT) levels were determined in 8,420 plasmapheresis donations obtained from 431 donors over a period of 18 months. Using sex-differentiated normal ranges 2.5% of donations but 23% of donors exhibited elevated ALT levels on at least 1 occasion. Amongst the donors with elevated ALT this was only seen on 1 occasion in one third, while a quarter had elevations in consecutive donations. No donors with consecutive elevations above 100 IU/l were detected. The results are discussed in terms of the guidelines currently recommended for assessing post-transfusion hepatitis infectivity of blood products, such as factor VIII. It is concluded that the current allowance for infection acquired from sources other than blood products under consideration may be over-generous, leading to a potential underestimate of the true rate of infection.

Prevalências do HBsAg, do anti-HBc e do anti-HCV na população de candidatos a doadores de sangue do Hemocentro-Campinas

Em 29833 doadores pesquisados encontramos prevalência de 1,52% para o HBsAg e de 11% para o anti-HBc. A co-positividade anti-HBc/anti-HBs em 2783 doadores HBsAg negativos/anti-HBc positivos foi de 81,9%. A prevalência para o HBsAg é baixa nos doadores de Campinas, enquanto o anti-HBc apresenta-se com prevalência elevada quando comparado a outros países. A pesquisa do anti-HCV, em doadores de sangue de Campinas, mostrou prevalência de 2,6% para este marcador, que é bem maior que as observadas nos EUA e Europa. Cerca de 36% dos doadores anti-HCV positivos são anti-HBc reagentes, permitindo inferir, que estas duas viroses acometem simultânea ou sequencialmente os doadores de sangue brasileiros.

Alanine aminotransferase, gamma-glutamyltransferase, antibodies to hepatitis B core antigen and antibodies to hepatitis C virus in blood donor screening. A prospective study in Finland

Alanine aminotransferase (ALT), gamma-glutamyl-transferase and hepatitis B core antibodies were evaluated as donor markers in a prospective study of 685 open-heart surgery patients. Of these three surrogate markers, only an ALT level greater than or equal to 2 SD above the log mean had a significant association with recipient non-A, non-B hepatitis (NANBH, p = 0.02). Antibodies to the hepatitis C virus (anti-HCV) were detected by an enzyme immunoassay in 7 of the 136 units transfused to the 11 NANBH patients and 29 of 3,650 not associated with hepatitis (p less than 0.001). Calculated from this subgroup of donors, the anti-HCV test would have a 15.6% positive predictive value with 0.92% donor loss and thus is superior as a primary screening marker to all the three surrogate tests. The predictive value could be substantially increased by subsequent ALT testing or by the use of a recombinant immunoblot anti-HCV assay.